WorldWideScience

Sample records for ostomy continence nurses

  1. North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues.

    Science.gov (United States)

    Colwell, Janice C; McNichol, Laurie; Boarini, Joy

    The purpose of this study was to describe the practice of 796 ostomy nurses in North America in 2014 related to peristomal skin issues. Descriptive study. Participants were 796 wound, ostomy, and continence (WOC) and enterostomal therapy (ET) nurses currently practicing in the United States or Canada and caring for patients with ostomies. The collection of data occurred in conjunction with an educational program on peristomal skin complications and practice issues and solicited the participant's perception on the incidence and frequency of peristomal skin issues as well as on practice patterns. Participants attended an educational program. They were also asked to anonymously respond to multiple-choice questions on ostomy care management via an audience response system followed by discussion of each item and their responses. This descriptive study reports on the answers to the questions as well as the pertinent discussion points. Participants estimated that approximately 77.70% of their patients developed peristomal skin issues. The most commonly encountered problem was irritant contact dermatitis (peristomal moisture-associated skin damage). Contributing factors were inappropriate use of a pouching system owing to lack of follow-up after hospital discharge. Reported interventions for the prevention and management of peristomal skin issues included preoperative stoma site marking, use of a convex pouching system, and barrier rings. However, subsequent discussion revealed that the frequency of use of these products varied considerably. Participants identified shortened hospital stays, absence of preoperative stoma marking, and limited outpatient follow-up as contributing to development of peristomal skin problems. WOC and ET nurses estimate that more than three-quarters of persons living with an ostomy develop peristomal skin problems. Multiple interventions for managing these problems were identified, but some variability in management approaches emerged.

  2. Wound, Ostomy, and Continence Nursing: Scope and Standards of Practice, 2nd Edition: An Executive Summary.

    Science.gov (United States)

    2018-04-25

    Wound, ostomy, and continence (WOC) nursing was recognized as a nursing specialty by the American Nurses Association in February 2010, and the Society published the original scope and standards of WOC nursing practice in May 2010. The Wound, Ostomy, and Continence Nursing: Scope and Standards of Practice, 2nd Edition is the definitive resource promoting excellence in professional practice, quality care, and improved patient outcomes in WOC specialty practice. It can be used to articulate the value of WOC nurses to administrators, legislators, payers, patients, and others. The second edition also provides an overview of the scope of WOC nursing practice including a description of the specialty, the history and evolution of WOC nursing, characteristics of WOC nursing practice, and description of the trispecialty. The document describes various WOC nurse roles, populations served, practice settings, care coordination, and collaboration. Educational preparation, levels of practice within WOC specialty nursing, certification, mandate for continuous professional development, ethics, current trends, future considerations and challenges, and standards of WOC nursing practice and professional performance with competencies for each standard are provided. The purpose of this Executive Summary is to describe the process for developing the scope and standards document, provide an overview of the scope of WOC nursing practice, and list the standards of practice and professional performance along with the competencies for each level of WOC nurse provider. The original document is available from the WOCN Society's online book store (www.wocn.org).

  3. Colostomy Irrigation: Issues Most Important to Wound, Ostomy and Continence Nurses.

    Science.gov (United States)

    Tallman, Nancy J; Cobb, Martha D; Grant, Marcia; Wendel, Christopher S; Colwell, Janice; Ercolano, Elizabeth; Krouse, Robert

    2015-01-01

    The purpose of this study was to describe issues that WOC nurses find most important related to colostomy irrigation (CI). This is an additional analysis of a study focusing on qualitative responses to a survey querying WOC nurses about CI practices. The target population was members of the Wound, Ostomy and Continence Nurses Society. Of the 985 nurses who responded to the survey, 338 (34.3%) answered the optional open-ended question asking for additional comments. A 1-time online survey was conducted. In addition to demographic, educational information, and forced-choice questions about CI, an open-ended question asked for any additional comments about their experience with irrigation and WOC practice. Content analysis was used to identify common themes identified by WOC nurses. Three hundred thirty-eight out of 985 WOC nurses (34.3%) answered the optional open-ended question asking for additional comments; analysis for this study is based on these responses. WOC nurses who responded to the open-ended question had similar characteristics to those who responded to the entire survey but were significantly more experienced (15.1 vs 11.0 years; P irrigation techniques are recommended.

  4. Relationship of Wound, Ostomy, and Continence Certified Nurses and Healthcare-Acquired Conditions in Acute Care Hospitals.

    Science.gov (United States)

    Boyle, Diane K; Bergquist-Beringer, Sandra; Cramer, Emily

    The purpose of this study was to describe the (a) number and types of employed WOC certified nurses in acute care hospitals, (b) rates of hospital-acquired pressure injury (HAPI) and catheter-associated urinary tract infection (CAUTI), and (c) effectiveness of WOC certified nurses with respect to lowering HAPI and CAUTI occurrences. Retrospective analysis of data from National Database of Nursing Quality Indicators. The sample comprised 928 National Database of Nursing Quality Indicators (NDNQI) hospitals that participated in the 2012 NDNQI RN Survey (source of specialty certification data) and collected HAPI, CAUTI, and nurse staffing data during the years 2012 to 2013. We analyzed years 2012 to 2013 data from the NDNQI. Descriptive statistics summarized the number and types of employed WOC certified nurses, the rate of HAPI and CAUTI, and HAPI risk assessment and prevention intervention rates. Chi-square analyses were used to compare the characteristics of hospitals that do and do not employ WOC certified nurses. Analysis-of-covariance models were used to test the association between WOC certified nurses and HAPI and CAUTI occurrences. Just more than one-third of the study hospitals (36.6%) employed WOC certified nurses. Certified continence care nurses (CCCNs) were employed in fewest number. Hospitals employing wound care specialty certified nurses (CWOCN, CWCN, and CWON) had lower HAPI rates and better pressure injury risk assessment and prevention practices. Stage 3 and 4 HAPI occurrences among hospitals employing CWOCNs, CWCNs, and CWONs (0.27%) were nearly half the rate of hospitals not employing these nurses (0.51%). There were no significant relationships between nurses with specialty certification in continence care (CWOCN, CCCN) or ostomy care (CWOCN, COCN) and CAUTI rates. CWOCNs, CWCNs, and CWONs are an important factor in achieving better HAPI outcomes in acute care settings. The role of CWOCNs, CCCNs, and COCNs in CAUTI prevention warrants further

  5. Cost-utility analysis of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses.

    Science.gov (United States)

    Kaitani, Toshiko; Nakagami, Gojiro; Iizaka, Shinji; Fukuda, Takashi; Oe, Makoto; Igarashi, Ataru; Mori, Taketoshi; Takemura, Yukie; Mizokami, Yuko; Sugama, Junko; Sanada, Hiromi

    2015-01-01

    The high prevalence of severe pressure ulcers (PUs) is an important issue that requires to be highlighted in Japan. In a previous study, we devised an advanced PU management protocol to enable early detection of and intervention for deep tissue injury and critical colonization. This protocol was effective for preventing more severe PUs. The present study aimed to compare the cost-effectiveness of the care provided using an advanced PU management protocol, from a medical provider's perspective, implemented by trained wound, ostomy, and continence nurses (WOCNs), with that of conventional care provided by a control group of WOCNs. A Markov model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness ratio of advanced PU management compared with conventional care. The number of quality-adjusted life-years gained, and the cost in Japanese yen (¥) ($US1 = ¥120; 2015) was used as the outcome. Model inputs for clinical probabilities and related costs were based on our previous clinical trial results. Univariate sensitivity analyses were performed. Furthermore, a Bayesian multivariate probability sensitivity analysis was performed using Monte Carlo simulations with advanced PU management. Two different models were created for initial cohort distribution. For both models, the expected effectiveness for the intervention group using advanced PU management techniques was high, with a low expected cost value. The sensitivity analyses suggested that the results were robust. Intervention by WOCNs using advanced PU management techniques was more effective and cost-effective than conventional care. © 2015 by the Wound Healing Society.

  6. Calciphylaxis: no longer rare; no longer calciphylaxis? A paradigm shift for wound, ostomy and continence nursing.

    Science.gov (United States)

    Feeser, Dianne L

    2011-01-01

    This article challenges conventional wisdom that calciphylaxis is a rare condition. Rather, emerging evidence suggests that calciphylaxis is neither rare nor uncommon. In addition, the term calciphylaxis is questioned because misrepresents the underlying etiology of the condition. Multiple researchers and clinicians advocate abandoning the use of the term, but nursing literature has not yet followed suit. This article reviews the epidemiology, clinical manifestations, diagnosis, prevention, and treatment of this condition and associated wounds, and suggests areas for future research. The WOC nurse's role as an educator, leader, researcher, clinical expert, and patient advocate is summarized.

  7. Analysis of Qualitative Interviews about the Impact of Information Technology on Pressure Ulcer Prevention Programs: Implications for the Wound Ostomy Continence Nurse

    Science.gov (United States)

    Shepherd, Marilyn Murphy; Wipke-Tevis, Deidre D.; Alexander, Gregory L.

    2015-01-01

    Purpose The purpose of this study was to compare pressure ulcer prevention programs in 2 long term care facilities (LTC) with diverse Information Technology Sophistication (ITS), one with high sophistication and one with low sophistication, and to identify implications for the Wound Ostomy Continence Nurse (WOC Nurse) Design Secondary analysis of narrative data obtained from a mixed methods study. Subjects and Setting The study setting was 2 LTC facilities in the Midwestern United States. The sample comprised 39 staff from 2 facilities, including 26 from a high ITS facility and 13 from the low ITS facility. Respondents included Certified Nurse Assistants,, Certified Medical Technicians, Restorative Medical Technicians, Social Workers, Registered Nurses, Licensed Practical Nurses, Information Technology staff, Administrators, and Directors. Methods This study is a secondary analysis of interviews regarding communication and education strategies in two longterm care agencies. This analysis focused on focus group interviews, which included both direct and non-direct care providers. Results Eight themes (codes) were identified in the analysis. Three themes are presented individually with exemplars of communication and education strategies. The analysis revealed specific differences between the high ITS and low ITS facility in regards to education and communication involving pressure ulcer prevention. These differences have direct implications for WOC nurses consulting in the LTC setting. Conclusions Findings from this study suggest that effective strategies for staff education and communication regarding PU prevention differ based on the level of ITS within a given facility. Specific strategies for education and communication are suggested for agencies with high ITS and agencies with low ITS sophistication. PMID:25945822

  8. Evaluation of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses: a non-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kaitani T

    2015-02-01

    Full Text Available Toshiko Kaitani,1 Gojiro Nakagami,2 Junko Sugama,3 Masahiro Tachi,4 Yutaka Matsuyama,5 Yoshiki Miyachi,6 Takashi Nagase,2 Yukie Takemura,7 Hiromi Sanada2 1School of Nursing, Sapporo City University, Hokkaido, Japan; 2Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 3Department of Clinical Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan; 4Department of Plastic Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan; 5Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 6Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan; 7Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan Aims and objectives: We investigated the effectiveness and safety of an advanced pressure ulcer (PU management protocol comprising 1 ultrasonography to assess the deep tissue, 2 use of a non-contact thermometer to detect critical colonization, 3 conservative sharp debridement, 4 dressing selection, 5 negative pressure wound therapy, and 6 vibration therapy in comparison with those of a conventional approach. Each protocol was followed by trained wound, ostomy, and continence nurses (WOCNs. Background: At present, there is no systematic PU management protocol for nurses that includes appropriate assessment and intervention techniques for deep tissue injury and critical colonization. In Japan, there is no such protocol that the nurses can follow without a physician’s orders. Design and methods: This was a prospective non-randomized controlled trial. Over a 3-week period, we evaluated the effectiveness of an advanced protocol by comparing the PU severity and healing on the basis of the DESIGN-R scale and presence of patients' discomfort. We recruited ten WOCNs to follow

  9. Quality of life for patients living with ostomies: influence of contact with an ostomy nurse.

    Science.gov (United States)

    Aronovitch, Sharon A; Sharp, Robbie; Harduar-Morano, Laurel

    2010-01-01

    This study was conducted to determine whether or not contact with a WOC nurse improves quality of life for ostomy patients. Home health care agencies, hospitals, and a durable medical equipment company in northern Florida were contacted to participate in the study. The role of the participating facilities was to address the provided envelopes and mail the patient survey packet (introductory letter, Ostomy Quality of Life Questionnaire [OQLQ], and demographic survey) directly to the patient. The mean age or respondents was 62 years, and the mean time of living with an ostomy was 10 years. Ninety-six percent of the sample participants did not attend support groups, yet nearly 50% reported receiving education following discharge home. Analysis of OQLQ scores revealed statistically significant differences based on who the respondent lived with, the number of comorbidities, how the respondent received supplies, and the type of appliance worn. There was no significant difference between respondents who saw an ostomy nurse and those who did not among the various sections of the OQLQ, even though 83% indicated seeing an ostomy nurse. Body image was a concern to respondents. The data demonstrated that most participants maintained satisfactory quality of life despite the presence of an ostomy. Individuals who were working part-time had a better health-related quality of life than those who worked full-time. More than 50% of our study sample participants reported satisfaction with the healthcare services they received, regardless of whether services were provided by a WOC or a nonspecialist nurse.

  10. Ostomy

    Science.gov (United States)

    An ostomy is surgery to create an opening (stoma) from an area inside the body to the outside. It ... small intestine, colon, rectum, or bladder. With an ostomy, there must be a new way for wastes ...

  11. Bags and blogs: creating an ostomy experience for nursing students.

    Science.gov (United States)

    Reed, Karen S

    2012-01-01

    There are well over three-quarters of a million people living in the United States with an ostomy. These individuals experience many physical and emotional challenges which nurses should address during the in-patient hospitalization experience. The purpose of this educational activity was to provide undergraduate nursing students with a simulated laboratory experience which allowed the student to discuss and experience some of the challenges of living with an ostomy. Small group work, an experiential learning activity, and blogging were used to foster the cognitive, psychomotor, and affective development of the nursing students. All 134 students participated in the small group work and blogging experience and over 100 students participated in the experiential learning activity of wearing an ostomy bag overnight with the bag containing a small amount of simulated fecal material. The impact of the simulated experience is evident in the depth of awareness and emotion expressed in the blogs. The students collectively acknowledged the value of the activity and the impact the gained awareness had on their careers as nurses. The use of social technology and the provision of learning activities, not available on the clinical unit, can have a significant impact on the cognitive, psychomotor, and affective development of nursing students. © 2012 Association of Rehabilitation Nurses.

  12. Looking back: a review of classic ostomy literature in the WOCN society's official publication.

    Science.gov (United States)

    Colwell, Janice C; Schuller, Nancy

    2013-01-01

    In recognition of the 40-year anniversary of the Journal of Wound, Ostomy and Continence Nursing, a review of ostomy-related articles in the Society's official publications was done. The goal was to find what were considered classic ostomy articles, articles that contributed to the practice of ostomy care nursing, and articles that as clinicians practicing in the late 70s we felt helped to shape the future of ostomy care nursing. The review began with the 1975 ET Journal and continued forward ending in 1990. A classic article was defined as one that described a new or unique use of an ostomy product, a new procedure that impacted ostomy practice, the evolution of evidence-based ostomy practice, concepts that would drive our future practice, and management of stoma complications. These articles are a glimpse into the unique, creative, and evolving practice that makes our ostomy specialty distinctive.

  13. Continence care is every nurse's business.

    Science.gov (United States)

    Booth, Joanne

    Maintaining continence lies at the heart of a sense of adulthood and is essential to preserving dignity, a core and universal nursing value. This article explores the reasons why poor continence care was found at Mid Staffordshire Foundation Trust, the changes to the culture of the health service that led to it, and why it is so important for nurses to maintain patients' dignity. Recommendations for changing this culture in the future are discussed.

  14. What do surgical oncology staff nurses know about colorectal cancer ostomy care?

    Science.gov (United States)

    Gemmill, Robin; Kravits, Kathy; Ortiz, Mildred; Anderson, Casandra; Lai, Lily; Grant, Marcia

    2011-02-01

    For most patients diagnosed with colorectal cancer, dealing with the adjustment and rehabilitation after treatment can be overwhelming. There is a significant need for expert educational and counseling support, especially for the patient with a new ostomy. This pilot study describes acute care oncology staff nurses' knowledge about and attitudes toward providing direct ostomy care support and education. This study is part of a larger project assessing gaps in education and services in support of patients with colorectal cancer. The Survey on Ostomy Care questionnaire designed to assess nurses' knowledge about and attitudes toward ostomy care was administered to oncology staff nurses at a comprehensive cancer center. Only 30% of staff nurses surveyed strongly agreed or agreed with the statement, "I care for ostomy patients often enough to keep up my skills in ostomy care." Maintaining staff nurses' ability to teach and demonstrate to patients complex care such as ostomy care depends on the ability to practice both education and hands-on skills. Staff nurses identify that lack of opportunity to care for the new ostomy patient influences their ability to maintain skill expertise. The results show the need to explore the provision of ongoing staff education for low-volume patient populations using creative teaching strategies, such as clinical simulation and short videos. Copyright 2011, SLACK Incorporated.

  15. Welcoming Home the Patient with a New Ostomy.

    Science.gov (United States)

    Walker, Cynthia A; Rau, Lou Ann; Green, Mary Phyllis

    2015-01-01

    The 5-day average inpatient hospital length-of-stay postostomy limits opportunities for patients and family members to master self-care of the new ostomy prior to discharge. The literature suggests premature discharge, poor care coordination, lack of symptom reporting and follow-up as the primary factors supporting causes of readmissions. Home care nurses are faced with failed handoffs, limited resources, poor care coordination, payor restrictions, and knowledge and skill deficits that negatively impact safe and effective discharge practices of patients with a new ostomy. This article describes an evolving community standard related to nursing care of the patient with a new ostomy as identified by the Baltimore Wound, Ostomy, Continence (WOC) Nursing Affiliate. Case managers, discharge planners, intake team members, and home care nurses benefit from ongoing education from WOC nurse experts to master the skills needed to care for patients with ostomies.

  16. Evidence-based nursing care management for the pregnant woman with an ostomy.

    Science.gov (United States)

    Sredl, Darlene; Aukamp, Virginia

    2006-01-01

    Pregnancy presents many problems without working through additional problems in coping with an ostomy. Yet many women with an ostomy do get pregnant and do deliver healthy babies. Evidence-based nursing is of the utmost importance, as there is little published information on this topic. Because of the scarcity of pregnant subjects within the ostomy category, most studies, by necessity, select a purposive subject base. Therefore, other information sources regarding nursing management of the pregnant woman with an ostomy take on considerably more importance. This article explores other forms of evidence that can be used in managing the care of pregnant ostomy patients and specifically how nurses can integrate various sources of information in designing an evidence-based nursing care plan. Nonpharmacologic forms of relaxation therapy, easily used by nurses, such as mindfulness-based stress reduction, guided imagery, and hypnosis, are also identified as some ways nurses can relieve anxiety and experiential stress associated with pregnancy in women who have an ostomy.

  17. Ostomate-for-a-Day: A Novel Pedagogy for Teaching Ostomy Care to Baccalaureate Nursing Students.

    Science.gov (United States)

    Kerr, Noël

    2015-08-01

    The literature describing successful pedagogies for teaching ostomy care to baccalaureate nursing students is limited. This qualitative study investigated the potential benefits of participating in an immersive simulation that allowed baccalaureate nursing students to explore the physical and psychosocial impact of ostomy surgery. Junior-level nursing students attended a 2-hour interactive session during which they learned about preoperative stoma site marking and practiced the maneuvers on a peer. Students then wore an ostomy appliance for the next 24 hours, completed tasks simulating ostomy self-care, and submitted a three- to four-page reflection on the experience. These data were coded using the iterative process of constant comparison described by Glaser. Six major themes were identified: Accommodation for Activities of Daily Living, Coping with Annoyances, Body Image and Feelings, Disclosure, Insights for Teaching, and Empathy. Each participant affirmed the value of the experience. Suggestions for future research studies are discussed. Copyright 2015, SLACK Incorporated.

  18. The nursing care to old people with ostomy in the perspective of complexity

    OpenAIRE

    Edaiane Joana Lima Barros; Silvana Sidney Costa Santos; Alacoque Lorenzini Erdmann

    2012-01-01

    The aim of this qualitative case study was to (re) view the nursing care to old people with ostomy in a complex perspective. The subjects of this study were four old people with ostomy assisted in an ostomy therapy service in Rio Grande do Sul. Interviews were made in depth, and the analysis indicated three categories: Human being ostomized, complex– who shows his biopsycosocial totality and needs to stimulate his self-care, self-determination and independence; Old Ostomate Complex Health – p...

  19. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of America (UOAA). The skills kit ... AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of America (UOAA). Back to Top ...

  20. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... ASCRS), American Urological Association (AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of America ( ... ASCRS), American Urological Association (AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of America ( ...

  1. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Nurses (CETN), and the United Ostomy Associations of America (UOAA). Program Overview The skills kit contains: A ... Nurses (CETN), and the United Ostomy Associations of America (UOAA). Back to Top Find A Surgeon Find ...

  2. Should WOC nurses measure health-related quality of life in patients undergoing intestinal ostomy surgery?

    Science.gov (United States)

    Pittman, Joyce; Kozell, Kathryn; Gray, Mikel

    2009-01-01

    Ostomy surgery requires significant reconstruction of the gastrointestinal tract, resulting in uncontrolled passage of fecal effluent from a stoma in the abdominal wall. Concerns about creation of an ostomy often supersede all other concerns. Ostomy-related concerns include impaired body image; fear of incontinence; fear of odor; limitations affecting social, travel-related, and leisure activities; and impaired sexual function. Because the creation of an ostomy affects multiple domains within the construct of health-related quality of life (HRQOL), it is not surprising that quality of life is a frequent outcome measure in ostomy-related research. We reviewed existing research in order to identify the influence of intestinal ostomy surgery on HRQOL. We sought to identify clinical evidence documenting the influence of nursing interventions on HRQOL in patients with an intestinal ostomy. In addition, we systematically reviewed the literature to evaluate the validity and reliability of condition-specific instruments for measuring HRQOL in this patient population. We completed an integrative review using the key terms "quality of life" and "ostomy" in order to identify sufficient evidence to determine the influence of intestinal ostomy surgery on HRQOL. A systematic review using the key terms "ostomy" and "nursing" was completed to identify the effect of specific nursing interventions on HRQOL in patients with intestinal ostomies. Only randomized clinical trials were included in this review. A systematic review using the key terms "quality of life" and "ostomy" was used to review and identify condition-specific HRQOL instruments and evidence of their validity and reliability. MEDLINE and CINAHL databases were used to address all 3 aims of this Evidence-Based Report Card. Searches were limited to studies published between 1980 and January 2009. Hand searches of the ancestry of studies and review articles were completed to identify additional studies. An integrative

  3. Testing a computer-based ostomy care training resource for staff nurses.

    Science.gov (United States)

    Bales, Isabel

    2010-05-01

    Fragmented teaching and ostomy care provided by nonspecialized clinicians unfamiliar with state-of-the-art care and products have been identified as problems in teaching ostomy care to the new ostomate. After conducting a literature review of theories and concepts related to the impact of nurse behaviors and confidence on ostomy care, the author developed a computer-based learning resource and assessed its effect on staff nurse confidence. Of 189 staff nurses with a minimum of 1 year acute-care experience employed in the acute care, emergency, and rehabilitation departments of an acute care facility in the Midwestern US, 103 agreed to participate and returned completed pre- and post-tests, each comprising the same eight statements about providing ostomy care. F and P values were computed for differences between pre- and post test scores. Based on a scale where 1 = totally disagree and 5 = totally agree with the statement, baseline confidence and perceived mean knowledge scores averaged 3.8 and after viewing the resource program post-test mean scores averaged 4.51, a statistically significant improvement (P = 0.000). The largest difference between pre- and post test scores involved feeling confident in having the resources to learn ostomy skills independently. The availability of an electronic ostomy care resource was rated highly in both pre- and post testing. Studies to assess the effects of increased confidence and knowledge on the quality and provision of care are warranted.

  4. Costs of an ostomy self-management training program for cancer survivors.

    Science.gov (United States)

    Hornbrook, Mark C; Cobb, Martha D; Tallman, Nancy J; Colwell, Janice; McCorkle, Ruth; Ercolano, Elizabeth; Grant, Marcia; Sun, Virginia; Wendel, Christopher S; Hibbard, Judith H; Krouse, Robert S

    2018-03-01

    To measure incremental expenses to an oncologic surgical practice for delivering a community-based, ostomy nurse-led, small-group, behavior skills-training intervention to help bladder and colorectal cancer survivors understand and adjust to their ostomies and improve their health-related quality of life, as well as assist family caregivers to understand survivors' needs and provide appropriate supportive care. The intervention was a 5-session group behavior skills training in ostomy self-management following the principles of the Chronic Care Model. Faculty included Wound, Ostomy, and Continence Nurses (WOCNs) using an ostomy care curriculum. A gender-matched peer-in-time buddy was assigned to each ostomy survivor. The 4-session survivor curriculum included the following: self-management practice and solving immediate ostomy concerns; social well-being; healthy lifestyle; and a booster session. The single family caregiver session was coled by a WOCN and an ostomy peer staff member and covered relevant caregiver and ostomate support issues. Each cohort required 8 weeks to complete the intervention. Nonlabor inputs included ostomy supplies, teaching materials, automobile mileage for WOCNs, mailing, and meeting space rental. Intervention personnel were employed by the University of Arizona. Labor expenses included salaries and fringe benefits. The total incremental expense per intervention cohort of 4 survivors was $7246 or $1812 per patient. A WOCN-led group self-help ostomy survivorship intervention provided affordable, effective, care to cancer survivors with ostomies. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Applying the Chronic Care Model to Support Ostomy Self-Management: Implications for Oncology Nursing Practice.

    Science.gov (United States)

    Ercolano, Elizabeth; Grant, Marcia; McCorkle, Ruth; Tallman, Nancy J; Cobb, Martha D; Wendel, Christopher; Krouse, Robert

    2016-06-01

    Living with an ostomy requires daily site and equipment care, lifestyle changes, emotional management, and social role adjustments. The Chronic Care Ostomy Self-Management Training Program (CCOSMTP) offers an ostomy self-management curriculum, emphasizing problem solving, self-efficacy, cognitive reframing, and goal setting. The qualitative method of content analysis was employed to categorize self-reported goals of ostomates identified during a nurse-led feasibility trial testing the CCOSMTP. Thirty-eight ostomates identified goals at three CCOSMTP sessions. The goals were classified according to the City of Hope Health-Related Qualify of Life Model, a validated multidimensional framework, describing physical, psychological, social, and spiritual ostomy-related effects. Nurse experts coded the goals independently and then collaborated to reach 100% consensus on the goals' classification. A total of 118 goals were identified by 38 participants. Eighty-seven goals were physical, related to the care of the skin, placement of the pouch or bag, and management of leaks; 26 were social goals, which addressed engagement in social or recreational roles and daily activities; and 5 were psychological goals, which were related to confidence and controlling negative thinking. Although the goals of survivors of cancer with an ostomy are variable, physical goals are most common in self-management training.

  6. Intestinal Ostomy.

    Science.gov (United States)

    Ambe, Peter C; Kurz, Nadja Rebecca; Nitschke, Claudia; Odeh, Siad F; Möslein, Gabriela; Zirngibl, Hubert

    2018-03-16

    About 100 000 ostomy carriers are estimated to live in Germany today. The creation of an ostomy represents a major life event that can be associated with impaired quality of life. Optimal ostomy creation and proper ostomy care are crucially important determinants of the success of treatment and of the patients' quality of life. This article is based on pertinent publications retrieved by a selective search in PubMed, GoogleScholar, and Scopus, and on the authors' experience. Intestinal stomata can be created using either the small or the large bowel. More than 75% of all stomata are placed as part of the treatment of colorectal cancer. The incidence of stoma-related complications is reported to be 10-70%. Skin irritation, erosion, and ulceration are the most common early complications, with a combined incidence of 25-34%, while stoma prolapse is the most common late complication, with an incidence of 8-75%. Most early complications can be managed conservatively, while most late complications require surgical revision. In 19% of cases, an ostomy that was initially planned to be temporary becomes permanent. Inappropriate stoma location and inadequate ostomy care are the most common causes of early complications. Both surgical and patient-related factors influence late complications. Every step from the planning of a stoma to its postoperative care should be discussed with the patient in detail. Preoperative marking is essential for an optimal stoma site. Optimal patient management with the involvement of an ostomy nurse increases ostomy acceptance, reduces ostomy-related complications, and improves the quality of life of ostomy carriers.

  7. The Prevalence of Ostomy-related Complications 1 Year After Ostomy Surgery: A Prospective, Descriptive, Clinical Study.

    Science.gov (United States)

    Carlsson, Eva; Fingren, Jeanette; Hallén, Anne-Marie; Petersén, Charlotta; Lindholm, Elisabet

    2016-10-01

    Despite advancements in the creation and care of stomas, ostomy and peristomal skin complications are common immediately following surgery as well as in the months and years thereafter. A prospective study to determine the prevalence of ostomy and peristomal skin complications and the influence of ostomy configuration on such complications was conducted 1 year after ostomy surgery among all patients at a university hospital in Sweden. All participants received regular (10 to 14 days post discharge, 6 weeks, 3 months, 6 months, and 1 year post surgery) ostomy follow-up care by a wound ostomy continence (WOC) nurse. All consecutive elective and emergency patients who had undergone surgery to create a colostomy (end colostomy), end ileostomy, or loop ileostomy were eligible to participate. Patients who were reoperated during their first year post-surgery, patients with a urostomy, and patients with double ostomies were excluded from the study. Patient data collected included age, gender, diagnosis, elective or emergency surgery, open or laparoscopic surgical procedure, presence of a colorectal surgeon specialist at surgery, type of ostomy (colostomy, end ileostomy, loop ileostomy), preoperative ostomy siting, counseling, body mass index, American Society of Anesthesiologists classification, and radiation and/or chemotherapy status. Ostomies were evaluated by 4 WOC nurses as to stoma configuration, convexity use, patient self-sufficiency in stoma care, and complications. All 207 patients (53% women) who were eligible agreed to participate in the study. Patient median age was 70 years (range 19-94); 74% underwent elective surgery. Main diagnoses were colorectal cancer (62%) and inflammatory bowel disease (19%). Ostomy types were: colostomy (71%), end ileostomy (26%), and loop ileostomy (3%). One or more complications occurred in 35% of the patients (27% ostomy complications, 11% peristomal skin complications). A colostomy hernia was the most common surgical complication

  8. Untreated Peristomal Skin Complications among Long-Term Colorectal Cancer Survivors with Ostomies: Lessons from a Study of Family Caregiving

    Science.gov (United States)

    McMullen, Carmit K.; Wasserman, Joseph; Altschuler, Andrea; Grant, Marcia; Hornbrook, Mark C.; Liljestrand, Petra; Briggs, Catherine; Krouse, Robert S.

    2013-01-01

    This ethnography of family caregiving explored why peristomal skin complications are both common and undertreated among colorectal cancer (CRC) survivors with intestinal ostomies. We sought to identify factors that hinder or facilitate prompt detection and treatment of ostomy and skin problems. We collected data through in-depth interviews with 31 cancer survivors and their family caregivers, fieldwork, structured assessments, and medical records review. We analyzed data using qualitative theme and matrix analyses. We found that survivors who received help changing the skin barrier around their stoma had fewer obstacles to detection and treatment of peristomal skin complications. Half of the survivors received unpaid help with ostomy care. All such help came from spouses. Married couples who collaborated in ostomy care reported that having assistance in placing the ostomy appliance helped with preventing leaks, detecting skin changes, and modifying ostomy care routines. Survivors who struggled to manage ostomy care independently reported more obstacles to alleviating and seeking treatment for skin problems. Nurses who encounter CRC survivors with ostomies can improve treatment of peristomal skin problems by asking patients and caregivers about ostomy care and skin problems, examining the peristomal area, and facilitating routine checkups with a wound, ostomy and continence nurse. PMID:22119975

  9. Outcome Criteria for Discharging the Patient With a New Ostomy From Home Health Care: A WOCN Society Consensus Conference.

    Science.gov (United States)

    Colwell, Janice C; Kupsick, Phyllis T; McNichol, Laurie L

    2016-01-01

    The Wound, Ostomy and Continence Nurses Society hosted a consensus panel of expert ostomy clinicians who were tasked with identifying minimal discharge criteria for home care patients with a new fecal or urinary diversion. Shortened hospital inpatient stays, higher patient acuity, and limited access to ostomy specialists send patients with new ostomies home with multiple educational and adjustment needs related to a new stoma. The Society recognized the lack of evidence-based ostomy practice and supported the work of the panel to develop statements that defined elements of the care plan for the patient or caregiver in home care who is adapting to living with a stoma. Eighteen statements were developed that provide minimum discharge criteria for the patient with a new ostomy in the home care setting. Support based upon current evidence as well as expert opinion with implementation strategies are offered for each statement.

  10. Development and Validation of the Role Profile of the Nurse Continence Specialist: A Project of the International Continence Society.

    Science.gov (United States)

    Paterson, Janice; Ostaszkiewicz, Joan; Suyasa, I Gede Putu Darma; Skelly, Jennifer; Bellefeuille, Lesley

    Although nurses have specialized in the management of incontinence, bladder, bowel, and pelvic floor dysfunction for more than 30 years, there is a lack of awareness and underutilization of their role. This article describes a 6-year project to define, characterize, and validate a role profile of the Nurse Continence Specialist. Data collection used a 2-phase, mixed-methods design. Phase 1 of the project resulted in a draft Nurse Continence Specialist role profile and Phase 2 led to validation of the draft profile. The result was a broad consensus about what constitutes the specific skill set for Nurse Continence Specialist specialization within nursing.

  11. Using a handbook to improve nurses' continence care.

    Science.gov (United States)

    Williams, K; Roe, B; Sindhu, F

    Nursing care should be based on sound research evidence with demonstrated clinical effectiveness. Dissemination of this research evidence is, therefore, of paramount importance. A study using focus groups was undertaken during 1993-1994 to evaluate the dissemination of a clinical handbook for continence care to qualified nurses, in relation to reported nursing practice in care of the elderly wards/units in one health authority. A total of 124 nurses participated in the study and 98 variables were included. Improvements were recorded in nurses' responses between the pre-test and post-test for 84 (86 per cent) variables in the experimental group and 58 (59 per cent) in the control group. This demonstrates the positive value of the clinical handbook as a method of disseminating research evidence.

  12. Promoting Simulation Globally: Networking with Nursing Colleagues Across Five Continents.

    Science.gov (United States)

    Alfes, Celeste M; Madigan, Elizabeth A

    Simulation education is gaining momentum internationally and may provide the opportunity to enhance clinical education while disseminating evidence-based practice standards for clinical simulation and learning. There is a need to develop a cohesive leadership group that fosters support, networking, and sharing of simulation resources globally. The Frances Payne Bolton School of Nursing at Case Western Reserve University has had the unique opportunity to establish academic exchange programs with schools of nursing across five continents. Although the joint and mutual simulation activities have been extensive, each international collaboration has also provided insight into the innovations developed by global partners.

  13. Ostomy Home Skills Program

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    Full Text Available ... Education Patients Medical Professionals Skills Programs Find a Treatment Center Patient Safety Resources About the Patient Education ... Surgeons (ASCRS), American Urological Association (AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of ...

  14. Ostomy Home Skills Program

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    Full Text Available ... ASCRS), American Urological Association (AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of America (UOAA). Program Overview The skills kit contains: A booklet with information on the ...

  15. Ostomy Home Skills Program

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    Full Text Available ... AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of America (UOAA). Back to Top Find A Surgeon Find A Surgeon Information For Patients and Family Surgeons Residents and Associates ...

  16. Ostomy: Home Management and Other Resources

    Science.gov (United States)

    ... Resources 33 Overview There’s more to having an ostomy than changing pouches. You will have to make ... doctor or nurse. Pregnancy is possible following an ostomy. Surgical Patient Education SAMPLE 34 BAT HROOM Your ...

  17. How Do People Make Continence Care Happen? An Analysis of Organizational Culture in Two Nursing Homes

    Science.gov (United States)

    Lyons, Stacie Salsbury

    2010-01-01

    Purpose: Although nursing homes (NHs) are criticized for offering poor quality continence care, little is known about the organizational processes that underlie this care. This study investigated the influence of organizational culture on continence care practices in two NHs. Design and Methods: This ethnographic study explored continence care…

  18. "Dignity": A central construct in nursing home staff understandings of quality continence care.

    Science.gov (United States)

    Ostaszkiewicz, Joan; Tomlinson, Emily; Hutchinson, Alison M

    2018-02-03

    To explore nursing home staff members' beliefs and expectations about what constitutes "quality continence care" for people living in nursing homes. Most nursing home residents require assistance to maintain continence or manage incontinence. Best practice guidelines promote active investigation of incontinence, treatment of underlying potentially reversible causes, and initial conservative interventions to prevent, minimise and/or treat incontinence. Despite research showing the positive benefits of implementing active interventions, translating the findings of research into practice in nursing homes has been modest. Understanding the perspectives of individuals who provide continence care may help bridge the gap between evidence and practice. A qualitative exploratory descriptive design. Qualitative interviews were conducted with 19 nursing home staff: eight registered nurses, four enrolled nurses and seven personal care workers working in a nursing home in Australia between 2014-2015. Data were analysed inductively to identify themes and subthemes that described and explained staff beliefs about quality continence care in nursing homes. Participants' understanding and expectations about quality continence care were linked to beliefs about incontinence being an intractable and undignified condition in nursing homes. The key theme to emerge was "protecting residents' dignity" which was supported by the following six subthemes: (i) using pads, ii) providing privacy, (iii) knowing how to "manage" incontinence, (iv) providing timely continence care, (v) considering residents' continence care preferences and (vi) communicating sensitively. The findings provide new insight into the basis for continence care practices in nursing homes. Education about continence care should challenge beliefs that limit continence care practice to cleaning, containing and concealing incontinence. There is a need for a multidimensional framework that is informed by social, psychological

  19. Ostomy Home Skills Program

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    Full Text Available ... Ostomy Home Skills Program Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo ...

  20. Ostomy Home Skills Program

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    Full Text Available ... Data Registry Quality and Safety Conference Resources ... interactive program has been developed by the American College of Surgeons (ACS) in collaboration with the American Society of Colon and Rectal Surgeons (ASCRS), American Urological Association (AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of ...

  1. Implementation of an Evidence-Based and Content Validated Standardized Ostomy Algorithm Tool in Home Care: A Quality Improvement Project.

    Science.gov (United States)

    Bare, Kimberly; Drain, Jerri; Timko-Progar, Monica; Stallings, Bobbie; Smith, Kimberly; Ward, Naomi; Wright, Sandra

    Many nurses have limited experience with ostomy management. We sought to provide a standardized approach to ostomy education and management to support nurses in early identification of stomal and peristomal complications, pouching problems, and provide standardized solutions for managing ostomy care in general while improving utilization of formulary products. This article describes development and testing of an ostomy algorithm tool.

  2. The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization

    OpenAIRE

    Rojanasarot, Sirikan

    2017-01-01

    PURPOSE: To evaluate the impact of a postdischarge ostomy support program as an adjunct to nurse-led ostomy care on preventable healthcare utilization. DESIGN: A cross-sectional study. SUBJECTS AND SETTING: A postdischarge support program offered by an ostomy product's manufacturer provides persons living with an ostomy with patient-centered and easily accessible assistance. Individuals who underwent ostomy surgery within 18 months prior to the survey date were selected from an ostomy patient...

  3. Ostomy Home Skills Program

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    Full Text Available ... Workforce Trauma and EMS Cancer and Research Health Information Technology Scope of Practice Pediatric Issues Other Federal Legislative Issues Regulatory Issues Regulatory Issues Regulatory Issues Stop Overregulating My OR ... Rectal Surgeons (ASCRS), American Urological Association (AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of America (UOAA). The skills kit contains: A booklet with information on the operation, home skills such as emptying ...

  4. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Workforce Trauma and EMS Cancer and Research Health Information Technology Scope of Practice Pediatric Issues Other Federal Legislative Issues Regulatory Issues Regulatory Issues Regulatory Issues Stop Overregulating My OR ... American Urological Association (AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of America (UOAA). Program Overview The skills kit contains: A booklet with information on the operation, home skills such as emptying ...

  5. Development of a chronic care ostomy self-management program.

    Science.gov (United States)

    Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C; Wendel, Christopher S; Krouse, Robert

    2013-03-01

    Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long-term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self-Management Program, which was informed by (1) evidence on published quality-of-life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self-Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies.

  6. Development of a Chronic Care Ostomy Self Management Program

    Science.gov (United States)

    Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C.; Wendel, Christopher S.; Krouse, Robert

    2012-01-01

    Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self Management Program, which was informed by (1) evidence on published quality of life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies. PMID:23104143

  7. Changing your ostomy pouch

    Science.gov (United States)

    Ostomy - pouch change; Colostomy - pouch change ... of surgery you had. You may need your ostomy for just a short time. Or, you may ... it for the rest of your life. The ostomy pouch attaches to your belly, away from your ...

  8. Ostomy Home Skills Program

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    Full Text Available ... ACS Careers at ACS About ACS Career Types Working at ACS ... Education Patients and Family Skills Programs Ostomy Home Skills Program Ostomy Home Skills Program Adult Ostomy ...

  9. Ostomy Home Skills Program

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    Full Text Available ... de Destrezas para manejo Doméstico de Ostomía Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía The Ostomy Home Skills Kit supports patients with educational and simulation ...

  10. Content validation of a standardized algorithm for ostomy care.

    Science.gov (United States)

    Beitz, Janice; Gerlach, Mary; Ginsburg, Pat; Ho, Marianne; McCann, Eileen; Schafer, Vickie; Scott, Vera; Stallings, Bobbie; Turnbull, Gwen

    2010-10-01

    The number of ostomy care clinician experts is limited and the majority of ostomy care is provided by non-specialized clinicians or unskilled caregivers and family. The purpose of this study was to obtain content validation data for a new standardized algorithm for ostomy care developed by expert wound ostomy continence nurse (WOCN) clinicians. After face validity was established using overall review and suggestions from WOCN experts, 166 WOCNs self-identified as having expertise in ostomy care were surveyed online for 6 weeks in 2009. Using a cross-sectional, mixed methods study design and a 30-item instrument with a 4-point Likert-type scale, the participants were asked to quantify the degree of validity of the Ostomy Algorithm's decisions and components. Participants' open-ended comments also were thematically analyzed. Using a scale of 1 to 4, the mean score of the entire algorithm was 3.8 (4 = relevant/very relevant). The algorithm's content validity index (CVI) was 0.95 (out of 1.0). Individual component mean scores ranged from 3.59 to 3.91. Individual CVIs ranged from 0.90 to 0.98. Qualitative data analysis revealed themes of difficulty associated with algorithm formatting, especially orientation and use of the Studio Alterazioni Cutanee Stomali (Study on Peristomal Skin Lesions [SACS™ Instrument]) and the inability of algorithms to capture all individual patient attributes affecting ostomy care. Positive themes included content thoroughness and the helpful clinical photos. Suggestions were offered for algorithm improvement. Study results support the strong content validity of the algorithm and research to ascertain its construct validity and effect on care outcomes is warranted.

  11. Characteristics of the patient with an ostomy.

    Science.gov (United States)

    Pittman, Joyce

    2011-01-01

    Complications following intestinal and urinary diversion (OSTOMY) surgery are a significant problem for many individuals. Patient characteristics or risk factors have been associated with the development of ostomy complications, but research in this area is limited. To examine the demographic and clinical characteristics of new ostomy patients. Descriptive, cross-sectional study. A convenience sample of 144 new ostomy patients was recruited from a large midwest urban level i trauma teaching hospital system. A descriptive, cross-sectional design was used to examine the demographic and clinical characteristics in persons with a new ostomy. demographic and clinical characteristics included were age, gender, disposition, diagnosis, ostomy type, type of procedure (emergent or elective), stoma type (temporary or permanent), technique of stoma creation (loop or end), stoma site marked preoperatively, body type, stoma height, and complicating factors. Data were collected through a medical record review and direct observation by the WOC nurse. Significant differences were found among demographic and clinical characteristics and ostomy type and disposition. Age, type of procedure, reason for surgery, stoma type, stoma site marking, and complicating factors were significantly different by ostomy type. The majority of stomas were not marked preoperatively (67%). Sixty-eight percent of persons with a stoma above skin level versus 38% with a stoma below skin level were discharged to their home. Statistically significant relationships were found among disposition and type of procedure (P = .036), stoma height (P = .003), reason for surgery (P = .000), and age (P = .005). This study provides additional information regarding specific patient characteristics (demographic and clinical) and their relationship to ostomy type and disposition.

  12. How do we promote independent ostomy management for people with disability?

    Science.gov (United States)

    Zeigler, Mary

    2012-01-01

    To describe how people with ostomies became independent with their ostomy management. Two clinical ostomy consultations which incorporated traditional ostomy management along with state-of-the-art ostomy technology aimed at the needs of the disabled person. The newer technologies eliminated several of the traditional steps and made a one-handed approach possible. This article describes two clinical consultations which incorporated traditional ostomy management along with state-of-the-art ostomy technology aimed at the needs of the disabled person. Peristomal skin preparation and protection, barrier wafer preparation, proper pouch emptying, and newer technology are discussed. The consultations resulted in ostomy care autonomy and an improved quality of life in both patients. © 2012 Association of Rehabilitation Nurses.

  13. WOCN Society Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy-An Executive Summary.

    Science.gov (United States)

    This article provides an executive summary of the recommendations from the Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy, published by the Wound, Ostomy and Continence Nurses Society (WOCN Society). It presents an overview of the process used to update and develop the guideline and lists specific recommendations from the guideline. We provide recommendations that include the following topics: stoma construction, preoperative education, stoma site marking, selection of an ostomy pouching system, postoperative education, postoperative management issues, follow-up care after discharge from the acute care setting, health-related quality of life, and stomal and peristomal complications. The intent of the guideline is to provide information that will assist healthcare providers to manage adult patients with ostomies, prevent or decrease complications, and improve patient outcomes. The full text of the published guideline, which includes available evidence supporting the recommendations and a complete reference list, is available in print and as a mobile application from the WOCN Society's online bookstore (http://www.wocn.org). Refer to Supplemental Digital Content 1 (available at: http://links.lww.com/JWOCN/A40) associated with this article for a complete reference list for the guideline.

  14. Ostomy Home Skills Program

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    Full Text Available ... with demonstration of each skill Stoma Practice Model Stoma supplies (measurement guide, marking pen, scissors, sample pouch) Ostomy self-care checklist Evaluation (Complete the Ostomy Patient Survey . We ...

  15. Ostomy Home Skills Program

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    Full Text Available ... JACS Jobs Events Find a Surgeon Patients and Family Contact My Profile Shop ( 0 ) Cart Donate American College of Surgeons Education Patients and Family Skills Programs Ostomy Home Skills Program Ostomy Home ...

  16. Ostomy Home Skills Program

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    Full Text Available ... Emergency Preparedness Rural Trauma Team Development Course Trauma Evaluation and Management Trauma CME The FIRST Trial Patient ... pen, scissors, sample pouch) Ostomy self-care checklist Evaluation (Complete the Ostomy Patient Survey . We need your ...

  17. Ostomy Home Skills Program

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    Full Text Available ... Careers at ACS Careers at ACS About ACS Career Types Working at ACS ... American College of Surgeons Education Patients and Family Skills Programs Ostomy Home Skills Program Ostomy Home Skills ...

  18. Ostomy Home Skills Program

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    Full Text Available ... Resources Educational Resources E-Learning Entering Resident Readiness Assessment Evidence-Based Decisions in Surgery Medical Student Resources ... checklist Evaluation (Complete the Ostomy Patient Survey . We need your opinion!) Program outcomes The ACS Ostomy Home ...

  19. Ostomy Home Skills Program

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    Full Text Available ... Specific Registry Surgeon Specific Registry News and Updates Account Setup Resources and FAQs Features of the SSR ... Today Ostomy Home Skills Kit (login or create account first) Skills Kits Broadcast Rights for Hospitals Ostomy ...

  20. Stepping Into Their Shoes: The Ostomy Experience.

    Science.gov (United States)

    Hood, Donna G; Haskins, Tara L; Roberson, Sherrie C

    2018-04-01

    Empathetic patient care and reflective practice are linked to improved patient outcomes. Nurse educators play a key role in facilitating the development of empathy in nursing students. Research reveals an interest in reflective learning using a variety of approaches. Taking cues from the previous literature, "The Ostomy Experience" was developed, implemented, and evaluated qualitatively. The Ostomy Experience included paired learning, simulated ostomy stories, skills application in a laboratory setting, personal experience of an ostomate appliance, and structured reflective journaling throughout the process. Responses were evaluated for emerging themes. Data analysis revealed themes of Encountering Emotions, Becoming Aware, and Impacting Personal Practice. The structured reflective journaling yielded rich student learning data. Responses were evident of self-proclaimed change in attitudes, deeper understanding of the patient experience, and achievement of the learning objectives. [J Nurs Educ. 2018;57(4):233-236.]. Copyright 2018, SLACK Incorporated.

  1. Ostomy telehealth for cancer survivors: Design of the Ostomy Self-management Training (OSMT) randomized trial.

    Science.gov (United States)

    Sun, Virginia; Ercolano, Elizabeth; McCorkle, Ruth; Grant, Marcia; Wendel, Christopher S; Tallman, Nancy J; Passero, Frank; Raza, Sabreen; Cidav, Zuleyha; Holcomb, Michael; Weinstein, Ronald S; Hornbrook, Mark C; Krouse, Robert S

    2018-01-01

    An ostomy adversely affects health-related quality of life (HRQOL) in a diverse population of cancer survivors and their caregivers. Hit-or-miss ostomy care, nurse counseling, and community referral have been the primary modes of self-management education and support in the peri-operative setting. Few evidence-based, systematic ostomy self-management programs are available to ensure optimal post-operative care. This paper describes the study design of a telehealth-based Ostomy Self-management Training (OSMT) program for cancer survivors and their caregivers. The study is a three-year, randomized trial that tests the effectiveness of the OSMT program on survivor activation, self-efficacy, and HRQOL. The intervention integrates goal setting and problem-solving approaches to enhance survivor activation and self-efficacy to carry out ostomy care. The curriculum is delivered via four group sessions administered by trained ostomy certified nurses (WOCNs) and peer ostomates. An additional session is offered to caregivers to address their needs in relation to ostomy care. Telehealth approaches through videoconferencing are used to enhance program delivery to participants in three different geographic areas across two time zones. Participants join sessions via real-time videoconferencing from their homes. The OSMT program has high potential to make a positive impact on the unique physical, psychological, social, and spiritual needs of cancer survivors living with a permanent ostomy. The study design, process, and telehealth approach contributes to the success of future dissemination efforts of the intervention into diverse clinical and community settings. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Ostomy Surgery of the Bowel

    Science.gov (United States)

    ... Digestive System & How it Works Zollinger-Ellison Syndrome Ostomy Surgery of the Bowel What is ostomy surgery of the bowel? Ostomy surgery of the ... of the body. Why does a person need ostomy surgery of the bowel? A person may need ...

  3. Ongoing ostomy self-care challenges of long-term rectal cancer survivors.

    Science.gov (United States)

    Bulkley, Joanna E; McMullen, Carmit K; Grant, Marcia; Wendel, Christopher; Hornbrook, Mark C; Krouse, Robert S

    2018-05-29

    Surgical treatment for rectal cancer (RC) can result in an intestinal ostomy that requires lifelong adaptation and investment of physical, cognitive, and financial resources. However, little is known about the extent of ongoing challenges related to ostomy self-care among long-term RC survivors. We analyzed the prevalence of self-reported ostomy self-care challenges and the physical and environmental factors that can support or undermine ostomy self-care. We mailed surveys to long-term (≥ 5 years post-diagnosis) RC survivors, including 177 adults with ostomies who were members of integrated health systems in northern California, Oregon, and Washington State. Potential participants were identified through tumor registries. Data were also extracted from electronic health records. The response rate was 65%. The majority of respondents were male (67%), and the mean age was 75 years. Sixty-three percent of respondents reported at least one ostomy self-care challenge. The most common challenges were leakage or skin problems around the ostomy and needing to change the pouching system too frequently. Twenty-two percent reported difficulty caring for their ostomy. Younger age and higher BMI were consistently related to ostomy self-care challenges. The majority of RC survivors reported ostomy-related self-care challenges, and 31% experienced problems across multiple domains of ostomy self-care. In addition, most survivors reported significant physical challenges that could lead to ostomy-related disability. Although the participants surveyed had access to ostomy care nurses, the care gaps we found suggest that additional work is needed to understand barriers to ostomy care, reduce unmet needs, and improve well-being among this group.

  4. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma Practice Model Stoma supplies (measurement guide, marking pen, scissors, sample pouch) Ostomy self-care checklist Evaluation (Complete the Ostomy Patient Survey . We ...

  5. Drawing on international experience to reform the Belgian market for ostomy appliances.

    Science.gov (United States)

    Simoens, Steven; Van den Steen, Dirk; Vanleene, Veerle; De Maré, Luc; Moldenaers, Ingrid; Debruyne, Hans; Ramaekers, Dirk

    2007-02-01

    This article aims to review the regulatory framework governing the Belgian ostomy appliance market in the light of the experience of Denmark, France, the Netherlands and Ontario (Canada) with regulation of ostomy appliances. Information about the regulatory framework was derived from the international literature, analysis of legal texts and a survey completed by national experts. The comparative analysis revealed that these countries have adopted varying approaches towards regulating their domestic ostomy appliance market. Strategies to keep down prices include public procurement in Denmark, maximum prices in France and exclusion of expensive appliances from reimbursement in the Netherlands. To contain public expenditure on ostomy appliances, consumption patterns are monitored in the Netherlands, the quantity of reimbursed appliances is limited in Belgium and public reimbursement is restricted in Ontario. Ostomy appliances are generally distributed by community pharmacies and medical equipment shops. In countries that emphasise home care delivery such as Denmark, domiciliary distributors dominate the market to the detriment of community pharmacies which do not seem to be able to offer this service at a competitive price. An avenue for reforming the Belgian ostomy appliance market is proposed which valorizes the role of ostomy care nurses in guiding the choice of ostomy appliances. Furthermore, it is recommended that a competitive tendering process determines the price of ostomy appliances, that reimbursement for service provision by distributors is separated from reimbursement of appliances, and that patients receive a fixed grant from the third-party payer to buy ostomy appliances.

  6. Construct validation of an interactive digital algorithm for ostomy care.

    Science.gov (United States)

    Beitz, Janice M; Gerlach, Mary A; Schafer, Vickie

    2014-01-01

    The purpose of this study was to evaluate construct validity for a previously face and content validated Ostomy Algorithm using digital real-life clinical scenarios. A cross-sectional, mixed-methods Web-based survey design study was conducted. Two hundred ninety-seven English-speaking RNs completed the study; participants practiced in both acute care and postacute settings, with 1 expert ostomy nurse (WOC nurse) and 2 nonexpert nurses. Following written consent, respondents answered demographic questions and completed a brief algorithm tutorial. Participants were then presented with 7 ostomy-related digital scenarios consisting of real-life photos and pertinent clinical information. Respondents used the 11 assessment components of the digital algorithm to choose management options. Participant written comments about the scenarios and the research process were collected. The mean overall percentage of correct responses was 84.23%. Mean percentage of correct responses for respondents with a self-reported basic ostomy knowledge was 87.7%; for those with a self-reported intermediate ostomy knowledge was 85.88% and those who were self-reported experts in ostomy care achieved 82.77% correct response rate. Five respondents reported having no prior ostomy care knowledge at screening and achieved an overall 45.71% correct response rate. No negative comments regarding the algorithm were recorded by participants. The new standardized Ostomy Algorithm remains the only face, content, and construct validated digital clinical decision instrument currently available. Further research on application at the bedside while tracking patient outcomes is warranted.

  7. The Impact of an Ostomy on the Sexual Lives of Persons With Stomas: A Phenomenological Study.

    Science.gov (United States)

    Vural, Fatma; Harputlu, Deniz; Karayurt, Ozgul; Suler, Gulseren; Edeer, Aylin Durmaz; Ucer, Ceylanim; Onay, Deniz Cenan

    2016-01-01

    The purpose of this study was to describe the lived experiences of persons with stomas related to sexual function and perceptions and their expectations of the ostomy nurses who care for them. Qualitative, phenomenological study. Fourteen persons living with an ostomy for least 2 months participated in the study. Data collection occurred at the ostomy and wound care unit at Dokuz Eylul University Hospital in Izmir, Turkey. Data were collected using an in-depth interview method. Interviews lasted from 20 to 60 minutes and were audiotaped. These recordings were transcribed and subjected to content analysis. Five themes emerged from the unstructured interviews: (1) changes in sexual life; (2) changes in body image; (3) fear and anxiety experienced during sexual intercourse; (4) psychological impact of sexual problems; and (5) expectations concerning sexual counseling from ostomy nurses. Study findings suggest that persons with ostomies experience changes in their body image, along with a decrease in sexual desire. Respondents described avoiding sexual intercourse, and abstained from sleeping with their partners. Male respondents described erectile dysfunction, and female respondents reported pain during sexual intercourse (dyspareunia). Participants stated that they did not feel adequately informed about these problems and desired to receive more information and support from ostomy nurses regarding sexual issues. Based on these findings, we recommend that ostomy nurses provide more counseling concerning sexual function and challenges following ostomy surgery.

  8. “I Didn’t Feel Like I Was a Person Anymore”: Realigning Full Adult Personhood after Ostomy Surgery

    Science.gov (United States)

    Ramirez, Michelle; Altschuler, Andrea; McMullen, Carmit; Grant, Marcia; Hornbrook, Mark; Krouse, Robert

    2016-01-01

    Colorectal cancer (CRC) is the third most common cancer in the United States. For some CRC patients, cancer treatment involves creating a permanent or temporary intestinal ostomy. Having an ostomy often results in complex social and physical concerns—including unpredictable and at times publicly noticeable bowel output. In this article, we discuss findings from 30 in-depth interviews with female CRC survivors with ostomies in the western United States. We highlight how having an ostomy disrupts culturally sanctioned practices of continence that mark the attainment of full-adult personhood. We discuss how survivors reclaim a sense of full personhood after ostomy surgery through a process of realignment that entails both learning how to manage ostomy equipment to conceal bowel activity and reappraising their illness and suffering. We suggest that the anthropological categories of personhood and personhood realignment be incorporated into research and interventions aimed at increasing support among cancer survivors living with bodily impairments. PMID:24782269

  9. Ostomy Home Skills Program

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    Full Text Available ... Case Reviews Login CME Test Login Author Instructions Sample Article Chapter Competition Contact Resources in Surgical Education ... Model Stoma supplies (measurement guide, marking pen, scissors, sample pouch) Ostomy self-care checklist Evaluation (Complete the ...

  10. Ostomy Home Skills Program

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    Full Text Available ... for Hospitals Ostomy Home Skills Hospital Quality Improvement Package The standardized interactive program has been developed by the American College of Surgeons ... and Associates Medical Students International Surgeons ...

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    Full Text Available ... Trauma and EMS Cancer and Research Health Information Technology Scope of Practice Pediatric Issues Other Federal Legislative ... The Ostomy Home Skills Kit supports patients with educational and simulation materials to learn and practice the ...

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    Full Text Available ... Governance Governance Overview Governance Overview Bylaws College Officials Executive Staff Committees Board of Regents Board of Governors ... Model Stoma supplies (measurement guide, marking pen, scissors, sample pouch) Ostomy self-care checklist Evaluation (Complete the ...

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  19. Sexual health and quality of life among male veterans with intestinal ostomies.

    Science.gov (United States)

    Symms, Michelle R; Rawl, Susan M; Grant, Marcia; Wendel, Christopher S; Coons, Stephen Joel; Hickey, Sara; Baldwin, Carol M; Krouse, Robert S

    2008-01-01

    rates of sexual activity and sexual satisfaction were related to the social and psychological dimensions of HR-QOL among men with ostomies. Interventions to address sexual concerns of male ostomates and their partners may prevent decrements to HR-QOL for these patients. Results of the study have implications for the clinical nurse specialist role in supporting and educating patients with ostomies to minimize the negative impact of an intestinal ostomy on sexual health and HR-QOL. Implications also relate to the need to educate current and future nurses about the importance of assessing sexual health.

  20. Sexual Experiences of Chinese Patients Living With an Ostomy.

    Science.gov (United States)

    Zhu, Xiaomei; Chen, Yongyi; Tang, Xinhui; Chen, Yupan; Liu, Yangyu; Guo, Wei; Liu, Aizhong

    The purpose of this study was to examine the sexual experience of Chinese patients with ostomy and associated factors. A prospective descriptive study using self-report questionnaires. Seventy-five Chinese participants who underwent ostomy surgery in a large cancer specialist hospital in the Hunan province between 2008 and 2013. Data were collected face-to-face by the investigators in an outpatient setting from 75 participants who completed the Arizona Sexual Experience Inventory Scale (ASEX). The t test was used to compare variances between sexual function and dysfunction subgroups. A multiple linear regression model was used to analyze factors influencing sexual life after ostomy surgery. The mean ASEX score was 20.56 (5.378) years, which is higher than the standard for sexual dysfunction. The main subsection of sexual dysfunction included sexual arousal, orgasm ability, vaginal lubrication/penile erection, and sexual satisfaction. Significant differences in the ASEX score were observed in subgroups of age, gender, educational level, family relations, operation modes, stoma type, operation time, complications, supporters, self-care ability, and sexual life guidance. Multiple stepwise regression analysis indicated that family relations, operation modes, ostomy type, complications, and sexual life guidance affected sexual experience. The findings of this study demonstrate that patients with ostomy experience sexual dysfunction and many factors influence their quality of sexual life. WOC nurses and other healthcare providers should consider providing sexual health education for both the patient and spouse to improve the self-care capacity and quality of sexual life following ostomy surgery.

  1. Colostomy irrigation: current knowledge and practice of WOC nurses.

    Science.gov (United States)

    Cobb, Martha D; Grant, Marcia; Tallman, Nancy J; Wendel, Christopher S; Colwell, Janice; McCorkle, Ruth; Krouse, Robert S

    2015-01-01

    This study builds on the authors' previous studies that demonstrate that persons living with a colostomy who practice colostomy irrigation (CI) experience quality-of-life benefits. Studies also reveal that patients may not be taught about CI. The purpose of this study was to determine current knowledge, attitudes, and practices of WOC nurses on CI. The target population was ostomy nurses who were members of the Wound, Ostomy and Continence Nurse's Society. Nine hundred eighty-five nurses out of a possible pool of 4191 members responded, providing a response rate of 24%. Their average age was 53 years (range, 25-79 years). Respondents averaged 12 years' experience as a WOC nurse (range, 1-40 years) and 90% (n = 875) were certified. Participants practiced in a variety of settings, including acute and long-term care facilities, home health, and ambulatory clinics. They saw an average of 37 ± 60.5 (mean ± SD) ostomy patients per year (range, 0-1100). A 1-time online survey (SurveyMonkey) of members of the Wound, Ostomy and Continence Nurses (WOCN) Society was conducted. In addition to demographic and educational information, questions also included (1) CI advantages and disadvantages; (2) CI content routinely taught; (3) challenges in assisting patients to learn CI; and (4) where preparation was received for teaching this procedure. Nurses were asked whether they believe CI is evidence-based. More than half identified irrigation as an evidence-based practice (59%), but half indicated they do not routinely teach CI. Multiple factors correlated with nurses' decisions to teach CI, including years of experience (P = .03), specific CI education (P < .001), and considering the intervention evidence-based (P < .001). Factors influencing CI instruction are multifactorial; they include nurses' attitudes, experience base, education, medical indications, setting characteristics, and patient interest and physical abilities. Education on this procedure is urgently needed for

  2. Assessing peristomal skin changes in ostomy patients: validation of the Ostomy Skin Tool.

    Science.gov (United States)

    Jemec, G B; Martins, L; Claessens, I; Ayello, E A; Hansen, A S; Poulsen, L H; Sibbald, R G

    2011-02-01

    Peristomal skin problems are common and are treated by a variety of health professionals. Clear and consistent communication among these professionals is therefore particularly important. The Ostomy Skin Tool (OST) is a new assessment instrument for the extent and severity of peristomal skin conditions. Formal tests of reliability and validity are necessary for its use in clinical practice, research, and education. To estimate inter- and intra nurse assessment variability of the OST and validity by comparison to a 'gold standard' (GS) defined by an expert panel. Thirty photographs of peristomal skin were presented twice to 20 ostomy care nurses--10 from Denmark (DK) and 10 from Spain (ES)--to determine intra- and inter nurse assessment variability. The same photographs were presented to an international group of experts (dermatologist and ostomy care nurses), to establish a GS for comparison and validation of the results. A high intra-nurse assessment agreement, κ=0·84, was found with no differences in the intra-nurse assessments from the two groups of nurses (DK and ES). The inter-nurse assessment agreement was 'moderate to good', κ=0·54, with the agreement between the experts higher, κ=0·70. A high correlation between the scores from the nurses and the GS were seen in the lower part of the two scales [Discoloration, Erosion, Tissue overgrowth (DET) score<7)]. The study supported the validity of the OST. It is suggested that a categorical scale can be used to illustrate the severity of the DET scores. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

  3. Ostomy Home Skills Program

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    Full Text Available ... The Ostomy Home Skills Kit supports patients with educational and simulation materials to learn and practice the skills needed for optimal postoperative recovery. The kit supports the entire surgical team with quality, comprehensive education. The standardized interactive program has been ...

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  6. Psychometric evaluation of the ostomy complication severity index.

    Science.gov (United States)

    Pittman, Joyce; Bakas, Tamilyn; Ellett, Marsha; Sloan, Rebecca; Rawl, Susan M

    2014-01-01

    reliability and can be used to assess incidence and severity of ostomy complications in the early postoperative period. We found the OCSI to be brief, easy-to-use, and clinically practical. It can be used to (a) identify priority areas for nursing intervention related to the ostomy, (b) determine appropriate interventions to prevent or treat complications, and (c) evaluate the effects of nursing interventions designed to improve outcomes for patients with ostomies.

  7. Quality of life in ostomy patients: a qualitative study

    Directory of Open Access Journals (Sweden)

    Aazam Dabirian

    2010-12-01

    Full Text Available Aazam Dabirian, Farideh Yaghmaei, Maryam Rassouli, Mansoureh Zagheri TafreshiNursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, IranPurpose: Therapeutic procedures may not only treat disease but also affect patient quality of life. Therefore, quality of life should be measured in order to assess the impact of disease and therapeutic procedures. To identify clients' problems, it is necessary to assess several dimensions of quality of life, including physical, spiritual, economic, and social aspects. In this regard, we conducted a qualitative study to explore quality of life and its dimensions in ostomy patients referred to the Iranian Ostomy Association.Methods: Fourteen patients were interviewed about their quality of life dimensions by purposeful sampling. Data were gathered by semistructured interviews and analyzed using the content analysis method.Results: Nine main themes emerged using this approach, including physical problems related to colostomy, impact of colostomy on psychological functioning, social and family relationships, travel, nutrition, physical activity, and sexual function, as well as religious and economic issues.Conclusion: The findings of the study identified a number of challenges in quality of life for patients with ostomy. The results can be used by health care providers to create a supportive environment that promotes better quality of life for their ostomy patients.Keywords: ostomy, colostomy, qualitative study, quality of life

  8. From diagnosis through survivorship: health-care experiences of colorectal cancer survivors with ostomies

    Science.gov (United States)

    Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Mohler, M. Jane; Hornbrook, Mark C.; Herrinton, Lisa J.; Krouse, Robert S.

    2014-01-01

    Purpose The journey from diagnosis through treatment to survivorship can be challenging for colorectal cancer (CRC) survivors with permanent ostomies. Memories of both the positive and negative health-care interactions can persist years after the initial diagnosis and treatment. The purpose of this paper is to describe the health-care experiences of long-term (>5 years) CRC survivors with ostomies. Methods Thirty-three CRC survivors with ostomies who were members of Kaiser Permanente, an integrated care organization, in Oregon, southwestern Washington and northern California participated in eight focus groups. Discussions from the focus groups were recorded, transcribed, and analyzed for potential categories and themes. Results Health-care-related themes described CRC survivors’ experiences with diagnosis, treatment decision-making, initial experiences with ostomy, and survivorship. Participants discussed both positive and negative health-care-related experiences, including the need for continued access to trained nurses for ostomy self-care, access to peer support, and resources related to managing persistent, debilitating symptoms. Conclusions Long-term CRC survivors with ostomies have both positive and negative health-care experiences, regardless of health-related quality of life (HRQOL) and gender. Long-term support mechanisms and quality survivorship care that CRC survivors with ostomies can access are needed to promote positive adjustments and improved HRQOL. Structured abstract The current literature in CRC survivor-ship suggests that HRQOL concerns can persist years after treatment completion. The coordination of care to manage persistent late- and long-term effects are still lacking for CRC survivors living with an ostomy. Findings from this qualitative analysis will aid in the development of support strategies that foster more positive adjustments for CRC survivors living with an ostomy and support their ongoing ostomy-related needs. PMID:24442998

  9. Ostomy-related complications after emergent abdominal surgery: a 2-year follow-up study.

    Science.gov (United States)

    Lindholm, Elisabet; Persson, Eva; Carlsson, Eva; Hallén, Anne-Marie; Fingren, Jeanette; Berndtsson, Ina

    2013-01-01

    The aim of this study was to prospectively evaluate ostomy-related complications and describe ostomy configuration in patients undergoing acute abdominal surgery. The study sample comprised 144 patients with a median age of 67 years (IOR: 53.5-78 years) who underwent an intestinal ostomy as part of an acute abdominal surgical procedure. The research setting was the surgical and gynecological clinics at the Sahlgrenska University Hospital in Gothenburg, Sweden. Ostomy configuration, diameter, height, and the presence of stomal and peristomal complications were assessed by a WOC nurse 1 to 2 times while in hospital, once at the ostomy outpatient clinic 2 weeks after discharge, and at 3, 6, 12, and 24 months following ostomy creation. The types of ostomies evaluated were end colostomy (58%), end ileostomy (18%), loop ileostomy (17%), and loop colostomy (7%). Most stomal or peristomal complications occurred within 1 year after surgery (31 of 57; 54.4%). Necrosis, separation, and stenosis were most common in patients with an end colostomy. Peristomal skin complications occurred in 45% of subjects during the first 6 months after surgery. The ostomy's diameter decreased significantly during the hospital course and over the first 2 weeks following hospital discharge in patients with end colostomy (Postomy had peristomal skin problems ranging between 21% and 57% over this time period. The frequency of using a pouching system that incorporated convexity was highest in the case of loop ileostomy, used in 67% at 6 months. During the first 2 weeks after discharge, the physical configuration of the ostomy evolves and the pouching system must be frequently adjusted by a WOC nurse. Stomal and peristomal complications are prevalent during the first 2 postoperative years and especially during the first 6 months.

  10. Italian Society of Surgery and Association of Stoma Care Nurses Joint Position Statement on Preoperative Stoma Siting.

    Science.gov (United States)

    Roveron, Gabriele; De Toma, Giorgio; Barbierato, Maria

    2016-01-01

    Drawing on the existing position statements approved by the Wound, Ostomy and Continence Nursing Society in collaboration with the American Society of Colon & Rectal Surgeons and the American Urological Association, the Italian Association of Stoma care Nurses and the Italian Society of Surgery jointly developed and approved this document on July 27, 2013. Its purpose was to provide a formal recommendation for preoperative stoma siting and associated counseling for all patients undergoing enterostomy or urostomy surgery, with the goals of preventing complications, enhancing health-related quality of life, improving care, achieving better health outcomes, and reducing health care costs.

  11. Application of the perineal ostomy in severe organophosphate poisoned patients after catharsis.

    Science.gov (United States)

    Zhang, D-M; Xiao, Q

    2014-01-01

    To investigate the efficacy of the one-piece ostomy bags for severe organophosphate poisoned patients after catharsis. Sixty cases of severe organophosphate poisoned patients who were given rhubarb catharsis after thorough nasal lavage were divided into two groups. The observation group used the one-piece ostomy bags whilst the control group used the disposable changing mats. The perineal skin changes, average daily hours of care, and cost of care rates were compared between the two groups. The rates of perineal skin changes were lower in the observation group than the control group (p ostomy bag in poisoned patients after the catharsis can prevent the risk of nursing by protecting and promoting the care quality, reducing the nursing workload and improving their work efficiency. It can enhance the nurses' self-esteem, reduce patients' expenses and provide an objective basis for assessing the treatments.

  12. 21 CFR 876.5895 - Ostomy irrigator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ostomy irrigator. 876.5895 Section 876.5895 Food... DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5895 Ostomy irrigator. (a) Identification. An ostomy irrigator is a device that consists of a container for fluid, tubing with a cone-shaped...

  13. A Descriptive Study Assessing Quality of Life for Adults With a Permanent Ostomy and the Influence of Preoperative Stoma Site Marking.

    Science.gov (United States)

    Maydick, Diane

    2016-05-01

    Diseases or anomalies of the genitourinary or gastrointestinal tract often require removal of organs and creation of an artificial opening (stoma) to allow for elimination of urine or stool. Preoperative stoma site marking can affect quality of life (QoL). A descriptive study was conducted to assess the relationship between QoL and preoperative stoma site marking in adults with a permanent ostomy. Using convenience sampling methods, 230 eligible participants attending a United Ostomy Association of America conference were invited to complete a survey of demographics regarding age, gender, time since surgeries, and ostomy type and the City of Hope National Medical Center Quality of Life Ostomy Questionnaire. The latter contains 2 sections of 30 and 43 items each that address life impact and quality of life, respectively. The researcher explained the study and provided a study packet to volunteers who were interested in participating. Volunteers were to complete the surveys over a 4-day period while at the conference; the investigator collected all study materials. Inclusion criteria stipulated study participants must be English writing/reading persons at least 18 years of age with a colostomy, ileostomy, or urostomy. All descriptive statistics (means, standard deviation, frequency, and percents) used to describe demographic and surgical history and quantitative data (logistic regression, cross-tabulation, Pearson product moment correlations, and analysis of covariance) used to determine relationships among factors were entered and analyzed using a computer software program. Of the 140 participants who met inclusion criteria and provided data, the majority (85, 60.7%) had their stoma site marked by a wound, ostomy, continence (WOC) nurse. WOC nurse marking was more likely in recent years, and WOC nurse marking was 1.03 times more likely for each year since stoma surgery (M = 13.44, SD = 13.48). Mean QoL was 7.56 (SD = 1.59, range 3.84-10.00) and was positively

  14. Stoma creation: does onset of ostomy care education delay hospital length of stay?

    Science.gov (United States)

    Rashidi, Laila; Long, Kevin; Hawkins, Melinda; Menon, Raman; Bellevue, Oliver

    2016-05-01

    Balancing patient safety with hospital length of stay (LOS) and associated cost is critically important. Subjectively, we have observed that patients undergoing ostomy creation early in the week have a shorter LOS. We retrospectively reviewed LOS based on day of the week the operation was performed. We reviewed 180 patients undergoing minimally invasive surgery with planned ostomy. Group 1 underwent surgery on Monday to Wednesday (n = 77), Group 2 on Thursday (n = 49), and Group 3 on Friday (n = 54). The average LOS for Group 1, 2, and 3 was 6.2, 4.9, and 7.2 days, respectively. The average number of visits with ostomy nursing for Group 1, 2, and 3 was 2.7, 1.8, and 2.3, respectively. Day of initial ostomy nursing visit was significantly correlated between the delay to initial visit and LOS with Group 3 delayed most. Patients with the longest delay to initial nurse visit had the longest LOS, with Friday operations being most delayed. A contributing factor may be absence of ostomy teaching over the weekend. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Evaluation of the Effectiveness of Nurse-Led Continence Care Treatments for Chinese Primary Care Patients with Lower Urinary Tract Symptoms.

    Directory of Open Access Journals (Sweden)

    Edmond P H Choi

    Full Text Available The aim of this study was to evaluate whether community-based nurse-led continence care interventions are effective in improving outcomes for adult Chinese primary care patients with lower urinary tract symptoms (LUTS.A case-controlled intervention study was conducted. An intervention group of 360 primary care patients enrolled into a nurse-led continence care programme were recruited by consecutive sampling. A control group of 360 primary care patients with LUTS identified by screening were recruited from the waiting rooms of primary care clinics by consecutive sampling. Both groups were monitored at baseline and at 12 months.Outcome measures included symptom severity, health-related quality of life (HRQOL, self-efficacy, global health and self-reported health service utilization at 12-months. The effect of the continence care programme on symptom severity and HRQOL was assessed by the difference-in-difference estimation, using independent t-test and multiple liner regression. Chi-square test was used to compare the self-efficacy, global health and self-reported health service utilization between the two groups at 12-months.After adjusting for baseline severity and socio-demographics, the intervention group had significant improvements in LUTS severity (P<0.05 and HRQOL (P<0.05. Improvements in the amount of urine leakage were not significantly different between the two groups. A higher proportion of subjects in the intervention group reported increased self-efficacy (43.48% vs. 66.83%, improved global health condition (17.74% vs. 41.5%, having doctor consultation (18.5% vs. 8.06, having medication due to LUTS (26.50% vs.11.29% and having non-drug therapy due to LUTS (59.5% vs.9.68%.Community-based nurse-led continence care can effectively alleviate symptoms, improve health-related quality of life, and enhance self-efficacy and the global health condition of Chinese male and female primary care patients with LUTS.

  16. A interpretação do cuidado com o ostomizado na visão do enfermeiro: um estudo de caso La interpretación del cuidado con el ostomizado en la visión del enfermero: un estudio de caso The meaning of ostomy care to nurses: a case study

    Directory of Open Access Journals (Sweden)

    Lorena Moraes Goetem Gemelli

    2002-01-01

    Full Text Available Este estudo teve como objetivo identificar como os enfermeiros de uma instituição hospitalar interpretam o cuidado com o ostomizado, por meio do método de estudo de caso. Os resultados obtidos deram origem a quatro categorias: o paciente precisa de um cuidado especial; é preciso orientar; para orientar a enfermagem precisa...; reconhecimento das dificuldades para o cuidado especial. Por essas categorias consideramos que os enfermeiros fornecem um cuidado inadequado devido à falta de conhecimentos específicos.Este estudio tuvo como objetivo identificar como los enfermeros de una institución hospitalaria interpretan el cuidado con el ostomizado, por medio del método de estudio de caso. Los resultados obtenidos dieron origen a cuatro categorías: el paciente necesita cuidado especial, es necesario orientar, para orientar la enfermera necesita..., reconocimiento de la dificultad para el cuidado. Por éstas categorías consideramos que los enfermeros brindan un cuidado inadecuado debido a la falta de conocimientos específicos.This study aimed to identify how nurses working in a hospital interpret ostomy care. The case-study methodology was used. The obtained results originated four categories: the patient needs special care, it is necessary to provide orientation, in order to provide orientation, the nurse needs..., the recognition of difficulties in delivering special care. These categories express that the care given to ostomy patient by the nurses is not appropriate due to the lack of specific knowledge.

  17. Evolving Continents

    Science.gov (United States)

    Hamilton, Warren

    Brian Windley succeeds very well indeed at the formidable task he sets for himself in this greatly revised second edition of a book that first appeared in 1977. He synthesizes primarily the tectonic and petrologic evolution of the continents and secondarily their economic geologic, stratigraphic, and biologic history. The book is organized in well-balanced time sequence and topical chapters, followed by a fine overview. The author describes examples, generalizes from them, and seeks understanding of variations with time and with depth of the process acting on continents within a plate tectonic framework.

  18. The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization.

    Science.gov (United States)

    Rojanasarot, Sirikan

    To evaluate the impact of a postdischarge ostomy support program as an adjunct to nurse-led ostomy care on preventable healthcare utilization. A cross-sectional study. A postdischarge support program offered by an ostomy product's manufacturer provides persons living with an ostomy with patient-centered and easily accessible assistance. Individuals who underwent ostomy surgery within 18 months prior to the survey date were selected from an ostomy patient database maintained by the ostomy patient support program provider. Of 7026 surveys sent to program enrollees, 493 (7%) responded, compared with 225 (5%) out of 4149 surveys sent to individuals in a comparison group. The 2 groups were similar in demographics. A majority of the survey respondents were female (60% of program enrollees vs 55% of respondents in the comparison group). Among the program enrollees, 44% had colostomy, 43% had ileostomy, 10% had urostomy, and 4% had at least 2 types of ostomy surgery compared with 52%, 32%, 12%, and 4% of the respondents in a comparison group, respectively. The study compared hospital readmission and emergency room (ER) visit rates attributable to ostomy complications between program enrollees and respondents in the comparison group. The event rates were measured in 2 study periods: within the first month of discharge and after the first month of discharge. Eligible individuals received an online survey that included the following domains: characteristics of ostomy surgery; readmissions and ER visits within the first month or after the first month of discharge, including reasons for preventable events; and level of health care access. Multivariate logistic regressions controlling for covariates were applied to investigate associations between program enrollment and ostomy-related readmission or ER visit rates. Logistic regression analyses showed that, when compared with respondents in the comparison group, program enrollees had a significantly lower likelihood of being

  19. "I didn't feel like I was a person anymore": realigning full adult personhood after ostomy surgery.

    Science.gov (United States)

    Ramirez, Michelle; Altschuler, Andrea; McMullen, Carmit; Grant, Marcia; Hornbrook, Mark; Krouse, Robert

    2014-06-01

    Colorectal cancer (CRC) is the third most common cancer in the United States. For some CRC patients, cancer treatment involves creating a permanent or temporary intestinal ostomy. Having an ostomy often results in complex social and physical concerns-including unpredictable and at times publicly noticeable bowel output. In this article, we discuss findings from 30 in-depth interviews with female CRC survivors with ostomies in the western United States. We highlight how having an ostomy disrupts culturally sanctioned practices of continence that mark the attainment of full-adult personhood. We discuss how survivors reclaim a sense of full personhood after ostomy surgery through a process of realignment that entails both learning how to manage ostomy equipment to conceal bowel activity and reappraising their illness and suffering. We suggest that the anthropological categories of personhood and personhood realignment be incorporated into research and interventions aimed at increasing support among cancer survivors living with bodily impairments. © 2014 by the American Anthropological Association.

  20. Elicitation of ostomy pouch preferences

    DEFF Research Database (Denmark)

    Bonnichsen, Ole

    2011-01-01

    Background: Previous studies about patients who have undergone ostomy surgery commonly address the issues of the surgery, complications, preoperative counseling, quality of life, and psychosocial changes following surgery. Only a limited number of studies deal with how technical improvements...... in stoma care would affect patients and, to the author's knowledge, the present study is the first to elicit preferences for potential improvements in ostomy pouches in the form of monetary values. Objective: This article examines and measures Swedish patients' preferences for potential improvements...... in ostomy pouch attributes. The theory, study design, elicitation procedure, and resulting preference structure of the sample is described. Methods: A discrete-choice experiment (DCE) was used to elicit preferences. Respondents were asked to choose between alternatives in choice sets, in which each...

  1. Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status.

    Science.gov (United States)

    Reese, J B; Finan, P H; Haythornthwaite, J A; Kadan, M; Regan, K R; Herman, J M; Efron, J; Diaz, L A; Azad, N S

    2014-02-01

    Research examining effects of ostomy use on sexual outcomes is limited. Patients with colorectal cancer were compared on sexual outcomes and body image based on ostomy status (never, past, and current ostomy). Differences in depression were also examined. Patients were prospectively recruited during clinic visits and by tumor registry mailings. Patients with colorectal cancer (N = 141; 18 past ostomy; 25 current ostomy; and 98 no ostomy history) completed surveys assessing sexual outcomes (medical impact on sexual function, Female Sexual Function Index, International Index of Erectile Function), body image distress (Body Image Scale), and depressive symptoms (Center for Epidemiologic Studies Depression Scale-Short Form). Clinical information was obtained through patient validated self-report measures and medical records. Most participants reported sexual function in the dysfunctional range using established cut-off scores. In analyses adjusting for demographic and medical covariates and depression, significant group differences were found for ostomy status on impact on sexual function (p ostomy groups reported worse impact on sexual function than those who never had an ostomy (p ostomy group reported worse body image distress than those who never had an ostomy (p ostomies as part of their treatment. Clinical information and support should be offered.

  2. The Ostomy: What Can Go Wrong? What About Special Procedures? Second of Two Parts.

    Science.gov (United States)

    Boarini, Joy; Alterescu, Karen Burke

    1985-01-01

    Teaches nurses to name three characteristics of a normal stoma, describe treatment for three common stomal complications, describe treatment for two complications of peristomal skin, and identify at least two factors to consider before preparing an ostomy patient for a radiologic procedure. (CT)

  3. Self-care practice of ostomy patients: contributions of the Orem’s theory

    Directory of Open Access Journals (Sweden)

    Luciana Catunda Gomes Menezes

    2013-05-01

    Full Text Available This study aimed to identify the conditioning factors to self-care practice of ostomy patients, and verify knowledge and practices on stoma care. Descriptive and qualitative study, referencing the Orem’s Self-Care Theory, carried out at the Ostomy Association of Fortaleza-CE, Brazil, in June and July 2007. We identified as the main conditioning factors for self-care: male, aged over 51 years, low education, from the capital city/metropolitan area, married, and with low family income. From the participants’ statements, emerged three categories: Learning to take care of stoma: education-support system; Stoma Care: knowledge and practices; and Difficulties found in the practice of self-care. It was concluded that ostomy patients require a multidimensional and individualized nursing care, which enables them to perform self-care effectively.

  4. The Lived Experiences of Persons Hospitalized for Construction of an Urgent Fecal Ostomy.

    Science.gov (United States)

    Herlufsen, Per; Brødsgaard, Anne

    The purpose of this study was to describe the lived experiences of hospital stays for patients undergoing urgent ostomy surgery. Qualitative, descriptive, phenomenological study. Six persons undergoing acute hospital admission and urgent ileostomy or colostomy surgery (either permanent or temporary) participated in the study. Participants were of Danish ethnicity and between the ages of 48 and 75 years. The research setting was the surgical department at a university hospital in the Capital Region of Denmark. Data collection and analyses were guided by a Reflective Lifeworld Research approach; this approach is based on phenomenological philosophy. Data were collected during in-depth interviews using a semistructured interview guide. Their average length was 50 minutes (range, 30-65 minutes). Interviews were digitally recorded and transcribed. Transcriptions were analyzed in 4 phases according to the principles of Reflective Lifeworld Research. The phenomenon we labeled "lived experiences of acute hospitalization with construction of an urgent unplanned fecal ostomy" comprised 4 constituents: (1) undergoing unexpected bodily changes, (2) partnership with professional caregivers, (3) experience of vulnerability, and (4) a lack of continuity. These constituents can be described as a number of challenges due to both hospitalization and ostomy creation. We found that individuals experience a number of challenges due to acute hospitalization and urgent construction of a fecal ostomy. These challenges are due to the unexpected bodily changes and interpersonal and organizational conditions. Nurses should be aware of not only the physical implications of urgent creation of a fecal ostomy but also the individual and psychological implications of this event.

  5. Psychosocial adjustment among patients with ostomy: a survey in stoma clinics, Nepal

    Directory of Open Access Journals (Sweden)

    Gautam S

    2016-08-01

    Full Text Available Sital Gautam,1 Surya Koirala,2 Anju Poudel,1 Dipak Paudel,3 1Department of Nursing, Nepal Medical College, 2Department of Nursing, Institute of Medicine, Tribhuvan University, Nursing Campus Maharajgunj, 3Department of Medicine, People’s Medical College, Kathmandu, Nepal Background: Ostomy changes the overall lifestyle of a person, and ostomates have been identified as a chronic illness population frequently experiencing adjustment problems. Purpose: The aim of this study was to determine the psychosocial adjustment and its predictors among patients with ostomy in Nepal. Patients and methods: A descriptive cross-sectional study was conducted in two stoma clinics of Nepal. Patients who had a colostomy, ileostomy, or urostomy, visited the selected stoma clinics during the data collection period, and who had ostomy for at least 6 months before data collection were included in the study. A total of 130 patients were included in this study. Data on sociodemographic and clinical variables were collected. Psychosocial adjustment score was measured using Ostomy Adjustment Inventory-23. Results: A total of 130 patients (80 males and 50 females were included in the study. The mean age of the patients was 51 years, ranging from 23 to 78 years. The study findings revealed that mean ±SD adjustment score was 41.49±13.57, indicating moderate impairment in the psychosocial adjustment among ostomates, and the mean ±SD scores of acceptance, anxious preoccupation, social engagement, and anger were 22.01±6.99, 8.75±3.89, 5.38±3.41, 5.35±1.62, respectively. Four variables contributed significantly to the final model, explaining 46.8% of variance in the psychosocial adjustment score (R2 =0.468, F(4, 125 =27.53, P<0.001. Perceived lack of family support (β=−0.367, P<0.001, total dependence on others to care for ostomy (ß=−0.357, P<0.001, and unemployment (ß=−0.144, P=0.032 significantly predicted lower psychosocial adjustment scores. However

  6. Perceived Barriers and Home Care Needs When Adapting to a Fecal Ostomy: A Phenomenological Study.

    Science.gov (United States)

    Cengiz, Burcu; Bahar, Zuhal

    The aim of this study was to determine perceived barriers to adaptation to life with a fecal ostomy based on the Health Belief Model and to reveal home care needs related to these perceptions. Phenomenological study. Twelve participants undergoing ileostomy or colostomy within 3 months of data collection participated in the study. The participants were recruited from Stomatherapy Outpatient Clinic of Dokuz Eylül University Hospital. Their mean age was 54.41 ± 19.14 years (mean ± SD). Eight (67%) underwent ostomy surgery 2 to 3 months prior to study participation; 9 (75%) underwent stoma surgery for the treatment of colorectal cancer, 5 (42%) had a temporary stoma, and 8 also received chemotherapy for the management of an underlying malignancy. A semistructured interview form was used to collect data, and obtained data were analyzed with inductive content analysis. The questions were based on the Health Belief Model and were directed at identifying challenges to adaptation to life at home and home care needs in patients with stoma. Inductive content analysis identified 4 main themes: "restriction of daily life activities"; "factors affecting adaptation to stoma"; "need for health professionals"; and "emotional effects." The theme, need for health professionals, was expressed by the highest number of the participants. The respondents explained that services from ostomy nurse specialists should begin in the hospital and continue into the home. Participants suggested that ostomy nurses are needed to improve self-care skills via telephone contact and home visits. They also expressed the need for nursing interventions for the management of adverse effects associated with chemotherapy. Individuals experience physical, mental, and social barriers when adapting to live with a new stoma and when receiving chemotherapy for underlying cancer. Additional services from ostomy nurses are needed to aid patients when adapting to these challenges.

  7. The socioeconomic impact of a pediatric ostomy in Uganda: a pilot study.

    Science.gov (United States)

    Muzira, Arlene; Kakembo, Nasser; Kisa, Phyllis; Langer, Monica; Sekabira, John; Ozgediz, Doruk; Fitzgerald, Tamara N

    2018-04-01

    Multiple pediatric surgical conditions require ostomies in low-middle-income countries. Delayed presentations increase the numbers of ostomies. Patients may live with an ostomy for a prolonged time due to the high backlog of cases with insufficient surgical capacity. In caring for these patients in Uganda, we frequently witnessed substantial socioeconomic impact of their surgical conditions. The operative log at the only pediatric surgery referral center in Uganda was reviewed to assess the numbers of children receiving ostomies over a 3-year period. Charts for patients with anorectal malformations (ARM) and Hirschsprung's disease (HD) were reviewed to assess delays in accessing care. Focus group discussions (FGD) were held with family members of children with ostomies based on themes from discussions with the surgical and nursing teams. A pilot survey was developed based on these themes and administered to a sample of patients in the outpatient clinic. During the period of January 2012-December 2014, there was one specialty-certified pediatric surgeon in the country. There were 493 ostomies placed for ARM (n = 234), HD (N = 114), gangrenous ileocolic intussusception (n = 95) and typhoid-induced intestinal perforation (n = 50). Primary themes covered in the FGD were: stoma care, impact on caregiver income, community integration of the child, impact on family unit, and resources to assist families. Many patients with HD and ARM did not present for colostomy until after 1 year of life. None had access to formal ostomy bags. 15 caregivers completed the survey. 13 (86%) were mothers and 2 (13%) were fathers. Almost half of the caregivers (n = 7, 47%) stated that their spouse had left the family. 14 (93%) caregivers had to leave jobs to care for the stoma. 14 respondents (93%) reported that receiving advice from other caregivers was beneficial. The burden of pediatric surgical disease in sub-Saharan Africa is substantial with significant disparities

  8. Exploring the Relationship Between Resilience and Ostomy Adjustment in Adults With a Permanent Ostomy.

    Science.gov (United States)

    Scardillo, Jody; Dunn, Karen S; Piscotty, Ronald

    2016-01-01

    The aims of this study were to describe the relationship between resilience and ostomy adjustment in adults with permanent stomas and to determine if participants who report higher levels of resilience also report higher levels of adjustment to a permanent ostomy. Descriptive, correlational research design utilizing the Roy Adaptation Model as the theoretical framework was used. Persons with permanent stomas were recruited from ostomy support groups on the East Coast of the United States. The study sample included 48 respondents. Their mean age was 66 ± 12.7 years (mean ± SD); the majority (60.4%) were women, had an ileostomy (62.5%), and had a history of inflammatory bowel disease (62.5%). Respondents completed a questionnaire that queried demographic and pertinent clinical data, along with 2 previously validated instruments, the Resilience Scale and Ostomy Adjustment Inventory-23. The relationships between levels of resilience, levels of adjustment to an ostomy, and demographic characteristics were examined. Participants with higher levels of ostomy adjustment had higher levels of resilience than respondents who reported lower levels of ostomy adjustment (r = 0.65, P ≤ .01). Findings from this study suggest that higher levels of resilience facilitate adjustment to a permanent ostomy.

  9. 21 CFR 876.5900 - Ostomy pouch and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ostomy pouch and accessories. 876.5900 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5900 Ostomy pouch and accessories. (a) Identification. An ostomy pouch and accessories is a device that consists of a bag that is...

  10. Factors associated with neonatal ostomy complications.

    Science.gov (United States)

    Lockhat, Aliyah; Kernaleguen, Guen; Dicken, Bryan J; van Manen, Michael

    2016-07-01

    Neonatal ostomies, either temporary or permanent, are created for numerous reasons. Limited attention has been given to understanding what factors might place infants at risk for surgical wound complications. The purpose of the study is to identify factors associated with risk of significant abdominal wound complications (wound dehiscence and wound infection) following neonatal ostomy creation. This is a retrospective chart review of infants undergoing ostomy between January 2009 and December 2013 at the University of Alberta Hospital. 66 infants were identified of which 18.2% (12/66) had wound complications. Variables associated with wound dehiscence included: findings of bowel necrosis during laparotomy (7/9 wound dehiscence, 18/57 none, p=0.008), perioperative sepsis (3/9 wound dehiscence, 3/57 none, p=0.006), and perioperative blood transfusion (9/9 wound dehiscence, 30/57 none, p=0.007). Wound infection was not predicted by any variables collected. Neonates undergoing creation of an ostomy appear to be at substantial risk for wound complications. As wound complications are significant issues for infants undergoing surgery, emerging strategies should be explored to either avoid ostomy creation or promote wound healing. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. An electronic approach to minimising moisture-associated skin damage in ostomy patients.

    Science.gov (United States)

    Lowry, Naomi; McLister, Anna; McCreadie, Karl; Davis, James

    2015-08-01

    Marked developments in the design of ostomy appliances in recent years have revolutionised stoma care and management but the prevalence of peristomal skin complications continues to be problematic with incidence rates ranging from 10% to 70%. Despite requisite pre and post-operative education for new patients, complications continue to arise - even under the close supervision of specialist nurses. Prolonged exposure of the skin to high pH stoma effluent is widely accepted as a key contributor to the onset of moisture-associated skin disease and it is our hypothesis that a "smart wafer", employing electrochemical manipulation of local pH, could mitigate some of the issues currently plaguing ostomy management. Current electrochemical research strategies translatable to stoma care are presented and their possible implementations critically appraised. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Sexuality of people with intestinal ostomy

    Directory of Open Access Journals (Sweden)

    Danyelle Braga Rodrigues Cardoso

    2015-09-01

    Full Text Available Objective: to describe the experience of sexuality and other everyday life aspects for people with intestinal ostomy. Methods: qualitative, descriptive study with ten participants of the Specialized Reference Unit who gave interviews with inductive content analysis. Results: the established themes were Physical, emotional and socio-cultural changes, Changes in the exercise of sexuality of people with intestinal ostomy and Importance of the interdisciplinary support of the new sexuality. These changes are linked to body image, the self-esteem and interpersonal relationships with the partner, family and friends, going beyond the visible with the emergence of fear, rejection, difficulty with new relationships, body shame, embarrassment by the collector equipment, fear of the sexual act causes damage to the stoma and difficult to talk about the condition. Conclusion: the ostomy condition requires adaptation process, requiring trained interdisciplinary team in physiological and psychosocial problems resulting from surgical and therapeutic adjuvant treatment, which hinder the sexuality of these individuals.

  13. A mixed-method study on the generic and ostomy-specific quality of life of cancer and non-cancer ostomy patients

    NARCIS (Netherlands)

    Jansen, Femke; van Uden-Kraan, Cornelia F; Braakman, J Annemieke; van Keizerswaard, Paulina M; Witte, Birgit I; Verdonck-de Leeuw, Irma M

    PURPOSE: The aim of this study is to compare the generic and ostomy-specific quality of life (QoL) between cancer and non-cancer ostomy patients using a mixed-method design. METHODS: All patients with an ostomy participating in the Stomapanel of the Dutch Ostomy Association were asked to complete a

  14. A mixed-method study on the generic and ostomy-specific quality of life of cancer and non-cancer ostomy patients.

    NARCIS (Netherlands)

    Jansen, F.; van Uden-Kraan, C.F.; Braakman, J.A.; van Keizerswaard, P.M.; Witte, B.I.; de Leeuw, I.M.

    2015-01-01

    Purpose: The aim of this study is to compare the generic and ostomy-specific quality of life (QoL) between cancer and non-cancer ostomy patients using a mixed-method design. Methods: All patients with an ostomy participating in the Stomapanel of the Dutch Ostomy Association were asked to complete a

  15. Ostomy

    Science.gov (United States)

    ... Library Quality Assessment and Safety Committee Initiatives Healthcare Economics Committee Resources Past Presidents Search form Search Online Learning Center Login Join Now Find a Surgeon You are here Patients / Resources / ...

  16. The effect of ostomy surgery between the ages of 6 and 12 years on psychosocial development during childhood, adolescence, and young adulthood.

    Science.gov (United States)

    Erwin-Toth, P

    1999-03-01

    To investigate the effect of ostomy surgery performed between the ages of 6 and 12 years on psychosocial development during subsequent childhood, adolescence, and young adulthood. Ethnographic. Six women and 4 men (mean age 30.7 years) who responded to a notice in a chapter newsletter of the United Ostomy Association. Spradley's Ethnographic interview format was used for this study. One interview was conducted with each informant over a 4-week period, and a second, more detailed interview was conducted with 2 subjects who were identified as key informants. The interviews were audiotaped and transcribed, and the transcripts were analyzed to detect shared patterns in the informants' language. The Ethnograph computer software program was used as an aid in analyzing the interview transcripts. The informants' subjective experiences during childhood, adolescence, and young adulthood. Nine of the 10 informants adjusted well in the first years after surgery. Key factors in good adjustment were support from family and a perception of "normalcy," including managing one's own ostomy care. All informants reported that their ostomy had a negative impact on their lives during adolescence and that they would have appreciated contact with other teens facing the same dilemma. The age at which an informant underwent ostomy surgery did not influence the difficulties reported during adolescence. Ostomy surgery performed between the ages of 6 and 12 years can have long-term effects on psychosocial development. Nurses should promote normalization, teach self-care of the ostomy as soon as possible after surgery, and refer children and parents to mutual support groups as appropriate.

  17. Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy.

    Science.gov (United States)

    Pittman, Joyce; Rawl, Susan M; Schmidt, C Max; Grant, Marcia; Ko, Clifford Y; Wendel, Christopher; Krouse, Robert S

    2008-01-01

    The purpose of this study is to describe demographic, clinical, and quality-of-life variables related to ostomy complications (skin irritation, leakage, and difficulty adjusting to an ostomy) in a veteran population in the United States. The original study employed a descriptive crosssectional study using a mixed method design. This secondary analysis used the quantitative data collected. Two hundred thirty-nine veterans with intestinal ostomies from 3 Veteran's Administration hospitals participated in the study. Instruments used for this investigation included the City of Hope Quality of Life: Ostomy Instrument. Demographic and medical history data were collected from the survey, the Veteran's Administration health information system, and the Tumor Registry database. A self-administered survey questionnaire (mCOH-QOL-Ostomy) was mailed to each participant. The severity of skin irritation, problems with leakage, and difficulty adjusting were significantly related to demographic, clinical, and quality-of-life domains. Univariate analyses showed that age, income, employment, preoperative care (stoma site marking and education), having a partner, ostomy type, reason for ostomy, time since surgery, total quality-of-life scores and scores on all 4 domains of quality of life were related to the severity of these ostomy complications. Age was inversely related to severity of all 3 ostomy complications (skin irritation, leakage, and difficulty adjusting). Having an ileostomy, rather than a colostomy, was associated with higher severity of skin irritation. Having had the stoma site marked preoperatively was associated with less difficulty adjusting to an ostomy, and having had preoperative ostomy education was associated with less severe problems with skin irritation and leakage. Severity of each ostomy complication predicted total quality-of-life scores. Difficulty adjusting to the ostomy was related to all 4 quality-of-life domains (physical, psychological, social, and

  18. Ostomy patients’ perception of the health care received

    Directory of Open Access Journals (Sweden)

    Candela Bonill-de las Nieves

    2017-12-01

    Full Text Available ABSTRACT Aim: to describe ostomy patient’s perception about health care received, as well as their needs and suggestions for healthcare system improvement. Method: qualitative phenomenological study was conducted, involving individual and semi-structured interviews on the life experiences of 21 adults who had a digestive stoma. Participants were selected following a purposive sampling approach. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stoma therapy nurses. The software Atlas.ti was used. Results: perception of health care received is closely related to the information process, as well as training for caring the stoma from peristomal skin to diet. It is worthy to point out the work performed by stoma care nurses ensuring support during all stages of the process. Conclusion: findings contribute to address the main patients’ needs (better prepared nurses, shorter waiting lists, information about sexual relation, inclusion of family members all along the process and recommendations for improving health care to facilitate their adaptation to a new status of having a digestive stoma.

  19. Quality of Life After Ostomy Surgery in Muslim Patients: A Systematic Review of the Literature and Suggestions for Clinical Practice.

    Science.gov (United States)

    Iqbal, Fareed; Kujan, Omar; Bowley, Douglas M; Keighley, Michael R B; Vaizey, Carolynne J

    2016-01-01

    To determine factors that influence health-related quality of life (HRQOL) after ostomy surgery in Muslim patients. A systematic literature review of published data was carried out using MeSH terms ("Muslim" OR "Islam") AND ("stoma" OR "ostomy" OR "colostomy" OR "ileostomy") AND "quality of life" AND "outcomes." Twelve studies enrolling 913 subjects were deemed suitable for inclusion in the review. HRQOL was found to be particularly impaired in Muslims; this impairment went beyond that experienced by non-Muslim patients. Factors associated with this difference included psychological factors, social isolation, underreporting of complications, and sexual dysfunction leading to breakdown of marital relations as well as diminished religious practices. Muslims requiring ostomies should receive preoperative counseling by surgeons and ostomy nurses. These discussions should also include faith leaders and/or hospital chaplains. Ongoing support after surgery can be extended into the community and encompass family doctors and faith leaders. Additional research exploring HRQOL after surgery in Muslims living in Western societies is indicated.

  20. GENDER DIFFERENCES IN QUALITY OF LIFE AMONG LONG-TERM COLORECTAL CANCER SURVIVORS WITH OSTOMIES

    Science.gov (United States)

    Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Mohler, M. Jane; Hornbrook, Mark C.; Herrinton, Lisa J.; Wendel, Christopher S.; Baldwin, Carol M.; Krouse, Robert S.

    2011-01-01

    Objective To describe how gender shapes the concerns and adaptations of long-term (> 5 years) colorectal cancer (CRC) survivors with ostomies. Design Qualitative study using content analysis of focus group content. Setting Member of Kaiser Permanente, residing in either Oregon, Southwest Washington State, or Northern California. Sample Four female and four male focus groups selected from quantitative survey participants with health-related quality of life (HRQOL) scores in the highest or lowest quartile. Methods Eight focus groups, discussed challenges of living with an ostomy. Content was recorded, transcribed, and analyzed using directive and summative content analysis. Main Research Variables HRQOL domains of physical, psychological, social and spiritual well being. Findings All groups reported avoiding foods that cause gas or rapid transit, and discussed how limiting the amount of food eaten controlled the output. All groups discussed physical activities, getting support from friends and family, and the importance of being resilient. Both genders identified challenges with sexuality/intimacy. Coping and adjustment difficulties were discussed by women with men only discussing these issues to a small extent. Difficulties with sleep were primarily identified by Low HRQOL women. Problems with body image and depression were discussed only by Low HRQOL women. Conclusions Common issues included diet management, physical activity, social support and sexuality. Women with low HRQOL discussed problems with depression, body image, and sleep. Implications for Nursing Application of these gender-based differences can inform educational interventions for CRC survivors with ostomies. PMID:21875846

  1. Culture and psychosocial function in british and Japanese people with an ostomy.

    Science.gov (United States)

    Simmons, Kingsley L; Maekawa, Atsuko; Smith, Jane A

    2011-01-01

    We compared social and psychological adjustment to surgery ending with an ostomy in British and Japanese patients. In response to a postal survey, 948 ostomy patients (464 British and 484 Japanese), selected at random from respective national databases, provided assessable data on the Ostomy Adjustment Inventory-23 (OAI-23), a validated scale for measurement of psychosocial adjustment to an ostomy. Analysis of variance revealed that country of residence (F1,876 = 50.9, P ostomy. British persons with an ostomy experienced higher psychosocial adjustment to an ostomy than did Japanese respondents. Multivariate analysis based on acceptance, social engagement, anxious-preoccupation, and anger also found that country of residence and time since surgery influenced psychosocial adjustment (Pillai's Trace: V = 0.22, F = 67.15, P ostomy, suggesting that culture influences psychosocial adjustment to life with an ostomy. These findings support the need for culturally informed ostomy care.

  2. The adjustments experienced by persons with an ostomy: an integrative review of the literature.

    Science.gov (United States)

    Torquato Lopes, Ana Patrícia Araujo; Decesaro, Maria das Neves

    2014-10-01

    The person with an ostomy may focus on the negative aspects of the stoma rather than its function to the detriment of self-image, acceptance of a new lifestyle, and ability to self-care. The purpose of this integrative literature review was to explore factors involved in the adaption process of persons with a gastrointestinal stoma with a focus on the role of nonspecialist professional nurses in the process. The authors searched the databases of the Virtual Health Library, the Latin American and Caribbean of Health Sciences Information System, the Scientific Electronic Library Online, the Spanish Bibliographic Index of Health Sciences, International Literature on Health Sciences (MEDLINE), and the Cochrane Library using the keywords ostomy, adaption, and nursing for full text articles in all languages published between 2008 and 2013. Of the 612 articles identified, 21 were not duplicates and met the inclusion criteria of availability of full text, published in the past 5 years, indexed, and covering the topic of stoma adaption; this literature was analyzed using Bardin's thematic analysis. Three categories emerged: experiences and adaption strategies employed by the person with a stoma, the role of the care provider, and education as a tool in healthcare. Persons with a stoma need time and support from caregivers, family, and friends to adjust to the changes and adapt to having a stoma. This includes the ability to overcome the stigma of appearance and activities involving social interaction. Caregivers and health professionals need to serve as information resources while encouraging care autonomy. The more informed the patient, the smoother the adaption process. The literature also suggests nursing education may affect caregiving. Further research to elucidate the adaption experienced by each person with an ostomy is needed to help the multidisciplinary team plan care appropriately.

  3. The effect of an interactive follow-up program on ostomy adjustment of inpatients after their discharge from surgical wards of the hospitals affiliated to Isfahan University of Medical Sciences.

    Science.gov (United States)

    Hamidi, Yaser; Moeini, Mahin; Yousefi, Hojatollah

    2018-04-07

    Ostomy patients suffer from many physical and mental problems, which can be solved to a large extent with the help of education and follow-up programs. These follow-ups can be done in person or on the telephone by the nurses, or even, by sending a text message that is an easier way for the patients to adapt to their condition. This study aimed to investigate the effect of an interactive follow-up program on the adjustment of ostomy inpatients after being discharged. This study is a clinical trial, conducted on 64 ostomy patients who were discharged from the surgical wards of the hospital affiliated to Isfahan University of Medical Sciences. Subjects in the experimental group participated in a 6-week follow-up program via text message. The information about the patients were collected by Olbrisch Ostomy Adjustment Scale. The obtained results have suggested that 34.4% of the patients in the experimental group and 28.1% of the patients in the control group were female. Before the intervention, comparing the mean score of ostomy adjustment and its dimensions in the two groups showed no significant difference (P > 0.05). However, a significant difference was observed between the two groups immediately after the intervention (P  0.05). The findings of this study suggested that using SMS can be considered as a proper tool or method for following up the ostomy patients.

  4. Penetrating Disease, Narcotic Use, and Loop Ostomy Are Associated with Ostomy and IBD-related Complications After Ostomy Surgery in Crohn's Disease Patients.

    Science.gov (United States)

    Hirsch, Ayal; Yarur, Andres J; Dezheng, Hou; Rodriquez, Dylan; Krugliak Cleveland, Noa; Ali, Tauseef; Hurst, Roger D; Umanskiy, Konstantin; Hyman, Neil; Colwell, Janice; Rubin, David T

    2015-10-01

    For medically refractory or obstructive Crohn's disease (CD), ostomy surgery remains an important therapeutic option. Outcomes and complications of this approach have not been well described in the era of biological therapies. Our study aims to characterize CD patients undergoing ostomy creation and assess outcome predictors. We performed a retrospective chart review of CD patients who underwent ostomy creation in our center from 2011 to 2014. Data collected include patient demographics, detailed disease- and surgery-related variables, and clinical outcomes after 26 weeks of follow-up. Of the 112 patients, 54 % were female, the median age was 39 years (range 19-78), the median disease duration was 13 years (range 0-50), 54 % had ileo-colonic disease, 55 % had stricturing phenotype, and 59 % had perianal disease. Sixty-two percent received end ostomies, and 38 % received loop ostomies. The leading indications for surgery were stricturing, fistulizing, and perianal disease (35 %). Forty-three (38 %) patients had 76 major complications, including dehydration (22 cases), intra-abdominal infection (16), and obstruction (14). Increased major postoperative complications correlated with penetrating disease (p = 0.02, odds ratio [OR] = 5.52, 95 % confidence interval [CI] = 1.25-24.42), the use of narcotics before surgery (p = 0.04, OR = 2.54, 95 % CI = 1.02-6.34), and loop ostomies (p = 0.004, OR = 4.2, 95 % CI = 1.57-11.23). Penetrating phenotype, the use of narcotics before surgery, and loop ostomies are associated with major complications in CD patients undergoing ostomy creation. These findings may influence risk management of CD patients needing ostomies.

  5. Learning to Live With a Permanent Intestinal Ostomy

    DEFF Research Database (Denmark)

    Danielsen, Anne Kjaergaard; Sørensen, Erik Elgaard; Burcharth, Kirsten

    2013-01-01

    The aim of the study was to explore the impact of a permanent stoma on patients' everyday lives and to gain further insight into their need for ostomy-related education.......The aim of the study was to explore the impact of a permanent stoma on patients' everyday lives and to gain further insight into their need for ostomy-related education....

  6. Use of Convexity in Ostomy Care

    Science.gov (United States)

    Salvadalena, Ginger; Pridham, Sue; Droste, Werner; McNichol, Laurie; Gray, Mikel

    2017-01-01

    Ostomy skin barriers that incorporate a convexity feature have been available in the marketplace for decades, but limited resources are available to guide clinicians in selection and use of convex products. Given the widespread use of convexity, and the need to provide practical guidelines for appropriate use of pouching systems with convex features, an international consensus panel was convened to provide consensus-based guidance for this aspect of ostomy practice. Panelists were provided with a summary of relevant literature in advance of the meeting; these articles were used to generate and reach consensus on 26 statements during a 1-day meeting. Consensus was achieved when 80% of panelists agreed on a statement using an anonymous electronic response system. The 26 statements provide guidance for convex product characteristics, patient assessment, convexity use, and outcomes. PMID:28002174

  7. Perioperative Clinical Nurse Specialist Role Delineation: A Systematic Review

    Science.gov (United States)

    2006-06-01

    care plans for psychosocial nursing diagnoses. Ostomy Wound Manage, 40(3), 18-22, 24-16. Heath, J., Andrews, J., & Balkstra, C. R. Potential reduction...the clinical nurse specialist. Clin Nurse Spec, 17(2), 83-85. O’Malley, P. (2004). New hope for patients with pulmonary hypertension: endothelin

  8. A Descriptive Study to Explore the Effect of Peristomal Skin Complications on Quality of Life of Adults With a Permanent Ostomy.

    Science.gov (United States)

    Maydick-Youngberg, Diane

    2017-05-01

    L score was 7.56 (SD 1.59). The mean number of complications was 0.83 (SD 1.03); approximately one third of participants experienced allergic contact dermatitis (43, 32.3%), and persons with irritant contact dermatitis reported significantly lower QoL total scores (mean 6.64 [SD 1.64], P = .02) than those without this complication (mean 7.77 [1.56]). Of those with complications, most saw an ostomy nurse (33, 47.8%), but many did not see anyone for help with their complications (24, 16.3%). Persons who sought help were generally satisfied with the help received (mean satisfaction score 77.94 ± 24.71). In this study, allergic contact dermatitis was the most common peristomal complication reported. Irritant contact dermatitis negatively affected QoL, and almost half of the participants sought the help of an ostomy care nurse. The results of this study suggest patients may benefit from more education about peristomal complications and the reporting of appliance-related contact dermatitis. Studies examining the presence of peristomal skin complications and their influence on QoL, as well as availability of and access to follow-up care with qualified ostomy nurses, are needed.

  9. Assessing peristomal skin changes in ostomy patients : validation of the Ostomy Skin Tool

    NARCIS (Netherlands)

    Jemec, G. B.; Martins, L.; Claessens, I.; Ayello, E. A.; Hansen, A. S.; Poulsen, L. H.; Sibbald, R. G.

    P>Background Peristomal skin problems are common and are treated by a variety of health professionals. Clear and consistent communication among these professionals is therefore particularly important. The Ostomy Skin Tool (OST) is a new assessment instrument for the extent and severity of peristomal

  10. Profile of ostomy patients residing in Pouso Alegre city

    Directory of Open Access Journals (Sweden)

    Geraldo Magela Salomé

    2015-04-01

    Full Text Available The objective was to characterize the clientele of ostomy patients living in Pouso Alegre, Minas Gerais, Brazil. Among the causes that led patients to acquire an ostomy, the most prevalent was neoplasia; the type of ostomy was a permanent colostomy. Most people were not told that they would be submitted to the stoma. In addition, individuals were not subject to stoma demarcation, and irrigation was not performed. Regarding the type of complication, 34 (48.60% had dermatitis; 14 (20%, retraction; and 13 (18.60%, prolapse. With respect to stoma diameter, 34 (48.60% had 20–40 mm and 23 (32.90%, 40–60 mm. With this study, we became aware of the profile of ostomized patients treated at the municipality of Pouso Alegre/MG; it is expected that, with these data, the improvement of care to this population can be subsidized. We suggest that nursing professionals think of health action strategies with respect to guidance on stoma manufacture and to measures aiming for the prevention of possible complications, promoting ways to help these patients to make decisions and to verbalize feelings, so that they feel supported in coping with changes in their body image, for the sake of survival. Resumo: O objetivo foi caracterizar a clientela de estomizados residentes em Pouso Alegre, Minas Gerais. maioria das causas que levaram os pacientes a adquirir ostomia foi neoplasia; o tipo de ostomia era colostomia em definitivo. A maioria dos indivíduos não foram comunicados de que seriam submetidos ao estoma. Além disso, os indivíduos não foram submetidos à demarcação do estoma e não foi realizada irrigação. Com relação ao tipo de complicação, 34(48,60% apresentaram dermatite; 14 (20%, retração e 13 (18,60%, prolapso. Com relação ao diâmetro do estoma, 34 (48,60% mensuravam 20 a 40 mm e 23 (32,90%, 40 a 60 mm. Este estudo possibilitou conhecer o perfil dos pacientes ostomizados atendidos do município de Pouso Alegre/MG e espera-se que, com

  11. The effects of involving a nurse practitioner in primary care for adult patients with urinary incontinence: The PromoCon study (Promoting Continence

    Directory of Open Access Journals (Sweden)

    Severens Johan

    2008-04-01

    Full Text Available Abstract Background Urinary incontinence affects approximately 5% (800.000 of the Dutch population. Guidelines recommend pelvic floor muscle/bladder training for most patients. Unfortunately, general practitioners use this training only incidentally, but prescribe incontinence pads. Over 50% of patients get such pads, costing €160 million each year. Due to ageing of the population a further increase of expenses is expected. Several national reports recommend to involve nurse specialists to support general practitioners and improve patient care. The main objective of our study is to investigate the effectiveness and cost-effectiveness of involving nurse specialists in primary care for urinary incontinence. This paper describes the study protocol. Methods/Design In a pragmatic prospective multi centre two-armed randomized controlled trial in the Netherlands the availability and involvement for the general practitioners of a nurse specialist will be compared with usual care. All consecutive patients consulting their general practitioner within 1 year for urinary incontinence and patients already diagnosed with urinary incontinence are eligible. Included patients will be followed for 12 months. Primary outcome is severity of urinary incontinence (measured with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF. Based on ICIQ-UI SF outcome data the number of patients needed to include is 350. For the economic evaluation quality of life and costs will be measured alongside the clinical trial. For the longer term extrapolation of the economic evaluation a Markov modelling approach will be used. Discussion/Conclusion This is, to our knowledge, the first trial on care for patients with urinary incontinence in primary care that includes a full economic evaluation and cost-effectiveness modelling exercise from the societal perspective. If this intervention proves to be effective and cost-effective, implementation of this

  12. Adjustable continence balloons

    DEFF Research Database (Denmark)

    Kjær, Line; Fode, Mikkel; Nørgaard, Nis

    2012-01-01

    Abstract Objective. This study aimed to evaluate the results of the Danish experience with the ProACT urinary continence device inserted in men with stress urinary incontinence. Material and methods. The ProACT was inserted in 114 patients. Data were registered prospectively. The main endpoints...... in urinary leakage > 50% was seen in 72 patients (80%). Complications were seen in 23 patients. All of these were treated successfully by removal of the device in the outpatient setting followed by replacement of the device. Another eight patients had a third balloon inserted to improve continence further....... Fourteen patients (12%) ended up with an artificial sphincter or a urethral sling. Sixty patients (63%) experienced no discomfort and 58 (61%) reported being dry or markedly improved. Overall, 50 patients (53%) reported being very or predominantly satisfied. Conclusions. Adjustable continence balloons seem...

  13. Ostomy: Adapting to Life After Colostomy, Ileostomy or Urostomy

    Science.gov (United States)

    ... your stoma. Be open to experimenting with different styles of clothes. But don't let your ostomy ... Accessed May 23, 2014. Doughty DB, et al. Management of patients with a colostomy or ileostomy. http:// ...

  14. Self-disclosing my ostomy to the dominant culture: an autoethnography.

    Science.gov (United States)

    Frohlich, Dennis Owen

    2012-01-01

    Living with an ostomy is a major change to a person's body and poses difficult questions about how to disclose personal medical information to others. This autoethnography examines my time with an ostomy through the lens of co-cultural theory and sheds light on how people with ostomies communicate with the dominant culture, in this case people without ostomies. I discuss how my communication goals and approaches evolved over time.

  15. Adolescent Perspectives Following Ostomy Surgery: A Grounded Theory Study.

    Science.gov (United States)

    Mohr, Lynn D; Hamilton, Rebekah J

    2016-01-01

    This purpose of this study was to provide a theoretical account of how adolescents aged 13 to 18 years process the experience of having an ostomy. Qualitative study using grounded theory design. The sample comprised of 12 English-speaking adolescents aged 13-18 years: 10 with an ostomy and 2 with medical management of their disease. Respondents completed audio-recorded interviews that were transcribed verbatim. Data were analyzed using the constant comparative method until data saturation occurred. Dedoose, a Web-based qualitative methods management tool, was used to capture major themes arising from the data. Study results indicate that for adolescents between 13 and 18 years of age, processing the experience of having an ostomy includes concepts of the "physical self" and "social self" with the goal of "normalizing." Subcategories of physical self include (a) changing reality, (b) learning, and (c) adapting. Subcategories of social self include (a) reentering and (b) disclosing. This study sheds light on how adolescents process the experience of having an ostomy and how health care providers can assist adolescents to move through the process to get back to their desired "normal" state. Health care providers can facilitate the adolescent through the ostomy experience by being proactive in conversations not only about care issues but also about school and family concerns and spirituality. Further research is needed in understanding how parents process their adolescents' ostomy surgery experience and how spirituality assists adolescents in coping and adjustment with body-altering events.

  16. Relative Tranquility in Ostomy Patients' Social Life: A Qualitative Content Analysis.

    Science.gov (United States)

    Sarabi, Nasrin; Navipour, Hassan; Mohammadi, Eesa

    2017-08-01

    Ostomy significantly alters one's elimination pattern and can affect the individual in physiological, psychosocial and spiritual aspects. Over time, the ostomy patient's experience changes and they develop coping strategies to handle the new reality. The aims of this study sought Iranian ostomy patients' main problem, how they deal and the outcome of their efforts to manage that problem in their daily lives. A qualitative content analysis was conducted involving twenty-seven ostomy patients that were chosen by purposeful sampling and referred to the Iranian Ostomy Association from October 2015 to June 2016. The mean age of the participants was 55 years, 15 were males, the major cause of ostomy was colorectal cancer and the colostomy was the most common type of ostomy, and nineteen of them between one and twenty years lived with an ostomy. Most of them were married, had bachelor degree and received adjuvant therapy, and few were employed. Guarantee indecisive to maintain a stable life with an ostomy and the possibility of ostomy disclosure unpredictability show relative tranquility in patients' social life. Because of the ostomy nature, there is not the possibility of full control over life with an ostomy and this issue is causing concerns in their family and social life.

  17. The timing of ostomy closure in infants with necrotizing enterocolitis: A systematic review

    NARCIS (Netherlands)

    A.E.C.J.M. Struijs (Marie-Chantal); C.E.J. Sloots (Pim); W.C.J. Hop (Wim); D. Tibboel (Dick); R.M.H. Wijnen (René)

    2012-01-01

    textabstractPurpose The optimal timing of ostomy closure is a matter of debate. We performed a systematic review of outcomes of early ostomy closure (EC, within 8 weeks) and late ostomy closure (LC, after 8 weeks) in infants with necro-tizing enterocolitis. Methods PubMed, EMbase, Web-of-Science,

  18. The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review

    NARCIS (Netherlands)

    Struijs, M.C.; Sloots, C.E.J.; Hop, W.C.J.; Tibboel, D.; Wijnen, R.M.H.

    2012-01-01

    PURPOSE: The optimal timing of ostomy closure is a matter of debate. We performed a systematic review of outcomes of early ostomy closure (EC, within 8 weeks) and late ostomy closure (LC, after 8 weeks) in infants with necrotizing enterocolitis. METHODS: PubMed, EMbase, Web-of-Science, and Cinahl

  19. A mixed-method study on the generic and ostomy-specific quality of life of cancer and non-cancer ostomy patients.

    Science.gov (United States)

    Jansen, Femke; van Uden-Kraan, Cornelia F; Braakman, J Annemieke; van Keizerswaard, Paulina M; Witte, Birgit I; Verdonck-de Leeuw, Irma M

    2015-06-01

    The aim of this study is to compare the generic and ostomy-specific quality of life (QoL) between cancer and non-cancer ostomy patients using a mixed-method design. All patients with an ostomy participating in the Stomapanel of the Dutch Ostomy Association were asked to complete a generic (RAND-36) and ostomy-specific (Stoma-QoL) QoL questionnaire. In addition, open-ended questions on symptoms, restrictions or adaptations influencing daily life were included. The generic and ostomy-specific QoL between cancer and non-cancer ostomy patients were compared using linear regression analyses. Qualitative responses were analysed using content analysis. In total, 668 patients were included: 379 cancer patients (80 % colorectal, 17 % bladder and 3 % other) and 289 non-cancer patients (38 % colitis ulcerosa, 22 % Crohn's disease and 40 % other) with a colostomy (55 %), ileostomy (31 %) and/or urostomy (16 %). Adjusted for gender, age, type of ostomy and time elapsed since ostomy surgery, cancer ostomy patients scored higher (better) on Stoma-QoL (β = 2.1) and all RAND-36 domains (9.1 ostomy patients. Of the 33 themes coded for in the content analysis, fatigue or sleeplessness, leakages, pain, bladder or bowel complaints, physical functioning or activity, travelling or being away from home, other daily activities (including work), clothing and diet were among the 10 most frequently reported themes, although ranking differed between both patient groups. Besides, cancer ostomy patients frequently reported on the impact on (engaging in a) relationship or sexual intimacy and non-cancer ostomy patients frequently reported to be relieved of symptoms and restrictions in daily life. Cancer patients reported better generic and ostomy-specific QoL than non-cancer ostomy patients. In both cancer and non-cancer ostomy patients, fatigue or sleeplessness, leakages, pain, bladder or bowel complaints, physical functioning or activity, travelling or being away from home, other daily

  20. The Ostomy-Q: Development and Psychometric Validation of an Instrument to Evaluate Outcomes Associated with Ostomy Appliances.

    Science.gov (United States)

    Nafees, Beenish; Rasmussen, Mikkel; LLoyd, Andrew

    2017-01-01

    Using an ostomy appliance can affect many aspects of a person's health-related quality of life (HRQL). A 2-part, descrip- tive study was designed to develop and validate an instrument to assess quality-of-life outcomes related to ostomy ap- pliance use. Study inclusion/exclusion criteria stipulated participants should be 18 to 85 years of age, have an ileostomy or colostomy, used an appliance for a minimum of 3 months without assistance, and able to complete an online survey. All participants provided sociodemographic and clinical information. In phase 1, a literature search was conducted and existing instruments used to measure HRQL in persons with an ostomy were assessed. Subsequently, the Ostomy-Q, a 23-item, Likert-response type questionnaire, divided into 4 domains (Discreetness, Comfort, Confidence, and Social Life), was developed based on published evidence and existing ostomy-related HRQL tools. Seven (7) participants re- cruited from a manufacturer user panel took part in exploratory/cognitive qualitative interviews to refine the new quality- of-life questionnaire. In phase 2, the instrument was tested to assess item variability and conceptual structure, item-total correlation, internal consistency, test-retest reliability, sensitivity, and minimal important difference (MID) in an online validation study among 200 participants from the manufacturer's user panel (equally divided by gender, 125 [62.5%] >50 years old, 128 [64%] with an ileostomy). This exercise also included completion of the Stoma Quality of Life Question- naire and 2 domains from the Ostomy Adjustment Inventory-23 to assess convergent validity. Eighty-two (82) participants recompleted these study instruments 2 weeks later to assess test-retest reliability. Sociodemographic and clinical data were assessed using descriptive statistics; Cronbach's alpha was used for internal consistency (minimum 0.70), principle component analysis for item variability/conceptual structure, and item

  1. Ostomy metastasis after pull endoscopic gastrostomy: a unique favorable outcome.

    Science.gov (United States)

    Fonseca, Jorge; Adriana, Carla; Fróis-Borges, Miguel; Meira, Tânia; Oliveira, Gabriel; Santos, José Carlos

    2015-04-01

    Head and neck cancer (HNC) patients tend to develop dysphagia. In order to preserve the nutritional support, many undergo endoscopic gastrostomy (PEG). In HNC patients, ostomy metastasis is considered a rare complication of PEG, but there are no reports of successful treatment of these metastatic cancers. We report the case of a 65 years old pharyngeal/laryngeal cancer patient who underwent a PEG before the neck surgery. He was considered to be cured, resumed oral intake and the PEG tube was removed. Ten months after, he returned with a metastasis at the ostomy site. A block resection of the stomach and abdominal wall was performed. Two years after the abdominal surgery, he is free of disease. Although usually considered a rare complication of the endoscopic gastrostomy, ostomy metastasis may be more frequent than usually considered and the present case report demonstrates that these patients may have a favourable outcome. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  2. Elicitation of preferences for improvements in ostomy pouches

    DEFF Research Database (Denmark)

    Bonnichsen, Ole

    This paper attempts to examine and measure ostomates’ preferences for improvements in ostomy pouches. Described are the study design, elicitation procedure and resulting preference structure of the Swedish ostomate sample. The method used to elicit the preferences is a Discrete Choice Experiment...... (DCE), where respondents are asked to choose between alternatives in choice sets. Each alternative is comprised of a number of attributes relating to the adhesive, filter and flexibility of ostomy pouches. The choice between alternatives made by the respondent implies an implicit trade-off between...... the attributes and allows for the estimation of individuals’ Willingness to Pay (WTP) for the attributes of ostomy pouches when cost is included as an attribute. The data consists of 254 ostomates responding to the survey. The respondents have positive WTP for all improvement attributes presented to them...

  3. Evaluation of Web-Based Ostomy Patient Support Resources.

    Science.gov (United States)

    Pittman, Joyce; Nichols, Thom; Rawl, Susan M

    To evaluate currently available, no-cost, Web-based patient support resources designed for those who have recently undergone ostomy surgery. Descriptive, correlational study using telephone survey. The sample comprised 202 adults who had ostomy surgery within the previous 24 months in 1 of 5 hospitals within a large healthcare organization in the Midwestern United States. Two of the hospitals were academic teaching hospitals, and 3 were community hospitals. The study was divided into 2 phases: (1) gap analysis of 4 Web sites (labeled A-D) based on specific criteria; and (2) telephone survey of individuals with an ostomy. In phase 1, a comprehensive checklist based on best practice standards was developed to conduct the gap analysis. In phase 2, data were collected from 202 participants by trained interviewers via 1-time structured telephone interviews that required approximately 30 minutes to complete. Descriptive analyses were performed, along with correlational analysis of relationships among Web site usage, acceptability and satisfaction, demographic characteristics, and medical history. Gap analysis revealed that Web site D, managed by a patient advocacy group, received the highest total content score of 155/176 (88%) and the highest usability score of 31.7/35 (91%). Two hundred two participants completed the telephone interview, with 96 (48%) reporting that they used the Internet as a source of information. Sixty participants (30%) reported that friends or family member had searched the Internet for ostomy information on their behalf, and 148 (75%) indicated they were confident they could get information about ostomies on the Internet. Of the 90 participants (45%) who reported using the Internet to locate ostomy information, 73 (82%) found the information on the Web easy to understand, 28 (31%) reported being frustrated during their search for information, 24 (27%) indicated it took a lot of effort to get the information they needed, and 39 (43%) were

  4. The VA Ostomy Health-Related Quality of Life Study: objectives, methods, and patient sample.

    Science.gov (United States)

    Krouse, Robert S; Mohler, M Jane; Wendel, Christopher S; Grant, Marcia; Baldwin, Carol M; Rawl, Susan M; McCorkle, Ruth; Rosenfeld, Kenneth E; Ko, Clifford Y; Schmidt, C Max; Coons, Stephen Joel

    2006-04-01

    To present the design and methods of a multisite study of health-related quality of life (HR-QOL) in veterans living with ostomies. Veterans from Tucson, Indianapolis, and Los Angeles VA Medical Centers were surveyed using the validated City of Hope ostomy-specific tool (mCOH-QOL-Ostomy) and the SF-36V. Cases (ostomates) had a major gastrointestinal procedure that required an intestinal stoma, while controls had similar procedures for which an ostomy was not required. Ostomy subjects were recruited for four focus groups in each of two sites divided by ostomy type (colostomy versus ileostomy) and overall mCOH-QOL-Ostomy HR-QOL score (highest versus lowest quartile). The focus groups further evaluated barriers, concerns, and adaptation methods and skills. This report presents recruitment results, reliability of survey instruments, and demographic characteristics of the sample. The overall response (i.e., recruitment) rate across all sites was 48% and by site was 53%, 57%, and 37%, respectively (p ostomies had significantly longer time since surgery than controls (p ostomies is an illustration of a successful mixed methods approach to HR-QOL research. We collected meaningful quantitative and qualitative data that will be used in the development of new approaches to care that will lead to improved functioning and well-being in persons living with ostomies. Subsequent reports will provide the results of this research project.

  5. Bonanza from the frozen continent

    Digital Repository Service at National Institute of Oceanography (India)

    Setty, M.G.A.P.

    Antarctica is a circumpolar continent surrounded by the Southern Ocean which is about 36 million sq kms and about 10% of the worlds oceans. Ice covers 98% of the continent and the rest is a non glacial terrain. Temperatures on Antarctica...

  6. Paleomagnetism continents and oceans

    CERN Document Server

    McElhinny, Michael W; Dmowska, Renata; Holton, James R; Rossby, H Thomas

    1999-01-01

    Paleomagnetism is the study of the fossil magnetism in rocks. It has been paramount in determining that the continents have drifted over the surface of the Earth throughout geological time. The fossil magnetism preserved in the ocean floor has demonstrated how continental drift takes place through the process of sea-floor spreading. The methods and techniques used in paleomagnetic studies of continental rocks and of the ocean floor are described and then applied to determining horizontal movements of the Earth''s crust over geological time. An up-to-date review of global paleomagnetic data enables 1000 millionyears of Earth history to be summarized in terms of the drift of the major crustal blocks over the surface of the Earth. The first edition of McElhinny''s book was heralded as a "classic and definitive text." It thoroughly discussed the theory of geomagnetism, the geologicreversals of the Earth''s magnetic field, and the shifting of magnetic poles. In the 25 years since the highly successful first editio...

  7. Overcoming challenges: life with an ostomy.

    Science.gov (United States)

    Popek, Sarah; Grant, Marcia; Gemmill, Robin; Wendel, Christopher S; Mohler, M Jane; Rawl, Susan M; Baldwin, Carol M; Ko, Clifford Y; Schmidt, C Max; Krouse, Robert S

    2010-11-01

    Studies have demonstrated decreased health-related quality of life in patients with stomas. Using US Department of Veterans Affairs electronic medical records, veterans with stomas were surveyed using the City of Hope Quality of Life-Ostomy questionnaire. Focus groups were conducted segregated by type of stoma (ileostomy vs colostomy) and quality-of-life score (high vs low). Qualitative analysis was performed on the basis of the City of Hope Quality of Life for Ostomates format of health-related quality of life (physical, psychological, social, and spiritual). The findings of the colostomy focus groups are reported. Two new domains emerged: colostomy specific and health care specific. The most common domains discussed were colostomy specific, psychological, and social. The most frequently discussed colostomy-specific theme was effective and ineffective solutions to colostomy care. Family and spousal relationships were the main theme from the psychological category. The predominant social issue was sexual relationships. Awareness of patients' social, psychological, and medical status allows surgeons to identify those likely to have problems and devote resources to those veterans. Published by Elsevier Inc.

  8. Quality of life in ostomy patients: a qualitative study.

    Science.gov (United States)

    Dabirian, Aazam; Yaghmaei, Farideh; Rassouli, Maryam; Tafreshi, Mansoureh Zagheri

    2010-12-21

    Therapeutic procedures may not only treat disease but also affect patient quality of life. Therefore, quality of life should be measured in order to assess the impact of disease and therapeutic procedures. To identify clients' problems, it is necessary to assess several dimensions of quality of life, including physical, spiritual, economic, and social aspects. In this regard, we conducted a qualitative study to explore quality of life and its dimensions in ostomy patients referred to the Iranian Ostomy Association. Fourteen patients were interviewed about their quality of life dimensions by purposeful sampling. Data were gathered by semistructured interviews and analyzed using the content analysis method. Nine main themes emerged using this approach, including physical problems related to colostomy, impact of colostomy on psychological functioning, social and family relationships, travel, nutrition, physical activity, and sexual function, as well as religious and economic issues. The findings of the study identified a number of challenges in quality of life for patients with ostomy. The results can be used by health care providers to create a supportive environment that promotes better quality of life for their ostomy patients.

  9. [The Kock continent urinary diversion].

    Science.gov (United States)

    Boyd, S D; Skinner, D G; Lieskovsky, G

    1989-07-01

    The continent ileal reservoir as conceived by Kock produces a low-pressure, high-capacity reservoir with continent and nonrefluxing valves constructed from ileum. From August 1982 through March 1988, 531 patients underwent continent urinary diversion via a Kock reservoir at our institution. Of these, 39 males had a Kock bladder substitution, while the rest underwent cutaneous Kock diversion. Early complications occurred in 16% of all patients, and there was an operative mortality rate of 1.9%. Surgical modifications of nipple fixation, which are discussed in detail in this paper, help to reduce late complications to less than 10%. Patient satisfaction with both procedures remains excellent.

  10. The City of Hope-Quality of Life-Ostomy Questionnaire: Persian Translation and Validation

    OpenAIRE

    Anaraki, F; Vafaie, M; Behboo, R; Esmaeilpour, S; Maghsoodi, N; Safaee, A; Grant, M

    2014-01-01

    Background: Since there is no disease-specific instrument for measuring quality-of-life (QOL) in Ostomy patients in Persian language. Aim: This study was designed to translate and evaluate the validity and reliability of City of Hope-quality of life-Ostomy questionnaire (COH-QOL-Ostomy questionnaire). Subjects and Methods: This study was designed as cross-sectional study. Reliability of the subscales and the summary scores were demonstrated by intra-class correlation coefficients. Pearson's c...

  11. Diode laser hair removal around ileo-colo ostomys is safe, effective and beneficial: a pilot study

    NARCIS (Netherlands)

    van der Ploeg-Westerveld, Jos; Wagter, Jacqueline; van Gemert, Martin J. C.; Neumann, H. A. M.; Bour, H.; Zwart, A.

    2007-01-01

    BACKGROUND AND OBJECTIVE: Hair removal around an ileo-colo ostomy can cause a number of problems. We compared laser hair removal with mechanical shaving around the ostomy. METHOD: Eleven patients were selected with hairy skin around the ostomy for therapy with an AlGaAs diode laser at 800 nm. Three

  12. Smart wireless continence management system for persons with dementia.

    Science.gov (United States)

    Wai, Aung Aung Phyo; Fook, Victor Foo Siang; Jayachandran, Maniyeri; Biswas, Jit; Nugent, Chris; Mulvenna, Maurice; Lee, Jer-En; Kiat, Philp Yap Lian

    2008-10-01

    Incontinence is highly prevalent in the elderly population, especially in nursing home residents with dementia. It is a distressing and costly health problem that affects not only the patients but also the caregivers. Effective continence management is required to provide quality care, and to eliminate high labor costs and annoyances to the caregivers resulting from episodes of incontinence. This paper presents the design, development, and preliminary deployment of a smart wireless continence management system for dementia-impaired elderly or patients in institutional care settings such as nursing homes and hospitals. Specifically, the mote wireless platform was used to support the deployment of potentially large quantities of wetness sensors with wider coverage and with dramatically less complexity and cost. It consists of an intelligent signal relay mechanism so that the residents are free to move about in the nursing home or hospital and allows personalized continence management service. Preliminary results from a trial in a local nursing home are promising and can significantly improve the quality of care for patients.

  13. Quality of Life in Chinese Persons Living With an Ostomy: A Multisite Cross-sectional Study.

    Science.gov (United States)

    Geng, Zhaohui; Howell, Doris; Xu, Honglian; Yuan, Changrong

    The aim of the study was to describe health-related quality of life (HRQOL) in persons with ostomies and to explore influencing factors. Secondary analysis of data from a cross-sectional survey. Eight hundred twenty-seven persons living with an ostomy were enrolled from 5 provinces and cities in China from October 2010 to November 2012; the final sample comprises 729 individuals who completed data collection. Their mean ± SD age was 62.59 ± 12.40 years (range 26-93 years). Health-related quality of life was assessed using the Chinese language version of the City of Hope-Quality of Life-Ostomy Questionnaire-Chinese Version. Sociodemographic data, clinical characteristics, self-efficacy, adjustment to an ostomy, social support, and psychological state of patients were measured by a general information questionnaire. We also administered the Stoma Self-Efficacy Scale, Ostomy Adjustment Inventory-Chinese Version, the Social Support Revalued Scale, and Hospital Anxiety Depression Scale. Of the 729 ostomy patients, the overall HRQOL in ostomy patients was in the moderate range (mean score 5.19 ± 1.29); scores of physical domain, psychological domain, social domain, and spiritual domains also in the moderate range (5.00 ± 1.73, 5.97 ± 1.59, 4.86 ± 2.31, and 4.93 ± 2.08 respectively). Multivariate analysis found that multiple factors influenced HRQOL in persons with an ostomy; they were gender, religious belief, and marital status, psychological factors depression and anxiety, and specific components related to social support, self-efficacy in ostomy care, and adjustment to an ostomy. Health-related quality of life among Chinese patients with fecal ostomies was less than optimal and influenced by multiple demographic and psychosocial factors. Additional research is needed to design strategies to improve HRQOL in this population.

  14. Ostomy creation in neonates with acute abdominal disease: friend or foe?

    Science.gov (United States)

    van Zoonen, Anne G J F; Schurink, Maarten; Bos, Arend F; Heineman, Erik; Hulscher, Jan B F

    2012-08-01

    An ostomy seems a safe alternative in neonates with an acute abdomen when immediate restoration of bowel continuity is deemed undesirable. Faced with several complications in our center, and the feeling we are not the only center with these complications, we decided to assess the rate and type of complications after both ostomy creation and closure. All data regarding neonates (ostomy take down, and complications and mortality directly related to both creation and closure of the ostomy. A total of 155 patients who underwent a laparotomy for suspect acute abdomen were identified. Median gestational age was 33 weeks (range 25 to 40) and median birth weight was 1926 g (range 560 to 4380). Median age at laparotomy was 8 days (range 0 to 30). Indications for surgery were necrotizing enterocolitis (n = 38), spontaneous intestinal perforation (n = 11), intestinal atresia (n = 9) or obstruction (n = 5), and volvulus (n = 4). An ostomy was created in 67 patients (67/155: 43%): 38 boys and 29 girls. There were 8 jejuno-, 49 ileo-, and 10 colostomies created. In almost all cases (94%), a mucous fistula was also constructed.In 23 patients (23/67: 34%) ostomy-related complications occurred. Most frequent were high output ostomy (n = 10) and necrosis of the enterostomy (n = 7). Due to either one of the complications, nine patients (9/67: 13%) needed a reoperation.In this study, 11 patients died before ostomy closure could occur. In 53 patients, the ostomy was closed after a median of 107 days (range 4 to 299).After ostomy closure, complications occurred in 13 cases (13/53: 25%). Seven patients (7/53: 13%) needed another reoperation because of anastomotic leakage (n = 4), adhesions (n = 2), or incisional hernia (n = 1). There was no closure-related mortality. Although creating a temporary ostomy in newborns is preferable in certain situations, there is a considerable occurrence of complications and reoperations. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001

  15. The Impact of Ostomy on Quality of Life and Functional Status of Crohn's Disease Patients.

    Science.gov (United States)

    Abdalla, Maisa I; Sandler, Robert S; Kappelman, Michael D; Martin, Christopher F; Chen, Wenli; Anton, Kristen; Long, Millie D

    2016-11-01

    The potential need for an ostomy is a main concern for patients with inflammatory bowel disease. We performed this study to evaluate the impact of a long-term ostomy (≥6 mo duration) on the functional status and specific patient-reported outcomes in a population of patients with Crohn's disease (CD). We performed a cross-sectional analysis within the Crohn's and Colitis Foundation of America Partners cohort. Bivariate analyses and logistic regression models were used to investigate associations between ostomy and various demographic, disease factors, and patient-reported outcomes for health-related quality of life. A total of 402 CD patients with ostomy for a minimum duration of 6 months were compared with 4331 CD patients with no ostomy. Patients with ostomy were more likely to be in clinical remission compared with those without ostomy, 48.5% versus 31.3%, respectively. Having an ostomy did not impact the overall health-related quality of life and was not associated with anxiety, depression, sleep disturbances, or reduced sexual interest and satisfaction. However, the presence of ostomy was associated with reduced social role satisfaction in both patients with controlled and active disease. Additionally, in the subset of patients who did not achieve clinical remission, those with ostomy experienced greater pain interference (odds ratio, 1.63; 95% confidence interval, 1.12-2.35) and fatigue (odds ratio, 1.66; 95% confidence interval, 1.15-2.39). Ostomy is well tolerated in CD patients, particularly when clinical remission is achieved.

  16. Surviving colorectal cancer: long-term, persistent ostomy-specific concerns and adaptations.

    Science.gov (United States)

    Sun, Virginia; Grant, Marcia; McMullen, Carmit K; Altschuler, Andrea; Mohler, M Jane; Hornbrook, Mark C; Herrinton, Lisa J; Baldwin, Carol M; Krouse, Robert S

    2013-01-01

    The purpose of this article was to describe persistent ostomy-specific concerns and adaptations in long-term (>5 years) colorectal cancer survivors with ostomies. Thirty-three colorectal cancer survivors who participated in 8 gender- and health-related quality of life stratified focus groups and 130 colorectal cancer survivors who provided written comments to 2 open-ended questions on ostomy location and pouch problems participated in the study. Data were collected on health maintenance organization members in Oregon, southwestern Washington, and northern California. Qualitative data were analyzed for the 8 focus groups and written comments from 2 open-ended survey questions. Discussions from the focu s groups were recorded, transcribed, and analyzed using content analysis. Written content from the open-ended questions was derived from a mailed questionnaire on health-related quality of life in survivors with ostomies and analyzed using content analysis. Discussions related to persistent ostomy-related issues more than 5 years after formation were common. Persistent ostomy-related issues were focused on clothing restrictions and adaptations, dietary concerns, issues related to ostomy equipment and self-care, and the constant need to find solutions to adjust and readjust to living with an ostomy. Ostomy-specific concerns persist 5 years and more for long-term colorectal cancer survivors after initial ostomy formation. Adaptations tend to be individualized and based on trial and error. Findings underscore the need to develop long-term support mechanisms that survivors can access to promote better coping and adjustment to living with an ostomy.

  17. Las personas portadoras de estomas: La narrativa y los cuidados humanizados People ostomy take: The narrative and the humanized cares

    Directory of Open Access Journals (Sweden)

    Mª del Carmen Carrasco-Acosta

    2009-12-01

    Full Text Available En este artículo se presenta una experiencia docente realizada en los Talleres Teóricos-Prácticos de la Asignatura de Enfermería Médico Quirúrgica, impartidos en la Escuela de Enfermería de la Universidad de Huelva. El cuerpo enfermo es un extraño para sí mismo, la imagen que se refleja en el espejo de la persona portadora de estoma, es una imagen fragmentada que origina una ruptura en la identidad y genera nuevas significaciones a las que podemos aproximarnos a través de sus narrativas. Entre las reflexiones, mencionar que las narrativas de las personas afectadas son una herramienta eficaz para educar al alumnado de Enfermería desde un enfoque de Cuidados Humanistas. El alumnado experimenta un cambio en las percepciones de las personas portadoras de estomas de eliminación, obtenidas en su mayoría, en las prácticas clínicas.In this article an educational experience is presented that is carried out in the theoretical-practical workshops of the subject of Medical-Surgical Nursing, imparted in the School of Nursing of the University of Huelva. The sick body is a stranger for itself, the image that is reflected in mirror people ostomy take, is a broken into fragments image that it originates a rupture in the identity and it generates new significances to those that we can approach through its narratives. Among the reflections, to mention that the narratives of affected people are an effective tool to educate to the student Nursing from a focus of Humanist Cares. The student experiences a change in the perceptions of people take of elimination ostomy, obtained in its majority, in the clinical practices.

  18. Îles et continents

    OpenAIRE

    Resztak, Karolina; Sanson, Hervé

    2017-01-01

    Ce numéro huit de la revue Continents manuscrits, à l’enseigne des « Iles et continents », se veut un numéro de varias, une fois n’est pas coutume. Iles et continents car : du Congo aux Antilles, en passant par l’Amérique du Nord, le numéro assume sa géographie plurielle, polycentrée. Le panorama d’auteurs représentés dans la revue est riche et varié : de Joseph Zobel à Sony Labou Tansi, d’Aimé Césaire à Nathanaël, ou René Maran, c’est bien des cartographies mises en relation que ce numéro té...

  19. A study of long-term complications associated with enteral ostomy and their contributory factors.

    Science.gov (United States)

    Jayarajah, Umesh; Samarasekara, Asuramuni M P; Samarasekera, Dharmabandhu N

    2016-12-05

    Complications of ostomy significantly affect the quality of life of ostomates. There is little evidence on the rate of long-term complications in ostomates, especially from the developing countries which include Sri Lanka. This study was aimed to describe the long-term complications of enteral ostomies and their contributory factors. A retrospective analysis was carried out on 192 patients who underwent ostomy creation over a period of 5 years. Data on type of complications, age, sex, type of ostomy, type of surgery and perioperative care by enteric stoma therapist were gathered. Associations were established using Chi square test and multiple logistic regression. Out of 192 patients, only 146 patients presented regularly for follow up. The mean follow up duration was 28 months (range: 3-183). Around 34.2% developed surgical long-term complications related to the ostomy. Common complications were prolapse (n = 24, 16.4%), skin excoriation (n = 22, 15.1%) and parastomal hernia (n = 14, 9.6%). Overall complication rate was significantly less in loop ostomies (p ostomies (p ostomies (p < 0.05). Perioperative care by enteric stoma therapist reduced the overall and specific complications (p < 0.001). The overall complication rate in our cohort of patients was 34.2%. The perioperative care of a stoma therapist may be very effective in preventing complications particularly in a setting with limited resources.

  20. Early and late complications among long-term colorectal cancer survivors with ostomy or anastomosis.

    Science.gov (United States)

    Liu, Liyan; Herrinton, Lisa J; Hornbrook, Mark C; Wendel, Christopher S; Grant, Marcia; Krouse, Robert S

    2010-02-01

    Among long-term (>or=5 y) colorectal cancer survivors with permanent ostomy or anastomosis, we compared the incidence of medical and surgical complications and examined the relationship of complications with health-related quality of life. The incidence and effects of complications on long-term health-related quality of life among colorectal cancer survivors are not adequately understood. Participants (284 survivors with ostomies and 395 survivors with anastomoses) were long-term colorectal cancer survivors enrolled in an integrated health plan. Health-related quality of life was assessed via mailed survey questionnaires from 2002 to 2005. Information on colorectal cancer, surgery, comorbidities, and complications was obtained from computerized data and analyzed by use of survival analysis and logistic regression. Ostomy and anastomosis survivors were followed up for an average of 12.1 and 11.2 years, respectively. Within 30 days of surgery, 19% of ostomy survivors and 10% of anastomosis survivors experienced complications (P Ostomy was associated with long-term fistula (odds ratio, 5.4; 95% CI 1.4-21.2), and among ostomy survivors, fistula was associated with reduced health-related quality of life (P ostomy have more complications early in their survivorship period, but complications among anastomosis survivors catch up after 20 years, when the 2 groups have convergent complication rates. Among colorectal cancer survivors with ostomy, fistula has especially important implications for health-related quality of life.

  1. The impact of an ostomy on older colorectal cancer patients: a cross-sectional survey.

    Science.gov (United States)

    Verweij, N M; Hamaker, M E; Zimmerman, D D E; van Loon, Y T; van den Bos, F; Pronk, A; Borel Rinkes, I H M; Schiphorst, A H W

    2017-01-01

    Ostomies are being placed in 35 % of patients after colorectal cancer surgery. As decision-making regarding colorectal surgery is challenging in the older patients, it is important to have insight in the potential impact due to ostomies. An internet-based survey was sent to all members with registered email addresses of the Dutch Ostomy Patient Association. The response rate was 49 %; 932 cases were included of whom 526 were aged Ostomy-related limitations were similar in the different age groups, just as uncertainty (8-10 %) and dependency (18-22 %) due to the ostomy. A reduced quality of life was experienced least in the oldest old group (24 % vs 37 % of the elderly and 46 % of the younger respondents, p ostomy was observed. Older ostomates do not experience more limitations or psychosocial impact due to the ostomy compared to their younger counterparts. Over the years, impact becomes less distinct. Treatment decision-making is challenging in the older colorectal cancer patients but ostomy placement should not be withheld based on age alone.

  2. Effects of enterostomal nurse telephone follow-up on postoperative adjustment of discharged colostomy patients.

    Science.gov (United States)

    Zhang, Jun-e; Wong, Frances Kam Yuet; You, Li-ming; Zheng, Mei-chun; Li, Qiong; Zhang, Bing-yan; Huang, Man-rong; Ye, Xin-Mei; Liang, Ming-juan; Liu, Jin-ling

    2013-01-01

    People with a new colostomy encounter many difficulties as they struggle to adjust to their ostomies. Nurse telephone follow-up is a convenient way to ensure continuity of care. There is a paucity of studies testing if nurse telephone follow-up can enhance adjustment of postdischarged colostomy patients. The purpose of this study was to evaluate the effect of enterostomal nurse telephone follow-up on the adjustment levels of discharged colostomy patients. This was a randomized controlled trial. Participants (n = 103) who had undergone colostomy operations in China were recruited and randomly assigned to the study or control group. Both the study and control groups received routine discharge care, whereas the study group received 2-3 nurse telephone calls in the follow-up period. The outcome measures included Ostomy Adjustment Scale, Stoma Self-efficacy Scale, satisfaction with care, and stoma complications. Results of this study indicated that participants in the study group had significantly better ostomy adjustment, higher stoma self-efficacy, higher satisfaction with care, and less stoma complications compared with those in the control group. This study provided evidence to support that enterostomal nurse telephone follow-up can improve patient ostomy adjustment level and other related outcomes. Nurse telephone follow-up is an effective intervention to support the adjustment of stoma patients after hospital discharge.

  3. Skin problems in ostomy patients: a case-control study of risk factors

    DEFF Research Database (Denmark)

    Nybaek, Hanne; Bang Knudsen, Dorte; Nørgaard Laursen, Troels

    2009-01-01

    Skin complications are frequent in ostomy patients and a number of risk factors have been suggested. The data on risk factors have, however, been documented mainly in single-centre studies and the actual importance of the suggested risk factors should therefore be verified in a group of ostomy...... patients broadly selected from the gene-ral population. All patients with permanent ostomies living in Roskilde County, Denmark, were invited to participate in the study. A total of 338 responded and 199 agreed to participate. Forty-five percent of all patients presented a skin problem. Less than half (43......%) of patients with a skin problem were aware of the skin problems, and less than 1 in 5 (16%) had sought treatment for their skin problem. Ileostomies, ostomies with leakage and ostomies in patients with body mass index >30 were associated with skin problems. In conclusion, ileostomy, leakage and obesity...

  4. The Impact of Ostomy on Quality of Life and Functional Status of Crohn’s Disease Patients within CCFA Partners

    Science.gov (United States)

    Abdalla, Maisa I.; Sandler, Robert S.; Kappelman, Michael D.; Martin, Christopher F.; Chen, Wenli; Anton, Kristen; Long, Millie D.

    2016-01-01

    Background The potential need for an ostomy is a main concern for patients with inflammatory bowel disease. We performed this study to evaluate the impact of a long term ostomy (≥ 6 months duration) on the functional status and specific patient-reported outcomes (PRO) in a population of patients with Crohn’s disease (CD). Methods We performed a cross-sectional analysis within the CCFA Partners cohort Study. Bivariate analyses and logistic regression models were used to investigate associations between ostomy and various demographic, disease factors, and PROs for health related quality of life (HRQOL). Results A total of 402 CD patients with ostomy for a minimum duration of 6 months were compared to 4331 CD patients with no ostomy. Patients with ostomy were more likely to be in clinical remission compared to those without ostomy, 48.5% vs. 31.3%, respectively. Having an ostomy did not impact overall HRQOL and was not associated with anxiety, depression, sleep disturbances, or reduced sexual interest and satisfaction. However, the presence of ostomy was associated with reduced social role satisfaction in patients both with controlled and active disease. Additionally, in the subset of patients who did not achieve clinical remission, those with ostomy experienced greater pain interference (OR 1.63, 95% CI 1.12–2.35) and fatigue (OR 1.66 95% CI 1.15–2.39). Conclusion Ostomy is well-tolerated in CD patients, particularly when clinical remission is achieved. PMID:27661669

  5. Conditional cooperation on three continents

    NARCIS (Netherlands)

    Kocher, M.G.; Cherry, T.; Kroll, S.; Netzer, R.; Sutter, M.

    2007-01-01

    We show in a public goods experiment on three continents that conditional cooperation is a universal behavioral regularity. Yet, the number of conditional cooperators and the extent of conditional cooperation are much higher in the U.S.A. than anywhere else.

  6. Factors related to ostomy leakage in the community setting.

    Science.gov (United States)

    Ratliff, Catherine R

    2014-01-01

    The purpose of this study was to describe demographic and clinical variables related to ostomy pouch leakage from those discharged from a major medical center during a 2-year period. A convenience sample of 198 persons with an ostomy was obtained using the ICD-9 (International Classification of Diseases, Ninth Revision) codes for colostomy, ileostomy, and ileal conduit for patients who were discharged from the medical center within the time frame of July 2009 to July 2011. One hundred seven participants (55%) returned a completed survey. Respondents included 57 men (53%) and 50 women (47%). The mean age was 60 years with age range from 23 to 91 years. Fecal ostomies made up the majority of the stomas representing 71 patients (66%). A descriptive, cross-sectional research design was used to describe clinical variables related to ostomy pouch leakage for those discharged from a major academic medical center over a 2-year period of time. Participants were mailed an introductory letter from the principal investigator, a self-administered questionnaire, and a prepaid return envelope. Ninety-three patients (87%) reported leakage; however, 48 patients (45%) stated that they did not leak often. A logistic regression was estimated to determine which variables were significant predictors of the dependent variable of leaking status (no/seldom leaking vs more frequent leaking). Two variables were individually significant predictors, sex (P = .021) and 2-piece pouch (P = .015). Women were 4 times more likely to be in the more frequent leaking group than were men. Those who were wearing 2-piece pouches were 78% less likely to be in the more frequent leaking group. Participants with ileostomies or urostomies were more likely to be in the more frequent leaking group and those with peristomal skin irritation were more likely to be in the more frequent leaking group. Findings from this study reveal that women were more likely to experience leakage than men and that wearing a 2-piece

  7. The Ostomy: Part One of Two Parts.

    Science.gov (United States)

    Watt, Rosemary C.; And Others

    1985-01-01

    Teaches nurses to identify four common indications for fecal diversion surgery: list three types of colostomies; distinguish a colostomy from an ileostomy; describe the two basic methods of colostomy management; and identify factors that influence the choice of method of colostomy care. (CT)

  8. Ostomy creation with fewer sutures using tissue adhesives (cyanoacrylates) in inflammatory bowel disease: a pilot study.

    Science.gov (United States)

    Uchino, M; Ikeuchi, H; Bando, T; Sasaki, H; Chohno, T; Horio, Y; Takesue, Y

    2018-03-01

    Introduction Fistula formation around the ostomy site is a stoma-related complication often requiring surgical intervention. This complication may be caused by sutures or may develop as a complication of inflammatory bowel disease. Before conducting a clinical trial, we set out to investigate the safety of ostomy creation with fewer sutures using tissue adhesives in this pilot study. Methods Patients with inflammatory bowel disease who required surgery with ostomy creation at the Hyogo College of Medicine between January 2014 and December 2015 were enrolled. Safety was assessed by evaluating the incidence of stoma-related complications. Ostomy was restricted to loop ileostomy and was created with two sutures and tissue adhesives. Results A total of 14 patients were enrolled. Mean body mass index was 18.9 ± 2.0 kg/m 2 . There were no cases of ostomy retraction and no severe adverse events were observed. Conclusions This pilot study demonstrates that ostomy creation using tissue adhesives is safe. Although retraction and adverse events were not observed, even in patients with inflammatory bowel disease who generally exhibit delayed wound healing, the body mass index was extremely low in this series. This study does not strongly recommend ostomy creation with tissue adhesives; further studies are needed to clarify the efficacy and safety of the procedure.

  9. The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review.

    Science.gov (United States)

    Struijs, Marie-Chantal; Sloots, Cornelius E J; Hop, Wim C J; Tibboel, Dick; Wijnen, Rene M H

    2012-07-01

    The optimal timing of ostomy closure is a matter of debate. We performed a systematic review of outcomes of early ostomy closure (EC, within 8 weeks) and late ostomy closure (LC, after 8 weeks) in infants with necrotizing enterocolitis. PubMed, EMbase, Web-of-Science, and Cinahl were searched for studies that detailed time to ostomy closure, and time to full enteral nutrition (FEN) or complications after ostomy closure. Patients with Hirschsprung's disease or anorectal malformations were excluded. Analysis was performed using SPSS 17 and RevMan 5. Of 778 retrieved articles, 5 met the inclusion criteria. The median score for study quality was 9 [range 8-14 on a scale of 0 to 32 points (Downs and Black, J Epidemiol Community Health 52:377-384, 1998)]. One study described mean time to FEN: 19.1 days after EC (n = 13) versus 7.2 days after LC (n = 24; P = 0.027). Four studies reported complication rates after ostomy closure, complications occurred in 27% of the EC group versus 23% of the LC group. The combined odds ratio (LC vs. EC) was 1.1 [95% CI 0.5, 2.5]. Evidence that supports early or late closure is scarce and the published articles are of poor quality. There is no significant difference between EC versus LC in the complication rate. This systematic review supports neither early nor late ostomy closure.

  10. EARLY AND LATE COMPLICATIONS AMONG LONG-TERM COLORECTAL CANCER SURVIVORS WITH OSTOMY OR ANASTOMOSIS

    Science.gov (United States)

    Liu, Liyan; Herrinton, Lisa J.; Hornbrook, Mark C.; Wendel, Christopher S.; Grant, Marcia; Krouse, Robert S.

    2012-01-01

    Purpose Among long-term (≥5 years) colorectal cancer survivors with permanent ostomy or anastomosis, we compared the incidence of medical and surgical complications and examined the relationship of complications with health-related quality of life. Background The incidence and effects of complications on long-term health-related quality of life among colorectal cancer survivors are not adequately understood. Methods Participants (284 ostomy/395 anastomosis) were long-term colorectal cancer survivors enrolled in an integrated health plan. Health-related quality of life was assessed via mailed survey questionnaire in 2002–2005. Information on colorectal cancer, surgery, co-morbidities, and complications was obtained from computerized data and analyzed using survival analysis and logistic regression. Results Ostomy and anastomosis survivors were followed an average 12.1 and 11.2 years, respectively. Within 30 days of surgery, 19% of ostomy and 10% of anastomosis survivors experienced complications (pOstomy was associated with long-term fistula (odds ratio 5.4; 95% CI 1.4–21.2), and among ostomy survivors, fistula was associated with reduced health-related quality of life (postomy have more complications early in their survivorship period, but complications among anastomosis survivors catch up after 20 years, when the two groups have convergent complication rates. Among colorectal cancer survivors with ostomy, fistula has especially important implications for health-related quality of life. PMID:20087096

  11. The importance of continent tectonic study

    International Nuclear Information System (INIS)

    Carneiro, C.D.R.

    1992-01-01

    Some aspects of tectonic study in the continents are presented, including the use of methods that measure the isotope radioactive disintegration of some elements presents in rocks and the mineral distribution in African and South American continents. (author)

  12. Gender differences in sleep disruption and fatigue on quality of life among persons with ostomies.

    Science.gov (United States)

    Baldwin, Carol M; Grant, Marcia; Wendel, Christopher; Hornbrook, Mark C; Herrinton, Lisa J; McMullen, Carmit; Krouse, Robert S

    2009-08-15

    The aim of this study is to examine differences in sleep disruption and fatigue of men and women colorectal cancer (CRC) survivors with intestinal ostomies and associated health-related quality of life (HR-QOL). Participants in this cross-sectional study of long-term (> 5 years) CRC survivors received care at Kaiser Permanente. Measures included the City of Hope QOL Ostomy questionnaire with narrative comments for ostomy-related "greatest challenges." The Short Form-36 Version 2 (SF-36v2) health survey provided physical (PCS) and mental composite scale (MCS) scores to examine generic HR-QOL. The "sleep disruption" and "fatigue" items from the ostomy questionnaire (scale from 0 to 10 with higher scores indicating better HR-QOL) were dependent variables, while independent variables included age, ethnicity, education, partnered status, body mass index, and time since surgery. Data were analyzed using chi-square for nominal variables, Student t-tests for continuous variables, and logistic regression with significance set at p ostomy-specific measure, women (n = 118) compared to men (n = 168) reported more sleep disruption (p ostomy-associated fear of or actual leakage during sleep. Although women CRC survivors with ostomies report more sleep disruption and fatigue, which is reflected in their reduced physical and mental health scores on the SF-36v2 compared to men with ostomies, their stated reasons for disrupted sleep are similar to their male counterparts. These findings can provide a foundation for gender-relevant ostomy interventions to improve sleep and HR-QOL in this patient population.

  13. Multiple sclerosis and continence issues: an exploratory study.

    Science.gov (United States)

    Wollin, Judy; Bennie, Mary; Leech, Christine; Windsor, Carol; Spencer, Nancy

    The study described in this article aimed to identify issues relating to incontinence and assess the impact of referral to a continence adviser on the lives of people with multiple sclerosis (MS). The study design used an in-depth, two-phase anonymous mail survey within a general community as nominated by the participants. Fifty-six people participated in phase 1 and eleven people completed phase 2. The results indicated that incontinence is a problem for the vast majority of participants--people with MS. One-third of the eligible participants took up the option of a consultation, assessment and treatment from a continence nurse. Reasons for not taking up the visit from the continence nurse included 'managing OK', 'didn't think it would help', 'embarrassed' and 'too busy'. Increasing awareness of urinary incontinence in the community is important and education needs to focus on at-risk groups in presenting the range of options available to assist people experiencing incontinence.

  14. PHYSICAL DIMENSION OF QUALITY OF LIFE IN OSTOMY PATIENTS

    Directory of Open Access Journals (Sweden)

    Gordana Repić

    2014-09-01

    Full Text Available Colorectal cancer is the most common cancer of abdominal visceral organs. The basic principle of management is radical surgery treatment, with creation of stoma. Quality of life is of great importance for ostomy patients. Considering the fact that colostomy is mutilizing intervention wich results in irreversible body changes, in most cases as a result of underlying colorectal cancer, patients have to cope with two major issues - life threatening disease and extensive surgical procedure which leads to irreversible changes in all aspects of life. The aim of this study was to assess physical well-beig in patients with ostomy regarding their gender, education level and time after surgery. There were 67 patients of both genders who were followed up at the Specialist Polyclinic after colostomy surgery at the Clinical Center of Vojvodina. The quality of life for patients with colostomy questionnaire by M. Grant was used. Average age of respondents was 65.87 years. Majority of them had colostomy, mainly permanent, mostly due to malignancy. The most dominant physical issues were skin irritation, diarrhea, leakage of feces from pouch and obstipation. There were no statistically significant differences in self-assessment of physical well-being among sexes; gas and diarrhea were more commonly reported in higher education level groups, while patients who had stoma longer than 12 months better perceived their physical strength. The average score of self-assessment of physical well-being was 3.91 (0 was the best, 10 was the worst, better perceived by men and patients who had stoma longer than 12 months. Although self-assessment of physical well-being in ostomy patients was at a satisfactory level, it is necessary to provide continuous patient support in order to overcome physical problems that alter their quality of life.

  15. El proceso de afrontamiento en personas recientemente ostomizadas The coping process in people who have a recently ostomy surgery

    Directory of Open Access Journals (Sweden)

    Begoña Martín Muñoz

    2010-09-01

    Full Text Available Objetivo: Explorar el proceso de afrontamiento de las personas recientemente ostomizadas. Metodología: Estudio cualitativo fenomenológico. La selección de los participantes fue intencional. La información se obtuvo mediante entrevistas semiestructuradas y observación participante durante el postoperatorio de 21 personas ostomizadas. El análisis se realizó según el método de Taylor-Bogdan. Resultados: Se descubre una respuesta muy variada con estrategias dirigidas a paliar las emociones negativas y estrategias dirigidas a la solución de problemas. Estas últimas se reconocen como esenciales para lograr la autonomía del paciente y un adecuado ajuste socio-familiar. Se identifican además factores moduladores del afrontamiento como conocer otras personas ostomizadas, las experiencias durante la hospitalización, la información prequirúrgica o la relación enfermera-paciente. Conclusiones: Los resultados permiten individualizar y reorientar el cuidado. Las intervenciones deben dirigirse hacia los aspectos valorados como más conflictivos a la vez que se aumenta el afrontamiento potenciando las actitudes adaptativas y actuando sobre los factores moduladores.Aim: To explore the coping process in people who have a recently ostomy surgery. Methodology: A qualitative- phenomenological design was used. Participants were selected in an intentional way. The collection data was gathered through semi-structured interviews and participant observation during postoperative period of 21 persons with an ostomy. The analysis was performed using the method of Taylor-Bogdan. Results: A varied response was found with strategies aimed at mitigate negative emotions and solve problems. These strategies are recognized as essential to achieving patient autonomy and an adequate social and familiar adjusment. It were also identified factors which modulate coping as knowing ostomy patients, the experiences during the hospitalization, the preoperative information

  16. [Elderly human being with ostomy and environments of care: reflection on the perspective of complexity].

    Science.gov (United States)

    Barros, Edaiane Joana Lima; Santos, Silvana Sidney Costa; Lunardi, Valéria Lerch; Lunardi Filho, Wilson Danilo

    2012-01-01

    This is discussion about the relationship between elderly human beings with ostomy and their environments care, under the perspective of Complexity Edgar Morin. An axis holds the reflection: environments of care for elderly humans with ostomy. In this sense, we present three types of environment that surround the context of elderly humans with ostomy: home environment, group environment and hospital environment. This brings, as a social contribution, a new look about resizing caring of elderly humans with ostomy in their environment. It is considered that the environment hosting this human being contains a diversity of feelings, emotions, experiences; it binds multiple meanings, from the Complexity perspective, about the relationship between the environment and the caring process.

  17. Self-efficacy and Associated Factors in Patients With Temporary Ostomies: A Cross-sectional Survey.

    Science.gov (United States)

    Su, Xi; Qin, Fang; Zhen, Li; Ye, Xinmei; Kuang, Yinyi; Zhu, Mulan; Yin, Xuexia; Wang, Huizhen

    To examine stoma self-efficacy (SE) and its association with health-related quality of life (HRQOL) and social support in patients with temporary ostomies. Convenience sampling was used to recruit 150 patients from 5 hospitals in Guangdong province, China, who had been living with a temporary ostomy for at least 1 month. Cross-sectional survey. Respondents completed a questionnaire that included ostomy-related sociodemographic and clinical data, and Chinese language versions of several validated instruments, the Stoma Self-efficacy Scale (C-SSES), City of Hope-Quality of Life-Ostomy Questionnaire (C-COH-QOL-OQ), and Perceived Social Support Scale (C-PSSS). Of the 150 questionnaires distributed, 122 (81.3%) were returned, and 111 (74%) had sufficiently complete responses to be included in the final analysis. The average score from the C-SSES was 78.55 ± 14.72 (mean ± standard deviation) for total stoma SE; 85.6% of respondents showed low or moderate self-efficacy related to ostomy care. The scores from the C-SSES were 39.36 ± 7.72 for stoma care SE and 23.33 ± 6.69 for social SE. Stoma care SE was significantly associated with HRQOL domains, psychological well-being (B = 2.09, P ostomies reported low or moderate levels of SE, suggesting the need to focus on HRQOL aspects of psychological and social well-being, as well as social support. We hypothesize that interaction with other ostomy patients, especially those with long-term enterostomy experience or those trained through ostomy organizations, may improve stoma SE.

  18. A comparative study of two-piece ostomy appliances.

    Science.gov (United States)

    Welser, Marion; Riedlinger, Inge; Prause, Ulla

    The quality of life of people with a stoma may be affected by peristomal skin disorders and by frequent unplanned changes of ostomy appliances due to problems with those appliances. The aim of this study was to evaluate two new, two-piece ostomy appliances with mechanical couplings (both from the SenSura range by Coloplast) and their ability to address areas that may be important to the quality of life of people with stomas, including appliance changes, stool seepage and overfilling. The study design featured two comparative, crossover, randomized multi-centre studies that were conducted in Germany. The SenSura appliances were evaluated against established reference appliances. Seventy-three individuals with a colostomy (closed-end appliances) and 75 individuals with an ileostomy (drainable appliances) participated in the studies. The participants tested 4-6 flanges of each type within a maximum period of two weeks. The results demonstrated that there was less seepage of stool observed under the SenSura flange when it was removed (pappliances. The SenSura flanges had better adhesion and flexibility and were easier to remove than the references (pappliances on quality of life indicators - there were fewer unplanned changes and less seepage of stool was observed in patients using the SenSura products.

  19. Revision and psychometric testing of the City of Hope Quality of Life-Ostomy Questionnaire.

    Science.gov (United States)

    Grant, Marcia; Ferrell, Betty; Dean, Grace; Uman, Gwen; Chu, David; Krouse, Robert

    2004-10-01

    Ostomies may be performed for bowel or urinary diversion, and occur in both cancer and non-cancer patients. Impact on physical, psychological, social and spiritual well-being is not unexpected, but has been minimally described in the literature. The City of Hope Quality of Life (COH-QOL)-Ostomy Questionnaire is an adult patient self-report instrument designed to assess quality of life. This report focuses on the revision and psychometric testing of this questionnaire. The revised COH-QOL-Ostomy Questionnaire involved in-depth patient interviews and expert panel review. The format consisted of a 13-item disease and demographic section, a 34-item forced-choice section, and a 41-item linear analogue scaled section. A mailed survey to California members of the United Ostomy Association resulted in a 62% response rate (n = 1513). Factor analysis was conducted to refine the instrument. Construct validity involved testing a number of hypotheses identifying contrasting groups. Factor analysis confirmed the conceptual framework. Reliability of subscales ranged from 0.77 to 0.90. The questionnaire discriminated between subpopulations with specific concerns. Overall, the analyses provide evidence for the validity and reliability of the COH-QOL-Ostomy Questionnaire as a comprehensive, multidimensional self-report questionnaire for measuring quality of life in patients with intestinal ostomies.

  20. Nursing care to an ostomy patient: application of the Orem´s theory Asistencia de enfermería a paciente colostomizada: aplicación de la teoría de Orem Assistência de enfermagem a paciente com colostomia: aplicação da teoria de Orem

    Directory of Open Access Journals (Sweden)

    Francisca Aline Arrais Sampaio

    2008-03-01

    Full Text Available OBJECTIVE: To apply the "Orem's Self-care Theory" in ostomy patient care. METHODS: This is a clinical study with an intestinal ostomy patient, whose illness is a consequence of the "Chagas disease". Data collection was performed during the home visits, using a form with questions referred to the Orem's presuppositions. The data were analyzed and presented according to the determining factors in self-care development. RESULTS: Some self-care requirements were modified, such as: "Balance between loneliness and social interaction" and "Self-care in health disorders". The home care delivered based on the supporteducation system allowed for the promotion of health and the patient's perception regarding the importance of self-care. CONCLUSION: The self-care theory allowed for appropriate care and therapeutic communication adjusted to the patient's situation.OBJETIVO: Aplicar la teoría del autocuidado de Orem en la asistencia a paciente portadora de ostomía. MÉTODOS: Se trata de un estudio clínico realizado con una paciente portadora de ostomía intestinal, secundaria a la enfermedad de Chagas. Los datos fueron recolectados a través del cuidado domiciliario y del uso de un formulario con preguntas referentes a las premisas de Orem. El análisis del discurso fue presentado de acuerdo con los factores determinantes en el desarrollo del autocuidado. RESULTADOS: algunos requisitos del autocuidado estaban alterados tales como: "Equilibrio entre la soledad y la interacción social" y "Autocuidado en el desvío de la salud". El cuidado domiciliario basado en el sistema del apoyo-educación permitió la promoción de la salud y la percepción de la importancia de la paciente en el cuidado. CONCLUSIÓN: La teoría del Autocuidado posibilitó el cuidado y la comunicación terapéutica adecuándose a la situación de la paciente.OBJETIVO: Aplicar a Teoria do Autocuidado de Orem na assistência a paciente portadora de estomia. MÉTODOS: Estudo cl

  1. [Continent colostomy and colon irrigation].

    Science.gov (United States)

    Kostov, D; Temelkov, T; Kiriazov, E; Ivanov, K; Ignatov, V; Kobakov, G

    2000-01-01

    The authors have studied a functional activity of a continent colostomy at 20 patients, undergone an abdomeno-perineal extirpation of rectum and carried out periodic colonirrigations, during a period of 6 months. A conus type, closed irrigating system has been used. The degree of an incontinency at patients has been compared before and after the beginning of the colonirrigations. The irrigating procedures have reduced spontaneous defications at patients during a week 28 times and have improved the quality of life significantly. The application of colostomy bags has been restricted in 8 (40%) patients. An intraluminal ultrasonographic investigation has been done at 12 (60%) patients at the end of 6 month irrigating period. No changes of the ultrasonographic image of the precolostomic segment of colon has been observed.

  2. Overall quality of life and difficulty paying for ostomy supplies in the Veterans Affairs ostomy health-related quality of life study: an exploratory analysis.

    Science.gov (United States)

    Coons, Stephen Joel; Chongpison, Yuda; Wendel, Christopher S; Grant, Marcia; Krouse, Robert S

    2007-09-01

    To explore whether there was a significant relationship between difficulty paying for ostomy supplies and overall quality of life among a sample of ostomates receiving care from the Veterans Health Administration (VHA). The data were collected as part of the Veterans Affairs (VA) Ostomy Health-Related Quality of Life Study, in which 511 respondents (239 cases, 272 controls) completed a survey instrument that included the modified City of Hope Quality of Life (mCOH-QOL) Ostomy questionnaire, SF-36V, and sociodemographic items. Responses from the 239 cases (ie, patients with intestinal stomas) were used in this analysis. The modified City of Hope Quality of Life Ostomy questionnaire item, "How good is your overall quality of life?," was the dependent variable for this analysis. The primary independent variable was the response (yes/no) to the item, "If you pay for any of the (ostomy) costs, is it difficult for you?" A hierarchical regression model was used to examine whether difficulty paying was significantly related to overall quality of life after adjusting for age, income, race/ethnicity, and physical health. After accounting for the proportion of variance explained by age, income, race/ethnicity, and physical health, the additional proportion of variance explained by difficulty paying was statistically significant. Individuals reporting difficulty paying had a roughly 1 point lower (ie, beta-coefficient = -1.052; SE = 0.481) overall quality of life score on the 11-point scale. We found a significant association between difficulty paying for ostomy supplies and overall quality of life. Although the cross-sectional study design does not allow causal inference, the results suggest a relationship that merits further examination.

  3. Sentimentos de pessoas ostomizadas: compreensão existencial Sentimiento de las personas ostomizadas: comprensión existencial Emotions of people living with ostomies: existential comprehension

    Directory of Open Access Journals (Sweden)

    Catarina Aparecida Sales

    2010-03-01

    cuán dolorosos o placenteros son los acontecimientos de la vida, quedando a cargo del enfermero estar atento a sus diferentes modos de expresarse.The objective of this study was to better understand the emotions of ostomy patients and to reinforce their own moral value as beings-in-the-world, through actions of humanized care. This qualitative study followed the existential phenomenology school of thought and was performed at a teaching hospital in Northwestern Paraná - Brazil. Interviews were performed with 15 ostomy patients receiving care at the stomal therapy outpatient clinic during the months of June and July, 2006. The guiding question was: What does being an ostomy patient mean to you? From the analysis, three existential themes emerged: finding oneself in the world of ostomy; daily life with an ostomy bag; and the importance of spirituality in understanding the situation. It was observed that ostomy patients, in their existentiality, express their vicissitudes differently, revealing how painful or pleasant life events can be to them. It is the nurse's challenge to be mindful of their varying forms of expression.

  4. Bridging the gap: perceived educational needs in the inpatient to home care setting for the person with a new ostomy.

    Science.gov (United States)

    Werth, Sherry Lynn; Schutte, Debra L; Stommel, Manfred

    2014-01-01

    The purpose of this study was to investigate what specific ostomy self-care educational content is considered the most useful by the new ostomy patient after discharge. A cross-sectional, correlational design was used to address study aims. The sample comprised 33 men and 27 women with a mean age of 55.58 ± 15.56 (mean ± SD) years, range 27 to 79 years old. The study setting was a 587-bed teaching hospital, level 1 trauma center in the Midwest, with Magnet designation. Demographic data were collected during the patients' hospital stay as part of routine care. This information is used for follow-up with all ostomy patients who have surgery in this hospital. All of the participants in this study completed an interview administered by phone or in person. A semistructured interview guide was used to elicit participant perceptions of the usefulness of 4 categories of ostomy care, including (1) ostomy information (ostomy function), (2) activities of daily living (strategies to manage travel, bathing, intimacy, odor), (3) ostomy care (strategies for managing the ostomy), and (4) other informational needs (social support resources). Participants were asked to rate these 4 areas from most useful to least useful, using a 4-point scale. At the end of the interview, participants were asked, "Has there been anything that has happened or event related to your ostomy that your ostomy teaching did not prepare you for?" The interview took place several weeks after surgery or during their readmission visit for surgical ostomy takedown. Sixty-two patients were enrolled into the study, and 60 participants completed the data collection. The sample included 26 (43%) patients with ileostomies, 18 (30%) with colostomies, and 16 (27%) with urostomies. Ninety percent ranked the education category of ostomy self-care as the most useful content, 55% ranked information on resuming activities of daily living as the second most useful category, and 55% ranked general information as third most

  5. Quality of life in elderly patients with an ostomy - a study from the population-based PROFILES registry.

    Science.gov (United States)

    Verweij, N M; Bonhof, C S; Schiphorst, A H W; Maas, H A; Mols, F; Pronk, A; Hamaker, M E

    2018-04-01

    Ostomies are being placed frequently in surgically treated elderly patients with colorectal cancer (CRC). An insight into the (potential) impact of ostomies on quality of life (QoL) could be useful in patient counselling as well as in the challenging shared treatment decision-making. Patients with CRC diagnosed between 2000 and 2009 and registered in the population-based Eindhoven Cancer Registry received a QoL questionnaire (EORTC QLQ-C30) in 2010. In addition, QoL was compared with an age- and sex-matched normative population. The study included 2299 CRC patients, of whom 494 had an ostomy. No differences were found in reported ostomy-related problems between patients aged ≤65, 66-75 and ≥76 years. Ostomy patients aged 66-75 and ≥76 years reported significantly lower physical functioning compared with those without an ostomy. In the elderly (those aged ≥76 years) ostomates reported a worse physical and social functioning compared with the normative population. All these differences were of small clinical relevance. The impact of an ostomy seems to be more prominent in younger (≤75 years old) ostomates, as they experience more functional limitations and a decrease in global health status compared with younger nonostomy patients and the normative population. Although elderly (≥76 years old) patients with an ostomy report significantly more limitations in functioning compared with a normative population and elderly CRC patients without an ostomy, the clinical relevance of this finding is limited. In contrast, the impact of an ostomy is more prominent in younger patients. Thus, age itself is not a reason for withholding an ostomy. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

  6. Health care service for ostomy patients: profile of the clientele

    Directory of Open Access Journals (Sweden)

    Vanessa Damiana Menis Sasaki

    2012-09-01

    Full Text Available The study aimed to identify the profile of ostomy patients in a Health Care Service in São José do Rio Preto, São Paulo, Brazil. This is an exploratory, descriptive and retrospective study. Data were obtained by registration forms of patients assisted from January 1st, 2000, to December 31st, 2010. Out of the 252 ostomy patients, 51.1% were females and 48.9% were males; the age group with the highest concentration was from 68 to 78 years old (26.3% for both genders, with mean age of 73 years old. The main reason for making the stoma was rectal (35.0% and colon neoplasm (14.1%. The prevalent stoma was temporary colostomy (41.4% and the period of permanence of the collecting equipment was longer than 36 months. Even though the service provides full assistance to the ostomy patients, it is necessary to review human resources aspects to provide appropriate assistance to its clientele.O estudo teve como objetivo identificar o perfil de pacientes estomizados de um Serviço de Atenção ao Estomizado de São José do Rio Preto e Região. A pesquisa é exploratória, descritiva e retrospectiva. Os dados foram obtidos das fichas cadastrais dos pacientes atendidos no período de 1º de janeiro de 2000 a 31 de dezembro de 2010. Dos 252 estomizados, 51,1% eram mulheres e 48,9% homens, a faixa etária de maior concentração encontrou-se, em ambos os sexos, entre 68 a 78 anos (26,3% com média de idade de 73 anos. O principal motivo da confecção do estoma foi a neoplasia de reto (35,0% e cólon (14,1%. O estoma prevalente foi a colostomia temporária (41,4% e o tempo de permanência do equipamento coletor foi superior a 36 meses. O Serviço, embora proporcione assistência integral ao estomizado, necessita rever aspectos de recursos humanos à assistência adequada à clientela.

  7. A chronic care ostomy self-management program for cancer survivors.

    Science.gov (United States)

    Krouse, Robert S; Grant, Marcia; McCorkle, Ruth; Wendel, Christopher S; Cobb, Martha D; Tallman, Nancy J; Ercolano, Elizabeth; Sun, Virginia; Hibbard, Judith H; Hornbrook, Mark C

    2016-05-01

    Individuals with ostomies experience extensive changes in health-related quality of life (HRQOL) and daily routine. Patients and families are typically forced to use trial and error to improve self-management. This is a longitudinal one-group design pilot study of a five-session ostomy self-care curriculum based on the Chronic Care Model to improve HRQOL and self-management for cancer survivors with ostomies. Participants were surveyed to evaluate each session. Multiple instruments were administered to examine outcomes at baseline, post-intervention, and at 6-month follow-up (Patient Activation Measure, self-efficacy, Hospital Anxiety and Depression Scale, Ways of Coping, Group Health Association of America Satisfaction with ostomy care survey, and the City of Hope Quality of Life Ostomy). Changes from pre-intervention to post-intervention and pre-intervention to follow-up were evaluated with paired t-tests. Text responses were coded and evaluated for important themes and recommendations. Thirty-eight subjects participated in the study. Most had a history of rectal cancer (60.5%) or bladder cancer (28.9%). Participants rated the overall program high (4.4-4.8 on 5-point scale). Text feedback indicated that participants enjoyed the group forums, wanted more participants, and more hands-on training. Scores on multiple surveys were shown to be improved and sustained, including patient activation (p = 0.0004), self-efficacy (p = 0.006), total HRQOL (p = 0.01), physical well-being (p = 0.005), and social well-being (p = 0.002). Survivor anxiety was significantly reduced by follow-up (p = 0.047). This self-management ostomy program can help cancer survivors with ostomies adapt to their stoma. Initiating this program in the community setting would be beneficial to many cancer survivors. Copyright © 2016 John Wiley & Sons, Ltd.

  8. Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review

    NARCIS (Netherlands)

    Sylvia M. Vonk-Klaassen; Hilde M. de Vocht; Erik Hans Eddes; Prof. Dr. Marieke J. Schuurmans; Marjolein E.M. den Ouden

    2016-01-01

    Aim Many long-term ostomates are ‘out-of-sight’ of healthcare, and it is unknown how ostomates deal with ostomy- related problems and how these problems affect their quality of life (QOL). The aim is to examine patient-related studies describing ostomy-related problems and their impact on the

  9. Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates : a systematic review

    NARCIS (Netherlands)

    Vonk-Klaassen, Sylvia M.; de Vocht, Hilde M.; den Ouden, Marjolein E M; Eddes, Eric Hans; Schuurmans, Marieke J.

    2016-01-01

    Aim: Many long-term ostomates are ‘out-of-sight’ of healthcare, and it is unknown how ostomates deal with ostomy-related problems and how these problems affect their quality of life (QOL). The aim is to examine patient-related studies describing ostomy-related problems and their impact on the

  10. Quality of life in elderly patients with an ‘ostomy : A study from the population-based PROFILES registry

    NARCIS (Netherlands)

    Verweij, N. M.; Bonhof, C.S.; Schiphorst, A. H. W.; Maas, H. A.; Mols, F.; Pronk, A.; Hamaker, M. E.

    2018-01-01

    Background: 'Ostomies are being placed frequently in surgically treated elderly colorectal cancer (CRC) patients. Having insight into the (potential) impact of 'ostomies on their quality of life (QoL) can be useful in patient counselling as well as in the challenging shared treatment decision

  11. Management of Necrotizing Fasciitis and Fecal Peritonitis following Ostomy Necrosis and Detachment by Using NPT and Flexi-Seal

    Directory of Open Access Journals (Sweden)

    Fahri Yetışır

    2015-01-01

    Full Text Available Management of necrotizing fasciitis and severe faecal peritonitis following ostomy in elderly patient with comorbid disease is challenging. We would like to report management of frozen Open Abdomen (OA with colonic fistula following ostomy necrosis and detachment in an elderly patient with comorbid disease and malignancy. 78-year-old woman with high stage rectum carcinoma was admitted to emergency department and underwent operation for severe peritonitis and sigmoid colonic perforation. Loop sigmoidostomy was performed. At postoperative 15th day, she was transferred to our clinic with necrotizing fasciitis and severe faecal peritonitis due to ostomy necrosis and detachment. Enteric effluent was removed from the OA wound by using the Flexi-Seal Fecal Management System (FMS (ConvaTec and pesser tube in deeply located colonic fistula in conjunction with Negative Pressure Therapy (NPT. Maturation of ostomy was facilitated by using second NPT on ostomy side. After source control, delayed abdominal closure was achieved by skin flap approximation.

  12. Quality of life and need for care in patients with an ostomy: a survey of 2647 patients of the Berlin OStomy-Study (BOSS).

    Science.gov (United States)

    Braumann, Chris; Müller, Verena; Knies, Moritz; Aufmesser, Birgit; Schwenk, Wolfgang; Koplin, Gerold

    2016-12-01

    Although ostomies are sometimes necessary, it is unclear which type of ostomy is advantageous for quality of life (QoL). In an observational study of 2647 patients, QoL after colostomy (CS) and small bowel stoma (SBS) formation was evaluated. The European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30 and CR-38 questionnaires were used. Patient characteristics, retrospective information about the ostomy and previous treatments, and current stoma-related complications were recorded. All questionnaires were distributed and collected by stoma therapists at the homecare company PubliCare®. In all, 1790 patients had a CS, and 756 had an SBS. The mean Global Health Score (mGHS-a general QoL indicator) was 52.33 in CS and 49.40 in SBS patients (p = 0.004), but the effect size (Cohen's d) was 0.1. In SBS patients, all functional scores were lower and most of the symptom scores were higher. QoL differed significantly for CS and SBS patients, but the effect size was marginal. The care of certain patient groups, particularly (female) patients who receive emergency surgeries, must be improved. More professional education and guidance are necessary for a larger proportion of patients. This survey provided reference data for quality of life in patients with an ostomy.

  13. The City of Hope-Quality of Life-Ostomy Questionnaire: Persian Translation and Validation

    Science.gov (United States)

    Anaraki, F; Vafaie, M; Behboo, R; Esmaeilpour, S; Maghsoodi, N; Safaee, A; Grant, M

    2014-01-01

    Background: Since there is no disease-specific instrument for measuring quality-of-life (QOL) in Ostomy patients in Persian language. Aim: This study was designed to translate and evaluate the validity and reliability of City of Hope-quality of life-Ostomy questionnaire (COH-QOL-Ostomy questionnaire). Subjects and Methods: This study was designed as cross-sectional study. Reliability of the subscales and the summary scores were demonstrated by intra-class correlation coefficients. Pearson's correlations of an item with its own scale and other scales were calculated to evaluated convergent and discriminant validity. Clinical validity was also evaluated by known-group comparisons. Results: Cronbach's alpha coefficient for all subscales was about 0.70 or higher. Results of interscale correlation were satisfactory and each subscale only measured a single and specified trait. All subscales met the standards of convergent and discriminant validity. Known group comparison analysis showed significant differences in social and spiritual well-being. Conclusion: The findings confirmed the reliability and validity of Persian version of COH-QOL-Ostomy questionnaire. The instrument was also well received by the Iranian patients. It can be considered as a valuable instrument to assess the different aspects of health related quality-of-life in Ostomy patients and used in clinical research in the future. PMID:25221719

  14. Struggles, strengths, and strategies: an ethnographic study exploring the experiences of adolescents living with an ostomy

    Science.gov (United States)

    Nicholas, David B; Swan, Sylvia R; Gerstle, Ted J; Allan, Theresa; Griffiths, Anne Marie

    2008-01-01

    Background Adolescents with IBD requiring ostomy surgery experience perioperative needs that may exceed those of patients experiencing other major abdominal surgery [1]. This procedure requires ongoing and vigilant daily care and management. Gastrointestinal symptoms and complications impose psychological and social stresses on young patients [2], and the procedure results in body image changes and daily regimens of self-care. This study aimed to explore adolescents' experiences and quality of life following ostomy surgery. Methods Ethnographic interviews and a subsequent focus group were conducted with 20 adolescents with an ostomy or j-pouch being treated at the Hospital for Sick Children in Toronto, Canada. Interviews were transcribed verbatim and subjected to theme generation. Results Findings suggest that adolescents are profoundly affected by their ostomy. Adolescents convey strength as well as adjustment struggles. Identified impacts include body intrusion and body image changes, decreased independence, secrecy about the ostomy, adjustment over time, challenges for the family, and strategies for constructively moving forward. Conclusion Implications address the importance of ensuring meaningful opportunities to understand and reframe the stresses of illness. An ongoing clinical challenge involves the promotion of a healthy self-esteem and psychosocial adjustment for these adolescents and their families. Finding effective ways to minimize stress and embarrassment and reframe personal shame, constitute important clinical priorities. Opportunities for peer support and family dialogue may assist in clarifying worries and easing the burden carried by these young persons. Flexible and adequately funded resources are advocated in fostering quality of life. PMID:19091104

  15. Struggles, strengths, and strategies: an ethnographic study exploring the experiences of adolescents living with an ostomy

    Directory of Open Access Journals (Sweden)

    Allan Theresa

    2008-12-01

    Full Text Available Abstract Background Adolescents with IBD requiring ostomy surgery experience perioperative needs that may exceed those of patients experiencing other major abdominal surgery 1. This procedure requires ongoing and vigilant daily care and management. Gastrointestinal symptoms and complications impose psychological and social stresses on young patients 2, and the procedure results in body image changes and daily regimens of self-care. This study aimed to explore adolescents' experiences and quality of life following ostomy surgery. Methods Ethnographic interviews and a subsequent focus group were conducted with 20 adolescents with an ostomy or j-pouch being treated at the Hospital for Sick Children in Toronto, Canada. Interviews were transcribed verbatim and subjected to theme generation. Results Findings suggest that adolescents are profoundly affected by their ostomy. Adolescents convey strength as well as adjustment struggles. Identified impacts include body intrusion and body image changes, decreased independence, secrecy about the ostomy, adjustment over time, challenges for the family, and strategies for constructively moving forward. Conclusion Implications address the importance of ensuring meaningful opportunities to understand and reframe the stresses of illness. An ongoing clinical challenge involves the promotion of a healthy self-esteem and psychosocial adjustment for these adolescents and their families. Finding effective ways to minimize stress and embarrassment and reframe personal shame, constitute important clinical priorities. Opportunities for peer support and family dialogue may assist in clarifying worries and easing the burden carried by these young persons. Flexible and adequately funded resources are advocated in fostering quality of life.

  16. The city of hope-quality of life-ostomy questionnaire: persian translation and validation.

    Science.gov (United States)

    Anaraki, F; Vafaie, M; Behboo, R; Esmaeilpour, S; Maghsoodi, N; Safaee, A; Grant, M

    2014-07-01

    Since there is no disease-specific instrument for measuring quality-of-life (QOL) in Ostomy patients in Persian language. This study was designed to translate and evaluate the validity and reliability of City of Hope-quality of life-Ostomy questionnaire (COH-QOL-Ostomy questionnaire). This study was designed as cross-sectional study. Reliability of the subscales and the summary scores were demonstrated by intra-class correlation coefficients. Pearson's correlations of an item with its own scale and other scales were calculated to evaluated convergent and discriminant validity. Clinical validity was also evaluated by known-group comparisons. Cronbach's alpha coefficient for all subscales was about 0.70 or higher. Results of interscale correlation were satisfactory and each subscale only measured a single and specified trait. All subscales met the standards of convergent and discriminant validity. Known group comparison analysis showed significant differences in social and spiritual well-being. The findings confirmed the reliability and validity of Persian version of COH-QOL-Ostomy questionnaire. The instrument was also well received by the Iranian patients. It can be considered as a valuable instrument to assess the different aspects of health related quality-of-life in Ostomy patients and used in clinical research in the future.

  17. Effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy.

    Science.gov (United States)

    Gautam, Sital; Poudel, Anju

    2016-12-01

    Stoma can pose extensive challenges for colorectal cancer survivors. Identifying the psychological and social adjustment among them and how it differs by gender will aid in identifying those particularly at risk of having poor adjustment and in planning programs to improve their adjustment. The purpose of this study was to determine the effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy. A descriptive cross sectional study was carried out in the stoma clinic of B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal. A purposive sample of 122 patients with ostomy was taken from the above mentioned setting. Selection criteria included colorectal cancer survivors having ostomy for at least 6 months. Data on socio-demographic and clinical variables were collected. Psychosocial adjustment was measured using Ostomy Adjustment Inventory-23 (OAI-23). A total of 122 patients were included in the study. Mean time since ostomy surgery was 2.53 and 1.98 years for men and women respectively. Both men and women had significant impairment in the psychosocial adjustment, however, men had significantly lower psychosocial adjustment score (37.68±12.96 vs . 43.45±12.81, t=-2.47, P=0.015) at 95% CI as compared to women and they reported more negative emotions. Furthermore, men significantly predicted low acceptance {β=-3.078, P=0.023, ΔR 2 =0.036, F [4,117] =7.90, Postomy should be monitored for psychosocial concerns in regular basis and health care providers should tailor care based on their need. Approaches of survivorship care and psychosocial interventions in colorectal cancer survivors with ostomy should take into account gender specific concerns and requirements to aid adjustment.

  18. Complication rates of ostomy surgery are high and vary significantly between hospitals.

    Science.gov (United States)

    Sheetz, Kyle H; Waits, Seth A; Krell, Robert W; Morris, Arden M; Englesbe, Michael J; Mullard, Andrew; Campbell, Darrell A; Hendren, Samantha

    2014-05-01

    Ostomy surgery is common and has traditionally been associated with high rates of morbidity and mortality, suggesting an important target for quality improvement. The purpose of this work was to evaluate the variation in outcomes after ostomy creation surgery within Michigan to identify targets for quality improvement. This was a retrospective cohort study. The study took place within the 34-hospital Michigan Surgical Quality Collaborative. Patients included were those undergoing ostomy creation surgery between 2006 and 2011. We evaluated hospital morbidity and mortality rates after risk adjustment (age, comorbidities, emergency vs elective, and procedure type). A total of 4250 patients underwent ostomy creation surgery; 3866 procedures (91.0%) were open and 384 (9.0%) were laparoscopic. Unadjusted morbidity and mortality rates were 43.9% and 10.7%. Unadjusted morbidity rates for specific procedures ranged from 32.7% for ostomy-creation-only procedures to 47.8% for Hartmann procedures. Risk-adjusted morbidity rates varied significantly between hospitals, ranging from 31.2% (95% CI, 18.4-43.9) to 60.8% (95% CI, 48.9-72.6). There were 5 statistically significant high-outlier hospitals and 3 statistically significant low-outlier hospitals for risk-adjusted morbidity. The pattern of complication types was similar between high- and low-outlier hospitals. Case volume, operative duration, and use of laparoscopic surgery did not explain the variation in morbidity rates across hospitals. This work was limited by its retrospective study design, by unmeasured variation in case severity, and by our inability to differentiate between colostomies and ileostomies because of the use of Current Procedural Terminology codes. Morbidity and mortality rates for modern ostomy surgery are high. Although this type of surgery has received little attention in healthcare policy, these data reveal that it is both common and uncommonly morbid. Variation in hospital performance provides an

  19. Spiritual well-being in long-term colorectal cancer survivors with ostomies.

    Science.gov (United States)

    Bulkley, Joanna; McMullen, Carmit K; Hornbrook, Mark C; Grant, Marcia; Altschuler, Andrea; Wendel, Christopher S; Krouse, Robert S

    2013-11-01

    Spiritual well-being (SpWB) is integral to health-related quality of life. The challenges of colorectal cancer (CRC) and subsequent bodily changes can affect SpWB. We analyzed the SpWB of CRC survivors with ostomies. Two-hundred-eighty-three long-term (≥ 5 years) CRC survivors with permanent ostomies completed the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O) questionnaire. An open-ended question elicited respondents' greatest challenge in living with an ostomy. We used content analysis to identify SpWB responses and develop themes. We analyzed responses on the three-item SpWB sub-scale. Open-ended responses from 52% of participants contained SpWB content. Fifteen unique SpWB themes were identified. Sixty percent of individuals expressed positive themes such as "positive attitude", "I am fortunate", "appreciate life more", and "strength through religious faith". Negative themes, expressed by only 29% of respondents, included "struggling to cope", "not feeling 'normal' ", and "loss". Fifty-five percent of respondents expressed ambivalent themes including "learning acceptance", "an ostomy is the price for survival", "reason to be around despite suffering", and "continuing to cope despite challenges". The majority (64%) had a high SpWB sub-scale score. Although CRC survivors with ostomies infrequently mentioned negative SpWB themes as a major challenge, ambivalent themes were common. SpWB themes were often mentioned as a source of resilience or part of the struggle to adapt to an altered body after cancer surgery. Interventions to improve the quality of life of cancer survivors should contain program elements designed to address SpWB that support personal meaning, inner peace, inter connectedness, and belonging. Copyright © 2013 John Wiley & Sons, Ltd.

  20. The origin of continents and oceans

    National Research Council Canada - National Science Library

    Wegener, Alfred 1880-1930; Biram, John

    1966-01-01

    .... Wegener proposed that in the remote past the earth's continents were not separate (as now), but formed one supercontinent which later split apart, the fragments gradually drifting away from one another...

  1. The Ostomy Adjustment Scale: translation into Norwegian language with validation and reliability testing.

    Science.gov (United States)

    Indrebø, Kirsten Lerum; Andersen, John Roger; Natvig, Gerd Karin

    2014-01-01

    The purpose of this study was to adapt the Ostomy Adjustment Scale to a Norwegian version and to assess its construct validity and 2 components of its reliability (internal consistency and test-retest reliability). One hundred fifty-eight of 217 patients (73%) with a colostomy, ileostomy, or urostomy participated in the study. Slightly more than half (56%) were men. Their mean age was 64 years (range, 26-91 years). All respondents had undergone ostomy surgery at least 3 months before participation in the study. The Ostomy Adjustment Scale was translated into Norwegian according to standard procedures for forward and backward translation. The questionnaire was sent to the participants via regular post. The Cronbach alpha and test-retest were computed to assess reliability. Construct validity was evaluated via correlations between each item and score sums; correlations were used to analyze relationships between the Ostomy Adjustment Scale and the 36-item Short Form Health Survey, the Quality of Life Scale, the Hospital Anxiety & Depression Scale, and the General Self-Efficacy Scale. The Cronbach alpha was 0.93, and test-retest reliability r was 0.69. The average correlation quotient item to sum score was 0.49 (range, 0.31-0.73). Results showed moderate negative correlations between the Ostomy Adjustment Scale and the Hospital Anxiety and Depression Scale (-0.37 and -0.40), and moderate positive correlations between the Ostomy Adjustment Scale and the 36-item Short Form Health Survey, the Quality of Life Scale, and the General Self-Efficacy Scale (0.30-0.45) with the exception of the pain domain in the Short Form 36 (0.28). Regression analysis showed linear associations between the Ostomy Adjustment Scale and sociodemographic and clinical variables with the exception of education. The Norwegian language version of the Ostomy Adjustment Scale was found to possess construct validity, along with internal consistency and test-retest reliability. The instrument is

  2. Health-Related Quality of Life in Persons With Ostomies Managed in an Outpatient Care Setting.

    Science.gov (United States)

    Santos, Vera Lucia Conceição de Gouveia; Augusto, Fabiana da Silva; Gomboski, Gustavo

    2016-01-01

    We examined health-related quality of life (HRQOL) in persons with ostomies receiving outpatient care. We also analyzed relationships among HRQOL, demographic, and pertinent clinical factors. We used a descriptive, exploratory, cross-sectional study design to collect and analyze data. Data in this article are a secondary analysis of data collected from a primary study, developed by Santos and Gomboski, on the adaptation and validation of the City of Hope-Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) to the Portuguese language in Brazil. A convenience sample of 215 adults living with an ostomy was evaluated. Slightly more than half (51.6%) were men, 67.5% underwent colostomy surgery, and 59.1% underwent cancer-related ostomy surgery. Subjects received care in specialized health care units in 3 cities in the Brazilian state of Rio Grande do Sul. After approval by the Research Ethics Committee and permission from health care units, data were collected using 2 instruments: the World Health Organization Quality of Life-Short Version (WHOQOL-Bref) (generic HRQOL instrument) and the COH-QOL-OQ (disease specific HRQOL instrument). Data were analyzed using χ test and logistic regression (via a stepwise forward method). Patients were classified into 3 groups according to the means and standard deviations of the scores: low, moderate, and high quality of life (QOL). Ostomy patients had total scores of 69.6 ± 20.2 and 6.1 ± 1.4 for the WHOQOL-Bref and COH-QOL-OQ instruments, respectively. Patients with shorter times since their ostomy creation had worse scores on both the specific QOL (P = .006) and generic QOL (P = .019) instruments. Patients who did not practice religion (P = .027; odds ratio [OR] = 3.39) and those without a partner/spouse (P = .007; OR = 4.90) had increased probability of having worse scores on the WHOQOL-Bref (generic instrument). Persons living with ostomies were found to have scores indicating moderate HRQOL on a disease-specific and generic

  3. Imagining life with an ostomy: Does a video intervention improve quality-of-life predictions for a medical condition that may elicit disgust?☆

    Science.gov (United States)

    Angott, Andrea M.; Comerford, David A.; Ubel, Peter A.

    2014-01-01

    Objective To test a video intervention as a way to improve predictions of mood and quality-of-life with an emotionally evocative medical condition. Such predictions are typically inaccurate, which can be consequential for decision making. Method In Part 1, people presently or formerly living with ostomies predicted how watching a video depicting a person changing his ostomy pouch would affect mood and quality-of-life forecasts for life with an ostomy. In Part 2, participants from the general public read a description about life with an ostomy; half also watched a video depicting a person changing his ostomy pouch. Participants’ quality-of-life and mood forecasts for life with an ostomy were assessed. Results Contrary to our expectations, and the expectations of people presently or formerly living with ostomies, the video did not reduce mood or quality-of-life estimates, even among participants high in trait disgust sensitivity. Among low-disgust participants, watching the video increased quality-of-life predictions for ostomy. Conclusion Video interventions may improve mood and quality-of-life forecasts for medical conditions, including those that may elicit disgust, such as ostomy. Practice implications Video interventions focusing on patients’ experience of illness continue to show promise as components of decision aids, even for emotionally charged health states such as ostomy. PMID:23177398

  4. Continent cecostomy. An account of 30 patients.

    Science.gov (United States)

    Kock, N G; Myrvold, H E; Philipson, B M; Svaninger, G; Ojerskog, B

    1985-10-01

    In this paper, an account is given of our experience with continent colostomy in man. In five patients, the end-sigmoidostomy was provided with an intussusception valve. Evacuation of the bowel by irrigation through a catheter was laborious and time-consuming and this method was abandoned. In another group of 30 patients, the cecum was isolated from the rest of the colon and its distal end was provided with an intussusception valve. Of the 30 patients, eight were later given continent ileostomies, two were converted to conventional sigmoidostomies, and one patient with fecal incontinence preferred to have intestinal continuity reestablished. Thus, 19 patients still have continent cecostomies and are satisfied with their function. When comparing the function of the continent cecostomy with that of the continent ileostomy, however, it is obvious that the ileostomy function is superior. The experience obtained with this group of patients has resulted in a widening of the indications for constructing a continent ileostomy, including selected patients with various anorectal disorders.

  5. NICU consultants and support staff

    Science.gov (United States)

    ... needed, they can perform surgery or place casts. OSTOMY NURSE An ostomy nurse is a nurse with special training in ... stick out. Such an opening is called an ostomy. Ostomies are the result of surgery needed to ...

  6. Continuing Education Preferences, Facilitators, and Barriers for Nursing Home Nurses.

    Science.gov (United States)

    Dyck, Mary J; Kim, Myoung Jin

    2018-01-01

    The purpose of the study was to determine the continuing education needs for nursing home nurses in rural central Illinois and to determine any potential facilitators or barriers to obtaining continuing education. Data were collected using the Educational Needs Assessment questionnaire. Descriptive statistics were computed to examine continuing education preferences, facilitators, and barriers among nursing home nurses. Independent samples t tests were used to compare preferences between administrative and staff nurses. The sample included 317 nurses from 34 facilities. The five top needs were related to clinical problems. Administrative nurses had greater needs for professional issues, managerial skills, and quality improvement than staff nurses. Barriers included rural settings, need for vacation time for programs, and inadequate staffing. Continuing education needs of nursing home nurses in Illinois are similar to previous studies conducted in Arizona and North Carolina. Continuing education barriers were mostly organizational, rather than personal. J Contin Nurs Educ. 2018;49(1):26-33. Copyright 2018, SLACK Incorporated.

  7. Children with chronic continence problems: the challenges for families.

    Science.gov (United States)

    Erickson, David V; Ray, Lynne D

    2004-01-01

    For families who are raising children with myelomeningocele, bowel and bladder incontinence presents unique challenges for everyday life. The Parenting and Childhood Chronicity model is used to describe the work of raising a child with a chronic condition in 6 areas, including medical care, adapted parenting, dealing with the systems, caring for siblings, maintaining relationships, and personal coping (keeping yourself going). This article provides an overview of the physiologic and developmental challenges inherent in this neural tube defect and illustrates the work that is involved in the child's care and the challenges of maintaining a balance in family life. Clinical implications are discussed, including the setting of appropriate expectations, providing parents with accurate information, ensuring that a focus on continence is not at the expense of other important aspects of the child's functioning, and supporting parents in their interaction with the school system. The medical team, consisting of nursing, urology, nephrology, and psychology working together, can be a strong support for families.

  8. [Continent ileostomy--indication and possibilities].

    Science.gov (United States)

    Hahnloser, P; Säuberli, H; Geroulanos, S; Schauwecker, H H; Kock, N G

    1975-06-21

    Proctocolectomy with conventional ileostomy cures patients with severe ulcerative colitis but ileostomy appliances must be worn for the rest of their lives. The continent ileostomy, as devised by Kock, provides the patient with an intraabdominal ileal reservoir and a valve constructed by invaginating the efferent ileal segment into the reservoir. The patient empties his reservoir 2-3 times a day by inserting a catheter through the valve. Our experience with 14 patients is reported. The continent ileostomy was in most cases constructed as a second procedure after proctocolectomy. Minor postoperative complications, such as abscess, fistula or partial luxation of the valve were easily corrected. One patient who underwent proctocolectomy and simultaneous construction of a continent ileostomy died in acute liver failure due to a severe preexisting cirrhosis. All the other patients are continent for feces and gas and do not need external appliances. The construction of a continent ileostomy as a secondary procedure can be recommended in patients with proctocolectomy. It offers patients a life situation with differs only insignificantly from that of normal persons.

  9. Ostomy Creation in Neonates with Acute Abdominal Disease : Friend or Foe?

    NARCIS (Netherlands)

    van Zoonen, Anne G. J. F.; Schurink, Maarten; Bos, Arend F.; Heineman, Erik; Hulscher, Jan B. F.

    Background An ostomy seems a safe alternative in neonates with an acute abdomen when immediate restoration of bowel continuity is deemed undesirable. Faced with several complications in our center, and the feeling we are not the only center with these complications, we decided to assess the rate and

  10. [The continent ileostomy--indication and results].

    Science.gov (United States)

    Säuberli, H; Akovbiantz, A; Hahnloser, P

    1982-01-01

    Proctocolectomy with conventional ileostomy cures patients with severe ulcerative colitis, however ileostomy appliances had to be worn for the rest of their lives. The continent ileostomy as devised by Kock provides the patient with an intraabdominal ileal reservoir and a valve constructed by invaginating the efferent ileal segment into the reservoir. The patient empties his reservoir 2 to 3 times a day by inserting a catheter through the valve. Our experience with 45 patients is reported. In most cases the continent ileostomy was constructed as a second procedure after proctocolectomy. The construction of a continent ileostomy as a secondary procedure can be recommended in patients with proctocolectomy. It offers patients a life situation differing only insignificantly from that of normal persons.

  11. Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review.

    Science.gov (United States)

    Vonk-Klaassen, Sylvia M; de Vocht, Hilde M; den Ouden, Marjolein E M; Eddes, Eric Hans; Schuurmans, Marieke J

    2016-01-01

    Many long-term ostomates are 'out-of-sight' of healthcare, and it is unknown how ostomates deal with ostomy-related problems and how these problems affect their quality of life (QOL). The aim is to examine patient-related studies describing ostomy-related problems and their impact on the perceived QOL of long-term colostomates. The electronic databases PubMed (MEDLINE), CINAHL, Cochrane Library and PsycINFO were systematically searched. All studies were included in which ostomy-specific QOL was measured using validated multidimensional instruments. Of the 6447 citations identified, 14 prevailingly descriptive cross-sectional studies were included. Three different validated multidimensional instruments for measuring QOL in ostomates were used (EORTC C30/CR38, MCOHQOLQO, Stoma QOL Questionnaire). All studies demonstrated that living with a colostomy influences the overall QOL negatively. The ostomy-related problems described included sexual problems, depressive feelings, gas, constipation, dissatisfaction with appearance, change in clothing, travel difficulties, feeling tired and worry about noises. In conclusion, all 14 studies gave an indication of the impact of ostomy-related problems on the perceived QOL and demonstrated that a colostomy influences the QOL negatively. There is a wide range of ostomy-specific QOL scores, and there seem to be higher QOL scores in the studies where the MCOHQOLQO instrument was used. The MCOHQOLQO and the Stoma QOL Questionnaire gave the most detailed information about which ostomy-related problems were experienced. This review adds knowledge about the impact of stoma-related problems on QOL of long-term ostomates, but more research has to be conducted, to detect ostomy-related problems and especially possible care needs.

  12. Untreated Peristomal Skin Complications among Long-Term Colorectal Cancer Survivors with Ostomies: Lessons from a Study of Family Caregiving

    OpenAIRE

    McMullen, Carmit K.; Wasserman, Joseph; Altschuler, Andrea; Grant, Marcia; Hornbrook, Mark C.; Liljestrand, Petra; Briggs, Catherine; Krouse, Robert S.

    2011-01-01

    This ethnography of family caregiving explored why peristomal skin complications are both common and undertreated among colorectal cancer (CRC) survivors with intestinal ostomies. We sought to identify factors that hinder or facilitate prompt detection and treatment of ostomy and skin problems. We collected data through in-depth interviews with 31 cancer survivors and their family caregivers, fieldwork, structured assessments, and medical records review. We analyzed data using qualitative the...

  13. Is An Ostomy Rod Useful for Bridging the Retraction During the Creation of a Loop Ileostomy? A Randomized Control Trial.

    Science.gov (United States)

    Uchino, Motoi; Ikeuchi, Hiroki; Bando, Toshihiro; Chohno, Teruhiro; Sasaki, Hirofumi; Horio, Yuki

    2017-08-01

    A loop ileostomy is generally created during restorative proctocolectomy (RPC) for treating ulcerative colitis (UC), and an ostomy rod is often used to prevent stoma retraction. However, its usefulness or harmfulness has not been proven. We performed a prospective randomized control study to investigate the non-inferiority of ostomy creation without a rod to prevent stoma retraction. Patients with UC who underwent RPC were enrolled and randomly divided into groups either with or without ostomy rod use. Incidences of stoma retraction and dermatitis were compared. Of the 320 patients in the study groups, 308 qualified for the intention-to-treat (ITT) analysis, and 257 were included in the per-protocol (PP) analysis. Ostomy retraction was recognized in 6 patients, 3 with a rod and 3 without. The difference with rod use (95% confidence interval) was 0.1 (-2.9 to 3.1)% in the PP analysis and 0.0 (-2.2 to 2.2)% in the ITT analysis. There were no significant differences in stoma retraction regardless of whether an ostomy rod was used in either analysis. Dermatitis was more common in patients with rod use (84/154) than in those without (40/154) (p ostomy rod is not routinely needed as it may increase the risk of dermatitis. However, results in obese patients may differ from those shown here, which should be clarified via further studies.

  14. EXPLORING PATENT ACTIVITY AND ITS POTENTIAL ASSOCIATION WITH HEALTHCARE OUTCOMES: A CASE STUDY OF OSTOMY PRODUCTS IN SWEDEN.

    Science.gov (United States)

    Calara, Paul Samuel; Althin, Rikard; Inglese, Gary; Nichols, Thomas

    2017-01-01

    The aim of this study was to evaluate whether ostomy industry patent activity (PA) is associated with patient outcomes and healthcare costs. Two groups of ostomy pouch users based on manufacturer PA (low or high) were compared in terms of ostomy-related wear patterns, adverse events, and healthcare expenditure. Using Swedish registry data, all patients with newly formed stomas were divided between each group and were followed during a 2-year period (2011-12). Propensity score matching and parametric duration analysis were used to compare outcomes between patients of similar characteristics such as sex, age, and ostomy surgery type. In both one- and two-piece systems, the high PA group had significantly lower monthly ostomy-related expenditure than the low PA group (one-piece: 197.47 EUR versus 233.34 EUR; two-piece: 164.00 EUR versus 278.98 EUR). Fewer pouch and skin wafer purchases per month were an important driver of cost differences. Both groups had similar likelihood of purchasing dermatological products for skin complications over time. PA in the ostomy care industry was associated with reduced healthcare costs, but not necessarily with fewer skin complications. It suggests that there is a health economic benefit from products made by patent intensive companies which may differentiate them from generic comparators, but more research is needed to understand the impact of activities conducive to medical innovation on health outcomes.

  15. Continence following radical retropubic prostatectomy using self-reporting instruments.

    Science.gov (United States)

    Lepor, Herbert; Kaci, Ledia; Xue, Xiaonan

    2004-03-01

    We performed a global self-assessment of continence following radical retropubic prostatectomy (RRP) and determined how this global self-assessment of continence correlates with commonly used definitions of continence. Between October 2000 and February 2002 all men who underwent RRP were encouraged to complete the University of California-Los Angeles Prostate Cancer Index 3, 6, 12 and 24 months postoperatively. Beginning October 2002 a single question capturing the patient global self-assessment of continence status was added to the postoperative continence assessment. The study design was cross-sectional since only continence surveys submitted between October 2002 through February 2003 were evaluated. Sensitivity, specificity and kappa coefficient was determined for the relationship between the patient global assessment of continence vs the definition of continence based on pad requirement, problem due to incontinence and frequency of incontinence. Continence progressively improved 3 to 24 months following RRP for all continence outcomes. At 24 months following RRP 97.1% of men considered themselves continent, while 97.1%, 94.1% and 97.1% were considered continent using continence definitions, including the requirement of no or 1 pad in a 24-hour interval, no or slight bother due to incontinence and total control or occasional dribbling, respectively. Our 3 definitions of continence derived from responses to the University of California-Los Angeles Prostate Cancer Index had excellent agreement with patient global self-assessment of continence (kappa coefficients between 0.76 and 0.83). The majority of men achieve continence without invasive intervention following RRP. Final continence status should be ascertained at 24 months. The patient global assessment of continence provides face validity for other definitions of continence based on responses to validated self-administered questionnaires.

  16. Europe the continent with the lowest fertility

    NARCIS (Netherlands)

    Baird, D. T.; Collins, J.; Evers, J. L. H.; Leridon, H.; Lutz, W.; Velde, E. Te; Thevenon, O.; Crosignani, P. G.; Devroey, P.; Diedrich, K.; Fauser, B. C. J. M.; Fraser, L.; Geraedts, J. P. M.; Gianaroli, L.; Glasier, A.; Sunde, A.; Tarlatzis, B.; Van Steirteghem, A.; Veiga, A.

    2010-01-01

    INTRODUCTION: Although fertility rates are falling in many countries, Europe is the continent with the lowest total fertility rate (TFR). This review assesses trends in fertility rates, explores possible health and social factors and reviews the impact of health and social interventions designed to

  17. Improving Health-Related Quality of Life of Patients With an Ostomy Using a Novel Digital Wearable Device: Protocol for a Pilot Study.

    Science.gov (United States)

    Rouholiman, Dara; Gamble, Jamison G; Dobrota, Sylvie D; Encisco, Ellen M; Shah, Ashish G; Grajales Iii, Francisco J; Chu, Larry F

    2018-03-26

    Ostomy surgeries involving the placement of an ostomy bag (eg, colostomy, ileostomy, urostomy, etc) have been shown to have a negative impact on health-related quality of life. To date, no studies have been conducted examining what impact, if any, wearable biosensors have on the health-related quality of life of ostomy patients. In the present study, we plan to assess the quality of life of ostomy patients using the Ostom-i alert sensor, a portable, wearable, Bluetooth-linked biosensor that facilitates easier ostomy bag output measurements. We hypothesize that using the Ostom-i alert sensor will result in an improved, ostomy-specific, health-related quality of life as compared to baseline measurement before the use of the sensor. A total of 20 ostomy patients will be screened and recruited to participate in this prospective, observational, cross-over pilot study using an Ostom-i alert sensor for one month. The primary outcome of this study will compare ostomy-specific, health-related quality of life at baseline (prior to Ostom-i alert sensor use) to ostomy-specific, health-related quality of life after 2 and 4 weeks of Ostom-i use by utilizing the City of Hope Quality of Life Questionnaire for Patients with an Ostomy. Secondary outcomes of general health-related quality of life and adjustment to ostomy will be evaluated using the Medical Outcomes Study 36-item short form health survey and the Olbrisch Ostomy Adjustment Scale Short Form 2. The project was funded by the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine. Enrollment is currently underway and data analysis is expected to be completed in 2018. Proposed benefits of mobile, internet-linked personal health monitors, such as the Ostom-i, include a reduction in the cost of care by reducing resource utilization and infection rates, improving patient-provider communication, reducing time spent as an inpatient as well as improved quality of life. Prior

  18. Differences in Ostomy Pouch Seal Leakage Occurrences Between North American and European Residents.

    Science.gov (United States)

    Fellows, Jane; Forest Lalande, Louise; Martins, Lina; Steen, Anne; Størling, Zenia M

    The purpose of this study was to compare experiences and concerns about pouch seal leakage between persons with ostomies residing in North America (Canada and the United States) and Europe (United Kingdom, Netherlands, Sweden, Germany, Belgium, France, and Italy). Differences in reported pouch wear time and accessories used between the 2 groups were also examined. Secondary analysis of data from a cross-sectional study (Ostomy Life Study). Responses from persons residing in European countries (n = 1939) were compared with responses of 1387 individuals residing in North American countries. Persons with an ostomy completed a questionnaire that focused on 4 topics related to the daily use of an ostomy pouching system (pouch seal leakage, ballooning, appearance of pouching system such as color and size of the pouch and whether it is discrete under clothing, and coupling failure of 2-piece pouching systems). Pouch seal leakage was defined as stomal effluent seeping between the skin and the wafer of the ostomy pouching system. Statistical analysis was performed using a proportional odds model including various variable effects. Special attention was given to frequency of pouch seal leakage occurrences. All tests were 2-sided; P values ≤.05 were deemed statistically significant. Participants living in the North American countries indicated they were more likely to experience leakage from the ostomy (odds ratio = 2.610, 95% CI 2.187-3.115; P < .0001). Findings also indicated they were more likely to worry about pouch seal leakage than those in the European countries' data set (odds ratio = 2.722, 95% CI 2.283-3.246; P < .0001). Participants residing in the North American countries had significantly longer wear times than those participants in the European countries (P < .0001, χ test). The use of accessories was associated with a longer pouching system wear time. Study results suggest that participants from the North American countries indicated significantly more

  19. Long-term follow-up of patients after antegrade continence enema procedure.

    Science.gov (United States)

    Siddiqui, Anees A; Fishman, Steven J; Bauer, Stuart B; Nurko, Samuel

    2011-05-01

    Antegrade continence enema (ACE) has become an important therapeutic modality in the treatment of intractable constipation and fecal incontinence. There are little data available on the long-term performance of the ACE procedure in children. A retrospective review of patients who underwent the ACE procedure was conducted. Irrigation characteristics and complications were noted. Outcome was assessed for individual encounters based on frequency of bowel movements, incontinence, pain, and predictability. One hundred seventeen patients underwent an ACE. One hundred five patients had at least 6 months of follow-up, and were included in the analysis. Diagnoses included myelodysplasia (39%), functional intractable constipation (26%), anorectal malformations (21%), nonrelaxing internal anal sphincter (7%), cerebral palsy (3%), and other diagnoses (4%). The average follow-up was 68 months (range 7-178 months). At the last follow-up, 69% of patients had successful bowel management. Of the 31% of patients who did not have successful bowel management, 20% were using the ACE despite suboptimal results, 10% required surgical removal, and 2% were not using the ACE because of behavioral opposition to it. Patients were started on normal saline, but were switched to GoLYTELY (PEG-3350 and electrolyte solution) if there was an inadequate response (61% at final encounter). Additives were needed in 34% of patients. The average irrigation dose was 23 ± 0.7 mL/kg. The average toilet sitting time was 51.7 ± 3.5 minutes, with infusions running for 12.1 ± 1.2 minutes. Stomal complications occurred in 63% (infection, leakage, and stenosis) of patients, 33% required surgical revision and 6% eventually required diverting ostomies. Long-term use of the ACE gives successful results in 69% of patients, whereas 63% had a stoma-related complication and 33% required surgical revision of the stoma.

  20. Failed pelvic pouch substituted by continent ileostomy.

    Science.gov (United States)

    Wasmuth, H H; Tranø, G; Wibe, A; Endreseth, B H; Rydning, A; Myrvold, H E

    2010-07-01

    The long-term failure rate of ileal pouch-anal anastomosis (IPAA) is 10-15%. When salvage surgery is unsuccessful, most surgeons prefer pouch excision with conventional ileostomy, thus sacrificing 40-50 cm of ileum. Conversion of a pelvic pouch to a continent ileostomy (CI, Kock pouch) is an alternative that preserves both the ileal surface and pouch properties. The aim of the study was to evaluate clinical outcome after the construction of a CI following a failed IPAA. During 1984-2007, 317 patients were operated with IPAA at St Olavs Hospital and evaluated for failure, treatment and outcome. Seven patients with IPAA failure had CI. Four patients with IPAA failure referred from other hospitals underwent conversion to CI and are included in the final analysis. Seven patients had a CI constructed from the transposing pelvic pouch and four had the pelvic pouch removed and a new continent pouch constructed from the distal ileum. Median follow up after conversion to CI was 7 years (0-17 years). Two CI had to be removed due to fistulae. One patient needed a revision of the nipple valve due to pouch loosening. At the end of follow-up, 8 of the 11 patients were fully continent. One patient with Crohn's disease had minor leakage. In patients with pelvic pouch failure, the possibility of conversion to CI should be presented to the patient as an alternative to pouch excision and permanent ileostomy. The advantage is the continence and possibly a better body image. Construction of a CI on a new ileal segment may be considered, but the consequences of additional small bowel loss and risk of malnutrition if the Kock pouch fails should be appraised.

  1. Spreading continents kick-started plate tectonics.

    Science.gov (United States)

    Rey, Patrice F; Coltice, Nicolas; Flament, Nicolas

    2014-09-18

    Stresses acting on cold, thick and negatively buoyant oceanic lithosphere are thought to be crucial to the initiation of subduction and the operation of plate tectonics, which characterizes the present-day geodynamics of the Earth. Because the Earth's interior was hotter in the Archaean eon, the oceanic crust may have been thicker, thereby making the oceanic lithosphere more buoyant than at present, and whether subduction and plate tectonics occurred during this time is ambiguous, both in the geological record and in geodynamic models. Here we show that because the oceanic crust was thick and buoyant, early continents may have produced intra-lithospheric gravitational stresses large enough to drive their gravitational spreading, to initiate subduction at their margins and to trigger episodes of subduction. Our model predicts the co-occurrence of deep to progressively shallower mafic volcanics and arc magmatism within continents in a self-consistent geodynamic framework, explaining the enigmatic multimodal volcanism and tectonic record of Archaean cratons. Moreover, our model predicts a petrological stratification and tectonic structure of the sub-continental lithospheric mantle, two predictions that are consistent with xenolith and seismic studies, respectively, and consistent with the existence of a mid-lithospheric seismic discontinuity. The slow gravitational collapse of early continents could have kick-started transient episodes of plate tectonics until, as the Earth's interior cooled and oceanic lithosphere became heavier, plate tectonics became self-sustaining.

  2. Use of biologic mesh at ostomy takedown to prevent incisional hernia: A case series

    Directory of Open Access Journals (Sweden)

    Sepehr Lalezari

    Full Text Available Introduction: Incisional hernias are a relatively common occurrence after ostomy takedown with a incidence of 30–35%. The use of biologic mesh offers a means to bolster the stoma incision site with a lower risk of infection than synthetic mesh. Methods: This study represents a retrospective chart review of six patients who underwent stoma takedown and had biologic mesh placed in the retrorectus position during repair from March 2015 until March 2016. Results: There has been a zero-rate of hernia occurrence for the six patients who underwent stoma takedown. No incisional hernias were noted on physical exam with follow up ranging from 11 to 25 months. Conclusion: We conclude that placement of biologic mesh is a safe and effective way of preventing incisional hernias at stoma sites. Keywords: Biologic mesh, Ostomy takedown, Stoma reversal, Incisional hernia, Parastomal hernia, Hernia prophylaxis

  3. Discharge planning for a patient with a new ostomy: best practice for clinicians.

    Science.gov (United States)

    Prinz, Anita; Colwell, Janice C; Cross, Heidi H; Mantel, Janet; Perkins, Jacqueline; Walker, Cynthia A

    2015-01-01

    A comprehensive discharge plan for a patient with a new stoma is needed to ensure the individual receives the necessary ostomy education prior to discharge. The plan should include teaching basic skills and providing information about how to manage the ostomy (ie, emptying and changing the pouch, how to order supplies, available manufacturers, dietary/fluid guidelines, potential complications, medications, and managing gas and odor), assisting with transitions in care, and providing information about resources for support and assistance. The purpose of this best practice guideline is to provide clinicians with a brief overview of the essential elements that should be included in the discharge plan to facilitate patient education and the transition of care from hospital to home.

  4. Use of Convexity in Ostomy Care: Results of an International Consensus Meeting.

    Science.gov (United States)

    Hoeflok, Jo; Salvadalena, Ginger; Pridham, Sue; Droste, Werner; McNichol, Laurie; Gray, Mikel

    Ostomy skin barriers that incorporate a convexity feature have been available in the marketplace for decades, but limited resources are available to guide clinicians in selection and use of convex products. Given the widespread use of convexity, and the need to provide practical guidelines for appropriate use of pouching systems with convex features, an international consensus panel was convened to provide consensus-based guidance for this aspect of ostomy practice. Panelists were provided with a summary of relevant literature in advance of the meeting; these articles were used to generate and reach consensus on 26 statements during a 1-day meeting. Consensus was achieved when 80% of panelists agreed on a statement using an anonymous electronic response system. The 26 statements provide guidance for convex product characteristics, patient assessment, convexity use, and outcomes.

  5. Single-incision laparoscopic surgery through an ostomy site: a natural approach by an unnatural orifice.

    Science.gov (United States)

    Lopez, Nicole E; Peterson, Carrie Y; Ramamoorthy, Sonia L; McLemore, Elisabeth C; Sedrak, Michael F; Lowy, Andrew M; Horgan, Santiago; Talamini, Mark A; Sicklick, Jason K

    2015-02-01

    Single-incision laparoscopic surgery (SILS) is gaining popularity for a wide variety of surgical operations and capitalizes on the benefits of traditional laparoscopic surgery without incurring multiple incision sites. Traditionally, SILS is performed by a midline periumbilical approach. However, such a minimally invasive approach may be utilized in patients who already have an abdominal incision. Our series retrospectively reviews 7 cases in which we utilized the fascial defect at the time of after ostomy reversal as our SILS incision site. In turn, we performed a variety of concurrent intra-abdominal procedures with excellent technical success and outcomes. Our study is the largest single-institution case series of this novel approach and suggests that utilizing an existing ostomy-site abdominal incision is a safe and effective location for SILS port placement and should be considered in patients undergoing concurrent procedures.

  6. Clinical and Economic Burden of Peristomal Skin Complications in Patients With Recent Ostomies

    Science.gov (United States)

    Taneja, Charu; Netsch, Debra; Rolstad, Bonnie Sue; Inglese, Gary; Lamerato, Lois

    2017-01-01

    PURPOSE: The purpose of this study was to estimate the risk and economic burden of peristomal skin complications (PSCs) in a large integrated healthcare system in the Midwestern United States. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: The sample comprised 128 patients; 40% (n = 51) underwent colostomy, 50% (n = 64) underwent ileostomy, and 10% (n = 13) underwent urostomy. Their average age was 60.6 ± 15.6 years at the time of ostomy surgery. METHODS: Using administrative data, we retrospectively identified all patients who underwent colostomy, ileostomy, or urostomy between January 1, 2008, and November 30, 2012. Trained medical abstractors then reviewed the clinical records of these persons to identify those with evidence of PSC within 90 days of ostomy surgery. We then examined levels of healthcare utilization and costs over a 120-day period, beginning with date of surgery, for patients with and without PSC, respectively. Our analyses were principally descriptive in nature. RESULTS: The study cohort comprised 128 patients who underwent ostomy surgery (colostomy, n = 51 [40%]; ileostomy, n = 64 [50%]; urostomy, n = 13 [10%]). Approximately one-third (36.7%) had evidence of a PSC in the 90-day period following surgery (urinary diversion, 7.7%; colostomy, 35.3%; ileostomy, 43.8%). The average time from surgery to PSC was 23.7 ± 20.5 days (mean ± SD). Patients with PSC had index admissions that averaged 21.5 days versus 13.9 days for those without these complications. Corresponding rates of hospital readmission within the 120-day period following surgery were 47% versus 33%, respectively. Total healthcare costs over 120 days were almost $80,000 higher for patients with PSCs. CONCLUSIONS: Approximately one-third of ostomy patients over a 5-year study period had evidence of PSCs within 90 days of surgery. Costs of care were substantially higher for patients with these complications. PMID:28574928

  7. 21 CFR 876.5030 - Continent ileostomy catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Continent ileostomy catheter. 876.5030 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5030 Continent ileostomy catheter. (a) Identification. A continent ileostomy catheter is a flexible tubular device used as a form...

  8. Evaluation of a cyanoacrylate dressing to manage peristomal skin alterations under ostomy skin barrier wafers.

    Science.gov (United States)

    Milne, Catherine T; Saucier, Darlene; Trevellini, Chenel; Smith, Juliet

    2011-01-01

    Peristomal skin alterations under ostomy barrier wafers are a commonly reported problem. While a number of interventions to manage this issue have been reported, the use of a topically applied cyanoacrylate has received little attention. This case series describes the use of a topical cyanoacrylate for the management of peristomal skin alterations in persons living with an ostomy. Using a convenience sample, the topical cyanoacrylate dressing was applied to 11 patients with peristomal skin disruption under ostomy wafers in acute care and outpatient settings. The causes of barrier function interruption were also addressed to enhance outcomes. Patients were assessed for wound discomfort using a Likert Scale, time to healing, and number of appliance changes. Patient satisfaction was also examined. Average reported discomfort levels were 9.5 out of 10 at the initial peristomal irritation assessment visit decreased to 3.5 at the first wafer change and were absent by the second wafer change. Wafers had increasing wear time between changes in both settings with acute care patients responding faster. Epidermal resurfacing occurred within 10.2 days in outpatients and within 7 days in acute care patients. Because of the skin sealant action of this dressing, immediate adherence of the wafer was reported at all pouch changes.

  9. Growing up with confidence: using telehealth to support continence self-care deficits amongst young people with complex needs

    Directory of Open Access Journals (Sweden)

    Sharon Levy

    2014-05-01

    Full Text Available Background Many young people with chronic ill health use technology for selfcare activities, but little is known about the use of telehealth amongst those with spina bifida. The limited availability of specialist continence nurses in primary care settings, for this client group in the UK, exacerbates their reliance on parents or carers.Objectives1. Exploring the way in which home-based and technology-enabled clinical interventions affect young people’s engagement in continence self-care.2. Articulating the way in which telehealth impacts on nursing practice and the conduct of remote clinical encounters.Methods A virtual nurse-led clinic was established to support a small cohort of service users and their parents from home. Data from participants were collected and analysed alongside a narrative record of a reflective diary, used by the continence specialist nurse.Results Participants reported increased level of self-confidence, which was attributed to interacting remotely with the specialist nurse. The virtual clinic assisted users to attain some self-care goals as well as assert their role as partners in care planning. The specialist nurse gained new valuable skills in mastering telehealth technology and managing remote clinical provision.Conclusions Using Skype™ to support young people with complex needs is an effective intervention to support continence care at home. Dedicated technical support during the initial set-up phase and on-going clinical mentorship are needed to ensure that telehealth is successfully embedded within health care practice.

  10. [Functional anatomy of the male continence mechanism].

    Science.gov (United States)

    Schwalenberg, T; Neuhaus, J; Dartsch, M; Weissenfels, P; Löffler, S; Stolzenburg, J-U

    2010-04-01

    The basic structures and organs contributing to continence in men are far less well investigated than in women. This concerns anatomical and functional aspects as well. Especially the cooperation of single components and the dynamic anchoring in the pelvic floor require further investigation. An improved anatomical-functional interpretation is needed to generate therapeutic concepts orientated at the physiology of the bladder neck.Therefore, the focus of anatomical investigations should be on the external sphincter which is the main muscle responsible for urethral closure as well as on the connective tissue, smooth muscular and neuronal structures in the pelvis. The smooth muscular structures involved are the internal sphincter, the inner parts of the external sphincter, the urethral longitudinal musculature, and parts of the centrum perinei and of the ventral suspension apparatus which fixes the position of the bladder neck and seems to be vital for continence and initiation of micturition. These new findings imply an integral concept for men as was developed for women. A first step in this regard would be a consistent and updated anatomical nomenclature.

  11. Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex.

    Science.gov (United States)

    Krouse, Robert S; Herrinton, Lisa J; Grant, Marcia; Wendel, Christopher S; Green, Sylvan B; Mohler, M Jane; Baldwin, Carol M; McMullen, Carmit K; Rawl, Susan M; Matayoshi, Eric; Coons, Stephen Joel; Hornbrook, Mark C

    2009-10-01

    Intestinal stomas can pose significant challenges for long-term (> or = 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL). This was a matched cross-sectional study of long-term RC survivors conducted in three Kaiser Permanente regions. The mailed questionnaire included the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-Ostomy) and Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2). Groups surveyed were permanent ostomates (cases) and those who did not require an ostomy (controls). RC survivors were matched on sex, age, and time since diagnosis. Comparisons between groups used regression analysis with adjustment for age, comorbidity score, history of radiation therapy, income, and work status. Response rate was 54% (491 of 909). Cases and controls had similar demographic characteristics. On the basis of the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared with controls, while only female cases reported significantly worse overall HRQOL and psychological well-being. For younger females (ostomy had a greater impact on physical well-being compared with older females. Based on the SF-36v2, statistically significant and meaningful differences between female cases and controls were observed for seven of the eight scales and on the physical and mental component summary scores. Men and women report a different profile of challenges, suggesting the need for targeted or sex-specific interventions to improve HRQOL in this population. This may include focus on physical HRQOL for female ostomy survivors younger than age 75.

  12. Practice implications for peristomal skin assessment and care from the 2014 world council of enterostomal therapists international ostomy guideline.

    Science.gov (United States)

    Stelton, Susan; Zulkowski, Karen; Ayello, Elizabeth A

    2015-06-01

    All persons with an ostomy are at risk for development of peristomal skin problems. This is true regardless of the person's nation of residence, type of stoma, or supplies available for stoma care. There are measures that can be taken to lessen the potential for peristomal skin problems. These measures include preoperative stoma site marking, preoperative education, appropriate pouch/barrier fitting, and pouch maintenance. The 2014 World Council of Enterostomal Therapists International Ostomy Guideline includes recommendations that can be implemented to prevent situations that may lead to peristomal skin complications.

  13. Integrating Systems Thinking Into Nursing Education.

    Science.gov (United States)

    Phillips, Janet M; Stalter, Ann M

    2016-09-01

    A critical need exists for nursing leadership in current complex health care settings. Systems thinking can be incorporated into nursing education at all levels by using evidence-based principles in education. Teaching tips are provided using a systems awareness model to guide nurse educators in the assessment and integration of systems thinking and engaging learners in interprofessional education and practice. J Contin Educ Nurs. 2016;47(9):395-397. Copyright 2016, SLACK Incorporated.

  14. Quality of life in ostomy patients: a qualitative study

    OpenAIRE

    Tafreshi, Mansoureh Zagheri; Rassouli,Maryam; Dabirian,Azam; Yaghmaie,Farideh

    2010-01-01

    Aazam Dabirian, Farideh Yaghmaei, Maryam Rassouli, Mansoureh Zagheri TafreshiNursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, IranPurpose: Therapeutic procedures may not only treat disease but also affect patient quality of life. Therefore, quality of life should be measured in order to assess the impact of disease and therapeutic procedures. To identify clients' problems, it is necessary to assess several dimensions of quality of life, including p...

  15. Young Africans Tackle Their Continent's Environmental Issues

    Science.gov (United States)

    Olwoch, Jane Mukarugwiza

    2008-11-01

    Young African Scientists Session at the Fourth International Geosphere-Biosphere Programme Congress; Cape Town, South Africa, 7 May 2008; Africa is often described as a unique and diverse continent. This is reflected in its biodiversity, economic and social circumstances, and diversity in culture and environment. The Young African Scientists (YAS) session at the International Geosphere-Biosphere Programme Congress was one of the congress's highlights. Global environmental change research in Africa was presented to an audience that included visiting international and national scientists, policy makers, and a group of schoolchildren. From the uniqueness of Africa's paleoclimate to the diversity and complexity of current and future impacts of environmental change on Africa, the session not only provided an overview of current projects but also highlighted the problems that are intertwined with poverty. This session was sponsored by the Global Change System for Analysis, Research, and Training (START).

  16. The view of nurses about educational practices targeted at people with a stoma

    Directory of Open Access Journals (Sweden)

    Vanessa Cristina Maurício

    2017-09-01

    Full Text Available Abstract Objective: To analyze the point of view of nurses in respect to educational activities aimed at social inclusion of people with ostomies. Method: A qualitative and exploratory, interpretive and critical study based on a dialectical perspective was carried out with six nurses in a municipal rehabilitation center in Rio de Janeiro. The triangulation method was used with individual interviews, participant observation and analysis of documents. Data was analyzed using a historical and dialectical approach. Results: The preparation of people with a stoma in relation to achieving autonomy and independence through teaching self-care was considered important by the nurses; this aspect was highlighted as the most important of all actions performed in the educational process. Conclusions: The nurses had a humanized practice with the educational strategies used by these professionals aiming at making the educational process more dynamic, focused on practical nursing and directed toward real customer needs.

  17. Clinical profile and post-operative lifestyle changes in cancer and non-cancer patients with ostomy

    Science.gov (United States)

    Anaraki, Fakhryalsadat; Vafaie, Mohamad; Behboo, Roobic; Maghsoodi, Nakisa; Esmaeilpour, Sahar

    2012-01-01

    Aim The aim of this was to investigate some clinical profiles and lifestyle changes in stoma patients. Background Stoma patients experienced multiple complications due to their ostomy formation. Patients and methods A cross-sectional study performed on 102 random samples of stoma patients. Any patient with adequate physical and mental capability to participate and having had an ostomy in place for at least 3 months was eligible to enter the study. Participants asked to answer study questions concerning age, sex, type of stoma, having permanent or temporary ostomy, underlying cause of stoma formation, type of cancers cause of stoma. Patient also questioned about some lifestyle changes because of stoma including: changing diet, sexual satisfaction (if sexually active after stoma formation), sense of depression, changing job, change clothing style. Results Colostomy was the most common type of stoma followed by ileostomy and urostomy. In 80.4% of patients under study the stoma was permanent. Most patients had a stoma because of cancer (77.5%), with colon cancer (41.2%) being the most common malignant diagnosis. The mean age of cancer patients (56.1±10.9) with stoma was significantly higher than non-cancer patients (44.7±12.9) (p ostomy. Conclusion In conclusion, stoma formation can caused multiple problems for both cancer and non-cancer patients. Counseling of patient is an important component of care that could help stoma patients to adjust with new situations. PMID:24834234

  18. Nursing--a new tomorrow.

    Science.gov (United States)

    Barrow, D N

    1989-01-01

    This year's recipient of the prestigious Christiane Reimann Award, the "Nobel Prize of Nursing", was Dame Nita Barrow, Ambassador to the UN from Barbados, who was recognized for her distinguished accomplishments in nursing and health care over decades and continents. She was also the keynote speaker at ICN's 19th Quadrennial Congress in Seoul, Korea, 28 May-2 June 1989, described by Korean Prime Minister Kang Young Hoon in his address at the opening ceremonies as the "festival of peace and friendship for nurses the world over". Below, her keynote address.

  19. Frequency, risk factors, and adverse sequelae of bone loss in patients with ostomy for inflammatory bowel diseases.

    Science.gov (United States)

    Gupta, Supriya; Wu, Xianrui; Moore, Travis; Shen, Bo

    2014-02-01

    Bone loss in patients with inflammatory bowel disease (IBD) with ostomy has not been systemically studied. The aims of the study were to evaluate the frequency, risk factors, and sequelae of bone loss in patients with IBD and stomas and to monitor the change in bone mineral density (BMD) over time after ostomy. A total of 126 patients met the inclusion criteria (i.e., those with IBD diagnosis and stoma), including ileostomy (N = 120), colostomy (N = 3), and jejunostomy (N = 3). BMD was measured on dual-energy X-ray absorptiometry (DEXA). Patients were classified as having normal or low BMD based on the International Society for Clinical Densitometry criteria. Thirty-two demographic and clinical variables were evaluated with logistic regression models. At a median of 6.6 years (interquartile range, 2-18.7 yr) after stoma, 37 (29.4%) patients had a low BMD. On univariate analysis, there were no significant differences between the normal and low BMD groups in the following variables: gender, race, age at diagnosis of IBD, prevalence of Crohn's disease and ulcerative colitis, age at ostomy, duration from diagnosis to DEXA and from ostomy to DEXA, menopausal age, diabetes, hypothyroidism, renal stones, short bowel syndrome, history of smoking or excessive alcohol use, family history of IBD or osteoporosis, daily calcium and vitamin D supplement, estrogen replacement, and steroid use. Body mass index was significantly lower in the low BMD group than the normal BMD group (23.3 ± 5.5 versus 26.0 ± 5.2, P = 0.013). Fragility fracture occurred in 8 (21.6%) patients in low BMD group and 4 (4.5%) patients in normal BMD group (P = 0.006). In a multivariate analysis, low body mass index was the only covariate-adjusted factor associated with low BMD. In patients with multiple DEXA scans available over time after ostomy, hip BMD was found to improve marginally, and the lumbar and femoral BMD remained stable. Low BMD was common in patients with IBD after ostomy, largely based on

  20. Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection.

    Science.gov (United States)

    Camacho-Mauries, Daniel; Rodriguez-Díaz, José Luis; Salgado-Nesme, Noel; González, Quintín H; Vergara-Fernández, Omar

    2013-02-01

    The use of temporary stomas has been demonstrated to reduce septic complications, especially in high-risk anastomosis; therefore, it is necessary to reduce the number of complications secondary to ostomy takedowns, namely wound infection, anastomotic leaks, and intestinal obstruction. To compare the rates of superficial wound infection and patient satisfaction after pursestring closure of ostomy wound vs conventional linear closure. Patients undergoing colostomy or ileostomy closure between January 2010 and February 2011 were randomly assigned to linear closure (n = 30) or pursestring closure (n = 31) of their ostomy wound. Wound infection within 30 days of surgery was defined as the presence of purulent discharge, pain, erythema, warmth, or positive culture for bacteria. Patient satisfaction, healing time, difficulty managing the wound, and limitation of activities were analyzed with the Likert questionnaire. The infection rate for the control group was 36.6% (n = 11) vs 0% in the pursestring closure group (p ostomy wound closure (shorter healing time and improved patient satisfaction).

  1. Our Continent, Our Future: African Perspectives on Structural ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Our Continent, Our Future: African Perspectives on Structural Adjustment ... Our Continent, Our Future presents the emerging African perspective on this complex issue. ... approach to structural adjustment, and it does so with the input and support ... Committee of the Association of African Universities, the International Board ...

  2. Living with the physical and mental consequences of an ostomy: a study among 1-10-year rectal cancer survivors from the population-based PROFILES registry.

    Science.gov (United States)

    Mols, Floortje; Lemmens, Valery; Bosscha, Koop; van den Broek, Wim; Thong, Melissa S Y

    2014-09-01

    This study examined the physical and mental consequences of an ostomy among 1-10-year rectal cancer survivors. Patients with rectal cancer diagnosed from 2000 to 2009, as registered in the population-based Eindhoven Cancer Registry, received a questionnaire on quality of life (QOL; EORTC QLQ-C30), disease-specific health status (EORTC QLQ-CR38), depression and anxiety (HADS), illness perceptions (Brief Illness Perception Questionnaire), and health care utilization; 76% (n = 1019) responded. A total of 408 (43%) rectal cancer survivors had an ostomy at survey and they reported a statistically significant and clinically relevant lower physical, role, and social functioning, and global health status/QOL but fewer problems with constipation and diarrhea compared with those without an ostomy. Also, they had a significantly worse body image, more male sexual problems, and fewer gastrointestinal problems although these differences were not clinically relevant. No differences regarding the prevalence of symptoms of anxiety and depression were found. Survivors with an ostomy believed that their illness have significantly more serious consequences, will last longer (clinically relevant), and were more concerned about their illness compared with those without an ostomy. Survivors with an ostomy visited their medical specialist, but not their general practitioner, significantly more often. Also, they more often received additional support after cancer treatment. Rectal cancer survivors with an ostomy have a lower QOL, worse illness perceptions, and a higher health care consumption compared with those without an ostomy 1-10 years after diagnosis. Copyright © 2014 John Wiley & Sons, Ltd.

  3. A continent in chaos: Africa's environmental issues.

    Science.gov (United States)

    Clay, R

    1994-12-01

    Half of Africa's almost 450 million inhabitants have no access to health services, while two-thirds lack safe drinking water, according to a 1991 report by the World Bank. Most Africans are also seriously affected by poverty, civil war, indoor and outdoor pollutants, diarrhea-causing microbes, tropical diseases such as malaria, rapid population growth, inadequate sanitation and sewage treatment, poor environmental management, corrupt government policies, desertification and deforestation, mining, and the overuse of pesticides and insecticides. Environmentally-related diseases compromise the continent's productivity, making it more difficult to generate revenue to fight the environmental health problems. Industrial pollutants remain rare, however, since almost 80% of sub-Saharan Africa remains pastoral or agro-pastoral. Even so, urbanization is exposing growing numbers of sub-Saharan Africans to hazardous and toxic wastes. Developing countries ship their most dangerous wastes to Africa because their own domestic environmental laws and the high costs of disposal make it difficult and expensive to dispose of them at home. The author discusses population growth in Africa; the lack of good data on the environment and health in Africa; infant and child mortality; water, sewage, and garbage; agriculture, mining, and industry; and sustainable development and the future.

  4. Improving and ensuring best practice continence management in residential aged care.

    Science.gov (United States)

    Heckenberg, Gayle

    2008-06-01

    Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness

  5. Continous Infusion of Remifentanil Plus Ketamine Compared with Continous Remifentanil for Pain Relief in Labour

    Directory of Open Access Journals (Sweden)

    Anooshe Khajehdehi

    2011-12-01

    Full Text Available Abstract Background and objective: Pain relief during labour is an important determinant of a women’s birth experience. There are numerous pain relief techniques which can be used either with or without pain medication. The aim of our study was to compare the effect of remifentanil alone and its effect in pain relief while using with ketamine during labour. Methods: After obtaining informed consent and approval of hospital ethics committee, 40 women with gestational age between 38 and 42 weeks gestation in early labour were recruited for this study. They were randomly allocated into two groups: group RK (20 cases received 25 μg remifentanil as a starting dose and continuous infusion of 0.06 μg/kg/min remifentanil plus 0.5 mg/kg/h ketamine for 4 hours via pump and group R (20 cases received 25 μg remifentanil as a starting dose and continous infusion of 0.06 μg/kg/min remifentanil. Results: The baseline of pain scores were similar in both groups (5.75 ± 2.51 vs 7 ± 2.45, p= 0.12 but after 30 minutes to 120 minutes the VAS scores were significantly higher in R group (p< 0.001. The rate of patients who were satisfied (excellent and very good in RK was 80% but in R group was 45% (p = 0.03. Nausea and vomiting were significantly higher in R group (p<0.05. Conclusion: The remifentanil plus ketamine produced better pain relief during labour with continous monitoring than continous remifentanil with no adverse effects for mothers and infants.

  6. TECHNICAL CHARACTERISTICS OF RADICAL PROSTATECTOMY FOR EARLY CONTINENCE RECOVERY

    Directory of Open Access Journals (Sweden)

    V. A. Perepechay

    2014-07-01

    Full Text Available The paper presents the technical characteristics of radical prostatectomy (RPE for early continence recovery in patients with prostate cancer. Restoration of the fascial structures of the small pelvis after RPE has been found to promote early urinary continence recovery. A method for total restoration of the fascial structures of the small pelvis (an operation after A. Tewari and a procedure for performing posterior suspension of urethrocystic neoanastomosis in Denonvilliers’ fascia length deficit are considered, which show the similar results in the time of continence recovery.

  7. Factors predicting early return of continence after radical prostatectomy.

    Science.gov (United States)

    Sandhu, Jaspreet S; Eastham, James A

    2010-05-01

    Success of radical prostatectomy is measured by control of cancer and return of urinary and sexual function. Urinary incontinence is generally considered the greatest impairment in immediate postoperative urinary function. Multiple factors are associated with earlier return of urinary continence after radical prostatectomy. These factors can be divided into those known prior to surgery, and therefore possibly not modifiable, and factors that can be controlled during surgery or surgical planning. In addition, various postoperative maneuvers can help hasten urinary continence. This article examines the effect of known factors related to early return of urinary continence after radical prostatectomy.

  8. A Cross-sectional Study to Determine Whether Adjustment to an Ostomy Can Predict Health-related and/or Overall Quality of Life.

    Science.gov (United States)

    Indrebø, Kirsten Lerum; Natvig, Gerd Karin; Andersen, John Roger

    2016-10-01

    Ostomy-specific adjustment may or may not predict health-related quality of life (HRQoL) and/or overall quality of life (QoL). A cross-sectional study was conducted among patients recruited from the customer registers of 8 surgical suppliers and pharmacies across Norway between November 2010 and March 2011 to determine which of the 34 items of the Ostomy Adjustment Scale (OAS) are the strongest predictors for HRQoL and overall QoL and to determine the HRQoL and overall QoL of individuals with an ostomy compared to a control group representing the general population. Persons who were >18 years old; had a permanent colostomy, ileostomy, or urostomy for >3 months; and could read and write Norwegian were invited to participate. The participants received information about the study in a letter from the researcher and returned their demographic information (addressing gender, age, marital status, education, diagnosis, time since surgery, and ostomy type) and study questionnaires using prepaid envelopes. The 158 participants (mean age 64 years [range 29-91], 89 [56%] men and 69 [44%] women) completed and returned by mail a sociodemographic questionnaire, the 34-item OAS (questions scored on a scale of 1 to 6, totally disagree to totally agree, score range 34 to 204), the Short Form-36 (SF-36, including 2 main components [physical and mental issues] divided into 8 subscales, scored from 0 to 100), and the 16-item Quality of Life Scale (QOLS) instrument (each response scored 1 to 7, from very dissatisfied to very satisfied; total score ranging from 16 to 112). Statistical analysis, including ordinary least square regression analyses, assessed whether the OAS independently predicted the sum scores of the SF-36 (physical component summary [PCS] and mental component summary [MCS]) and the QOLS score after adjusting for age, gender, marital status, education, diagnosis, time since surgery, and ostomy type. The OAS significantly predicted the SF-36 (PCS and MCS) and QOLS scores

  9. A Randomized Controlled Trial Determining Variances in Ostomy Skin Conditions and the Economic Impact (ADVOCATE Trial).

    Science.gov (United States)

    Colwell, Janice C; Pittman, Joyce; Raizman, Rose; Salvadalena, Ginger

    To compare ostomy-related costs and incidence of peristomal skin complications (PSCs) for ceramide-infused ostomy skin barriers and control skin barriers. The ADVOCATE trial is a multi-centered randomized controlled trial, and double-blinded international study with an adaptive design. The sample comprised 153 adults from 25 sites from the United States, Canada, and Europe. Participants were seen in hospital and outpatient care settings. Data were collected by investigators at each site during face-to-face visits and during telephone check-in calls between visits. Cost of care data were collected using a questionnaire developed specifically for the study. The peristomal skin was assessed using the Ostomy Skin Tool. Health-related quality of life was measured using the SF-12v2. Patient-reported outcomes were collected using a patient-centered study-specific questionnaire. Cost of care was analyzed via analysis of covariance comparing total cost of care for 12 weeks between the 2 groups. The incidence of PSC was analyzed via Barnard's exact test comparing the incidence of PSCs between the control and treatment groups. Tertiary outcomes were exploratory in nature and not statistically powered. Use of the ceramide-infused barrier significantly reduced stoma-related cost of care over a 12-week period, resulting in a $36.46 decrease in cost (14% relative decrease). The adjusted average costs were $223.73 in the treatment group and $260.19 in the control group (P = .017). The overall incidence of PSCs in the study was 47.7%; PSC incidence was 40.5% for the treatment group versus 55.4% for controls (P = .069, 95% confidence interval of the difference: -1.2 to 30.4). Significantly more participants using the ceramide-infused skin barrier were "very satisfied" with barrier performance (75% vs 55%; P = .033), prevention of leakage (63% vs 38%; P < .01), and prevention of itching (53% vs 31%; P = .016). General postoperative improvement in health-related quality of life was

  10. Adoption of innovations by specialised nurses: personal, work and organisational characteristics.

    NARCIS (Netherlands)

    Weide, M.J.A. van der; Smits, J.P.J.M.

    2004-01-01

    BACKGROUND: To gain insight in the factors that influence the adoption of professional information by specialised nurses, we studied the effects of individual, work and organisational characteristics on the extent to which continence nurses gained knowledge and made use of a book on nursing

  11. Preferential rifting of continents - A source of displaced terranes

    Science.gov (United States)

    Vink, G. E.; Morgan, W. J.; Zhao, W.-L.

    1984-01-01

    Lithospheric rifting, while prevalent in the continents, rarely occurs in oceanic regions. To explain this preferential rifting of continents, the total strength of different lithospheres is compared by integrating the limits of lithospheric stress with depth. Comparisons of total strength indicate that continental lithosphere is weaker than oceanic lithosphere by about a factor of three. Also, a thickened crust can halve the total strength of normal continental lithosphere. Because the weakest area acts as a stress guide, any rifting close to an ocean-continent boundary would prefer a continental pathway. This results in the formation of small continental fragments or microplates that, once accreted back to a continent during subduction, are seen as displaced terranes. In addition, the large crustal thicknesses associated with suture zones would make such areas likely locations for future rifting episodes. This results in the tendency of new oceans to open along the suture where a former ocean had closed.

  12. Literature review of factors affecting continence after radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Dalibor Pacik

    2017-01-01

    Full Text Available Radical prostatectomy (RP is the most common cause of stress urinary incontinence (UI in men. Several anatomic structures affect or may affect urinary continence - urethral sphincter, levator ani muscle, puboprostatic ligaments, bladder neck, endopelvic fascia, neurovascular bundle - and understanding of the anatomy of pelvic floor and urethra is crucial for satisfactory functional outcome of the procedure. Surgical techniques implemented to improve continence rates include nerve-sparing procedure, bladder neck preservation/plication, urethral length preservation, musculofascial reconstruction, puboprostatic ligaments preservation or seminal vesicle preservation. Perioperative (preoperative and postoperative pelvic floor muscle training (PFMT aims to shorten the duration of postoperative UI and thus, improve early continence rates postoperatively. In the review, complex information regarding anatomical, intra- and perioperative factors affecting urinary continence after RP is provided, including description of important anatomical structures, possible implications for surgical technique and evaluation of different PFMT strategies in perioperative period.

  13. Grupo operativo como estratégia pedagógica em um curso graduação em enfermagem: um continente para as vivências dos alunos quartanistas Grupo operativo como estrategia pedagógica en un curso de graduación en enfermería: un continente para las vivencias de los alumnos del cuarto ano Operative group as a pedagogical strategy in a nursing graduation course: a continent for the fourth-year students' experiences

    Directory of Open Access Journals (Sweden)

    Roselma Lucchese

    2002-03-01

    ' experiencé, a qualitative study with the research-action method was produced. The problematic of the study involved the concept that learning is a socialization process which demands changes and mobilize the novices' feelings. The operative group worked as a continent for the students' experiences in which they could explain their feelings. Such feelings, mobilized on their graduation process, were impossible to be ignored the nursing teacher.

  14. The utilization and valuation of the program CONTIN

    International Nuclear Information System (INIS)

    Yu Weizhong; Sun Yizhan

    2000-01-01

    The updated analysis program CONTIN(PALS2) based on the Laplace inversion of positron annihilation spectra has been studied comprehensively. The principle and utilization of the program have been explained exhaustively. Three auxiliary programs have been made to help the transportation of data and adjustment of the data's pattern. Four experiments have been made, the results computed by program CONTIN(PALS2) have been analyzed, and compared with those by POSIREONFIT program

  15. Triple-Tube-Ostomy: A Novel Technique for the Surgical Treatment of Iatrogenic Duodenal Perforation

    Directory of Open Access Journals (Sweden)

    Nobuaki Fujikuni

    2011-12-01

    Full Text Available Although duodenal perforation is currently an infrequent complication of medical procedures, its incidence in the future predictably will increase as endoscopic treatment of duodenal neoplasms becomes more frequently used. In some cases, duodenal perforation is difficult to treat even surgically. We report here a novel technique called ‘triple-tube-ostomy’ for the treatment of iatrogenic duodenal perforation. Since November 2009, there have been three cases of iatrogenic perforation of the duodenum, due to various causes, which we have treated with our novel technique. The main principles of the technique are biliary diversion, decompression of the duodenum, and early enteral nutrition. All patients who underwent the triple-tube-ostomy procedure had good postoperative courses, with few complications. The novel surgical technique we describe in this report is safe, reliable, easy to learn and perform, and led to a good postoperative course in all cases where we performed it.

  16. Experiences of the family caregiver of a person with intestinal ostomy due to colorectal cancer

    Directory of Open Access Journals (Sweden)

    Gláucia Sousa Oliveira

    2014-04-01

    Full Text Available This is a study with the objective to know the experiences of the family caregiver of a person with intestinal ostomy due to colorectal cancer. A qualitative research, grounded on the humanization referential, made in 2013, through serialized semi-structured interviews and inductive analysis. It was approved by the Ethics and Research Committee under legal opinion no. 237,771. Seven family caregivers participated in this study in a county of southern Minas Gerais state, Brazil. Three categories emerged from the data: Relation with the disease and its treatments; Impact facing treatment and rehabilitation and Nets of support. The representation of the disease associated to finitude is reaffirmed. In order to lessen anguish and suffering, the family caregivers search support, mainly in spirituality. The impact resulting from the illness and the rehabilitation process imposes a new order to the caregivers, with personal and social renouncing, which provides a closer and more dedicated relation with the patient.

  17. Fission track imaging of the Australian continent

    International Nuclear Information System (INIS)

    Gleadow, A.; Kohn, B.; O'Sullivan, P.; Brown, R.; Gallagher, K.

    1999-01-01

    Full text: Techniques to reconstruct the thermal histories of rocks in the low-temperature environment of the upper crust have previously found important applications in such areas as sedimentary basin analysis, the evolution of convergent orogenic belts and studies of extensional tectonic environments. Increasingly large sets of thermochronology data are now becoming available on an even larger scale from the apatite fission-track system (for temperatures <∼110 deg C). Additional information is also now starting to emerge at even lower temperatures (<∼75 deg C) from the apatite (U-Th)/He system. The results from such systems can be used in novel ways to examine and visualise the evolution of the upper part of the continental crust. Quantitative modelling has brought a new dimension to this work and forward-modelling procedures are now well established which give 'best fit' thermal histories for temperatures less than about 110 deg C. In many cases the modelled thermal histories provide a proxy for rock transport towards the surface as overlying material is removed by denudation. Such information allows a reconstruction of the denudation history of the land surface. Applying these modelling procedures to large regional arrays of fission-track data means that the thermal history information can now be integrated with other regional data sets to provide an important new perspective on crustal and surface evolution. Apatite fission track analysis has now been completed on nearly 3000 surface outcrop samples across Australia under an AGCRC project to image the thermotectonic evolution of the exposed basement rocks of the continent. The samples analysed are mostly from rocks of broadly granitic composition and the apatites separated from these are overwhelmingly fluorapatites, which are consistent in their fission-track annealing properties with those on which the numerical annealing models are based. By interpolating the calculated thermal histories a series of

  18. The Influence of Husbands' or Male Partners' Support on Women's Psychosocial Adjustment to Having an Ostomy Resulting from Colorectal Cancer

    Science.gov (United States)

    Altschuler, Andrea; Ramirez, Michelle; Grant, Marcia; Wendel, Christopher; Hornbrook, Mark C.; Herrinton, Lisa; Krouse, Robert S.

    2009-01-01

    Objective Some patients with colorectal cancer (CRC) require a permanent ostomy, which changes bodily function and can create psychosocial distress. However, little is known about the influence of men's support on women's psychosocial adjustment to having an ostomy as a result of CRC. Methods Participants initially completed the City of Hope-CRC Quality of Life questionnaire. We then conducted in-depth interviews with 30 female participants. Interview questions focused on body image, gender, and sexuality. Interviews were recorded and transcribed. We used qualitative methods to analyze the interview data and compared global HRQOL quartile scores to the overall ways that women discussed husbands' or partners' support regarding psychosocial adjustments to having ostomies. Results Of 30 participants, 22 were married or partnered at the time of surgery and 8 were single. The non-partnered respondents are not included in this analysis. Of the 22 married/partnered women, 17 described positive support from husbands being central to their psychosocial adjustment, 3 described a lack or withdrawal of support negatively affecting adjustment, and 2 described support as neither positive nor negative. In 17 cases, women's high or low quantitative HRQOL scores matched the positive or negative qualitative findings. There were 3 cases in which there were positive qualitative data and low HRQOL scores, but each of these cases, women reported serious current co-morbidities. Conclusions These findings suggest that the provision or withdrawal of husbands' or partners' support can have a considerable impact on the psychosocial adjustment of female CRC patients with ostomies. These findings appear to be both short- and long-term. Survivorship assessments should include appraisals of women's relationships to spouses/partners. PMID:19448512

  19. Psychological well-being and quality of life in Crohn's disease patients with an ostomy: a preliminary investigation.

    Science.gov (United States)

    Knowles, Simon R; Wilson, Jarrad; Wilkinson, Annette; Connell, William; Salzberg, Michael; Castle, David; Desmond, Paul; Kamm, Michael A

    2013-01-01

    The aims of this research were to explore associations among elective versus emergency surgery, type of ostomy (permanent vs temporary), illness perceptions and coping style, anxiety, depression, and health-related quality of life in persons with Crohn's disease. A further aim was to determine the extent of current and past use of psychological care and use of psychotropic medications. The sample comprised 31 persons (17 men and 14 women; mean age 45 years) with Crohn's disease and an ostomy from 2 large teaching hospitals in Melbourne, Australia. Data were collected using a descriptive, cross-sectional design. The questionnaire incorporated 3 validated instruments: the Brief Illness Perceptions Questionnaire, the Hospital Anxiety and Depression Scale, and the Stoma Quality of Life Scale. Poor illness perception correlated significantly with increased anxiety, depression, and reduced health-related quality of life (specifically, sexuality and body image, work and social functioning, stoma function, and financial concerns). Forty-eight percent of patients scored more than the cutoff for anxiety, and 42% scored more than the cutoff for depression on the Hospital Anxiety and Depression Scale. Of these, only 20% and 31%, respectively, reported currently receiving psychological care. The timing of ostomy surgery (planned vs emergency) or ostomy type (permanent vs temporary) was not significantly associated with anxiety, depression, or health-related impaired quality of life. In this exploratory, cross-sectional study, patients with Crohn's disease and a stoma had high rates of psychological comorbidity and low scores on quality of life. Adverse illness perception appeared to explain some of these findings, but most were not receiving psychological help. Psychological care is indicated for many of these patients and further research is indicated.

  20. The influence of husbands' or male partners' support on women's psychosocial adjustment to having an ostomy resulting from colorectal cancer.

    Science.gov (United States)

    Altschuler, Andrea; Ramirez, Michelle; Grant, Marcia; Wendel, Christopher; Hornbrook, Mark C; Herrinton, Lisa; Krouse, Robert S

    2009-01-01

    Some patients with colorectal cancer (CRC) require a permanent ostomy, which changes bodily function and can create psychosocial distress. However, little is known about the influence of men's support on women's psychosocial adjustment to having an ostomy as a result of CRC. Participants initially completed the City of Hope-CRC Quality of Life questionnaire. We then conducted in-depth interviews with 30 female participants. Interview questions focused on body image, gender, and sexuality. Interviews were recorded and transcribed. We used qualitative methods to analyze the interview data and compared global health-related quality of life (HRQOL) quartile scores to the overall ways that women discussed husbands' or partners' support regarding psychosocial adjustments to having ostomies. Of 30 participants, 22 were married or partnered at the time of surgery and 8 were single. The nonpartnered respondents are not included in this analysis. Of the 22 married/partnered women, 17 described positive support from husbands being central to their psychosocial adjustment, 3 described a lack or withdrawal of support negatively affecting adjustment, and 2 described support as neither positive nor negative. In 17 cases, women's high or low quantitative HRQOL scores matched the positive or negative qualitative findings. There were 3 cases in which there were positive qualitative data and low HRQOL scores, but in each of these cases, women reported serious current comorbidities. These findings suggest that the provision or withdrawal of husbands' or partners' support can have a considerable impact on the psychosocial adjustment of female CRC patients with ostomies. These findings appear to be both short term and long term. Survivorship assessments should include appraisals of women's relationships to their spouses/partners.

  1. [Pseudo-continent perineal colostomy. Results and techniques].

    Science.gov (United States)

    Lasser, P; Dubé, P; Guillot, J M; Elias, D

    1997-09-01

    This prospective study was conducted to assess functional results obtained after pseudo-continent perineal colostomy using the Schmidt procedure. Functional outcome was assessed in 40 patients who had undergone amputation of the rectum for cancer and pseudo-continent perineal colostomy reconstruction between 1989 and 1995 in our institution. The cancer pathology, operative procedure and post-operative care were noted. Morbidity, functional outcome and degree of patient satisfaction were recorded. Mean follow-up was 45 months (18-87) in 100% of the patients. There were no operative deaths. Twenty patients had post-operative complications and 2 patients required early conversion to definitive abdominal colostomy due to severe perineal complications. Function outcome showed normal continence in 4 patients, air incontinence in 23, occasional minimal leakage in 9 and incontinence requiring iliac colostomy in 2. Eighty-six percent of the patients were highly satisfied or satisfied with their continence capacity. Pseudo-continent perineal colostomy is a reliable technique which can be proposed as an alternative to left iliac colostomy after amputation of the rectum for cancer if a rigorous procedure is applied: careful patient selection, informed consent, rigorous surgical procedure, daily life-long irrigation of the colon.

  2. Study on sediments from Almirantado Bay in the Antarctica continent

    International Nuclear Information System (INIS)

    Gomes, Marcelo da Silva; Montone, Rosalinda Carmela; Weber, Rolf Roland

    1999-01-01

    The Antarctic Continent is relatively free from human activities but it already comes presenting low levels of environmental contamination for anthropogenic sources. The anthropogenic contamination can be taken mainly to the continent through different manners for the marine and atmospheric currents. This work has as objective to analyze samples of sediments from Antarctic Continent in the area of Almirantado Bay, where the Brazilian Station of Resource Comandante Ferraz is located. The concentrations of ten metallic elements (Ni, Cu, Zn, Cd, Sn, Pb, U, Al, Fe and Li) were analyzed in twelve collection sites along the whole Bay. AAS and HR-ICPMS accomplished the analyses of those metallic elements. It was verified in the obtained results that a variation does not exist in the concentrations obtained among the collection sites, indicating a homogeneity in the area and there is no evidence of polluting source, at least at those obtained concentration levels. (author)

  3. A Geological Model for the Evolution of Early Continents (Invited)

    Science.gov (United States)

    Rey, P. F.; Coltice, N.; Flament, N. E.; Thébaud, N.

    2013-12-01

    Geochemical probing of ancient sediments (REE in black shales, strontium composition of carbonates, oxygen isotopes in zircons...) suggests that continents were a late Archean addition at Earth's surface. Yet, geochemical probing of ancient basalts reveals that they were extracted from a mantle depleted of its crustal elements early in the Archean. Considerations on surface geology, the early Earth hypsometry and the rheology and density structure of Archean continents can help solve this paradox. Surface geology: The surface geology of Archean cratons is characterized by thick continental flood basalts (CFBs, including greenstones) emplaced on felsic crusts dominated by Trondhjemite-Tonalite-Granodiorite (TTG) granitoids. This simple geology is peculiar because i/ most CFBs were emplaced below sea level, ii/ after their emplacement, CFBs were deformed into relatively narrow, curviplanar belts (greenstone basins) wrapping around migmatitic TTG domes, and iii/ Archean greenstone belts are richly endowed with gold and other metals deposits. Flat Earth hypothesis: From considerations on early Earth continental geotherm and density structure, Rey and Coltice (2008) propose that, because of the increased ability of the lithosphere to flow laterally, orogenic processes in the Archean produced only subdued topography (continents, Flament et al. (2008) proposed a theory for the hypsometry of the early Earth showing that, until the late Archean, most continents were flooded and Earth was largely a water world. From this, a model consistent with many of the peculiar attributes of Archean geology, can be proposed: 1/ Continents appeared at Earth's surface at an early stage during the Hadean/Archean. However, because they were i/ covered by continental flood basalts, ii/ below sea level, and iii/ deprived of modern-style mountain belts and orogenic plateaux, early felsic

  4. Early reported rectal sensation predicts continence in anorectal anomalies.

    Science.gov (United States)

    Skerritt, Clare; Tyraskis, Athanasios; Rees, Clare; Cockar, Iram; Kiely, Edward

    2016-03-01

    Straining at stool is an automatic reflex in babies and implies the presence of rectal sensation. We hypothesised that early reported rectal sensation would predict future continence in children with anorectal anomalies. The aim of this study is to determine if early straining at stool was a useful predictor of future continence in infants born with high anorectal malformations. A retrospective case note review of prospectively collected clinical information was performed with institutional review board approval. All patients with intermediate/high anorectal malformation operated on by a single surgeon from 1984 to 2010 were included. After stoma closure, parents were asked: The responses were noted within the first year of stoma closure and then all patients were followed up until they were at least 3 ½years old and continence could be assessed using the Krickenbeck outcome classification. Data were compared using Fisher's exact test and sensitivity, specificity and positive predictive value (PPV) were calculated. Forty-eight patients were included in the study. Sixteen (33%) were female (12 cloacal malformation, 3 rectovaginal fistula, 1 rectal atresia) and 32 (66%) were male (6 rectovesical fistulae, 22 rectourethral fistulae, 4 no fistula). Median follow-up was 9.7years (range 3.5-17.9). Twenty-one children were noted by their parents to exhibit early straining at stool after stoma closure. Twenty of them achieved long term continence. The sensitivity of early straining as a predictor for long term continence was 77%, specificity 95% and positive predictive value 95%. The presence of early rectal sensation reported by parents is a good predictor of long term continence. This allows more informed discussion with families in the early years of life. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Characterization of patients with ostomy treated at a public municipal and regional reference center

    Directory of Open Access Journals (Sweden)

    Luis Fernando Melotti

    2013-04-01

    Full Text Available Objective: to characterize patients with ostomy treated at a municipal and regional refer- ence center in the state of Rio Grande do Sul. Methods: this is a retrospective and descriptive study, based on the records of patients with ileostomy or colostomy recorded in this service between 2000 and 2010. Results: a total of 273 patients were studied, of which 145 were females. The mean age was 64.5 years. Patients with incomplete elementary education (43.6% and retirees/pensioners (44.7% were the most prevalent. The main cause for the stoma was neoplastic disease, with 45.8% of colorectal cancer and 5.5% of cancers at other sites. Other causes were: diverticular disease (7%, bowel obstruction (7%, functional bowel disorders (4.8%, abdominal trauma (2.9%, non-traumatic bowel perforation (2.6%, inflammatory bowel diseases (1.8% and intestinal polyposis (0.7%. Regarding the type of ostomy, 85.7% were performed by colostomy and 15.8% by ileostomy. Conclusions: the study population consisted mainly of patients older than 60 and females. The main intervention performed was permanent colostomy and the most important cause for the procedure performance was colorectal cancer. Resumo: Objetivo: caracterizar as pessoas com estomia atendidas em um serviço de referência mu- nicipal e regional do Rio Grande do Sul. Métodos: estudo retrospectivo e documental, com consulta aos registros dos usuários com ileostomia ou colostomia cadastrados no referido serviço entre 2000 e 2010. Resultados: foram avaliadas 273 pessoas, sendo 145 mulheres e 128 homens. A média de idade foi de 64,5 anos. Prevaleceram usuários com ensino fundamental incompleto (43,6% e da classe de aposentados/pensionistas (44,7%. A principal causa motivadora da estomia foi a neoplásica, sendo 45,8% de neoplasia de intestino e 5,5% de neoplasias em outros sí- tios. Outras causas encontradas foram: doença diverticular (7%, obstrução intestinal (7%, transtornos funcionais do intestino (4

  6. A qualitative study exploring the experiences and emotional responses of female community continence link workers and female patients in relation to performing clean intermittent self-catheterisation

    OpenAIRE

    Ramm, Dianne; Kane, Ros

    2011-01-01

    Aim: This paper represents a report of a study designed to explore the experiences of female community continence link nurses in relation to female catheterisation and their psychological and educational preparedness to teach it. The lived experiences and emotional responses of female patients learning to perform Clean Intermittent Self-Catheterisation (CISC) are also examined. Background: There is general consensus that CISC should be considered in preference to indwelling catheterisat...

  7. Abdominal Wall Reconstruction with Concomitant Ostomy-Associated Hernia Repair: Outcomes and Propensity Score Analysis.

    Science.gov (United States)

    Mericli, Alexander F; Garvey, Patrick B; Giordano, Salvatore; Liu, Jun; Baumann, Donald P; Butler, Charles E

    2017-03-01

    The optimal strategy for abdominal wall reconstruction in the presence of a stomal-site hernia is unclear. We hypothesized that the rate of ventral hernia recurrence in patients undergoing a combined ventral hernia repair and stomal-site herniorraphy would not differ clinically from the ventral hernia recurrence rate in patients undergoing an isolated ventral hernia repair. We also hypothesized that bridged ventral hernia repairs result in worse outcomes compared with reinforced repairs, regardless of stomal hernia. We retrospectively reviewed prospectively collected data from consecutive abdominal wall reconstructions performed with acellular dermal matrix (ADM) at a single center between 2000 and 2015. We compared patients who underwent a ventral hernia repair alone (AWR) and those who underwent both a ventral hernia repair and ostomy-associated herniorraphy (AWR+O). We conducted a propensity score matched analysis to compare the outcomes between the 2 groups. Multivariable Cox proportional hazards and logistic regression models were used to study associations between potential predictive or protective reconstructive strategies and surgical outcomes. We included 499 patients (median follow-up 27.2 months; interquartile range [IQR] 12.4 to 46.6 months), 118 AWR+O and 381 AWR. After propensity score matching, 91 pairs were obtained. Ventral hernia recurrence was not statistically associated with ostomy-associated herniorraphy (adjusted hazard ratio [HR] 0.7; 95% CI 0.3 to 1.5; p = 0.34). However, the AWR+O group experienced a significantly higher percentage of surgical site occurrences (34.1%) than the AWR group (18.7%; adjusted odds ratio 2.3; 95% CI 1.4 to 3.7; p < 0.001). In the AWR group, there were significantly fewer ventral hernia recurrences when the repair was reinforced compared with bridged (5.3% vs 38.5%; p < 0.001). There was no statistically significant difference in ventral hernia recurrence between the AWR and AWR+O groups. Bridging was associated

  8. Impact of aerosols from the Asian Continent on the adjoining ...

    Indian Academy of Sciences (India)

    J. Earth Syst. Sci. ... aerosol impact on weather and climate, which is ... factor in climate models. The impact of aerosols from the Asian Continent .... as cloudy. Such data grids generated for each month in different years for the period of study.

  9. Our Continent, Our Future: African Perspectives on Structural ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Our Continent, Our Future: African Perspectives on Structural Adjustment ... Our Future presents the emerging African perspective on this complex issue. ... This important book should be read by students, professors, academics, and ... the Council for the Development of Social Research in Africa in Dakar, Senegal.

  10. a simple test to predict faecal continence before colostomy closure

    African Journals Online (AJOL)

    reconstituted with water to a consistency that matches the surgeon's notion of normal faeces. ... there be no leakage the colostomy can be reversed. The study was a .... 100 mmHg, more than a quarter of matched continent controls also had a ...

  11. Exercise and cancer: return to work as a firefighter with ostomy after rectal carcinoma - a case report.

    Science.gov (United States)

    Wiskemann, Joachim; Schommer, Kai; Jaeger, Dirk; Scharhag-Rosenberger, Friederike

    2016-07-01

    Colorectal cancer survivors are deconditioned through anticancer therapy. Furthermore, about 10% of them have a permanent ostomy which is associated with weakened abdominal muscles and an increased risk of a hernia. This case study reports on how a firefighter with rectal carcinoma and ostomy was trained to regain operational fitness. A 44-year-old firefighter (178 cm, 82 kg) with an adenocarcinoma of the rectum (diagnosed 24 months prior) had been treated with neoadjuvant radiochemotherapy and surgery. After 2 temporary ileostomies, a permanent colostomy was performed 14 weeks before the start of a 9-months training program. The program included sensorimotor, endurance, and strength training of increasing volume and intensity. Endurance, strength, and patient reported outcomes were assessed every 2 to 3 months. Training frequency varied from 1 to 3 sessions/week, although 3 to 5 sessions/week were prescribed. Peak power output was 150, 158, 167, 192, and 175 watts at baseline, 2, 4, 6, and 9 months. Maximal oxygen uptake increased from 1.56 L/min (19.0 mL/min/kg) to 2.39 L/min (28.8 mL/min/kg) after 6 months. Maximal isokinetic peak torque (MIPT) of the knee extensors were 138.0 and 196.5 Nm (Newton meter) at baseline and 6 months. MIPT of the elbow and hip flexors increased from 51.8 to 66.0 Nm and 213.8 to 239.7 Nm, respectively, after 6 months. Physical fatigue decreased by 65% and distress by about 50% after 9 months. The firefighter passed a test for occupational fitness after 6 months and was permitted to work with an exterior crew on a pump truck. It is possible for colorectal cancer survivors with ostomy to regain occupational fitness for physically demanding tasks like firefighting through an individually tailored and supervised training program.

  12. A Chinese version of the City of Hope Quality of Life-Ostomy Questionnaire: validity and reliability assessment.

    Science.gov (United States)

    Gao, Wenjun; Yuan, Changrong; Wang, Jichuan; Du, Jiarui; Wu, Huiqiao; Qian, Xiaojie; Hinds, Pamela S

    2013-01-01

    The City of Hope Quality of Life-Ostomy Questionnaire is a widely accepted scale to assess quality of life in ostomy patients. However, the validity and reliability of the Chinese version (C-COH) have not been studied. The objective of the study was to assess the validity and reliability of the C-COH among ostomy patients sampled from Shanghai from August 2010 to June 2011. Content validity was examined based on the reviews of a panel of 10 experts; test-retest was conducted to assess the item reliabilities of the scale; a pilot sample (n = 274) was selected to explore the factorial structure of the C-COH using exploratory factor analysis; a validation sample (n = 370) was selected to confirm the findings from the exploratory study using confirmatory factor analysis (CFA). Statistical package SPSS version 16.0 was used for the exploratory factor analysis, and Amos 17.0 was used for the CFA. The C-COH was developed by modifying 1 item and excluding 11 items from the original scale. Four factors/subscales (physical well-being, psychological well-being, social well-being, and spiritual well-being) were identified and confirmed in the C-COH The scale reliabilities estimated from the CFA results for the 4 subscales were 0.860, 0.885, 0.864, and 0.686, respectively. Findings support the reliability and validity of the C-COH. The C-COH could be a useful measure of the level of quality of life among Chinese patients with a stoma and may provide important intervention implications for healthcare providers to help improve the life quality of patients with a stoma.

  13. The problem of early continence recovery after radical prostatectomy

    Directory of Open Access Journals (Sweden)

    A. A. Kachmazov

    2017-01-01

    Full Text Available Background. The highest rate of incontinence after radical prostatectomy (RP is observed in the first 2–6 months after surgery. In order  to decrease the period of incontinence, virous surgical methods aimed at preservation and reconstruction of structures participating  in the mechanism of urine retention has been developed and improved.The study objective is to evaluate effectiveness of an original method of formation of an urethral anastomosis in the early continence recovery.Materials and methods. Data on 126 patients who underwent retropubic RP were analyzed. Depending on the method of urethral anastomosis formation, patients were divided into 2 groups: in the 1st group (n = 52 the patients underwent PR with urethra suspension m. levator ani, in the 2nd (n = 74 – standard RP. In the 1st group, 6 ligatures were applied to the anterior and posterior urethra walls: at the 12 and 6 hour projections through the mucosa, submucosa, and smooth muscle; at the 10, 2, 4, and 8 hour projections – more laterally with capture of the m. levator ani medial margins. Continence recovery was evaluated on days 1, 7, and 14 after urinary catheter removal and then at days 30, 90, 180, and 365 after RP. The criteria of continence were absence of urine leakage at rest and during physical activity and a necessity of using a safety liner.Results. There weren’t any significant differences at day 1 after urinary catheter removal between the two groups (р > 0.05. In the 1st group, continence values at days 30, 90, and 180 after RP were significantly higher (57.7, 69.2, and 71.1 %, respectively compared to the 2nd group (35.1, 41.9, and 51.3 %, respectively (р <0.05.Conclusion. Results of this work show significant benefits of RP with urethra suspension m. levator ani compared to standard RP per continence recovery criteria at days 7, 14, 30, 90, and 180 after the surgery. The technique of urethra suspension m. levator ani is easy to perform and ensures

  14. Mantle temperature under drifting deformable continents during the supercontinent cycle

    Science.gov (United States)

    Yoshida, Masaki

    2013-04-01

    The thermal heterogeneity of the Earth's mantle under the drifting continents during a supercontinent cycle is a controversial issue in earth science. Here, a series of numerical simulations of mantle convection are performed in 3D spherical-shell geometry, incorporating drifting deformable continents and self-consistent plate tectonics, to evaluate the subcontinental mantle temperature during a supercontinent cycle. Results show that the laterally averaged temperature anomaly of the subcontinental mantle remains within several tens of degrees (±50 °C) throughout the simulation time. Even after the formation of the supercontinent and the development of subcontinental plumes due to the subduction of the oceanic plates, the laterally averaged temperature anomaly of the deep mantle under the continent is within +10 °C. This implies that there is no substantial temperature difference between the subcontinental and suboceanic mantles during a supercontinent cycle. The temperature anomaly immediately beneath the supercontinent is generally positive owing to the thermal insulation effect and the active upwelling plumes from the core-mantle boundary. In the present simulation, the formation of a supercontinent causes the laterally averaged subcontinental temperature to increase by a maximum of 50 °C, which would produce sufficient tensional force to break up the supercontinent. The periodic assembly and dispersal of continental fragments, referred to as the supercontinent cycle, bear close relation to the evolution of mantle convection and plate tectonics. Supercontinent formation involves complex processes of introversion, extroversion or a combination of these in uniting dispersed continental fragments, as against the simple opening and closing of individual oceans envisaged in Wilson cycle. In the present study, I evaluate supercontinent processes in a realistic mantle convection regime. Results show that the assembly of supercontinents is accompanied by a

  15. Living with the physical and mental consequences of an ostomy : A study among 1–10-year rectal cancer survivors from the population-based PROFILES registry

    NARCIS (Netherlands)

    Mols, F.; Lemmens, V.E.P.P.; Bosscha, K.J.; Broek van den, W.; Thong, M.S.Y.

    2014-01-01

    Background This study examined the physical and mental consequences of an ostomy among 1–10-year rectal cancer survivors. Methods Patients with rectal cancer diagnosed from 2000 to 2009, as registered in the population-based Eindhoven Cancer Registry, received a questionnaire on quality of life

  16. Nursing, Nursing Education, and Anxiety.

    Science.gov (United States)

    Biggers, Thompson; And Others

    In response to the current crisis in the field of nursing, a study examined nursing students' perceived work-related stress and differences among associate degree, diploma, and baccalaureate nursing programs in their preparation of nursing students. The 171 subjects, representing the three different nursing programs, completed a questionnaire…

  17. Madagascar: Heads It's a Continent, Tails It's an Island

    Science.gov (United States)

    de Wit, Maarten J.

    Neither geologists nor biologists have a definition that is capable of classifying Madagascar unambiguously as an island or a continent; nor can they incorporate Malagasy natural history into a single model rooted in Africa or Asia. Madagascar is a microcosm of the larger continents, with a rock record that spans more than 3000 million years (Ma), during which it has been united episodically with, and divorced from, Asian and African connections. This is reflected in its Precambrian history of deep crustal tectonics and a Phanerozoic history of biodiversity that fluctuated between cosmopolitanism and parochialism. Both vicariance and dispersal events over the past 90 Ma have blended a unique endemism on Madagascar, now in decline following rapid extinctions that started about 2000 years ago.

  18. A review of continent scale hydrological datasets available for Africa

    OpenAIRE

    Bonsor, H.C.

    2010-01-01

    As rainfall becomes less reliable with predicted climate change the ability to assess the spatial and seasonal variations in groundwater availability on a large-scale (catchment and continent) is becoming increasingly important (Bates, et al. 2007; MacDonald et al. 2009). The scarcity of observed hydrological data, or difficulty in obtaining such data, within Africa means remotely sensed (RS) datasets must often be used to drive large-scale hydrological models. The different ap...

  19. What is important for continent catheterizable stomas: angulations or extension?

    Directory of Open Access Journals (Sweden)

    Marcelo L. Vilela

    2007-04-01

    Full Text Available OBJECTIVE: We developed an experimental ex-vivo model to define factors that may influence continence of catheterizable channels by urinary and colonic stomas based on the principle of imbrication of the outlet tube. MATERIALS AND METHODS: From 20 pigs, colon specimens with 25 cm length were obtained and a transverse flap with 3.0 cm length x 1.5 cm width in the average point of the intestine was tubulated to create an efferent tube. With the tube configured, it was embedded by 3 seromuscular stitches far 0.5 cm each other. A pressure study of both intra-luminal surface and channel was then conducted during the filling of the submerse piece with environmental air in a water container, to define the efferent channel continence. The study was repeated after the progressive release of suture stitches until only one stitch remains. RESULTS: Channel continence analyzed in each segment in three different valve length situations, making a total of 20 segments, revealed that with 3 stitches (1.5 cm valve the maximum average pressure prior to overflow was 54 cm H2O; 53.65 cm H2O with 2 stitches (1.0 cm of valve, and 55.45 cm H2O with only one stitch (0.5 cm of valve, which are the same values. The record at the segment explosion pressure was 67.87 cm H2O. CONCLUSION: The study showed that angulation of channel with colon, maintained by only one stitch (0.5 cm imbrication was more important than a larger extension of the valve, represented by 3 suture stitches (1.5 cm imbrication in order to allow continence to the efferent channel.

  20. Colon pouch (Mainz III) for continent urinary diversion.

    Science.gov (United States)

    Stolzenburg, Jens-Uwe; Schwalenberg, Thilo; Liatsikos, Evangelos N; Sakelaropoulos, George; Rödder, Kilian; Hohenfellner, Rudolph; Fisch, Margit

    2007-06-01

    To evaluate the use of a continent cutaneous pouch made exclusively of colon (Mainz pouch III), as excellent results with the Mainz pouch III in irradiated patients suggested that the indication for this type of urinary diversion could be extended. The outcome of 24 patients with continent cutaneous urinary diversions using colon segments (Mainz pouch III) was investigated retrospectively. Overall, 22 of the patients had a malignant disease and two a benign disease; 16 had a hysterectomy and pelvic exenteration for gynaecological tumours; two men with a rhabdomyosarcoma of the prostate had a radical cystoprostatectomy; one woman had pelvic exenteration for bladder cancer; one man had a simultaneous rectum resection due to infiltrating rectal cancer, and another a left nephrectomy with cystectomy for concomitant kidney and bladder tumour. Benign indications were hyper-reflexive bladder after polytrauma and two cases of neurogenic bladder dysfunction. Eighteen patients had radiotherapy (32-48 Gy) before the urinary diversion. The mean (range) follow-up was 35 (12-65) months. The mean pouch capacity was 293.8 mL. Three patients died during the follow-up (two from disease progression and one suicide); 20 patients were fully continent, four with reduced pouch capacity (<300 mL) had slight incontinence and are wearing a protective pad (band-aid at the umbilicus). All patients use intermittent self-catheterization (mean catheterization frequency 6.8/day, range 6-12). Complications related to the pouch were one outlet stenosis that required revision. Postoperative pouchograms showed asymptomatic reflux in four patients. None of the patients developed metabolic acidosis or diarrhoea. The Mainz pouch III is an alternative to other types of continent urinary diversion.

  1. Groundwater systems of the Indian Sub-Continent

    Directory of Open Access Journals (Sweden)

    Abhijit Mukherjee

    2015-09-01

    Full Text Available The Indian Sub-Continent is one of the most densely populated regions of the world, hosting ∼23% of the global population within only ∼3% of the world's land area. It encompasses some of the world's largest fluvial systems in the world (River Brahmaputra, Ganges and Indus Basins, which hosts some of the highest yielding aquifers in the world. The distribution of usable groundwater in the region varies considerably and the continued availability of safe water from many of these aquifers (e.g. Bengal Basin is constrained by the presence of natural contaminants. Further, the trans-boundary nature of the aquifers in the Indian Sub-Continent makes groundwater resource a potentially politically sensitive issue, particularly since this region is the largest user of groundwater resources in the world. Indeed, there is considerable concern regarding dwindling well yield and declining groundwater levels, even for the highly productive aquifers. Though irrigation already accounts for >85% of the total ground water extraction of the region, there is a mounting pressure on aquifers for food security of the region. Highly variable precipitation, hydrogeological conditions and predicted, impending climate change effects provide substantial challenges to groundwater management. The observed presence of natural groundwater contaminants together with the growing demand for irrigated food production and predicted climate change further complicate the development of strategies for using groundwater resources sustainably. We provide an introduction and overview of 11 articles, collated in this special issue, which describe the current condition of vulnerable groundwater resources across the Indian Sub-Continent.

  2. A Zn isotope perspective on the rise of continents.

    Science.gov (United States)

    Pons, M-L; Fujii, T; Rosing, M; Quitté, G; Télouk, P; Albarède, F

    2013-05-01

    Zinc isotope abundances are fairly constant in igneous rocks and shales and are left unfractionated by hydrothermal processes at pH 1‰ during the ~2.35 Ga Great Oxygenation Event. By 1.8 Ga, BIF δ(66) Zn has settled to the modern value of FeMn nodules and encrustations (~0.9‰). The Zn cycle is largely controlled by two different mechanisms: Zn makes strong complexes with phosphates, and phosphates in turn are strongly adsorbed by Fe hydroxides. We therefore review the evidence that the surface geochemical cycles of Zn and P are closely related. The Zn isotope record echoes Sr isotope evidence, suggesting that erosion starts with the very large continental masses appearing at ~2.7 Ga. The lack of Zn fractionation in pre-2.9 Ga BIFs is argued to reflect the paucity of permanent subaerial continental exposure and consequently the insignificant phosphate input to the oceans and the small output of biochemical sediments. We link the early decline of δ(66) Zn between 3.0 and 2.7 Ga with the low solubility of phosphate in alkaline groundwater. The development of photosynthetic activity at the surface of the newly exposed continents increased the oxygen level in the atmosphere, which in turn triggered acid drainage and stepped up P dissolution and liberation of heavy Zn into the runoff. Zinc isotopes provide a new perspective on the rise of continents, the volume of carbonates on continents, changing weathering conditions, and compositions of the ocean through time. © 2013 Blackwell Publishing Ltd.

  3. Archean komatiite volcanism controlled by the evolution of early continents.

    Science.gov (United States)

    Mole, David R; Fiorentini, Marco L; Thebaud, Nicolas; Cassidy, Kevin F; McCuaig, T Campbell; Kirkland, Christopher L; Romano, Sandra S; Doublier, Michael P; Belousova, Elena A; Barnes, Stephen J; Miller, John

    2014-07-15

    The generation and evolution of Earth's continental crust has played a fundamental role in the development of the planet. Its formation modified the composition of the mantle, contributed to the establishment of the atmosphere, and led to the creation of ecological niches important for early life. Here we show that in the Archean, the formation and stabilization of continents also controlled the location, geochemistry, and volcanology of the hottest preserved lavas on Earth: komatiites. These magmas typically represent 50-30% partial melting of the mantle and subsequently record important information on the thermal and chemical evolution of the Archean-Proterozoic Earth. As a result, it is vital to constrain and understand the processes that govern their localization and emplacement. Here, we combined Lu-Hf isotopes and U-Pb geochronology to map the four-dimensional evolution of the Yilgarn Craton, Western Australia, and reveal the progressive development of an Archean microcontinent. Our results show that in the early Earth, relatively small crustal blocks, analogous to modern microplates, progressively amalgamated to form larger continental masses, and eventually the first cratons. This cratonization process drove the hottest and most voluminous komatiite eruptions to the edge of established continental blocks. The dynamic evolution of the early continents thus directly influenced the addition of deep mantle material to the Archean crust, oceans, and atmosphere, while also providing a fundamental control on the distribution of major magmatic ore deposits.

  4. Climate control of terrestrial carbon exchange across biomes and continents

    Energy Technology Data Exchange (ETDEWEB)

    Yi Chuixiang; Wolbeck, John; Xu Xiyan [School of Earth and Environmental Sciences, Queens College, City University of New York, NY 11367 (United States); Ricciuto, Daniel [Environmental Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831 (United States); Li Runze [Department of Statistics, Pennsylvania State University, University Park, PA 16802 (United States); Nilsson, Mats [Department of Forest Ecology, Swedish University of Agricultural Sciences, SE-901 83 Umeaa (Sweden); Aires, Luis [CESAM and Department of Environmental Engineering, School of Technology and Management, Polytechnic Institute of Leiria (Portugal); Albertson, John D [Department of Civil and Environmental Engineering, Duke University, Durham, NC 22708-0287 (United States); Ammann, Christof [Federal Research Station Agroscope Reckenholz-Taenikon, Reckenholzstrasse 191, 8046 Zuerich (Switzerland); Arain, M Altaf [School of Geography and Earth Sciences, McMaster University, Hamilton, ON, L8S 4K1 (Canada); De Araujo, Alessandro C [Instituto Nacional de Pesquisas da Amazonia, Programa LBA, Campus-II, Manaus-Amazonas 69060 (Brazil); Aubinet, Marc [University of Liege, Gembloux Agro-Bio Tech, Unit of Biosystem Physics, 2 Passage des Deportes, 5030 Gembloux (Belgium); Aurela, Mika [Finnish Meteorological Institute, Climate Change Research, FI-00101 Helsinki (Finland); Barcza, Zoltan [Department of Meteorology, Eoetvoes Lorand University, H-1117 Budapest, Pazmany setany 1/A (Hungary); Barr, Alan [Climate Research Division, Environment Canada, Saskatoon, SK, S7N 3H5 (Canada); Berbigier, Paul [INRA, UR1263 EPHYSE, Villenave d' Ornon F-33883 (France); Beringer, Jason [School of Geography and Environmental Science, Monash University, Clayton, Victoria 3800 (Australia); Bernhofer, Christian [Institute of Hydrology and Meteorology, Dresden University of Technology, Pienner Strasse 23, D-01737, Tharandt (Germany)

    2010-07-15

    Understanding the relationships between climate and carbon exchange by terrestrial ecosystems is critical to predict future levels of atmospheric carbon dioxide because of the potential accelerating effects of positive climate-carbon cycle feedbacks. However, directly observed relationships between climate and terrestrial CO{sub 2} exchange with the atmosphere across biomes and continents are lacking. Here we present data describing the relationships between net ecosystem exchange of carbon (NEE) and climate factors as measured using the eddy covariance method at 125 unique sites in various ecosystems over six continents with a total of 559 site-years. We find that NEE observed at eddy covariance sites is (1) a strong function of mean annual temperature at mid- and high-latitudes, (2) a strong function of dryness at mid- and low-latitudes, and (3) a function of both temperature and dryness around the mid-latitudinal belt (45 deg. N). The sensitivity of NEE to mean annual temperature breaks down at {approx} 16 deg. C (a threshold value of mean annual temperature), above which no further increase of CO{sub 2} uptake with temperature was observed and dryness influence overrules temperature influence.

  5. Experimental study of faecal continence and colostomy irrigation.

    Science.gov (United States)

    O'Bichere, A; Sibbons, P; Doré, C; Green, C; Phillips, R K

    2000-07-01

    Colostomy irrigation is a useful method of achieving faecal continence in selected conditions, but remains largely underutilized because it is time consuming. This study investigated the effect of modifying irrigation technique (route, infusion regimen and pharmacological manipulation) on colonic emptying time in a porcine model. An end-colostomy and caecostomy were fashioned in six pigs. Twenty markers were introduced into the caecum immediately before colonic irrigation. Irrigation route (antegrade or retrograde), infusion regimen (tap water, polyethylene glycol (PEG), 1.5 per cent glycine) and pharmacological agent (glyceryl trinitrate (GTN) 0.25 mg/kg, diltiazem 3.9 mg/kg, bisacodyl 0.25 mg/kg) were assigned to each animal at random. Colonic transit was assessed by quantifying cumulative expelled markers (CEM) and stool every hour for 12 h. Mean CEM at 6 h for bisacodyl, GTN and diltiazem were 18.17, 12.17 and zero respectively; all pairwise differences in means were significant (P irrigation. PEG and glycine enhance emptying similar to bisacodyl and GTN solution. These findings show promise for improved faecal continence by colostomy irrigation and may justify construction of a Malone conduit at the time of colostomy in selected patients who wish to irrigate. Presented in part to the British Society of Gastroenterology in Glasgow, UK, March 1999, and published in abstract form as Gut 1999; 44(Suppl 1): A135

  6. Continents as lithological icebergs: The importance of buoyant lithospheric roots

    Science.gov (United States)

    Abbott, D.H.; Drury, R.; Mooney, W.D.

    1997-01-01

    An understanding of the formation of new continental crust provides an important guide to locating the oldest terrestrial rocks and minerals. We evaluated the crustal thicknesses of the thinnest stable continental crust and of an unsubductable oceanic plateau and used the resulting data to estimate the amount of mantle melting which produces permanent continental crust. The lithospheric mantle is sufficiently depleted to produce permanent buoyancy (i.e., the crust is unsubductable) at crustal thicknesses greater than 25-27 km. These unsubductable oceanic plateaus and hotspot island chains are important sources of new continental crust. The newest continental crust (e.g., the Ontong Java plateau) has a basaltic composition, not a granitic one. The observed structure and geochemistry of continents are the result of convergent margin magmatism and metamorphism which modify the nascent basaltic crust into a lowermost basaltic layer overlain by a more silicic upper crust. The definition of a continent should imply only that the lithosphere is unsubductable over ??? 0.25 Ga time periods. Therefore, the search for the oldest crustal rocks should include rocks from lower to mid-crustal levels.

  7. Climate control of terrestrial carbon exchange across biomes and continents

    International Nuclear Information System (INIS)

    Yi Chuixiang; Wolbeck, John; Xu Xiyan; Ricciuto, Daniel; Li Runze; Nilsson, Mats; Aires, Luis; Albertson, John D; Ammann, Christof; Arain, M Altaf; De Araujo, Alessandro C; Aubinet, Marc; Aurela, Mika; Barcza, Zoltan; Barr, Alan; Berbigier, Paul; Beringer, Jason; Bernhofer, Christian

    2010-01-01

    Understanding the relationships between climate and carbon exchange by terrestrial ecosystems is critical to predict future levels of atmospheric carbon dioxide because of the potential accelerating effects of positive climate-carbon cycle feedbacks. However, directly observed relationships between climate and terrestrial CO 2 exchange with the atmosphere across biomes and continents are lacking. Here we present data describing the relationships between net ecosystem exchange of carbon (NEE) and climate factors as measured using the eddy covariance method at 125 unique sites in various ecosystems over six continents with a total of 559 site-years. We find that NEE observed at eddy covariance sites is (1) a strong function of mean annual temperature at mid- and high-latitudes, (2) a strong function of dryness at mid- and low-latitudes, and (3) a function of both temperature and dryness around the mid-latitudinal belt (45 deg. N). The sensitivity of NEE to mean annual temperature breaks down at ∼ 16 deg. C (a threshold value of mean annual temperature), above which no further increase of CO 2 uptake with temperature was observed and dryness influence overrules temperature influence.

  8. Community health nursing, wound care, and...ethics?

    Science.gov (United States)

    Bell, Sue Ellen

    2003-09-01

    Because of changing demographics and other factors, patients receiving care for wounds, ostomies, or incontinence are being referred in increasing numbers to community health nursing organizations for initial or continued care. As home-based wound care becomes big business, little discussion is being focused on the moral and ethical issues likely to arise in the high-tech home setting. Progressively more complex and expensive home care relies on family members to take on complicated care regimens in the face of decreasing numbers of allowable skilled nursing home visits. A framework and a principle-based theory for reflection on the character and content of moral and ethical conflicts are provided to encourage informed and competent care of patients in the home. Common moral and ethical conflicts for WOC nurses in the United States are presented. These conflicts include issues of wound care supply procurement; use of documentation to maximize care or profit; problems of quality, care consistency, and caregiver consent; and dilemmas of tiered health care options. The advantages of a framework to address ethical conflicts are discussed.

  9. Nurses who work outside nursing.

    Science.gov (United States)

    Duffield, Christine; Pallas, Linda O'Brien; Aitken, Leanne M

    2004-09-01

    The desire to care for people, a family history of professional health care work, and security in career choice are documented reasons for entering nursing. Reasons for leaving include workload, unsafe work environments and harassment. The relationship between these factors and the time nurses spend in the profession has not been explored. This paper reports a study with people who have left nursing, to investigate why they became a nurse, how long they stayed in nursing, and their reasons for leaving. A questionnaire was mailed to Registered Nurses currently working outside nursing, seeking respondents' reasons for entering and leaving nursing, and perceptions of the skills gained from nursing and the ease of adjustment to working in a non-nursing environment. Data analysis included descriptive statistics, exploratory and confirmatory factor analysis, correlational analysis and linear and multiple regression analysis. A model incorporating the factors 'altruistic reasons', 'default choice' and 'stepping stone' explained 36.2% of the variance in reasons for becoming a nurse. A model incorporating the factors 'legal and employer', 'external values and beliefs about nursing', 'professional practice', 'work life/home life' and 'contract requirements' explained 55.4% of the variance in reasons for leaving nursing. Forty-eight per cent of the variance in tenure in nursing practice was explained through personal characteristics of nurses (36%), reasons for becoming a nurse (7%) and reasons for leaving (6%). The reasons why nurses entered or left the profession were varied and complex. While personal characteristics accounted for a large component of tenure in nursing, those managing the nursing workforce should consider professional practice issues and the balance between work life and home life.

  10. High velocity missile-related colorectal injuries: In-theatre application of injury scores and their effects on ostomy rates.

    Science.gov (United States)

    Kaymak, Şahin; Ünlü, Aytekin; Harlak, Ali; Ersöz, Nail; Şenocak, Rahman; Coşkun, Ali Kağan; Zeybek, Nazif; Lapsekili, Emin; Kozak, Orhan

    2016-03-01

    Treatment of colorectal injuries (CRIs) remains a significant cause of morbidity and mortality. The aim of the present study was to analyze treatment trends of Turkish surgeons and effects of the American Association for the Surgery of Trauma (AAST), Injury Severity (ISS), and Penetrating Abdominal Trauma Index (PATI) scoring systems on decision-making processes and clinical outcomes. Data regarding high velocity missile (HVM)-related CRIs were retrospectively gathered. Four patient groups were included: Group 1 (stoma), Group 2 (no stoma in primary surgery), Group 2a (conversion to stoma in secondary surgery), and Group 2b (remaining Group 2 patients). Groups 1, 2, 2a, and 2b included 39 (66%), 20 (34%), 6 (30%), and 14 (70%) casualties, respectively. Ostomies were performed in casualties with significantly higher AAST scores (pcolon/rectum injury scores.

  11. Nursing Homes

    Science.gov (United States)

    ... Home › Aging & Health A to Z › Nursing Homes Font size A A A Print Share Glossary Basic ... Reason For Living in A Nursing Home Some type of disability with activities of daily living (ADLs) ...

  12. Clinical value of colonic irrigation in patients with continence disturbances.

    Science.gov (United States)

    Briel, J W; Schouten, W R; Vlot, E A; Smits, S; van Kessel, I

    1997-07-01

    Continence disturbances, especially fecal soiling, are difficult to treat. Irrigation of the distal part of the large bowel might be considered as a nonsurgical alternative for patients with impaired continence. This study is aimed at evaluating the clinical value of colonic irrigation. Thirty-two patients (16 females; median age, 47 (range, 23-72) years) were offered colonic irrigation on an ambulatory basis. Sixteen patients suffered from fecal soiling (Group I), whereas the other 16 patients were treated for fecal incontinence (Group II). Patients were instructed by enterostomal therapists how to use a conventional colostomy irrigation set to obtain sufficient irrigation of the distal part of their large bowel. Patients with continence disturbances during the daytime were instructed to introduce 500 to 1,000 ml of warm (38 degrees C) water within 5 to 10 minutes after they passed their first stool. In addition, they were advised to wait until the urge to defecate was felt. Patients with soiling during overnight sleep were advised to irrigate during the evening. To determine clinical outcome, a detailed questionnaire was used. Median duration of follow-up was 18 months. Ten patients discontinued irrigation within the first month of treatment. Symptoms resolved completely in two patients. They believed that there was no need to continue treatment any longer. Irrigation had no effect in two patients. Despite the fact that symptoms resolved, six patients discontinued treatment because they experienced pain (n = 2) or they considered the irrigation to be too time-consuming (n = 4). Twenty-two patients are still performing irrigations. Most patients irrigated the colon in the morning after the first stool was passed. Time needed for washout varied between 10 and 90 minutes. Frequency of irrigations varied from two times per day to two times per week. In Group I, irrigation was found to be beneficial in 92 percent of patients, whereas 60 percent of patients in Group II

  13. [Facilitators of the transition process for the self-care of the person with stoma: subsidies for Nursing].

    Science.gov (United States)

    Mota, Marina Soares; Gomes, Giovana Calcagno; Petuco, Vilma Madalosso; Heck, Rita Maria; Barros, Edaiane Joana Lima; Gomes, Vera Lúcia de Oliveira

    2015-02-01

    To know the facilitating factors of the transition process from dependency to the self-care of people with a stoma. This is a descriptive study of qualitative approach, including 27 people with permanent stomas due to cancer. The data were collected through semi-structured interviews and submitted to content analysis based on the Transition Theory as theoretical reference. The self-care facilitators related to the person were the positive significance of ostomy; the preparation for this experience already in the preoperative period; emotional stability; faith; religiousness; and a sense of normalcy acquired from a next image similar to the previous one. The facilitators related to the community were the following: receiving equipment for free from the government; support from family and the multidisciplinary team, especially the nurses; and having contact with other people with stomata. The results allow that nurses develop strategies to help people with stomata to resume their self-care.

  14. Facilitators of the transition process for the self-care of the person with stoma: subsidies for Nursing

    Directory of Open Access Journals (Sweden)

    Marina Soares Mota

    2015-02-01

    Full Text Available OBJECTIVE To know the facilitating factors of the transition process from dependency to the self-care of people with a stoma. METHOD This is a descriptive study of qualitative approach, including 27 people with permanent stomas due to cancer. The data were collected through semi-structured interviews and submitted to content analysis based on the Transition Theory as theoretical reference. RESULTS The self-care facilitators related to the person were the positive significance of ostomy; the preparation for this experience already in the preoperative period; emotional stability; faith; religiousness; and a sense of normalcy acquired from a next image similar to the previous one. The facilitators related to the community were the following: receiving equipment for free from the government; support from family and the multidisciplinary team, especially the nurses; and having contact with other people with stomata. CONCLUSION The results allow that nurses develop strategies to help people with stomata to resume their self-care.

  15. Nursing Reclaims its Role.

    Science.gov (United States)

    Diers, Donna

    1982-01-01

    An attempt is made to explain the nurses' role: what the nurse is, what the nurse does, how the nurse is viewed by society, why nurses suffer burnout, nursing costs, and health care system reform. (CT)

  16. Neonatal Nursing

    OpenAIRE

    Crawford, Doreen; Morris, Maryke

    1994-01-01

    "Neonatal Nursing" offers a systematic approach to the nursing care of the sick newborn baby. Nursing actions and responsibilities are the focus of the text with relevant research findings, clinical applications, anatomy, physiology and pathology provided where necessary. This comprehensive text covers all areas of neonatal nursing including ethics, continuing care in the community, intranatal care, statistics and pharmokinetics so that holistic care of the infant is described. This book shou...

  17. Quality of Life in Persons Living With an Ostomy Assessed Using the SF36v2: Mental Component Summary: Vitality, Social Function, Role-Emotional, and Mental Health.

    Science.gov (United States)

    Nichols, Thom R

    The purpose of this study was to assess the Mental Health Component of health-related quality of life (HRQOL) in community-dwelling persons with ostomies residing in the United States. Cross-sectional descriptive study. Two thousand three hundred twenty-nine participants completed the survey for a response rate of 14.9% and a margin of error of 2.03%. Study respondents were geographically distributed throughout the United States, representing all 50 states. Fifty-three percent of study respondents were male. Respondents had a median age of 65 years. Forty percent have colostomies, 44% are living with ileostomies, and 13% have urostomies. The remaining 3% are living with multiple stomas or they indicated that they were uncertain as to the type of stoma. The SF36v2 was used to assess HRQOL. This instrument was selected because it has the ability to measure HRQOL in a target population and it allows comparison with the general population. Potential participants were randomly selected from an electronic database of 15,591 persons with ostomies. They were contacted by e-mails and provided with an electronic nontransferable link to the survey. This is a secondary analysis of findings from the Mental Component Summary (MCS) of the SF36v2. Persons who have undergone ostomy surgery did not score as well as the general population when components of the MCS were compared. While overall differences were identified, they differed based on age and cumulative MCS score levels. Analysis of individuals found to have significant impairment in MCS scores (cumulative soccer ostomies as lower than scores generated from the general population. However, these findings varied based on age and cumulative MCS score.

  18. Anorectal function in patients with complete rectal prolapse. Differences between continent and incontinent individuals.

    Science.gov (United States)

    Roig, J V; Buch, E; Alós, R; Solana, A; Fernández, C; Villoslada, C; García-Armengol, J; Hinojosa, J

    1998-11-01

    A study is made of the alterations in anorectal physiology among rectal prolapse patients, evaluating the differences between fecal continent and incontinent individuals. Eighteen patients with complete rectal prolapse were divided into two groups: Group A (8 continent individuals) and Group B (10 incontinent women), while 22 healthy women were used as controls (Group C). Clinical exploration and perineal level measurements were performed, along with anorectal manometry, electrophysiology, and anorectal sensitivity to electrical stimuli. The main antecedents of the continent subjects were excess straining efforts, while the incontinent women presented excess straining and complex deliveries. Pathological perineal descent was a frequent finding in both groups, with a hypotonic anal canal at rest (p rest than the continent women (p rest, regardless of whether they are continent to feces or not. Continent patients have less pudendal neuropathy and therefore less pressure alterations at voluntary sphincter squeeze than incontinent individuals.

  19. Social Work in a Developing Continent: The Case of Africa

    Directory of Open Access Journals (Sweden)

    Christopher Chitereka

    2009-11-01

    Full Text Available Social work is a professional approach to ameliorating social problems. It is generally understood as a helping profession that utilizes professionally qualified personnel who use its knowledge base to help people tackle their social problems (Mupedziswa, 2005. Nevertheless, in developing countries, social work is a relatively young profession which was influenced by colonialism in its formation. The type of social work practiced in these countries largely mirrors the one that is being practiced in Britain, France and Portugal among others. Utilizing the continent of Africa as a case study, this article argues that social work practice in Africa tends to be curative or remedial in nature and is not adequately addressing people’s problems. It therefore proposes a paradigm shift from remedial to a social development paradigm if it is to make an impact in the 21st century.

  20. International Continence Society Good Urodynamic Practices and Terms 2016

    DEFF Research Database (Denmark)

    Rosier, Peter F W M; Schaefer, Werner; Lose, Gunnar

    2017-01-01

    AIMS: The working group initiated by the ICS Standardisation Steering Committee has updated the International Continence Society Standard "Good Urodynamic Practice" published in 2002. METHODS: On the basis of the manuscript: "ICS standard to develop evidence-based standards," a new ICS Standard......). RESULTS: This evidence-based ICS-GUP2016 has newly or more precisely defined more than 30 terms and provides standards for the practice, quality control, interpretation, and reporting of urodynamics; cystometry and pressure-flow analysis. Furthermore, the working group has included recommendations for pre......-testing information and for patient information and preparation. On the basis of earlier ICS standardisations and updating according to available evidence, the practice of uroflowmetry, cystometry, and pressure-flow studies are further detailed. CONCLUSION: ICS-GUP2016 updates and adds on to ICS-GUP2002 to improve...

  1. Radon at the Mauna Loa Observatory: transport from distant continents

    International Nuclear Information System (INIS)

    Whittlestone, S.; Robinson, E.; Ryan, S.

    1992-01-01

    Continuous measurements of radon have been made at an altitude of 3400m at the Mauna Loa Observatory, Hawaii. Concentrations ranged from about 20 to more than 700mBq m -3 . These were similar to values at remote Macquarie I., some 2000 km south of Australia in the Southern Ocean. At Mauna Loa, the radon concentrations could usually be separated into free tropospheric and island influenced categories on the basis of local meteorological observations. On one occasion a long range transport event from Asia brought relatively high radon concentrations to Mauna Loa and persisted for several days. The Asian origin of this event was supported by wind trajectories. This measurement program demonstrates the value of radon data in evaluating air transport models and the influence of transport from distant continents on baseline atmospheric measurements. (author)

  2. Electricity in Africa or the continent of paradoxes

    International Nuclear Information System (INIS)

    Heuraux, Christine

    2011-01-01

    This article first proposes an overview of the present situation of the electricity sector in Africa: the continent is an energy giant because of all the resources it possesses, but an electricity dwarf regarding its present and actual capacities. The author outlines the differences between potential and actual productions, gives an overview of the current status of supply and of production capacities. She comments the status of electricity demand, electricity consumption and electricity markets in the different parts of Africa (data of electricity consumption, of global, urban and rural electrification in Northern Africa, Western Africa, Central Africa, Eastern Africa, Southern Africa with or without South Africa), and issues related to costs and tariffs. She proposes some explanations for the observed discrepancies between African regions and countries: history, too small markets supported by too fragile economies, political and economic failures. Then, she discusses how to favour a durable development of the African electricity sector

  3. Plants of the American continent with antimalarial activity

    Directory of Open Access Journals (Sweden)

    Ingrid R. Mariath

    Full Text Available Malaria is a human parasitic disease caused by protozoa species of the Plasmodium genus. This disease has affected populations of the tropical and subtropical regions. About 500 million new cases occur annually on the world and therefore it is considered an emerging disease of important public health problem. In this context, the natural products as vegetables species have their bioactive molecules as targets for pharmacological, toxicological and phytochemical studies towards the development of more effective medicines for the treatment of many diseases. So this work intends to aid the researchers in the study of natural products to the treatment of malaria. In this review, 476 plants of the American continent were related for the antimalarial activity and of these vegetables species 198 were active and 278 inactive for some type of Plasmodium when they were evaluated through of in vitro or in vivo bioassays models.

  4. [Psychological impact of ostomy on the quality of life of colorectal cancer patients: Role of body image, self-esteem and anxiety].

    Science.gov (United States)

    Beaubrun En Famille Diant, Laury; Sordes, Florence; Chaubard, Thierry

    2018-06-01

    Surgery accounts for an important part of the therapeutic arsenal of colorectal cancer treatment. In digestive cancers, ostomy devices induce the loss of anal function and control. This medical appliance generates changes affecting all aspects of patients' lives. This study explores, on the one hand, the psychological impact of colostomy on colorectal cancer patients' quality of life and on the other hand, it analyzes the correlational links between body image, self-esteem and anxiety during the stoma. Thirty-five patients with colorectal cancer participated in the study, divided into 2 subgroups: 23 were carriers of a definitive stoma and the 12 others with a temporary stoma. All completed the Functional Assessment Cancer Therapy (FACT-C), the Body Image Scale (BIS), the State Trait Anxiety Inventory (STAI-Y) and the Self Esteem Scale (ETES). Analysis revealed the quality of life of temporary ostomates is more affected than that of the definitive ones. All three of them, body image, self-esteem and anxiety negatively affect the quality of life regardless of the type of stoma. This study highlights the prevalence of physical self-esteem for temporary ostomy; the role of a good body image and substantial emotional self-esteem for the permanent ostomy. Future studies are required to explore the underlying causes of the acceptance of this equipment and the mediating role of care devices. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  5. Plasmodium vivax Diversity and Population Structure across Four Continents.

    Science.gov (United States)

    Koepfli, Cristian; Rodrigues, Priscila T; Antao, Tiago; Orjuela-Sánchez, Pamela; Van den Eede, Peter; Gamboa, Dionicia; van Hong, Nguyen; Bendezu, Jorge; Erhart, Annette; Barnadas, Céline; Ratsimbasoa, Arsène; Menard, Didier; Severini, Carlo; Menegon, Michela; Nour, Bakri Y M; Karunaweera, Nadira; Mueller, Ivo; Ferreira, Marcelo U; Felger, Ingrid

    2015-01-01

    Plasmodium vivax is the geographically most widespread human malaria parasite. To analyze patterns of microsatellite diversity and population structure across countries of different transmission intensity, genotyping data from 11 microsatellite markers was either generated or compiled from 841 isolates from four continents collected in 1999-2008. Diversity was highest in South-East Asia (mean allelic richness 10.0-12.8), intermediate in the South Pacific (8.1-9.9) Madagascar and Sudan (7.9-8.4), and lowest in South America and Central Asia (5.5-7.2). A reduced panel of only 3 markers was sufficient to identify approx. 90% of all haplotypes in South Pacific, African and SE-Asian populations, but only 60-80% in Latin American populations, suggesting that typing of 2-6 markers, depending on the level of endemicity, is sufficient for epidemiological studies. Clustering analysis showed distinct clusters in Peru and Brazil, but little sub-structuring was observed within Africa, SE-Asia or the South Pacific. Isolates from Uzbekistan were exceptional, as a near-clonal parasite population was observed that was clearly separated from all other populations (FST>0.2). Outside Central Asia FST values were highest (0.11-0.16) between South American and all other populations, and lowest (0.04-0.07) between populations from South-East Asia and the South Pacific. These comparisons between P. vivax populations from four continents indicated that not only transmission intensity, but also geographical isolation affect diversity and population structure. However, the high effective population size results in slow changes of these parameters. This persistency must be taken into account when assessing the impact of control programs on the genetic structure of parasite populations.

  6. Earth's first stable continents did not form by subduction.

    Science.gov (United States)

    Johnson, Tim E; Brown, Michael; Gardiner, Nicholas J; Kirkland, Christopher L; Smithies, R Hugh

    2017-03-09

    The geodynamic environment in which Earth's first continents formed and were stabilized remains controversial. Most exposed continental crust that can be dated back to the Archaean eon (4 billion to 2.5 billion years ago) comprises tonalite-trondhjemite-granodiorite rocks (TTGs) that were formed through partial melting of hydrated low-magnesium basaltic rocks; notably, these TTGs have 'arc-like' signatures of trace elements and thus resemble the continental crust produced in modern subduction settings. In the East Pilbara Terrane, Western Australia, low-magnesium basalts of the Coucal Formation at the base of the Pilbara Supergroup have trace-element compositions that are consistent with these being source rocks for TTGs. These basalts may be the remnants of a thick (more than 35 kilometres thick), ancient (more than 3.5 billion years old) basaltic crust that is predicted to have existed if Archaean mantle temperatures were much hotter than today's. Here, using phase equilibria modelling of the Coucal basalts, we confirm their suitability as TTG 'parents', and suggest that TTGs were produced by around 20 per cent to 30 per cent melting of the Coucal basalts along high geothermal gradients (of more than 700 degrees Celsius per gigapascal). We also analyse the trace-element composition of the Coucal basalts, and propose that these rocks were themselves derived from an earlier generation of high-magnesium basaltic rocks, suggesting that the arc-like signature in Archaean TTGs was inherited from an ancestral source lineage. This protracted, multistage process for the production and stabilization of the first continents-coupled with the high geothermal gradients-is incompatible with modern-style plate tectonics, and favours instead the formation of TTGs near the base of thick, plateau-like basaltic crust. Thus subduction was not required to produce TTGs in the early Archaean eon.

  7. Clustered and transient earthquake sequences in mid-continents

    Science.gov (United States)

    Liu, M.; Stein, S. A.; Wang, H.; Luo, G.

    2012-12-01

    Earthquakes result from sudden release of strain energy on faults. On plate boundary faults, strain energy is constantly accumulating from steady and relatively rapid relative plate motion, so large earthquakes continue to occur so long as motion continues on the boundary. In contrast, such steady accumulation of stain energy does not occur on faults in mid-continents, because the far-field tectonic loading is not steadily distributed between faults, and because stress perturbations from complex fault interactions and other stress triggers can be significant relative to the slow tectonic stressing. Consequently, mid-continental earthquakes are often temporally clustered and transient, and spatially migrating. This behavior is well illustrated by large earthquakes in North China in the past two millennia, during which no single large earthquakes repeated on the same fault segments, but moment release between large fault systems was complementary. Slow tectonic loading in mid-continents also causes long aftershock sequences. We show that the recent small earthquakes in the Tangshan region of North China are aftershocks of the 1976 Tangshan earthquake (M 7.5), rather than indicators of a new phase of seismic activity in North China, as many fear. Understanding the transient behavior of mid-continental earthquakes has important implications for assessing earthquake hazards. The sequence of large earthquakes in the New Madrid Seismic Zone (NMSZ) in central US, which includes a cluster of M~7 events in 1811-1812 and perhaps a few similar ones in the past millennium, is likely a transient process, releasing previously accumulated elastic strain on recently activated faults. If so, this earthquake sequence will eventually end. Using simple analysis and numerical modeling, we show that the large NMSZ earthquakes may be ending now or in the near future.

  8. CYGNSS Surface Wind Validation and Characteristics in the Maritime Continent

    Science.gov (United States)

    Asharaf, S.; Waliser, D. E.; Zhang, C.; Wandala, A.

    2017-12-01

    Surface wind over tropical oceans plays a crucial role in many local/regional weather and climate processes and helps to shape the global climate system. However, there is a lack of consistent high quality observations for surface winds. The newly launched NASA Cyclone Global Navigation Satellite System (CYGNSS) mission provides near surface wind speed over the tropical ocean with sampling that accounts for the diurnal cycle. In the early phase of the mission, validation is a critical task, and over-ocean validation is typically challenging due to a lack of robust validation resources that a cover a variety of environmental conditions. In addition, it can also be challenging to obtain in-situ observation resources and also to extract co-located CYGNSS records for some of the more scientifically interesting regions, such as the Maritime Continent (MC). The MC is regarded as a key tropical driver for the mean global circulation as well as important large-scale circulation variability such as the Madian-Julian Oscillation (MJO). The focus of this project and analysis is to take advantage of local in-situ resources from the MC regions (e.g. volunteer shipping, marine buoys, and the Year of Maritime Continent (YMC) campaign) to quantitatively characterize and validate the CYGNSS derived winds in the MC region and in turn work to unravel the complex multi-scale interactions between the MJO and MC. This presentation will show preliminary results of a comparison between the CYGNSS and the in-situ surface wind measurements focusing on the MC region. Details about the validation methods, uncertainties, and planned work will be discussed in this presentation.

  9. National audit of continence care: laying the foundation.

    Science.gov (United States)

    Mian, Sarah; Wagg, Adrian; Irwin, Penny; Lowe, Derek; Potter, Jonathan; Pearson, Michael

    2005-12-01

    National audit provides a basis for establishing performance against national standards, benchmarking against other service providers and improving standards of care. For effective audit, clinical indicators are required that are valid, feasible to apply and reliable. This study describes the methods used to develop clinical indicators of continence care in preparation for a national audit. To describe the methods used to develop and test clinical indicators of continence care with regard to validity, feasibility and reliability. A multidisciplinary working group developed clinical indicators that measured the structure, process and outcome of care as well as case-mix variables. Literature searching, consensus workshops and a Delphi process were used to develop the indicators. The indicators were tested in 15 secondary care sites, 15 primary care sites and 15 long-term care settings. The process of development produced indicators that received a high degree of consensus within the Delphi process. Testing of the indicators demonstrated an internal reliability of 0.7 and an external reliability of 0.6. Data collection required significant investment in terms of staff time and training. The method used produced indicators that achieved a high degree of acceptance from health care professionals. The reliability of data collection was high for this audit and was similar to the level seen in other successful national audits. Data collection for the indicators was feasible to collect, however, issues of time and staffing were identified as limitations to such data collection. The study has described a systematic method for developing clinical indicators for national audit. The indicators proved robust and reliable in primary and secondary care as well as long-term care settings.

  10. Continent-Ocean Interactions Within East Asian Marginal Seas

    Science.gov (United States)

    Clift, Peter; Kuhnt, Wolfgang; Wang, Pinxian; Hayes, Dennis

    The study of the complex interactions between continents and oceans has become a leading area for 21st century earth cience. In this volume, continent—ocean interactions in tectonics, arc-continent collision, sedimentology, and climatic volution within the East Asian Marginal Seas take precedence. Links between oceanic and continental climate, the sedimentology of coastal and shelf areas, and the links between deformation of continental and oceanic lithosphere are also discussed. As an introduction to the science presented throughout the volume, Wang discusses many of the possible interactions between the tectonic evolution of Asia and both regional and global climate. He speculates that uplift of central Asia in the Pliocene may have triggered the formation of many of the major rivers that drain north through Siberia into the Arctic Ocean. He also argues that it is the delivery of this fresh water that allows the formation of sea ice in that area and triggered the start of Northern Hemispheric glaciation. This may be one of the most dramatic ways in which Asia has shaped the Earth's climate and represents an alternative to the other competing models that have previously emphasized the role of oceanic gateway closure in Central America. Moreover, his proposal for major uplift of at least part of Tibet and Mongolia as late as the Pliocene, based on the history of drainage evolution in Siberia, supports recent data from the southern Tarim Basin and from the Qilian Shan and Qaidam and Jiuxi Basins in northeast Tibet that indicate surface uplift at that time. Constraining the timing and patterns of Tibetan surface uplift is crucial to testing competing models for strain accommodation in Asia following India—Asia collision.

  11. Nursing: What's a Nurse Practitioner?

    Science.gov (United States)

    ... as advanced practice nurses, or APNs) have a master's degree in nursing (MS or MSN) and board certification ... NP training emphasizes disease prevention, reduction of health risks, and thorough patient education. Like doctors, NPs are ...

  12. The Malone antegrade continence enema for neurogenic and structural fecal incontinence and constipation.

    Science.gov (United States)

    Koyle, M A; Kaji, D M; Duque, M; Wild, J; Galansky, S H

    1995-08-01

    Problems of fecal elimination are commonly encountered by the pediatric urologist and surgeon. The Malone antegrade continence enema has been described as a means to administer a large volume enema via a continent catheterizable appendicocecostomy, resulting in reliable fecal elimination. Of 22 patients undergoing this procedure 16 reported total continence 4 months or longer after surgery. Complications are relatively minor and tap water appears to be a safe solution for the antegrade continence enema. A nonrefluxing, imbricated appendicocecostomy is preferable to prevent cutaneous fecal or gas leaks.

  13. Continent at a Crossroads: Prosperity, Justice, and Security in South America

    National Research Council Canada - National Science Library

    Scott, Frances K

    2006-01-01

    This Special Bibliography Series, Number 107, "Continent at the Crossroads: Prosperity, Justice, and Security in South America," was developed by Social Sciences Bibliographer and Reference Librarian Frances K...

  14. PS1-10: Spiritual Well-being and the Challenges of Living With an Ostomy: Resilience, Adaptation and Loss Among Colorectal Cancer Survivors

    Science.gov (United States)

    Bulkley, Joanna; McMullen, Carmit; Hornbrook, Mark; Altschuler, Andrea; Grant, Marcia; Herrinton, Lisa; Krouse, Robert

    2012-01-01

    Background Spiritual well-being (SpWB), defined as hopefulness, inner peace, and sensing a reason to be alive, is integral to health related quality of life (HRQOL). It is only partially related to spirituality and religiosity. The challenges of colorectal cancer (CRC) and subsequent bodily changes can affect SpWB. We explored expressions of SpWB reported by CRC survivors with ostomies. Methods We recruited all adult CRC survivors (>=5 years) with permanent ostomies who were members of Kaiser Permanente Northwest, Northern California, or Hawai‘i during 2000–2006 to complete a mailed survey (n=283). We asked participants to respond to an open-ended question about the greatest challenge they encountered in having an ostomy. Responses from the 62% (176 of 283) of patients who answered this question were analyzed based on the City of Hope HRQOL model for content related to SpWB, and to identify and categorize the SpWB themes found. Results The responses of 51% (90 of 176) of participants contained SpWB content. Seventeen SpWB themes were identified, reflecting positive, negative, and ambivalent dimensions. Some responses contained multiple themes but each theme was coded only once for each person. Fifty-three of 90 people (59%) expressed positive themes which included “positive attitude” “appreciate life more” “helping others helps me” “strength through religious faith” “leading an active life” and “I am fortunate.” Negative themes included “struggling to cope” “not feeling ‘normal’” and “loss” and were least common, expressed by only 28 of 90 people (31%). Ambivalent themes were most common (67%; 60 of 90 individuals) and included “learning acceptance” “ostomy is the price for survival” “reason to be around despite suffering” and “continuing to cope and function despite challenges.” Discussion These CRC survivors with ostomies infrequently cited negative SpWB as a major challenge, though the greatest number

  15. Nursing students assess nursing education.

    Science.gov (United States)

    Norman, Linda; Buerhaus, Peter I; Donelan, Karen; McCloskey, Barbara; Dittus, Robert

    2005-01-01

    This study assessed the characteristics of nursing students currently enrolled in nursing education programs, how students finance their nursing education, their plans for clinical practice and graduate education, and the rewards and difficulties of being a nursing student. Data are from a survey administered to a national sample of 496 nursing students. The students relied on financial aid and personal savings and earnings to finance their education. Parents, institutional scholarships, and government loans are also important sources, but less than 15% of the students took out bank loans. Nearly one quarter of the students, particularly younger and minority students, plan to enroll in graduate school immediately after graduation and most want to become advanced nursing practitioners. Most of the nursing students (88%) are satisfied with their nursing education and nearly all (95%) provided written answers to two open-ended questions. Comments collapsed into three major categories reflecting the rewards (helping others, status, and job security) and three categories reflecting the difficulties (problems with balancing demands, quality of nursing education, and the admissions process) of being a nursing student. Implications for public policymaking center on expanding the capacity of nursing education programs, whereas schools themselves should focus on addressing the financial needs of students, helping them strike a balance among their school, work, and personal/family responsibilities and modifying certain aspects of the curriculum.

  16. GOCE observations for Mineral exploration in Africa and across continents

    Science.gov (United States)

    Braitenberg, Carla

    2014-05-01

    The gravity anomaly field over the whole Earth obtained by the GOCE satellite is a revolutionary tool to reveal geologic information on a continental scale for the large areas where conventional gravity measurements have yet to be made (e.g. Alvarez et al., 2012). It is, however, necessary to isolate the near-surface geologic signal from the contributions of thickness variations in the crust and lithosphere and the isostatic compensation of surface relief (e.g. Mariani et al., 2013) . Here Africa is studied with particular emphasis on selected geological features which are expected to appear as density inhomogeneities. These include cratons and fold belts in the Precambrian basement, the overlying sedimentary basins and magmatism, as well as the continental margins. Regression analysis between gravity and topography shows coefficients that are consistently positive for the free air gravity anomaly and negative for the Bouguer gravity anomaly (Braitenberg et al., 2013; 2014). The error and scatter on the regression is smallest in oceanic areas, where it is a possible tool for identifying changes in crustal type. The regression analysis allows the large gradient in the Bouguer anomaly signal across continental margins to be removed. After subtracting the predicted effect of known topography from the original Bouguer anomaly field, the residual field shows a continent-wide pattern of anomalies that can be attributed to regional geological structures. A few of these are highlighted, such as those representing Karoo magmatism, the Kibalian foldbelt, the Zimbabwe Craton, the Cameroon and Tibesti volcanic deposits, the Benue Trough and the Luangwa Rift. A reconstruction of the pre-break up position of Africa, South and North America is made for the residual GOCE gravity field obtaining today's gravity field of the plates forming West Gondwana. The reconstruction allows the positive and negative anomalies to be compared across the continental fragments, and so helps

  17. Recent Aeromagnetic Anomaly views of the Antarctic continent

    Science.gov (United States)

    Ferraccioli, F.

    2012-04-01

    Antarctica is a keystone within the Gondwana and Rodinia supercontinents. However, despite intense geological research along the coastal fringes of Antarctica, the interior of the continent remains one of the most poorly understood regions on Earth. Aeromagnetic investigations are a useful tool to help disclose the structure and the evolution of continents from the Precambrian to the Cenozoic and Antarctica is no exception. Here I review a variety of aeromagnetic studies in East and West Antarctica performed since the completion of the first generation ADMAP -Antarctic Digital Magnetic Anomaly Project- in 2001. In western Dronning Maud, in East Antarctica, aeromagnetic data help delineate the extent of the Jurassic Jutulstraumen subglacial rift that is flanked by remnants of a Grenvillian-age (ca 1.1. Ga) igneous province and magmatic arc. Different magnetic signatures appear to characterize the Coats Land block but reconnaissance surveys are insufficient to fully delineate the extent and significance of the Coats Land block, a possible tectonic tracer of Laurentia within Rodinia (Loewy et al., 2011). Further in the interior of East Antarctica, a mosaic of distinct and hitherto largely unknown Precambrian provinces has recently been revealed by combining aeromagnetic and satellite magnetic data with models of crustal thickness constrained by gravity modeling and seismology (Ferraccioli et al., 2011, Nature). A major collisional suture may lie between the Archean Ruker Province and an inferred Proterozoic Gamburtsev Province but the age of final assembly of central East Antarctica remains uncertain and controversial. I favour a Grenville-age collisional event (linked to Rodinia assembly) or possibly older Paleoproteroic collision, followed by intraplate reactivation, as opposed to Neoproterozoic or Early Cambrian collision linked to East-West Gondwana assembly (Boger, 2011). New aerogeophysical surveys over Prince Elizabeth and Queen Mary Land could test this

  18. The City of Hope‑Quality of Life‑Ostomy Questionnaire: Persian ...

    African Journals Online (AJOL)

    Item 37 - 43 ... Annals of Medical and Health Sciences Research | Jul-Aug 2014 | Vol 4 | Issue 4 |. Address for ... Nursing Research at the COH National Medical Center, Duarte,. CA and ..... study. Asian Pac J Cancer Prev 2008;9:123‑6. 14.

  19. Urethral pressure response patterns induced by squeeze in continent and incontinent women.

    Science.gov (United States)

    Teleman, Pia M; Mattiasson, Anders

    2007-09-01

    Our aim was to compare the urethral pressure response pattern to pelvic floor muscle contractions in 20-27 years old, nulliparous continent women (n = 31) to that of continent (n = 28) and formerly untreated incontinent (n = 59) (53-63 years old) women. These women underwent urethral pressure measurements during rest and repeated pelvic muscle contractions. The response to the contractions was graded 0-4. The young continent women showed a mean urethral pressure response of 2.8, the middle-aged continent women 2.2 (NS vs young continent), and the incontinent women 1.5 (p continent, p continent). Urethral pressures during rest were significantly higher in the younger women than in both groups of middle-aged women. The decreased ability to increase urethral pressure on demand seen in middle-aged incontinent women compared to continent women of the same age as well as young women seems to be a consequence of a neuromuscular disorder rather than of age.

  20. Comparison of symptom severity and treatment response in patients with incontinent and continent overactive bladder

    NARCIS (Netherlands)

    Michel, Martin C.; de La Rosette, Jean J. M. C. H.; Piro, Maria; Schneider, Tim

    2005-01-01

    Purpose: Two thirds of patients with overactive bladder (OAB) are continent, but our knowledge on the treatment of the syndrome is largely based on studies with incontinent patients. Therefore, we have explored baseline symptoms and treatment responses to tolterodine in continent relative to

  1. Critical Thinking Disposition of Nurse Practitioners in Taiwan.

    Science.gov (United States)

    Hsu, Hsiu-Ying; Chang, Shu-Chen; Chang, Ai-Ling; Chen, Shiah-Lian

    2017-09-01

    Critical thinking disposition (CTD) is crucial for nurse practitioners who face complex patient care scenarios. This study explored the CTD of nurse practitioners and related factors. The study was a cross-sectional descriptive design. A purposive sample was recruited from a medical center and its hospital branches in central Taiwan. A structured questionnaire was used to collect data from 210 nurse practitioners. The participants obtained the highest average score on systematicity and analyticity. CTD had a significant positive correlation with fundamental knowledge readiness, professional knowledge readiness, and confidence in making clinical decisions. Professional knowledge readiness, education level, and on-the-job training predicted the score of the participants on overall CTD. On-the-job training and education level may influence the CTD of nurse practitioners. Providing formal or on-the-job continuing education training to nurse practitioners may help enhance their CTD. J Contin Educ Nurs. 2017;48(9):425-430. Copyright 2017, SLACK Incorporated.

  2. Earth's early O2 cycle suppressed by primitive continents

    Science.gov (United States)

    Smit, Matthijs A.; Mezger, Klaus

    2017-10-01

    Free oxygen began to accumulate in Earth's surface environments between 3.0 and 2.4 billion years ago. Links between oxygenation and changes in the composition of continental crust during this time are suspected, but have been difficult to demonstrate. Here we constrain the average composition of the exposed continental crust since 3.7 billion years ago by compiling records of the Cr/U ratio of terrigenous sediments. The resulting record is consistent with a predominantly mafic crust prior to 3.0 billion years ago, followed by a 500- to 700-million-year transition to a crust of modern andesitic composition. Olivine and other Mg-rich minerals in the mafic Archaean crust formed serpentine minerals upon hydration, continuously releasing O2-scavenging agents such as dihydrogen, hydrogen sulfide and methane to the environment. Temporally, the decline in mafic crust capable of such process coincides with the first accumulation of O2 in the oceans, and subsequently the atmosphere. We therefore suggest that Earth's early O2 cycle was ultimately limited by the composition of the exposed upper crust, and remained underdeveloped until modern andesitic continents emerged.

  3. Volcanic passive margins: another way to break up continents.

    Science.gov (United States)

    Geoffroy, L; Burov, E B; Werner, P

    2015-10-07

    Two major types of passive margins are recognized, i.e. volcanic and non-volcanic, without proposing distinctive mechanisms for their formation. Volcanic passive margins are associated with the extrusion and intrusion of large volumes of magma, predominantly mafic, and represent distinctive features of Larges Igneous Provinces, in which regional fissural volcanism predates localized syn-magmatic break-up of the lithosphere. In contrast with non-volcanic margins, continentward-dipping detachment faults accommodate crustal necking at both conjugate volcanic margins. These faults root on a two-layer deformed ductile crust that appears to be partly of igneous nature. This lower crust is exhumed up to the bottom of the syn-extension extrusives at the outer parts of the margin. Our numerical modelling suggests that strengthening of deep continental crust during early magmatic stages provokes a divergent flow of the ductile lithosphere away from a central continental block, which becomes thinner with time due to the flow-induced mechanical erosion acting at its base. Crustal-scale faults dipping continentward are rooted over this flowing material, thus isolating micro-continents within the future oceanic domain. Pure-shear type deformation affects the bulk lithosphere at VPMs until continental breakup, and the geometry of the margin is closely related to the dynamics of an active and melting mantle.

  4. Mid-Continent Rift: Rift, LIP, or Both?

    Science.gov (United States)

    Stein, C. A.; Stein, S. A.; Kley, J.; Hindle, D.; Keller, G. R., Jr.

    2014-12-01

    North America's Midcontinent Rift (MCR) is traditionally considered to have formed by midplate extension and volcanism ~1.1 Ga that ended due to compression from the Grenville orogeny, the ~1.3 - ~0.98 Ga assembly of Amazonia (Precambrian northeast South America), Laurentia (Precambrian North America), and other continents into the supercontinent of Rodinia. We find that a more plausible scenario is that it formed as part of the rifting of Amazonia from Laurentia and became inactive once seafloor spreading was established. The MCR has aspects both of a continental rift - a segmented linear depression filled with sedimentary and igneous rocks - and a large igneous province (LIP). Comparison of areas and volumes for a range of continental LIPS shows that the MCR volcanic rocks are significantly thicker than the others. The MCR flood basalts have steeper dips and thicker overlying sediments than other continental flood basalts, and were deposited in a subsiding basin after most extension ended, indicating that they are better viewed as post-rift than syn-rift rocks. Hence we view the MCR as a LIP deposited in crust weakened by rifting, and thus first a rift and then a LIP.

  5. Continent Idiopathic Vesicovaginal Fistula Coexisting with Moyamoya Disease

    Directory of Open Access Journals (Sweden)

    İbrahim Güven Kartal

    2017-09-01

    Full Text Available Vesicovaginal fistula (VVF is the abnormal anatomic communication between the female bladder and vagina. Usually presents itself as continuous urinary incontinence. There are many etiologic risk factors such as obstetric trauma, pelvic surgery, infections, congenital abnormalities, foreign materials, malignancy and pelvic radiation (1. Due to high education and sociocultural levels, the incidence seems to be low in the developed countries. On the other hand, in the developing countries, there is an obviously high incidence and prevalence. Considering the low level of medical informative feed-back mechanisms and poor obstetrics health care services, it seems very hard to keep VVF patient data that can be used for epidemiological research studies. In those areas, due to high maternal mortality and obstetric complications, the incidence of VVF is significantly increased (2. In this paper, we report a female patient with known moyamoya disease and a stable right ovarian cyst who was regularly followed up by the departments of neurology, gynecology and presented with radiological and cystoscopy findings of incidentally diagnosed asymptomatic continent VVF.

  6. International Continence Society supported pelvic physiotherapy education guideline.

    Science.gov (United States)

    Bakker, Els; Shelly, Beth; Esch, Fetske H; Frawley, Helena; McClurg, Doreen; Meyers, Peter

    2018-02-01

    To provide a guideline of desired knowledge, clinical skills and education levels in Pelvic Physiotherapy (PT). Physiotherapy (PT) involves "using knowledge and skills unique to physiotherapists" and, "is the service only provided by, or under the direction and supervision of a physiotherapist." 1 METHODS: The PT Committee, within the body of the International Continence Society (ICS), collected information regarding existing educational levels for pelvic floor PT. Through face to face and on on-line discussion consensus was reached which was summarized in three progressive educational levels based on knowledge and skills and brought together in a guideline. The guideline was submitted to all physiotherapists and the Educational Committee of the ICS, and after approval, submitted to the Executive Board of the ICS. The guideline lists, in a progressive way, knowledge areas and skills to be achieved by education. It is broad and allows for individual interpretation based on local situations regarding education and healthcare possibilities. It is intended to be dynamic and updated on a regular basis. The proposed Pelvic PT education guideline is a dynamic document that allows course creators to plan topics for continuing course work and to recognize educational level of a therapist in the field of Pelvic PT. This education guideline can be used to set minimum worldwide standards resulting in higher skill levels for local pelvic physiotherapists and thereby better patient care outcome. © 2018 Wiley Periodicals, Inc.

  7. Representations of OxyContin in North American Newspapers and Medical Journals

    Directory of Open Access Journals (Sweden)

    Emma Whelan

    2011-01-01

    Full Text Available Following the approval of OxyContin (Purdue Pharma, Canada for medical use, the media began to report the use of OxyContin as a street drug, representing the phenomenon as a social problem. Meanwhile, the pain medicine community has criticized the inaccurate and one-sided media coverage of the OxyContin problem. The authors of this study aimed to contribute to an understanding of both sides of this controversy by analyzing the coverage of OxyContin in newspapers and medical journals. The analyses revealed inconsistent messages about the drug from physicians in the news media and in medical journals, which has likely contributed to the drug’s perception as a social problem. The authors suggest ways to address the lack of medical consensus surrounding OxyContin. The results of this study may help resolve the concerns and conflicts surrounding this drug and other opioids.

  8. Nursing informatics and nursing ethics

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer

    2013-01-01

    All healthcare visions, including that of The TIGER (Technology-Informatics-Guiding-Educational-Reform) Initiative envisage a crucial role for nursing. However, its 7 descriptive pillars do not address the disconnect between Nursing Informatics and Nursing Ethics and their distinct communities......-of-(care)-decision. Increased pressure for translating 'evidence-based' research findings into 'ethically-sound', 'value-based' and 'patient-centered' practice requires rethinking the model implicit in conventional knowledge translation and informatics practice in all disciplines, including nursing. The aim is to aid 'how...... nurses and other health care scientists more clearly identify clinical and other relevant data that can be captured to inform future comparative effectiveness research. 'A prescriptive, theory-based discipline of '(Nursing) Decisionics' expands the Grid for Volunteer Development of TIGER's newly launched...

  9. Nursing students' attitudes about home health nursing.

    Science.gov (United States)

    Prestia, Mindy; Murphy, Susan; Yoder, Marian

    2008-09-01

    In an effort to address the home care nursing shortage, this pilot study was designed to measure nursing students' attitudes toward home health nursing and to test the Home Health Attitude Questionnaire developed specifically for this study based on the Theory of Planned Behavior. Senior undergraduate nursing students and registered nursing to bachelor of science in nursing students completed the questionnaire.

  10. Fostering nursing ethics for practical nursing

    OpenAIRE

    森田, 敏子; モリタ, トシコ; Morita, Toshiko

    2014-01-01

    Higher nursing ethics can raise nursing quality. The author attempts to define theproblem from the seedling of sensibility in practical nursing and focuses on the clinical environment surrounding nursing ethics from its pedagogical and historicalaspects. On the basis of these standpoints, the author discusses issues on the practical nursing as a practitioner of nursing ethics.

  11. American Nurses Association Nursing World

    Science.gov (United States)

    ... Standards Nursing Quality Ethics / Genetics & Genomics Code of Ethics Workplace Safety / Safe Patient Handling Needlestick Prevention Environmental Health Policy & Advocacy / Take Action Position Statements Member ...

  12. Wetland dynamics influence mid-continent duck recruitment

    Science.gov (United States)

    Anteau, Michael J.; Pearse, Aaron T.; Szymankski, Michael L.

    2013-01-01

    Recruitment is a key factor influencing duck population dynamics. Understanding what regulates recruitment of ducks is a prerequisite to informed habitat and harvest management. Quantity of May ponds (MP) has been linked to recruitment and population size (Kaminski and Gluesing 1987, Raveling and Heitmeyer 1989). However, wetland productivity (quality) is driven by inter-annual hydrological fluctuations. Periodic drying of wetlands due to wet-dry climate cycles releases nutrients and increases invertebrate populations when wet conditions return (Euliss et al. 1999). Wetlands may also become wet or dry within a breeding season. Accordingly, inter-annual and intra-seasonal hydrologic variation potentially influence duck recruitment. Here, we examined influences of wetland quantity, quality, and intra-seasonal dynamics on recruitment of ducks. We indexed duck recruitment by vulnerability-corrected age ratios (juveniles/adult females) for mid-continent Gadwall (Anas strepera). We chose Gadwall because the majority of the continental population breeds in the Prairie Pothole Region (PPR), where annual estimates of MP exist since 1974. We indexed wetland quality by calculating change in MP (?MP) over the past two years (?MP = 0.6[MPt – MPt-1] + 0.4[MPt – MPt-2]). We indexed intra-seasonal change in number of ponds by dividing the PPR mean standardized precipitation index for July by MP (hereafter summer index). MP and ?MP were positively correlated (r = 0.65); therefore, we calculated residual ?MP (?MPr) with a simple linear regression using MP, creating orthogonal variables. Finally, we conducted a multiple regression to examine how MP, ?MPr, and summer index explained variation in recruitment of Gadwall from 1976–2010. Our model explained 67% of the variation in mid-continent Gadwall recruitment and all three hydrologic indices were positively correlated with recruitment (Figure 1). Type II semi-partial R2 estimates indicated that MP accounted for 41%, ?MPr

  13. Stable Isotopes in Precipitation over Indonesia Maritime Continent

    Energy Technology Data Exchange (ETDEWEB)

    Ichiyanagi, K. [Graduate School of Science and Technology, Kumamoto University, and Japan Agency for Marine-Earth Science and Technology (JAMSTEC) (Japan); Suwarman, R. [Graduate School of Science and Technology, Kumamoto University (Japan); Yamanaka, M. D. [Japan Agency for Marine-Earth Science and Technology (JAMSTEC) (Japan)

    2013-07-15

    Daily variability of stable isotopes in precipitation was observed at 6 stations in the Indonesian Maritime Continent from 2000 to 2006. The annual mean {delta}{sup 18}O at Bukit Kototabang (GAW), Jambi, and Makassar are heavier than those for others. The precipitation amount effect was observed only at Denpasar and Makassar. There are 2 groups resulting from the local Meteoric Water line; (1) slope is nearly 7.0 and high d-excess more than 10 at GAW, Denpasar, and Manado, (2) slope is around 7.4 and low d-excess less than 7.5 per mille at Jambi, Makassar, and Palau. Seasonal variability of {delta}{sup 18}O and d-excess were classified into three patterns. There are no seasonal variations in {delta}{sup 18}O and d-excess at GAW and Jambi, but clear seasonal variations at Denpasar (DPS) and Makassar (MKS). Due to the amount effect, {delta}{sup 18}O in precipitation is high when the precipitation amount is low from May to october. In contrast, the amount effect is not significant and d-excess is constant throughout the year in Manado and Palau. The {delta}{sup 18}O in precipitation at 2 stations located in sumatra Island corresponded with the Madden-Jullian Oscillation index, while those for the other 4 stations in more easterly locations did not. This finding indicates that water vapour evaporated from the Indian Ocean can reach the Island of sumatra, but can't reach more easterly locations. (author)

  14. Smoke aerosol transport patterns over the Maritime Continent

    Science.gov (United States)

    Xian, Peng; Reid, Jeffrey S.; Atwood, Samuel A.; Johnson, Randall S.; Hyer, Edward J.; Westphal, Douglas L.; Sessions, Walter

    2013-03-01

    Smoke transport patterns over the Maritime Continent (MC) are studied through a combination of approaches, including a) analyzing AODs obtained from satellite products; b) aerosol transport modeling with AOD assimilation along with the atmospheric flow patterns; c) analyzing smoke wet deposition distributions; and d) examining forward trajectories for smoke events defined in this study. It is shown that smoke transport pathways are closely related to the low-level atmospheric flow, i.e., during June-Sept, smoke originating from the MC islands with a dominant source over central and southern Sumatra, and southern and western Borneo, is generally transported northwestward south of the equator and northeastward north of the equator with the cross-equatorial flow, to the South China Sea (SCS), the Philippines and even further to the western Pacific. During the October-November transitional period, smoke transport paths are more zonally oriented compared to June-September. Smoke originating from Java, Bali, Timor etc, and southern New Guinea, which are in the domain of easterlies and southeasterlies during the boreal summer (June-November), is generally transported westward. It is also found that smoke transport over the MC exhibits multi-scale variability. Smoke typically lives longer and can be transported farther in El Niño years and later MJO phases compared with non El Niño years and earlier MJO phases. During El Niño periods there is much stronger westward transport to the east tropical Indian Ocean. Finally, orographic effect on smoke transport over the MC is also clearly discernable.

  15. MONTI as continent catheterized stoma using serosal-lined trough "Ghoneim Abolenin" technique in ileocystoplasty

    Directory of Open Access Journals (Sweden)

    Mohammed T Sammour

    2011-01-01

    Full Text Available It is a great challenge to select and perform continent mechanism in a stoma for urinary reservoir. A new technique by combining MONTI ileal conduit with the serosal lined trough in order to achieve continent catheterizable stoma to the umbilicus as a part of augmentation ileocystoplasty. We applied serosal-lined trough as a continent mechanism with MONTI ileal tube in 12 years smart girl underwent ileocystoplasty for neuropathic bladder due to meylomeningocele in whom continence failed to be achieved by using Mitrofanoff with submucosal tunnel of the bladder as continent mechanism before, also the previous operation included left to right transuretero-ureterostomy, ureterocystoplasty and reimplantation of the right ureter. The patient became completely continent; she was able to do self-catheterization easily through the umbilical stoma using 16-French catheter and was able to wash the mucous easily. The capacity of the augmented bladder was 300ccs. She became independent from her mother and stopped using diapers, anticholinergic and antibiotics. Combining MONTI conduit with serosal-lined extramural valve trough (The Ghoneim technique is an effective continent technique and gives wider channel for catheterization and washing out the mucous.

  16. Modified Le Bag Pouch after Radical Cystectomy: Continence, Uro dynamic Results and Morbidity

    International Nuclear Information System (INIS)

    Nassar, O.A.H.

    2010-01-01

    To revaluate ileocolonic pouch for ortho-topic neobladder reconstruction, a cohort of patients with bladder cancer was selected to undergo radical cystectomy and modified Le Bag pouch. Evaluation concentrates on continence and associated morbidity observed on close follow-up. Patients and Methods: A total of 37 patients including 16 females with T2 3 bladder cancer (19 transitional, 15 : squamous and 3 adenocarcinoma) were treated by radical cystectomy and totally detubularized ileocolic neobladder. Post operative morbidity, continence and urodynamic studies were evaluated. Mean time to have full daytime continence was tested against age, gender, postoperative complications, technique of pouch creation either stapler or hand suture and adjuvant irradiation. Results: Cystometry 12 months post surgery showed 493 ml median capacity with basal and maximum reservoir median pressures of 16 and 38 cm H 2 O respectively. Uro-flowmetry had maximum voiding volume of 370ml, voiding time 45s and maximum flow rate of 11.6ml/s. Within the first 2 months post operative 44% were continent by day, 33% by night and 67% had stress incontinence. By 12 months post surgery 89% were continent by day, 73% by night and 27% had stress incontinence. Two years post surgery 94% were continent by day and 81 % had complete day and night control of uri-ne. Urinary leakage was the most frequent early complication (10.8%). Late complications were urinary tract infection (13.5%), metabolic acidosis (13.5%) and reflux (10.8%). Pouch over distension (5.4%) was consistent with bladder neck obstruction. Patient's gender and postoperative morbidity were statistically significant factors to increase the mean time to continence; whereas, age, use of stapler and adjuvant radiotherapy had no significant effect. Conclusion: Modified Le Bag pouch is a simple technique with adequate pouch capacity that offers excellent slowly progressing continence rates with minor morbidity rate. Post operative morbidity and

  17. Magnetic compression ostomy for simple tube colostomy in rats--magnacolostomy.

    Science.gov (United States)

    Uygun, Ibrahim; Okur, Mehmet H; Arayici, Yilmaz; Keles, Aysenur; Ozturk, Hayrettin; Otcu, Selcuk

    2012-01-01

    Magnetic compression anastomoses (magnamosis) have been previously described for gastrointestinal, biliary, urinary, and vascular anastomoses. Objectives. Herein, the authors report the creation of a magnetic compression colostomy (magnacolostomy) using a simple technique in rats. Animals were randomized into two groups (n = 8, each): a magnetic colostomy (MC) group and a control surgical tube colostomy (SC) group. In the MC group, the first magnetic ball (3 mm) was rectally introduced into the rat colon. The second magnetic ball (4 mm) was placed subcutaneously into the left quadrant, and the two magnetic balls strongly coupled. On postoperative day 20 for the MC group and postoperative day 10 in the SC group, the rats were sacrificed and the colostomies evaluated macroscopically, histopathologically, and for mechanical burst testing. From the macroscopic evaluation, two rats failed to form the colostomy canal due to colostomy catheter and magnetic ball removal. In the remaining rats, evidence of complications were not observed. Two rats in the MC group displayed mild adhesion and all rats in the SC group displayed moderate adhesion. No significant differences between the burst pressures were observed. However, a significant difference (p colostomy procedures such as antegrade continence enemas, percutaneous endoscopic, and colostomy/cecostomy in humans.

  18. Cybersecurity in the Clinical Setting: Nurses' Role in the Expanding "Internet of Things".

    Science.gov (United States)

    Billingsley, Luanne; McKee, Shawn A

    2016-08-01

    Nurses face growing complexity in their work. The expanding "Internet of Things" with "smart" technologies can reduce the burden. However, equipment and devices that connect to patients, the network, or to the Internet can be exploited by hackers. Nurses should be able to identify, understand, and protect against cybersecurity risks to safeguard patients. J Contin Educ Nurs. 2016;47(8):347-349. Copyright 2016, SLACK Incorporated.

  19. The thermal influence of continents on a model-generated January climate

    Science.gov (United States)

    Spar, J.; Cohen, C.; Wu, P.

    1981-01-01

    Two climate simulations were compared. Both climate computations were initialized with the same horizontally uniform state of rest. However, one is carried out on a water planet (without continents), while the second is repeated on a planet with geographically realistic but flat (sea level) continents. The continents in this experiment have a uniform albedo of 0.14, except where snow accumulates, a uniform roughness height of 0.3 m, and zero water storage capacity. Both runs were carried out for a 'perpetual January' with solar declination fixed at January 15.

  20. The “potato road” and biogeographic history of potato cyst nematode populations from different continents

    Directory of Open Access Journals (Sweden)

    Or Violeta

    2014-01-01

    Full Text Available The general opinion about the introduction of potato in Europe is the one regarding the direction from South America to Spain and subsequent distribution to other continents. Some historical data point out an alternative road. The potato spread from its place of origin to other continents in the light of parasite-host relationship, relying on nematode molecular data, is discussed in the present work. Biogeographic history of potato cyst nematode populations from different continents is in congruence with historical records. [Projekat Ministarstva nauke Republike Srbije, br. TR 31018 i br. III 46007

  1. Australian Hospital-Based Nurse Educators' Perceptions of Their Role.

    Science.gov (United States)

    Thornton, Karleen

    2018-06-01

    This article presents the findings from a phenomenological study that explored the understandings of Australian hospital-based nurse educators' experiences of their role. Purposive sampling resulted in 11 nurse educators from four large metropolitan hospitals within an Australian jurisdiction. The participants were asked how they understand their role and translate that understanding into practice. Thematic analysis identified four themes representative of nurse educators' understanding of their role: Becoming an Educator, Capability Building, Panacea, and Tension. A coherent picture emerged from subthemes highlighting that nurse educators were undervalued and value is added. Being undervalued and value adding are translated into nurse educator practice as resilience, being educationally literate, investing, and having a presence. This article identifies a gap in knowledge related to understanding the nurse educator role and informs recruitment and subsequent retention of nurses into nurse educator roles at a time when the nursing workforce in Australia and internationally is about to experience a major shortfall. Findings are specific to the Australian context and are not necessarily generalizable to other hospital jurisdictions. J Contin Educ Nurs. 2018;49(6):274-281. Copyright 2018, SLACK Incorporated.

  2. Empowering Nurses to Lead Interprofessional Collaborative Practice Environments Through a Nurse Leadership Institute.

    Science.gov (United States)

    Embree, Jennifer L; Wagnes, Lisa; Hendricks, Susan; LaMothe, Julie; Halstead, Judith; Wright, Lauren

    2018-02-01

    A year-long Nurse Leadership Institute (NLI) for emerging leaders in primary care clinics and acute care environments was developed, implemented, and evaluated. The NLI's goal was to foster empowerment in interprofessional collaborative practice environments for nurses in the three cohorts of NLIs. The NLI was framed around the Five Leadership Practices of modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart. To create a professional learning environment, foster community, and enhance leadership skills, the Lean In Circle materials developed by Sandberg were adapted for content reorganization and discussion. Minimal literature exists specifically addressing nursing leadership professionals' development based on Sandberg's Circle materials. The findings of the three NLI cohorts reported in this article begin to fill this existing knowledge gap. Participants reported a significant increase in leadership skills. Recommendations for refinement of future NLI offerings are provided. J Contin Educ Nurs. 2018;49(2):61-71. Copyright 2018, SLACK Incorporated.

  3. Journal of Special Operations Medicine. Volume 10, Edition 1, Winter 2010

    Science.gov (United States)

    2010-01-01

    2005). WOCN position statement, clean versus sterile: Management of chronic wounds, Wound Ostomy and Continence Nurses Society, IL, January. 51. Forgey W...tions. These patients are beyond the scope of practice for any short-term medical engagement. The key is to avoid creating false hope and/or...efforts in medical hu- manitarian missions with a sincere hope of im- proving the lives, however modestly, of the persons to whom we brought medical care

  4. Climate controls on fire pattern in African and Australian continents

    Science.gov (United States)

    Zubkova, M.; Boschetti, L.; Abatzoglou, J. T.

    2017-12-01

    Studies have primarily attributed the recent decrease in global fire activity in many savanna and grassland regions as detected by the Global Fire Emission Database (GFEDv4s) to anthropogenic changes such as deforestation and cropland expansion (Andela et al. 2017, van der Werf et al. 2008). These changes have occurred despite increases in fire weather season length (Jolly et al. 2015). Efforts to better resolve retrospective and future changes in fire activity require refining the host of influences on societal and environmental factors on fire activity. In this study, we analyzed how climate variability influences interannual fire activity in Africa and Australia, the two continents most affected by fire and responsible for over half of the global pyrogenic emissions. We expand on the analysis presented in Andela et al. (2017) by using the most recent Collection 6 MODIS MCD64 Burned Area Product and exploring the explanatory power of a broader suite of climate variables that have been previously shown to explain fire variability (Bowman et al. 2017). We examined which climate metrics show a strong interannual relationship with the amount of burned area and fire size accounting for antecedent and in-season atmospheric conditions. Fire characteristics were calculated using the 500m resolution MCD64A1 product (2002-2016); the analysis was conducted at the ecoregion scale, and further stratified by landcover using a broad aggregation (forest, shrublands and grasslands) of the Landcover CCI maps (CCI-LC, 2014); all agricultural areas fires were excluded from the analysis. The results of the analysis improve our knowledge of climate controls on fire dynamics in the most fire-prone places in the world which is critical for statistical fire and vegetation models. Being able to predict the impact of climate on fire activity has a strategic importance in designing future fire management scenarios, help to avoid degradation of biodiversity and ecosystem services and improve

  5. BRICS: challenges of cooperation on the African continent

    Directory of Open Access Journals (Sweden)

    Vladimir Ivanovich Yurtaev

    2016-12-01

    Full Text Available The happening paradigm shift of development both the kernel of world economy, and its periphery appearing by the hostage of limitation of financial resources updates task of judgment of the happening processes, especially with participation of the Brazil, Russia, India, China and South Africa (BRICS or the countries of the “big economies” which are looking for new formats of entry into worldwide policy. Also the problem of correlation of the monopolar structure of a world economic system which has arisen in the conditions of globalization of economies at the end of the 20th century with processes of forming of the new centers of world economic power is actual, including - in Africa, under the influence of an exit to the world scene of China and other countries of BRICS, disappearance of the so-called “second world”, opposition mitigation “East-West” and increase of contradictions on an axis “North-South”. The countries of Africa at the beginning of the second decade of the third millennium are more and more considerably involved in process of globalization which signs can be found everywhere on the African continent. First of all, it is necessary to pay attention on much the increased dynamics of political process, especially in North Africa where under the influence of “the Arab spring” scales and depth of the happened transformation of a socio-political context were shown, civilization breaks and perspective scenarios of development were more accurately designated. To conformably new challenges questions of regional integration have come under the spotlight in Africa, search of solutions of global problems of mankind in Africa is conducted (poverty, hunger, diseases, refugees, etc. new formats of interaction of the states for the benefit of effective development are developed. It is possible that in so dynamic and turbulent socio-political and economic situation regional vector of interaction and interregional international

  6. A Surface Wave's View of the Mid-Continent Rift

    Science.gov (United States)

    Foster, A. E.; Darbyshire, F. A.; Schaeffer, A. J.

    2017-12-01

    The presence of the Mid-Continent Rift (MCR), a 1.1Ga failed rift in central North America, raises many questions. We address the following: what lasting effects has it had on the continental lithosphere? Though many studies have looked at the area with a variety of data types, the combination of USArray Transportable Array stations to the south, permanent and temporary Canadian stations to the north, and SPREE stations in strategic locations crossing the rift provide a new opportunity for a regional surface-wave study. We select 80 stations with roughly 200 km spacing, resulting in dense path coverage of a broad area centered on the MCR. We use teleseismic data for all earthquakes from January 2005-August 2016 with a magnitude greater than 6.0, amounting to over 1200 events, and we make Rayleigh wave two-station dispersion measurements for all station pairs with suitable event-station geometry. We invert these measurements for anisotropic phase-velocity maps at periods of 20-200 s, yielding information not only on the wave speed but also the current fabric of the lithosphere, a complicated record of strain from formation, through modification from orogeny, attempted rifting, and hotspot interaction, to present day plate motion. We observe a clear signature of the MCR at short (20-25 s) periods, with the slowest phase-velocity anomaly in the region aligning with the strongest gravity anomaly. At increasing periods, and thus greater depths, this slowest anomaly shifts to beneath the center of Lake Superior (30-40 s). Eventually, it appears to merge with a slow anomaly to the north associated with the Nipigon Embayment, and contrasts sharply with an adjacent fast anomaly in the western Superior Province. In our preliminary anisotropy results, we observe weak anisotropy at the latitude of the MCR and to the south, whereas to the north of the MCR we find strong anisotropy. This is similar to the spatial variations in magnitude of delay times from shear-wave splitting

  7. 77 FR 35959 - Atlas Pipeline Mid-Continent WestTex, LLC; Pioneer Natural Resources USA, Inc.; Notice of...

    Science.gov (United States)

    2012-06-15

    ... Mid-Continent WestTex, LLC; Pioneer Natural Resources USA, Inc.; Notice of Application Take notice that on May 30, 2012, Atlas Pipeline Mid-Continent WestTex, LLC (Atlas) and Pioneer Natural Resources... President and General Counsel, Atlas Pipeline Mid-Continent, LLC, 110 W. 7th Street, Suite 2300, Tulsa, OK...

  8. Estomizado adulto no município de São Paulo: um estudo sobre o custo de equipamentos especializados Adulto ostomizado del municipio Sao Paulo: un estudio sobre el costo de los equipamientos especializados Adult ostomy patients in the city of São Paulo: a study of specialized equipment costs

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Conceição de Gouveia Santos

    2008-06-01

    y atendidos en el servicio con enfermero especialista. Hubo correlación estadísticamente significativa y positiva entre el costo mensual y el tiempo de ostomía. Este estudio contribuyó para la evaluación del costo del ostomizado en el Estado de Sao Paulo.This study was aimed at analyzing the monthly cost of the use of specialized equipment by ostomy patients. It is a retrospective study carried out at two Outpatient Health Centers in São Paulo. The data were collected in 635 records of adult ostomy patients assisted in June of 2005. For the costs, the data were obtained in electronic databases and official publications from the State of São Paulo Health Secretary, and the results were submitted to the Kolmogorov-Smirnov, Mann-Whitney, Kruskal-Wallis, Bonferroni and Spearman tests. Most of the individuals were female (51%, aged >60 years, with temporary colostomy (64.5%. The average monthly cost was US$ 51.0 per patient, higher for cancer urostomy patients with permanent stomas, with neoplasia in the urinary tract and assisted by the service with a therapist nurse. Statistically significant correlation between the monthly cost and the time with stoma was found. This study has contributed for the assessment of the cost of ostomy patients in the State of São Paulo.

  9. Naturalistic nursing.

    Science.gov (United States)

    Hussey, Trevor

    2011-01-01

    Where nurse education aims to provide an overarching intellectual framework, this paper argues that it should be the framework of naturalism. After an exposition of the chief features of naturalism and its relationship to science and morality, the paper describes naturalistic nursing, contrasting it with some other perspectives. There follows a defence of naturalism and naturalistic nursing against several objections, including those concerning spirituality, religion, meaning, morality, and alternative sources of knowledge. The paper ends with some of the advantages of the naturalistic approach. © 2010 Blackwell Publishing Ltd.

  10. Home visits as part of a new care pathway (iAID) to improve quality of care and quality of life in ostomy patients: a cluster-randomized stepped-wedge trial

    NARCIS (Netherlands)

    Sier, M. F.; Oostenbroek, R. J.; Dijkgraaf, M. G. W.; Veldink, G. J.; Bemelman, W. A.; Pronk, A.; Spillenaar-Bilgen, E. J.; Kelder, W.; Hoff, C.; Ubbink, D. T.; Havenga, K.; Veltkamp, S. C.; T Dekker, J. W.; Boerma, D.; Eijsbouts, Q. A. J.; Lamme, B.; Vuylsteke, R. J. C. L. M.; Tobon Morales, R. E.; van Tets, W. F.

    2017-01-01

    Aim Morbidity in patients with an ostomy is high. A new care pathway, including perioperative home visits by enterostomal therapists, was studied to assess whether more elaborate education and closer guidance could reduce stoma-related complications and improve quality of life (QoL), at acceptable

  11. The dual influences of age and obstetric history on fecal continence in parous women.

    LENUS (Irish Health Repository)

    Eogan, Maeve

    2011-02-01

    To assess whether women who underwent forceps delivery were more likely than those who delivered either normally (spontaneous vaginal delivery [SVD]) or by cesarean to experience deterioration in fecal continence as they aged.

  12. Bibliography of sandy beaches and sandy beach organisms on the African continent

    CSIR Research Space (South Africa)

    Bally, R

    1986-01-01

    Full Text Available This bibliography covers the literature relating to sandy beaches on the African continent and outlying islands. The bibliography lists biological, chemical, geographical and geological references and covers shallow marine sediments, surf zones off...

  13. The Aristotelian continence: channeling of righteous actions in the scientist´s experiments with animals

    Directory of Open Access Journals (Sweden)

    Luis Fernando Garcés Giraldo

    2014-06-01

    Full Text Available In Aristotelian ethics, the virtue of continence is responsible for mastering the soul and direct it towards the right reason; thus the continent, knowing that passions are bad does not follow them because of the reason; this virtuous is the one who subdues the passions, since both, reason and passions, oppose each other. For Aristotle the desire is the beginning of the action, followed by the discussion leading to choose the best and the most perfect virtuous action. It is important for bioethics that the virtue of continence applies to the actions of scientists who use animals for experimentation and that all their actions are mediated by the good actions. This article will deal with the virtue of continence as the channeling of actions mediated by right reason in the scientist who is experimenting with animals.

  14. Educação em saúde ao ostomizado: um estudo bibliométrico Orientación a la salud del ostomato: un estudio de bibliometría Health education to ostomy patients: a bibliometrics study

    Directory of Open Access Journals (Sweden)

    Audrey Garcia Reveles

    2007-06-01

    la autoestima de los pacientes para que sientan que, aún con ostomía, pueden llevar una vida normal. Así, concluimos que el enfermero, como educador de un ostomato debe conocer estas publicaciones para una mejor ayuda.This study has as its objective to identify the scientific studies dealing with the orientation to patients submitted to ostomy published between 1970 to 2004 and to classify them according to quantity, chronology of publication, authors' function, source, kind of study, topic, origin and key words by using the bibliometrics methodology. A total of 27 publications were collected in the DEDALUS databank, in the LILACS and MEDLINE data-bases and from a professor of the University of São Paulo's Nursing School (EEUSP, which is a national reference in ostomy in Brazil. Of these, 19 were written by Brazilians and 8 by non-Brazilians; most were written by nurses and enterostomal therapists. Dissertations, theses, orientation manuals, books and articles were found. The origin of the material was academia, laboratories and hospitals. The 1990s concentrated the largest number of studies in this thematic area. All of them have the purpose of elevating patients' self-esteem in order to make them feel that, even with an ostomy, they can have a normal life. Thus the study concludes that the nurse, as an educator for the ostomy patient, should be acquainted with those publications to improve the assistance he/she provides.

  15. Demystifying Nursing Theory: A Christian Nursing Perspective.

    Science.gov (United States)

    Schaffer, Marjorie A; Sandau, Kristin; Missal, Bernita

    How does nursing theory apply to nursing practice? Nursing theory can explain the why and how of nursing practice, guide nursing interventions, and provide a framework for measuring outcomes. This article briefly explains nursing theory, provides examples for applying theory to nursing practice, and proposes questions for examining the consistency of nursing theories with Christian perspectives. A helpful table illustrating grand, middle-range, and situation-specific theories and their application to nursing practice and research, along with references, is provided online as supplemental digital content. Three caring theories are analyzed from biblical beliefs.

  16. Impact of metabolic syndrome on early recovery of continence after robot-assisted radical prostatectomy.

    Science.gov (United States)

    Nishikawa, Masatomo; Watanabe, Hiromitsu; Kurahashi, Toshifumi

    2017-09-01

    To evaluate the impact of metabolic syndrome on the early recovery of urinary continence after robot-assisted radical prostatectomy. The present study included a total of 302 consecutive Japanese patients with clinically localized prostate cancer who underwent robot-assisted radical prostatectomy. In this study, postoperative urinary continence was defined as no leak or the use of a security pad. The continence status was assessed by interviews before and 1 and 3 months after robot-assisted radical prostatectomy. Metabolic syndrome was defined as follows: body mass index ≥25 kg/m 2 and two or more of the following: hypertension, diabetes mellitus and dyslipidemia. The effect of the presence of metabolic syndrome on the continence status of these patients was retrospectively examined. A total of 116 (38.4%) and 203 (67.2%) of the 302 patients were continent at 1 and 3 months after robot-assisted radical prostatectomy, respectively. A total of 31 (10.3%) patients were judged to have metabolic syndrome. Despite the operative time being longer in patients with metabolic syndrome, no significant differences were observed in the remaining preoperative, intraoperative or postoperative variables between patients with or without metabolic syndrome. On multivariate logistic regression analysis, metabolic syndrome and the duration of hospitalization were significantly correlated with the 1-month continence status. Similarly, metabolic syndrome and estimated blood loss during surgery were independent predictors of continence rates at 3 months after robot-assisted radical prostatectomy. These findings suggest that the presence of metabolic syndrome could have a significant impact on the early recovery of urinary continence after robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

  17. Effect of Nerve-Sparing Radical Prostatectomy on Urinary Continence in Patients With Preoperative Erectile Dysfunction

    Directory of Open Access Journals (Sweden)

    Yong Hyun Park

    2016-03-01

    Full Text Available Purpose: We aimed to assess whether nerve-sparing radical prostatectomy (nsRP is associated with improved recovery of urinary continence compared to non–nerve-sparing radical prostatectomy (nnsRP in patients with localized prostate cancer and preoperative erectile dysfunction. Methods: A total of 360 patients with organ-confined prostate cancer and an International Index of Erectile Function score of less than 17 were treated with nsRP or nnsRP in Seoul St. Mary’s Hospital. Patients who received neoadjuvant or adjuvant androgen deprivation therapy or had a history of prostate-related surgery were excluded. Recovery of urinary continence was assessed at 0, 1, 3, 6, and 12 months. Postoperative recovery of continence was defined as zero pad usage. The association between nerve-sparing status and urinary continence was assessed by using univariate and multivariate Cox regression analyses after controlling for known predictive factors. Results: Urinary continence recovered in 279 patients (77.5% within the mean follow-up period of 22.5 months (range, 6–123 months. Recovery of urinary continence was reported in 74.6% and 86.4% of patients after nnsRP and nsRP, respectively, at 12 months (P=0.022. All groups had comparable perioperative criteria and had no significant preoperative morbidities. Age, American Society of Anesthesiologists score, and nerve-sparing status were significantly associated with recovery of urinary continence on univariate analysis. On multivariate analysis, age (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.002–1.478; P=0.026 and nerve-sparing status (HR, 0.713; 95% CI, 0.548–0.929; P=0.012 were independently associated with recovery of urinary continence. Conclusions: nsRP, as compared to nnsRP, improves recovery rates of urinary incontinence and decreases surgical morbidity without compromising pathologic outcomes.

  18. Genetics Education in Nurse Residency Programs: A Natural Fit.

    Science.gov (United States)

    Hamilton, Nalo M; Stenman, Christina W; Sang, Elaine; Palmer, Christina

    2017-08-01

    Scientific advances are shedding light on the genetic underpinning of common diseases. With such insight, the entire health care team is faced with the need to address patient questions regarding genetic risk, testing, and the psychosocial aspects of genetics information. Nurses are in a prime position to help with patient education about genetic conditions, yet they often lack adequate genetics education within their nursing curriculum to address patient questions and provide resources. One mechanism to address this knowledge deficit is the incorporation of a genetics-based curriculum into nurse residency programs. This article describes a novel genetics-based curriculum designed and implemented in the UCLA Health System Nurse Residency Program. J Contin Educ Nurs. 2017;48(8):379-384. Copyright 2017, SLACK Incorporated.

  19. Free-volume distributions of polymers by positron annihilation spectroscopy: further experiences in using CONTIN for continuous lifetime distributions

    International Nuclear Information System (INIS)

    Dai, G.H.; Jean, Y.C.

    1995-01-01

    Thorough examinations of the CONTIN program were carried out by using the simulated positron lifetime spectra, to reveal the capability of CONTIN in the reconstruction of the positron lifetime distributions. It is shown that: 1. very high statistics is strongly desired by CONTIN to reproduce reliable lifetime distributions; 2. improving the time resolution of the measurement system, to the level of 0.030 ns full width at half maximum, does not significantly improve the resolving power of CONTIN; and 3. reducing the time width per channel is a practical way of improving the reconstruction of the lifetime probability density functions by CONTIN. (orig.)

  20. Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery.

    Science.gov (United States)

    Herrinton, Lisa J; Altschuler, Andrea; McMullen, Carmit K; Bulkley, Joanna E; Hornbrook, Mark C; Sun, Virginia; Wendel, Christopher S; Grant, Marcia; Baldwin, Carol M; Demark-Wahnefried, Wendy; Temple, Larissa K F; Krouse, Robert S

    2016-09-01

    For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter-sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. CA Cancer J Clin 2016;66:387-397. © 2016 American Cancer Society. © 2016 American Cancer Society.

  1. Conversations for Providers Caring for Rectal Cancer Patients: Comparison of Long-Term Patient-Centered Outcomes for Low Rectal Cancer Patients Facing Ostomy or Sphincter-Sparing Surgery

    Science.gov (United States)

    Herrinton, Lisa J.; Altschuler, Andrea; McMullen, Carmit K.; Bulkley, Joanna E.; Hornbrook, Mark C.; Sun, Virginia; Wendel, Christopher S.; Grant, Marcia; Baldwin, Carol M.; Demark-Wahnefried, Wendy; Temple, Larissa K.F.; Krouse, Robert S.

    2017-01-01

    For some low rectal cancer patients, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients eligible for sphincter-sparing surgery may not be well served by the surgery and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries, or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects following the two surgeries has not been synthesized. We therefore conducted a systematic review to examine this ? This systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. Our goals are: 1) improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) increase the patient’s participation in the decision; (3) alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, improve patients’ long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery, as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. PMID:26999757

  2. Nurses and Aides

    Science.gov (United States)

    Franklin, John

    1976-01-01

    Gerontological nursing (the care of the elderly) as a specialization for registered nurses, licensed practical nurses, and nursing aides is discussed with respect to training and qualifications, employment outlook, and earnings for each group. (JT)

  3. Primary Nurse - Role Evolution

    Science.gov (United States)

    Mundinger, Mary O'Neil

    1973-01-01

    Primary nursing means that each patient has an individual nurse who is responsible for assessing his nursing needs and planning and evaluating his nursing care. The article describes the advantages and problems connected with this approach to patient care. (AG)

  4. Value of intensified nursing

    OpenAIRE

    Raymann, Cornelia; Konta, Brigitte; Prusa, Nina; Frank, Wilhelm

    2006-01-01

    The concept "intensified nursing" is mentioned in differentiation to concepts of "nursing care" or "nursing" which intensifies resources or patient contact. Especially psychic and social needs of patients are very appreciated in nursing. A similar type of nursing is known under the concept "advanced nursing practice" (ANP) which means, that a specialised, academically trained nurse offers an extended nursing care in which a focus on the published knowledge of evidence based research is made. ...

  5. Nursing Librarians Cultivating Evidence-Based Practice Through an Asynchronous Online Course.

    Science.gov (United States)

    Mears, Kim; Blake, Lindsay

    2017-09-01

    In response to a request from the Nursing Shared Governance Evidence-Based Practice Council, librarians created an online evidence-based practice (EBP) continuing education course for clinical nurses. The curriculum was adapted from a previously created face-to-face course and was offered online through a learning management system. Although many nurses registered for the course, only a small sample was able to complete all modules. Feedback revealed that nurses appreciated the ease of online use, but they experienced technical barriers. Overall, nurses completing the course agreed that all learning objectives were met. An online asynchronous course for nurses is a viable option for teaching EBP, but hospital computer limitations must be taken into account to allow for participants' full immersion into the material. J Contin Educ Nurs. 2017;48(9):420-424. Copyright 2017, SLACK Incorporated.

  6. A unified model of avian species richness on islands and continents.

    Science.gov (United States)

    Kalmar, Attila; Currie, David J

    2007-05-01

    How many species in a given taxon should be found in a delimited area in a specified place in the world? Some recent literature suggests that the answer to this question depends strongly on the geographical, evolutionary, and ecological context. For example, current theory suggests that species accumulate as a function of area differently on continents and islands. Species richness-climate relationships have been examined separately on continents and on islands. This study tests the hypotheses that (1) the functional relationship between richness and climate is the same on continents and islands; (2) the species-area slope depends on distance-based isolation; (3) species-area relationships differ among land bridge islands, oceanic islands, and continents; (4) richness differs among biogeographic regions independently of climate and isolation. We related bird species numbers in a worldwide sample of 240 continental parcels and 346 islands to several environmental variables. We found that breeding bird richness varies similarly on islands and on continents as a function of mean annual temperature, an area x precipitation interaction, and the distance separating insular samples from the nearest continent (R2 = 0.86). Most studies to date have postulated that the slope of the species-area relationship depends upon isolation. In contrast, we found no such interaction. A richness-environment relationship derived using Old World sites accurately predicts patterns of richness in the New World and vice versa (R2 = 0.85). Our results suggest that most of the global variation in richness is not strongly context-specific; rather, it reflects a small number of general environmental constraints operating on both continents and islands.

  7. Representations of OxyContin in North American newspapers and medical journals

    Science.gov (United States)

    Whelan, Emma; Asbridge, Mark; Haydt, Susan

    2011-01-01

    BACKGROUND: There are public concerns regarding OxyContin (Purdue Pharma, Canada) and charges within the pain medicine community that media coverage of the drug has been biased. OBJECTIVE: To analyze and compare representations of OxyContin in medical journals and North American newspapers in an attempt to shed light on how each contributes to the ‘social problem’ associated with OxyContin. METHODS: Using searches of newspaper and medical literature databases, two samples were drawn: 924 stories published between 1995 and 2005 in 27 North American newspapers, and 197 articles published between 1995 and 2007 in 33 medical journals in the fields of addiction/substance abuse, pain/anesthesiology and general/internal medicine. The foci, themes, perspectives represented and evaluations of OxyContin presented in these texts were analyzed statistically. RESULTS: Newspaper coverage of OxyContin emphasized negative evaluations of the drug, focusing on abuse, addiction, crime and death rather than the use of OxyContin for the legitimate treatment of pain. Newspaper stories most often conveyed the perspectives of law enforcement and courts, and much less often represented the perspectives of physicians. However, analysis of physician perspectives represented in newspaper stories and in medical journals revealed a high degree of inconsistency, especially across the fields of pain medicine and addiction medicine. CONCLUSION: The prevalence of negative representations of OxyContin is often blamed on biased media coverage and an ignorant public. However, the proliferation of inconsistent messages regarding the drug from physicians plays a role in the drug’s persistent status as a social problem. PMID:22059195

  8. WOCN Society and AUA Position Statement on Preoperative Stoma Site Marking for Patients Undergoing Urostomy Surgery.

    Science.gov (United States)

    Salvadalena, Ginger; Hendren, Samantha; McKenna, Linda; Muldoon, Roberta; Netsch, Debra; Paquette, Ian; Pittman, Joyce; Ramundo, Janet; Steinberg, Gary

    2015-01-01

    Marking the optimal location for a stoma preoperatively enhances the likelihood of a patient's independence in stoma care, predictable pouching system wear times, and resumption of normal activities. Urologists and certified ostomy nurses are the optimal clinicians to select and mark stoma sites, as this skill is a part of their education, practice, and training. However, these providers are not always available, particularly in emergency situations. The purpose of this position statement, developed by the Wound, Ostomy and Continence Nurses Society in collaboration with the American Urological Association and the American Society of Colon and Rectal Surgeons, is to provide a guideline to assist clinicians (especially those who are not surgeons or WOC nurses) in selecting an effective stoma site.

  9. WOCN Society and ASCRS Position Statement on Preoperative Stoma Site Marking for Patients Undergoing Colostomy or Ileostomy Surgery.

    Science.gov (United States)

    Salvadalena, Ginger; Hendren, Samantha; McKenna, Linda; Muldoon, Roberta; Netsch, Debra; Paquette, Ian; Pittman, Joyce; Ramundo, Janet; Steinberg, Gary

    2015-01-01

    Marking the optimal location for a stoma preoperatively enhances the likelihood of a patient's independence in stoma care, predictable pouching system wear times, and resumption of normal activities. Colon and rectal surgeons and certified ostomy nurses are the optimal clinicians to select and mark stoma sites, as this skill is a part of their education, practice, and training. However, these providers are not always available, particularly in emergency situations. The purpose of this position statement, developed by the Wound, Ostomy and Continence Nurses Society in collaboration with the American Society of Colon and Rectal Surgeons and the American Urological Association, is to provide a guideline to assist clinicians (especially those who are not surgeons or WOC nurses) in selecting an effective stoma site.

  10. Report on workshop"Structure and evolution of Eurasia (super- continent"

    Directory of Open Access Journals (Sweden)

    Masaki Kanao

    2004-11-01

    Full Text Available A workshop on Structure and evolution of Eurasia (super- continent" was held on 23rd February 2004, at the National Institute of Polar Research with 29 participants. This provided an opportunity to review the history of amalgamation and breakup of past super-continents in the Earth's evolution, and speculate on the possibility of future super-continent formation. The largest continent on the present Earth, Eurasia, has been formed from an assembly of several sub-continental blocks including Asia, India and Europe, etc: it is also considered to be the nucleus of a future super-continent expected to form 250 m.y. after the present. In this workshop, several interesting topics were presented regarding the formation process, structure and dynamics of Eurasia, in particular in the deep crust and upper mantle. The first half of the workshop covered structural geology, shallow and deep seismic structure, and a simulation model of the Himalaya-Tibet region, known as a typical ongoing continent-continent collision zone. Inner crustal deformation of Eurasia was demonstrated by a newly developed Discrete Element method. In the latter half of the workshop, the possibility of formation of a future super-continent in the Western Pacific Triangular Zone was introduced with geological interpretation associated with an origin of the hot super-plumes. Seismic tomographic studies, particularly in China, which have revealed interesting features such as low velocity anomalies beneath the volcanic area, together with the presence of subducting Indian plates beneath the Tibet region were introduced. In the northwest Pacific region, remnant subducted slabs of the Kula plate have been found by local seismic tomography. Finally, a review of continental dynamics from gravity studies, and broadband seismic observations in the Baikal rift zones, were presented associated with the tectonics and evolution of central Eurasia. The formation mechanism of a hot super-plume in the

  11. The OxyContin crisis: problematisation and responsibilisation strategies in addiction, pain, and general medicine journals.

    Science.gov (United States)

    Whelan, Emma; Asbridge, Mark

    2013-09-01

    OxyContin(®) (Purdue Pharma, L.P., Stamford, CT) is now widely regarded as a drug of abuse fueling a larger opioid health crisis. While coverage in the North American press about OxyContin overwhelmingly focused upon the problems of related crime and addiction/misuse and the perspectives of law enforcement officials and police, coverage in those fields of medicine most intimately concerned with OxyContin-pain medicine and addiction medicine-was more nuanced. In this article, we draw upon the constructivist social problems tradition and Hunt's theory of moral regulation in a qualitative analysis of 24 medical journal articles. We compare and contrast pain medicine and addiction medicine representations of the OxyContin problem, the agents responsible for it, and proposed solutions. While there are some significant differences, particularly concerning the nature of the problem and the agents responsible for it, both pain medicine and addiction medicine authors 'take responsibility' in ways that attempt to mitigate the potential appropriation of the issue by law enforcement and regulatory agencies. The responses of pain medicine and addiction medicine journal articles represent strategic moves to recapture lost credibility, to retain client populations and tools necessary to their jobs, and to claim a seat at the table in responding to the OxyContin crisis. Copyright © 2013 Elsevier B.V. All rights reserved.

  12. The AP diameter of the pelvis: a new criterion for continence in the exstrophy complex?

    International Nuclear Information System (INIS)

    Ait-Ameur, A.; Kalifa, G.; Adamsbaum, C.; Wakim, A.; Dubousset, J.

    2001-01-01

    Reconstructive surgery of bladder exstrophy remains a challenge. By using CT of the pelvis, we suggest a new pre- and post-operative investigative procedure to define the AP diameter (APD) as a predictive criterion for continence in this anomaly. Patients and methods: Three axial CT slices were selected in nine children with exstrophy who had undergone neonatal reconstructive surgery. The three levels selected were the first sacral plate, the mid acetabular plane and the superior pubic spine. We used combined slices to measure: circle APD = distance between the first sacral vertebra and the pubic symphysis. circle Pubic diastasis (PD) circle Three angles defined on the transverse plane of the first sacral vertebra - iliac wing angle, sacropubic angle and acetabular version. In exstrophy, the angles demonstrate opening of the iliac wings and the pubic ramus, and acetabular retroversion compared to controls. Comparisons between controls, continent and incontinent patients reveal that in continent patients, APD increases with growth and seems to be a predictive criterion for continence, independent of diastasis of the pubic symphysis. We believe that CT of the pelvis with measurements of the APD should be performed in all neonates with bladder exstrophy before reconstructive surgery and for better understanding of the malformation. The APD seems to be predictive and may be a major criterion for continence, independent of PD. (orig.)

  13. Quality audit--a review of the literature concerning delivery of continence care.

    Science.gov (United States)

    Swaffield, J

    1995-09-01

    This paper outlines the role of quality audit within the framework of quality assurance, presenting the concurrent and retrospective approaches available. The literature survey provides a review of the limited audit tools available and their application to continence services and care delivery, as well as attempts to produce tools from national and local standard setting. Audit is part of a process; it can involve staff, patients and their relatives and the team of professionals providing care, as well as focusing on organizational and management levels. In an era of market delivery of services there is a need to justify why audit is important to continence advisors and managers. Effectiveness, efficiency and economics may drive the National Health Service, but quality assurance, which includes standards and audit tools, offers the means to ensure the quality of continence services and care to patients and auditing is also required in the purchaser/provider contracts for patient services. An overview and progress to date of published and other a projects in auditing continence care and service is presented. By outlining and highlighting the audit of continence service delivery and care as a basis on which to build quality assurance programmes, it is hoped that this knowledge will be shared through the setting up of a central auditing clearing project.

  14. [Nurse practitioner's capability].

    Science.gov (United States)

    Cheng, Chen-Hsiu; Chen, Shih-Chien

    2007-10-01

    Nurse practitioner development affirms the social value of nursing staff and promotes the professional image of nursing. As the medical environment and doctor-patient relations change, how should a nurse practitioner carry out clinical care? Apart from having foundations in medical knowledge and high-quality nursing techniques, nurse practitioners must have other clinical skills, in order to break out of their former difficult position, promote nursing competitiveness, provide a multi -dimensional service, win the people's acclamation and develop international links.

  15. Cecal rupture after continent ileocecal urinary diversion during total pelvic exenteration

    International Nuclear Information System (INIS)

    Brand, E.

    1991-01-01

    Continent ureteral diversion at the time of pelvic exenteration avoids an external appliance and allows patients to retain bladder reservoir function. The technical difficulty of this procedure requires meticulous attention to operative and perioperative care, particularly after pelvic irradiation. A patient with recurrent stage IIIB carcinoma of the cervix underwent total pelvic exenteration with reconstructive procedures including low rectal anastomosis, neovagina formation, and ileocecal (Indiana) continent diversion. Early catheterization of the reservoir began 2 weeks postoperatively. One week later cecal rupture occurred, not related to suture line (technical) failure. Because of the high wall tension and reduced compliance in the irradiated cecum, the authors do not recommend catheterization of the urinary reservoir before 4-6 weeks. In order for continent diversion to become the standard diversion in exenteration patients, the major complication rate must remain comparable to that of noncontinent diversion

  16. Early biochemical recurrence, urinary continence and potency outcomes following robot-assisted radical prostatectomy

    DEFF Research Database (Denmark)

    Berg, Kasper Drimer; Thomsen, Frederik Birkebæk; Hvarness, Helle

    2014-01-01

    OBJECTIVE: The aim of this study was to describe recovery of urinary continence and potency and report oncological and functional outcomes using the survival, continence and potency (SCP) system for patients undergoing robot-assisted radical prostatectomy (RARP). MATERIAL AND METHODS: From 2009...... with preoperative ESI, 77.6% (67.9-86.1) and 34.4% (24.1-47.5) maintained ESI 12 months postoperatively after bilateral and unilateral nerve-sparing surgery (NS), respectively. NS (p .... Using the SCP system and defining potency as ESI, functional and oncological success 12 months after surgery was achieved in 69 out of 135 (51.1%) preoperative continent and potent patients who underwent unilateral or bilateral NS, and did not require adjuvant treatment; when defining potency as IIEF...

  17. Presentación: La Historia continúa

    Directory of Open Access Journals (Sweden)

    Julio Perez Serrano

    2008-11-01

    Full Text Available Por fortuna para quienes humildemente cultivamos este conocimiento, la Historia continúa. Las utopías finalistas que hace sólo una década inundaron el mercado de la letra impresa han sido borradas de un plumazo por la tozudez de los hechos. Aunque parezca increíble, en muchos aspectos nuestro futuro es hoy más incierto de lo que lo era hace veinte, treinta o cincuenta años. En lógica correspondencia con ello, el presente ha recobrado un impetuoso protagonismo. Siempre cambiante, punta de flecha del tiempo, el presente no puede dejar de ser visto en nuestros días sino como una angosta ventana hacia el futuro. Por esta ventana se han asomado ya desde antiguo, en tiempos de crisis, literatos y filósofos, y más recientemente lo han hecho periodistas, sociólogos, demógrafos, politólogos, economistas, físicos, bioquímicos, ecólogos y muchos otros científicos. También el ciudadano de la calle vive y entiende su presente como producto del pasado e indicio de lo que habrá de depararle el porvenir. No es más que el reflejo de hasta qué punto carece de sentido fijar fronteras impenetrables en el ámbito temporal.Son todavía pocos, sin embargo, los historiadores que han osado acercarse al presente con esta perspectiva. Algunos más lo han hecho buscando el anclaje con el pasado más próximo, quizá como forma de asegurar una continuidad con lo que hasta hace poco, y aun actualmente, se ha considerado propio de este oficio: el estudio del pasado. La Historia del Tiempo Presente ha ido tomando cuerpo así como un campo específico de la Historia centrado en el análisis del pretérito inmediato, un tiempo que subsiste en la memoria de las generaciones vivas y que, por influencia de éstas, es considerado propio (presente por el conjunto de la sociedad[1]. Ciertamente en este terreno los avances teóricos no son desdeñables, y superan con creces a las realizaciones prácticas, aunque quizá éste no sea el principal obstáculo que se

  18. Fear and overprotection in Australian residential aged-care facilities: The inadvertent impact of regulation on quality continence care.

    Science.gov (United States)

    Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

    2016-06-01

    Most residents in residential aged-care facilities are incontinent. This study explored how continence care was provided in residential aged-care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care. Using grounded theory methodology, 18 residential aged-care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. There is a need to rethink the quality of continence care and its measurement in Australian residential aged-care facilities. © 2015 AJA Inc.

  19. Time to and predictors of dual incontinence in older nursing home admissions.

    Science.gov (United States)

    Bliss, Donna Z; Gurvich, Olga V; Eberly, Lynn E; Harms, Susan

    2018-01-01

    There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents. Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home-specific random effect was used. At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care. The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents. © 2017 Wiley Periodicals, Inc.

  20. Posterior and anterior fixation of the urethra during robotic prostatectomy improves early continence rates.

    Science.gov (United States)

    Koliakos, Nikolaos; Mottrie, Alexandre; Buffi, Nicolo; De Naeyer, Geert; Willemsen, Pieter; Fonteyne, Etienne

    2010-02-01

    To investigate whether posterior and anterior fixation of the vesicourethral anastomosis during robotic radical prostatectomy (RRP) helps to establish continence earlier. Forty-seven consecutive patients undergoing RRP were randomized into two groups. The first group received a typical Van Velthoven vesicourethral anastomosis and the second group a modified anastomosis with posterior and anterior fixation. In this group the posterior fibrous tissues of the sphincter were sutured to the residual Denonvilliers' fascia. The anastomosis with two running sutures started at the 6 o'clock position on the bladder neck and continued upwards. Two-step stitching was done on the upper half of the anastomosis to ensure good stabilization of the bladder: a small portion of urethral stump followed by a deep haemostatic stitch on the plexus. Continence, as measured by patient self-reporting of the number of pads used per 24 h, was assessed 7 weeks after catheter removal, by telephone interview. The use of no pads or one pad was defined as "continent", two pads as "moderate incontinence" and more than two pads as "severe incontinence". At catheter removal, more patients in the fixation group were continent than in the Van Velthoven group [9/23 (39%) vs 3/24 (12.5%), p = 0.036]. At 7 weeks, continence was even better in the fixation group [15/23 (65%) vs 8/24 (33%), p = 0. 029]. The mean pad usage was less in the fixation group (1.43 vs 2.25, p = 0.032). The posterior and anterior fixation of the vesicourethral anastomosis during RRP results in an intact sphincteric mechanism, because no stretch is applied to the urethra, resulting in earlier continence.

  1. Preoperative predictive model of recovery of urinary continence after radical prostatectomy

    Science.gov (United States)

    Matsushita, Kazuhito; Kent, Matthew T.; Vickers, Andrew J.; von Bodman, Christian; Bernstein, Melanie; Touijer, Karim A.; Coleman, Jonathan; Laudone, Vincent; Scardino, Peter T.; Eastham, James A.; Akin, Oguz; Sandhu, Jaspreet S.

    2016-01-01

    Objective ● To build a predictive model of urinary continence recovery following radical prostatectomy that incorporates magnetic resonance imaging parameters and clinical data. Patients and Methods ● We conducted a retrospective review of data from 2,849 patients who underwent pelvic staging magnetic resonance imaging prior to radical prostatectomy from November 2001 to June 2010. ● We used logistic regression to evaluate the association between each MRI variable and continence at 6 or 12 months, adjusting for age, body mass index (BMI), and American Society of Anesthesiologists (ASA) score and then used multivariable logistic regression to create our model. ● A nomogram was constructed using the multivariable logistic regression models. Results ● In total, 68% (n=1,742/2,559) and 82% (n=2,205/2,689) regained function at 6 and 12 months, respectively. ● In the base model, age, BMI, and ASA score were significant predictors of continence at 6 or 12 months on univariate analysis (p <0.005). ● Among the preoperative magnetic resonance imaging measurements, membranous urethral length, which showed great significance, was incorporated into the base model to create the full model. ● For continence recovery at 6 months, the addition of membranous urethral length increased the AUC to 0.664 for the validation set, an increase of 0.064 over the base model. For continence recovery at 12 months, the AUC was 0.674, an increase of 0.085 over the base model. Conclusions ● Using our model, the likelihood of continence recovery increases with membranous urethral length and decreases with age, body mass index, and ASA score. ● This model could be used for patient counseling and for the identification of patients at high risk for urinary incontinence in whom to study changes in operative technique that improve urinary function after radical prostatectomy. PMID:25682782

  2. The research of modern He discharge in volcanic and tectonically active areas of China's continent

    International Nuclear Information System (INIS)

    Shangguan, Z.G.

    1999-01-01

    The realising features of modern helium in volcanic and tectonically active areas of China's continent are here discussed, presenting that the current escaped He in volcanic areas are mainly the mantle-derived He. The 3 He/ 4 He ratios of crustal gases in Eastern China are relatively higher than those gases in Middle-Western China. The author considers difficult to interpret this phenomenon by means of the differences of tectonic activity in those areas: it may be related to the variation of crustal thickness of China's continent from East to West

  3. CONTIN XPCS: Software for Inverse Transform Analysis of X-Ray Photon Correlation Spectroscopy Dynamics.

    Science.gov (United States)

    Andrews, Ross N; Narayanan, Suresh; Zhang, Fan; Kuzmenko, Ivan; Ilavsky, Jan

    2018-02-01

    X-ray photon correlation spectroscopy (XPCS) and dynamic light scattering (DLS) both reveal dynamics using coherent scattering, but X-rays permit investigating of dynamics in a much more diverse array of materials. Heterogeneous dynamics occur in many such materials, and we showed how classic tools employed in analysis of heterogeneous DLS dynamics extend to XPCS, revealing additional information that conventional Kohlrausch exponential fitting obscures. This work presents the software implementation of inverse transform analysis of XPCS data called CONTIN XPCS, an extension of traditional CONTIN that accommodates dynamics encountered in equilibrium XPCS measurements.

  4. Regulatory Changes and Productivity of the Banking Sector in the Indian Sub-Continent

    OpenAIRE

    Shabbar Jaffry; Yaseen Ghulam; Sean Pascoe; Joe Cox

    2005-01-01

    This study seeks to measure changes in technical efficiency levels within the banking sectors of the Indian sub-continent: specifically India, Pakistan, and Bangladesh, over the period 1993–2002. This study is done in the context of a number of sweeping deregulations across the sub-continent in the early 1990s, and the possible effect these may have had upon efficiency levels. A Malmquist Index of TFP change over the time-period in question is employed, along with a Tobit regression, in order...

  5. A study on the birth and globalization of sports originated from each continent

    OpenAIRE

    Lee, Byung Jin; Kim, Tae Young

    2016-01-01

    The purpose of this research is to see how continent specific sports rose to its modern-day status through globalization. This research focuses on the historical background of how England?s football, America?s national pastime, baseball, Japan?s Judo, and Korea?s Taekwondo developed into sports in addition to the reasoning behind its globalization. Promoted by England and the rest of the European continent, Soccer is considered to be one of the world?s most popular sports and has served its f...

  6. Impact of posterior rhabdosphincter reconstruction during robot-assisted radical prostatectomy: retrospective analysis of time to continence.

    Science.gov (United States)

    Woo, Jason R; Shikanov, Sergey; Zorn, Kevin C; Shalhav, Arieh L; Zagaja, Gregory P

    2009-12-01

    Posterior rhabdosphincter (PR) reconstruction during robot-assisted radical prostatectomy (RARP) was introduced in an attempt to improve postoperative continence. In the present study, we evaluate time to achieve continence in patients who are undergoing RARP with and without PR reconstruction. A prospective RARP database was searched for most recent cases that were accomplished with PR reconstruction (group 1, n = 69) or with standard technique (group 2, n = 63). We performed the analysis applying two definitions of continence: 0 pads per day or 0-1 security pad per day. Patients were evaluated by telephone interview. Statistical analysis was carried out using the Kaplan-Meier method and log-rank test. With PR reconstruction, continence was improved when defined as 0-1 security pad per day (median time of 90 vs 150 days; P = 0.01). This difference did not achieve statistical significance when continence was defined as 0 pads per day (P = 0.12). A statistically significant improvement in continence rate and time to achieve continence is seen in patients who are undergoing PR reconstruction during RARP, with continence defined as 0-1 security/safety pad per day. A larger, prospective and randomized study is needed to better understand the impact of this technique on postoperative continence.

  7. Men student nurses: the nursing education experience.

    Science.gov (United States)

    Meadus, Robert J; Twomey, J Creina

    2011-01-01

    This study explored the phenomenon of being a male in a predominately female-concentrated undergraduate baccalaureate nursing program. Men remain a minority within the nursing profession. Nursing scholars have recommended that the profile of nursing needs to change to meet the diversity of the changing population, and the shortfall of the worldwide nursing shortage. However, efforts by nursing schools and other stakeholders have been conservative toward recruitment of men. Using Giorgi's method, 27 students from a collaborative nursing program took part in this qualitative, phenomenological study. Focus groups were undertaken to gather data and to develop descriptions of the experience. Five themes highlighted men students' experience of being in a university nursing program: choosing nursing, becoming a nurse, caring within the nursing role, gender-based stereotypes, and visible/invisible. The experiences of the students revealed issues related to gender bias in nursing education, practice areas, and societal perceptions that nursing is not a suitable career choice for men. Implications for nurse educators and strategies for the recruitment and retention of men nursing students are discussed. © 2011 Wiley Periodicals, Inc.

  8. Nursing shortages and international nurse migration.

    Science.gov (United States)

    Ross, S J; Polsky, D; Sochalski, J

    2005-12-01

    The United Kingdom and the United States are among several developed countries currently experiencing nursing shortages. While the USA has not yet implemented policies to encourage nurse immigration, nursing shortages will likely result in the growth of foreign nurse immigration to the USA. Understanding the factors that drive the migration of nurses is critical as the USA exerts more pull on the foreign nurse workforce. To predict the international migration of nurses to the UK using widely available data on country characteristics. The Nursing and Midwifery Council serves as the source of data on foreign nurse registrations in the UK between 1998 and 2002. We develop and test a regression model that predicts the number of foreign nurse registrants in the UK based on source country characteristics. We collect country-level data from sources such as the World Bank and the World Health Organization. The shortage of nurses in the UK has been accompanied by massive and disproportionate growth in the number of foreign nurses from poor countries. Low-income, English-speaking countries that engage in high levels of bilateral trade experience greater losses of nurses to the UK. Poor countries seeking economic growth through international trade expose themselves to the emigration of skilled labour. This tendency is currently exacerbated by nursing shortages in developed countries. Countries at risk for nurse emigration should adjust health sector planning to account for expected losses in personnel. Moreover, policy makers in host countries should address the impact of recruitment on source country health service delivery.

  9. Leaders from Nursing's History.

    Science.gov (United States)

    Fondiller, Shirley H.; And Others

    1995-01-01

    Looks at the lives and accomplishments of four leaders in professional nursing: (1) Loretta Ford, who championed the cause of nurse practitioners; (2) Mable Staupers, a pioneer in community health and nursing; (3) Janet Geister, a leader in private nursing; and (4) Isabel Stewart, who led the movement to standardize nursing education. (JOW)

  10. Adaptação e validação do city of hope quality of life – ostomy questionnaire para a cultura portuguesa

    OpenAIRE

    Barreira, Susana Isabel Rodrigues

    2016-01-01

    Introdução: Constatando-se a escassez de instrumentos específicos de avaliação de qualidade de vida para pessoas com ostomia em Portugal, e sendo estes pouco abrangentes em algumas áreas do bem-estar, este estudo teve como objetivo adaptar e validar o City of Hope Quality Of Life - Ostomy Questionnaire (COH-QOL-OQ) para a cultura portuguesa. Método: Para a adaptação e validação do COH-QOL-OQ para a cultura portuguesa desenvolvemos um estudo metodológico, onde realizámos a equivalência linguís...

  11. TALENTED CARING NURSES ARE NEEDED IN A GLOBAL WORLD

    Directory of Open Access Journals (Sweden)

    Débora Kirschbaum Nitkin

    2013-07-01

    Full Text Available Nursing professional practice has been strongly impacted by the increase of global affairs and the appeals for international exchanges arisen by globalization. Moreover, in the last decades, nursing scholars, graduate and undergraduate students from different continents and countries have been involved in joined research projects, knowledge exchange, and capacity building projects that concurrently contribute to the enrichment of knowledge transference, public good, and the achievement of the corporate university project. Besides to the aforementioned initiatives, one also observes an intense demand for nurses in developing countries divulged in the media1 that may stimulate Brazilian nurses’ migration, following a tendency that has been observed in North America and Europe in recent years.

  12. Student nurses as school nurse extenders.

    Science.gov (United States)

    Rossman, Carol L; Dood, Florence V; Squires, Darcy A

    2012-12-01

    The severe underuse of school nurses leaves students with unaddressed health needs that impact their safety and learning ability. An undergraduate pediatric clinical focusing on nursing students and the role of a school nurse in an elementary school setting can be a unique approach to combining the needs of school children and educating student nurses. One school of nursing created such a project to help address these needs and collect data on the activities student nurses performed in school nurse role and their impact on student health. This project serves as both a practice improvement project and an innovation in pediatric clinical education. The purposes of this project were to quantify baccalaureate nursing student activities related to the school nurse role and to evaluate the results that have the potential to impact on student health in an urban elementary school. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Feldspar basalts in lunar soil and the nature of the lunar continents

    Science.gov (United States)

    Reid, A. M.; Ridley, W. I.; Harmon, R. S.; Warner, J.; Brett, R.; Jakes, P.; Brown, R. W.

    1974-01-01

    It is found that 25% on the Apollo-14 glasses have the same composition as the glasses in two samples taken from the Luna-16 column. The compositions are equivalent to feldspar basalt and anorthosite gabbro, and are similar to the feldspar basalts identified from Surveyor-7 analysis for lunar continents.

  14. Papers presented to the Conference on Heat and Detachment in Crustal Extension on Continents and Planets

    Science.gov (United States)

    1985-01-01

    Several topics relative to heat and detachment in crustal extension on continents and planets are discussed. Rifting on Venus, heat flow and continental breakup, magnetism, the mountains and tectonic processes of Io, and the ductile extension of planetary lithospheres are among the topics covered.

  15. The African nuclear-weapon-free zone and sustainable development on the continent

    International Nuclear Information System (INIS)

    Selassie, T.W.

    1996-01-01

    This article looks at the concept of safeguards and nuclear non-proliferation in the context of the Treaty, and discusses the relevance and potential of nuclear science and technology for contributing to the solution of the continent's numerous and urgent problems

  16. Examination of 2015 Human Development Index in Terms of Education: Comparison of the Continents and Turkey

    Science.gov (United States)

    Nartgün, Senay Sezgin; Sezen-Gültekin, Gözde; Limon, Ibrahim

    2017-01-01

    This study aims to compare Turkey to the first three countries from each continent in terms of educational indicators in 2015 Human Development Report. In line with this aim, it is a case study utilizing document review method. Analysis of the data has been carried out on a single document which is United Nations Development Report (2015). To…

  17. Normalized difference vegetation index for the South American continent used as a climatic variability indicator

    International Nuclear Information System (INIS)

    Liu, W.T.; Massambani, O.; Festa, M.

    1992-01-01

    The NOAA AVHRR GAC data set was used to produce Normalized Difference Vegetation Index (NDVI) maps for the South American Continent covering the period from August 1, 1981 to June 30, 1987. A 15-day maximum value composite procedure was used to partially eliminate the cloud contamination and atmospheric attenuation. Monthly evolution of NDVI for a dry and a wet year within the period studied was used to estimate the area covered by NDVI value less than 0.223, This value was used as an indicator of the drought area and the delineation of the Low rainfall areas in the continent. It was observed a well defined regional dependence of the drought area variability for the Northeast, Southwest and Northwest continent and also for the Amazon region. It is shown a relative estimation of the area coverage with NDVI less than 0.223 for the years 1982/83 and 1984/85. The dynamics of the drought area evolution in the continent is discussed. It is also presented a diagnosis of regional variability of the continental distribution of drought area from 1981 to 1987 for the months of May and September. This information is also used to discuss its relationship with the EL-Nino-Southern Oscillation (ENSO) and the South American Precipitation patterns during this period. It is suggested that the use of NDVI image to identify the dynamics of the drought induced by low rainfall may provide us valuable information to study the large scale climatic variation

  18. Long Aftershock Sequences within Continents and Implications for Earthquake Hazard Assessment

    Science.gov (United States)

    Stein, S. A.; Liu, M.

    2014-12-01

    Recent seismicity in the Tangshan region in North China has prompted concern about a repetition of the 1976 M7.8 earthquake that destroyed the city, killing more than 242,000 people. However, the decay of seismicity there implies that the recent earthquakes are probably aftershocks of the 1976 event. This 37-year sequence is an example of the phenomenon that aftershock sequences within continents are often significantly longer than the typical 10 years at plate boundaries. The long sequence of aftershocks in continents is consistent with a simple friction-based model predicting that the length of aftershock sequences varies inversely with the rate at which faults are loaded. Hence the slowly-deforming continents tend to have aftershock sequences significantly longer than at rapidly-loaded plate boundaries. This effect has two consequences for hazard assessment. First, within the heavily populated continents that are typically within plate interiors, assessments of earthquake hazards rely significantly on the assumption that the locations of small earthquakes shown by the short historical record reflect continuing deformation that will cause future large earthquakes. This assumption would lead to overestimation of the hazard in presently active areas and underestimation elsewhere, if some of these small events are aftershocks. Second, successful attempts to remove aftershocks from catalogs used for hazard assessment would underestimate the hazard, because much of the hazard is due to the aftershocks, and the declustering algorithms implicitly assume short aftershock sequences and thus do not remove long-duration ones.

  19. High resolution magnetic resonance imaging of urethral anatomy in continent nulliparous pregnant women

    International Nuclear Information System (INIS)

    Preyer, Oliver; Brugger, Peter C.; Laml, Thomas; Hanzal, Engelbert; Prayer, Daniela; Umek, Wolfgang

    2011-01-01

    Introduction: To quantify the distribution of morphologic appearances of urethral anatomy and measure variables of urethral sphincter anatomy in continent, nulliparous, pregnant women by high resolution magnetic resonance imaging (MRI). Materials and methods: We studied fifteen women during their first pregnancy. We defined and quantified bladder neck and urethral morphology on axial and sagittal MR images from healthy, continent women. Results: The mean (±standard deviation) total transverse urethral diameter, anterior–posterior diameter, unilateral striated sphincter muscle thickness, and striated sphincter length were 15 ± 2 mm (range: 12–19 mm), 15 ± 2 mm (range: 11–20 mm), 2 ± 1 mm (range: 1–4 mm), and 13 ± 3 mm (range: 9–18 mm) respectively. The mean (±standard deviation) total urethral length on sagittal scans was 22 ± 3 mm (range: 17.6–26.4 mm). Discussion: Advances in MR technique combined with anatomical and histological findings will provide an insight to understand how changes in urethral anatomy might affect the continence mechanisms in pregnant and non-pregnant, continent or incontinent individuals.

  20. Runes around the North Sea and on the Continent AD 150-700; texts & contexts

    NARCIS (Netherlands)

    Looijenga, Jantina Helena

    1997-01-01

    Het onderzoek naar de oudste runeninscripties van het Europese continent, Engeland en Denemarken voerde onderzoekster van Liverpool aan de Ierse Zee naar Constanza aan de Zwarte Zee; van Zürich naar Bergen; van Parijs naar Stockholm. In dit enorme gebied kende men reeds bij het begin van de vroege

  1. Obesity and stress urinary incontinence in women: compromised continence mechanism or excess bladder pressure during cough?

    Science.gov (United States)

    Swenson, Carolyn W; Kolenic, Giselle E; Trowbridge, Elisa R; Berger, Mitchell B; Lewicky-Gaupp, Christina; Margulies, Rebecca U; Morgan, Daniel M; Fenner, Dee E; DeLancey, John O

    2017-09-01

    We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support. A secondary analysis was performed using data from a case-control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5-24.9 kg/m 2 ); overweight (25.0-29.9 kg/m 2 ); and obese (≥30 kg/m 2 ). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa. The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p continence mechanism.

  2. Measurement of Dynamic Urethral Pressures with a High Resolution Manometry System in Continent and Incontinent Women

    Science.gov (United States)

    Kirby, Anna C; Tan-Kim, Jasmine; Nager, Charles W.

    2015-01-01

    Objectives Female stress urinary incontinence (SUI) is caused by urethral dysfunction during dynamic conditions, but current technology has limitations in measuring urethral pressures under dynamic conditions. An 8-French high resolution manometry catheter (HRM) currently in clinical use in gastroenterology may accurately measure urethral pressures under dynamic conditions because it has a 25ms response rate and circumferential pressure sensors along the length of the catheter (ManoScan® ESO, Given Imaging). We evaluated the concordance, repeatability, and tolerability of this catheter. Methods We measured resting, cough, and strain maximum urethral closure pressures (MUCPs) using HRM and measured resting MUCPs with water perfusion side-hole catheter urethral pressure profilometry (UPP) in 37 continent and 28 stress incontinent subjects. Maneuvers were repeated after moving the HRM catheter along the urethral length to evaluate whether results depend on catheter positioning. Visual analog pain scores evaluated the comfort of HRM compared to UPP. Results The correlation coefficient for resting MUCPs measured by HRM vs. UPP was high (r = 0.79, prest, cough, and strain with HRM: r= 0.92, 0.89, and 0.89. Mean MUCPs (rest, cough, strain) were higher in continent than incontinent subjects (all p continent subjects during cough and strain maneuvers compared to rest. Conclusions This preliminary study shows that HRM is concordant with standard technology, repeatable, and well tolerated in the urethra. Incontinent women have more impairment of their urethral closure pressures during cough and strain than continent women. PMID:25185595

  3. Self-reported urinary continence outcomes for repeat midurethral synthetic sling placement

    Directory of Open Access Journals (Sweden)

    Jonathan A. Eandi

    2008-06-01

    Full Text Available OBJECTIVE: To evaluate our experience with tension-free transvaginal tape (TVT placement for the management of stress urinary incontinence (SUI in women who had previously undergone a failed midurethral synthetic sling (MUS procedure. MATERIALS AND METHODS: Ten women underwent retropubic TVT insertion for continued or recurrent SUI following a prior MUS procedure. No attempt was made to remove the previously placed sling at the time of surgery. A retrospective chart review was performed to obtain perioperative and follow-up patient information. Post-operatively, each patient completed a mailed incontinence questionnaire to assess self-reported urinary continence outcomes. RESULTS: All 10 women were available for follow-up at a mean period of 16 months (range 6 to 33. Four of the 10 patients achieved complete continence, and another three patients reported significantly improved continence and quality of life. Three women stated that their continence did not improve. CONCLUSIONS: TVT placement may be a viable option for the management of women with persistent or recurrent SUI following an initial MUS procedure.

  4. Rotational inertia of continents: A proposed link between polar wandering and plate tectonics

    Science.gov (United States)

    Kane, M.F.

    1972-01-01

    A mechanism is proposed whereby displacement between continents and the earth's pole of rotation (polar wandering) gives rise to latitudinal transport of continental plates (continental drift) because of their relatively greater rotational inertia. When extended to short-term polar wobble, the hypothesis predicts an energy change nearly equivalent to the seismic energy rate.

  5. Is continence status associated with quality of life in young children with spina bifida?

    Science.gov (United States)

    Freeman, Kurt A; Smith, Kathryn; Adams, Elizabeth; Mizokawa, Stacey; Neville-Jan, Ann

    2013-01-01

    To evaluate the relationship between child- and parent-reported quality of life (QOL) and bowel and bladder continence among young children with spina bifida (SB). 104 children ages 5-12 years and one of their parents/guardians completed the Pediatric Quality of Life Inventory - Generic Form (PedsQL; parent and child) and the Quality of Life in Spina Bifida Questionnaire (QOLSBQ, parent only). Data on continence, child age, and condition-specific variables were obtained by chart review. Parent and child QOL scores (on all measures of QOL) were positively correlated; parents rated child QOL lower than children's self report. QOL scores did not differ based on continence status. Total PedsQL scores were associated with age and mobility based on child report and with mobility based on parent report. QOL may not be affected by continence status among young children with SB, though demographic (i.e., age) and condition-specific (i.e., functional mobility status) variables appear relevant. Additional research is needed to further evaluate condition-specific variables, other protective variables, and possible measurement issues that influence QOL in young children with SB.

  6. Pediatric Endocrinology Nurses Society

    Science.gov (United States)

    ... Join Now International Welcome to PENS The Pediatric Endocrinology Nursing Society (PENS) is committed to the development ... nurses in the art and science of pediatric endocrinology nursing. Learn More Text1 2018 PENS Call for ...

  7. Analysis of the Environmental Management System based on ISO 14001 on the American continent.

    Science.gov (United States)

    Neves, Fábio de Oliveira; Salgado, Eduardo G; Beijo, Luiz A

    2017-09-01

    The American continent is in broad economic and industrial development. Consequently, a more detailed discussion of the impacts generated by such development is needed. Moreover, there is an increase in the number of ISO 14001 certificates issued to this continent. Given the above, no studies were found that bridge the gap to identify the influence of different factors on ISO 14001 in the Americas. Thus, this article has as its main aim to check which economic, environmental and cultural factors have influence on ISO 14001 Certification in the American Continent. The data were collected in the ISO Survey, World Bank, United Nations Development Programme and International Energy Agency. Among the countries of that continent, thirteen were analyzed and only two did not show the economic factors as the influence factor in the multiple regression models fitted with Brazil and the United State. In these models, all presented environmental factors as influencing factors. Only in Brazil the index HDI presented as cultural factor in multiple regression model fitted. The economic factors: Gross Domestic Product and exports of goods and services and environmental: Carbon Dioxide (CO 2 ) and fossil fuel consumption were the most influential in ISO 14001 certification. Venezuela, Uruguay, Colombia and the United States were countries that had factors dependent on each other, featuring the environmental marketing. Briefly, this study brings up several implications: to the academy, with the proposal of new concepts and guidance on the factors that assist in ISO 14001 certification in the American Continent. Additionally, taking into account the industry, the factors serve as efficiency parameters for the implementation of ISO 14001 standard, and for the Government to improve through factors that do not fit in multiple regression models. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Maritime Continent seasonal climate biases in AMIP experiments of the CMIP5 multimodel ensemble

    Science.gov (United States)

    Toh, Ying Ying; Turner, Andrew G.; Johnson, Stephanie J.; Holloway, Christopher E.

    2018-02-01

    The fidelity of 28 Coupled Model Intercomparison Project phase 5 (CMIP5) models in simulating mean climate over the Maritime Continent in the Atmospheric Model Intercomparison Project (AMIP) experiment is evaluated in this study. The performance of AMIP models varies greatly in reproducing seasonal mean climate and the seasonal cycle. The multi-model mean has better skill at reproducing the observed mean climate than the individual models. The spatial pattern of 850 hPa wind is better simulated than the precipitation in all four seasons. We found that model horizontal resolution is not a good indicator of model performance. Instead, a model's local Maritime Continent biases are somewhat related to its biases in the local Hadley circulation and global monsoon. The comparison with coupled models in CMIP5 shows that AMIP models generally performed better than coupled models in the simulation of the global monsoon and local Hadley circulation but less well at simulating the Maritime Continent annual cycle of precipitation. To characterize model systematic biases in the AMIP runs, we performed cluster analysis on Maritime Continent annual cycle precipitation. Our analysis resulted in two distinct clusters. Cluster I models are able to capture both the winter monsoon and summer monsoon shift, but they overestimate the precipitation; especially during the JJA and SON seasons. Cluster II models simulate weaker seasonal migration than observed, and the maximum rainfall position stays closer to the equator throughout the year. The tropics-wide properties of these clusters suggest a connection between the skill of simulating global properties of the monsoon circulation and the skill of simulating the regional scale of Maritime Continent precipitation.

  9. Is there any difference in pelvic floor muscles performance between continent and incontinent women?

    Science.gov (United States)

    Burti, Juliana Schulze; Hacad, Claudia R; Zambon, João Paulo; Polessi, Emily Assis; Almeida, Fernando G

    2015-08-01

    To compare pelvic floor muscles (PFMs) performance in women with and without stress urinary incontinence (SUI) during endurance test. It is a prospective case-control clinical trial. After determining PFM maximal voluntary contraction (MVC) by electromyography (EMG), women underwent endurance test, which consisted of consecutively PFM 1-sec fast contractions reaching MVC amplitude followed by 1-sec rest. Training time guided by Borg perceived exertion scale was noted. Heart rate (HR) behavior and EMG variables were assessed before and after training making a physiological analysis in both groups. A total of 56 women, mean age 52.19 years old, were evaluated (26 continent and 30 incontinent women). The time that SUI and continent women took to reach fatigue (Borg 10) was 9.1 ± 4.7 and 14.19 ± 8.32 min, respectively (P = 0.006). Confirming that all women performed similar effort during the test, analysis of variance with repeated measures showed that during the endurance test both groups presented similar increase in HR, showing detectable and significant increase from resting time to Borg 10 (P continent and SUI women, with a decrease from the baseline resting amplitude (P = 0.003 for SUI women and P = 0.006 for continent women). Women with SUI showed worse performance during an endurance test than continent women. It suggests that women have different capacity to perform PFM training. An initial evaluation based on PFM performance would help to define the best individualized PFM training. © 2014 Wiley Periodicals, Inc.

  10. Oceans and continents: Similarities and differences in the mechanisms of heat loss

    International Nuclear Information System (INIS)

    Sclater, J.G.; Parsons, B.; Jaupart, C.

    1981-01-01

    The principal objective of this paper is to present a simple and self-consistent review of the basic physical processes controlling heat loss from the earth. To accomplish this objective, we give a short summary of the oceanic and continental data and compare and contrast the respective mechanisms of heat loss . In the oceans we concentrate on the effect of hydrothermal circulation, and on the continents we consider in some detail a model relating surface heat flow to varying depth scales for the distribution of potassium, thorium, and uranium. From this comparison we conclude that the range in possible geotherms at depths below 100 to 150 km under continents and oceans overlaps and the thermal structure beneath an old stable continent is indistinguishable from that beneath an ocean were it at equilibrium. Oceans and continents are part of the same thermal system. Both have an upper rigid mechanical layer where heat loss is by conduction and a lower thermal boundary layer where convection is dominant. The simple conductive definition of the plate thickness is an oversimplification. The observed distribution of area versus age in the ocean allows us to investigate the dominant mechanism of heat loss which is plate creation. This distribution and an understanding of the heat flow through oceans and continents can be used to calculate the heat loss of the earth. This heat loss is 10 13 cal/s (4.2 x 10 13 W) of which more than 60% results from the creation of oceanic plate. The relation between area and age of the oceans is coupled to the ridge and subducting slab forces that contribute to the driving mechanism for plate motions. These forces are self-regulating and maintain the rate of plate generation required to achieve a balance between heat loss and heat generation

  11. Seminal vesicle sparing laparoscopic radical prostatectomy using a low-energy source: Better continence and potency

    Directory of Open Access Journals (Sweden)

    Shrenik J Shah

    2009-01-01

    Full Text Available Objectives: Ongoing with the newer developments in laparoscopic radical prostatectomy (LRP, we report our experience in a consecutive series of 42 patients with a mean 18-month follow-up. We also studied the use of a low-energy source, especially in the region of the prostatic apex and the neurovascular bundle and evaluated its outcome on continence and potency. Materials and Methods: Between November 2003 and December 2008, 50 patients aged 50-80 yrs underwent LRP with vesicourethral anastomosis and of these, 42 patients who had a minimum follow-up of 3 months were selected for the study. Of these, the initial 16 patients were operated by the routine method and the 26 patients operated in the later part of our experience were operated upon using a minimal energy source. Results: The mean follow-up was 18 months (range 3-60. Continence was evaluated at 1, 3, 6, and 12 months. Eleven of the 16 patients in Group I were continent as compared with 21 of 26 patients in Group II. The difference in continence rates was mainly due to less use of electrocautery and harmonic scalpel at the bladder neck. Of the eight patients who were potent pre-operatively in Group I, four remained potent 3 months after LRP. In Group II, 20 of the 26 patients were potent pre-operatively and 16 remained potent 3 months after LRP. Conclusions: Use of a low-energy source at the bladder neck and neurovascular bundle, sparing of seminal vesicle, and leaving behind a long, healthy stump of the urethra during apical dissection, is associated with better continence and potency without compromising oncological outcome.

  12. Developing nursing care plans.

    Science.gov (United States)

    Ballantyne, Helen

    2016-02-24

    This article aims to enhance nurses' understanding of nursing care plans, reflecting on the past, present and future use of care planning. This involves consideration of the central theories of nursing and discussion of nursing models and the nursing process. An explanation is provided of how theories of nursing may be applied to care planning, in combination with clinical assessment tools, to ensure that care plans are context specific and patient centred.

  13. Nursing specialty and burnout.

    Science.gov (United States)

    Browning, Laura; Ryan, Carey S; Thomas, Scott; Greenberg, Martin; Rolniak, Susan

    2007-03-01

    We examined the relationship between perceived control and burnout among three nursing specialties: nurse practitioners, nurse managers, and emergency nurses. Survey data were collected from 228 nurses from 30 states. Findings indicated that emergency nurses had the least control and the highest burnout, whereas nurse practitioners had the most control and the least burnout. Mediational analyses showed that expected control, hostility, and stressor frequency explained differences between specialties in burnout. The implications of these findings for interventions that reduce burnout and promote nursing retention are discussed.

  14. REGISTERED NURSES' (RNs) PERCEPTION OF THE NURSING ...

    African Journals Online (AJOL)

    PROF. BARTH EKWEME

    health worker performance and patient outcome. In 2009, International ... benefits and incentives for nurses in order to guarantee nurses wellbeing and retention in the profession. ..... Flexibility / demand for work in different areas. 8. 4.8. 23.

  15. Nurse Bullying: Impact on Nurses' Health.

    Science.gov (United States)

    Sauer, Penny A; McCoy, Thomas P

    2017-12-01

    Workplace bullying has been experienced by 27% to 80% of nurses who have participated in studies. Bullying behaviors negatively impact the health of nurses. This study examined whether nurses' resilience had an impact on the effects of bullying on the nurse's health. This cross-sectional descriptive study surveyed licensed registered nurses in one state. The sample ( N = 345) was predominately female (89%) and Caucasian (84%), with an average age of 46.6 years. In this sample, 40% of nurses were bullied. Higher incidence of bullying was associated with lower physical health scores ( p = .002) and lower mental health scores ( p = .036). Nurses who are bullied at work experience lower physical and mental health, which can decrease the nurses' quality of life and impede their ability to deliver safe, effective patient care.

  16. Virtually Nursing: Emerging Technologies in Nursing Education.

    Science.gov (United States)

    Foronda, Cynthia L; Alfes, Celeste M; Dev, Parvati; Kleinheksel, A J; Nelson, Douglas A; OʼDonnell, John M; Samosky, Joseph T

    Augmented reality and virtual simulation technologies in nursing education are burgeoning. Preliminary evidence suggests that these innovative pedagogical approaches are effective. The aim of this article is to present 6 newly emerged products and systems that may improve nursing education. Technologies may present opportunities to improve teaching efforts, better engage students, and transform nursing education.

  17. District nurse training

    OpenAIRE

    Elliott, Arnold; Freeling, Paul; Owen, John

    1980-01-01

    Training for district nursing is being reviewed. By 1981 district nurses will have a new administrative structure, a new curriculum, and a new examination. Training for nursing, like that for general practice, is to become mandatory. The history of the development of district nurse training is briefly described.

  18. Indiana pouch continent urinary reservoir in patients with previous pelvic irradiation

    International Nuclear Information System (INIS)

    Mannel, R.S.; Braly, P.S.; Buller, R.E.

    1990-01-01

    Little information exists on the use of continent urinary reservoirs in patients with previous pelvic irradiation. We report the use of the Indiana pouch urinary reservoir in ten women with a history of pelvic irradiation for cervical cancer, of whom eight underwent a total pelvic exenteration for recurrent pelvic tumor and two had diversion for radiation-induced vesicovaginal fistula. All ten women achieved daytime continence, with a median time between catheterizations of 4.5 hours and a median pouch capacity of 500 mL. There was no evidence of leakage from the reservoir or significant ureteral reflux or obstruction on postoperative radiographic evaluation. No patient has required reoperation or had significant postoperative complications with the technique described

  19. Variation of atmospheric 210Pb concentration in the inland area of Chinese continent

    International Nuclear Information System (INIS)

    Doi, Taeko; Sato, Jun.

    1995-01-01

    Atmospheric concentrations of 210 Pb and their variations over Urumqi, Lanzhou and Baotou, cities located in inland area of Chinese continent, were observed for a period of 1 year in 1992. The monthly average concentrations ranged from 0.27 to 4.57 mBq/m 3 . The concentrations over these cities in winter were several times higher than that observed at Tsukuba Science City, Japan, and the range of variation was also larger. The variations in concentration over the 3 localities were similar to each other, showing the same seasonal variation pattern: low concentration appeared in summer and high in winter. This variation pattern was different from that observed at Tsukuba Science City. The variations in concentration over Chinese continent, where precipitation is much lower than that in Japan, correlated quite well with the variation in precipitation. (author)

  20. Checking of seismic and tsunami hazard for coastal NPP of Chinese continent after Fukushima nuclear accident

    Institute of Scientific and Technical Information of China (English)

    Chang Xiangdong; Zhou Bengang; Zhao Lianda

    2013-01-01

    A checking on seismic and tsunami hazard for coastal nuclear power plant (NPP) of Chinese continent has been made after Japanese Fukushima nuclear accident caused by earthquake tsunami.The results of the checking are introduced briefly in this paper,including the evaluations of seismic and tsunami hazard in NPP siting period,checking results on seismic and tsunami hazard.Because Chinese coastal area belongs to the continental shelf and far from the boundary of plate collision,the tsunami hazard is not significant for coastal area of Chinese continent.However,the effect from tsunami still can' t be excluded absolutely since calculated result of Manila trench tsunami source although the tsunami wave is lower than water level from storm surge.The research about earthquake tsunami will continue in future.The tsunami warning system and emergency program of NPP will be established based on principle of defense in depth in China.

  1. Responses of Mean and Extreme Precipitation to Deforestation in the Maritime Continent

    Science.gov (United States)

    Chen, C. C.; Lo, M. H.; Yu, J. Y.

    2017-12-01

    Anthropogenic land use and land cover change, including tropical deforestation, could have substantial effects on local surface energy and water budgets, and thus on the atmospheric stability which may result in changes in precipitation. Maritime Continent has undergone severe deforestation in recent decades but has received less attention than Amazon or Congo rainforests. Therefore, this study is to decipher the precipitation response to deforestation in the Maritime Continent. We conduct deforestation experiments using Community Earth System Model (CESM) and through converting the tropical rainforest into grassland. The results show that deforestation in Maritime Continent leads to an increase in both mean temperature and mean precipitation. Moisture budget analysis indicates that the increase in precipitation is associated with the vertically integrated vertical moisture advection, especially the dynamic component (changes in convection). In addition, through moist static energy (MSE) budget analysis, we find the atmosphere among deforested areas become unstable owing to the combined effects of positive specific humidity anomalies at around 850 hPa and anomalous warming extended from the surface to 750 hPa. This instability will induce anomalous ascending motion, which could enhance the low-level moisture convergence, providing water vapor from the surrounding warm ocean. To further evaluate the precipitation response to deforestation, we examine the precipitation changes under La Niña events and global warming scenario using CESM Atmospheric Model Intercomparison Project (AMIP) simulations and Representative Concentration Pathway (RCP) 8.5 simulations. We find that the precipitation increase caused by deforestation in Maritime Continent is comparable in magnitude to that generated by either natural variability or global warming forcing. Besides the changes in mean precipitation, preliminary results show the extreme precipitation also increases. We will further

  2. Globalization in Urology: A Bibliographical Analysis of Cross-Continent Publication between 2002 and 2012.

    Science.gov (United States)

    Mani, Jens; Juengel, Eva; Bartsch, Georg; Filmann, Natalie; Ackermann, Hanns; Nelson, Karen; Haferkamp, Axel; Engl, Tobias; Blaheta, Roman A

    2015-01-01

    Asian scientists have now increasingly begun to contribute to globalization; yet it is not clear whether publishing in the field of urology is paralleled by elevated cross-continental scientific publishing. An exemplary bibliometric analysis of urologic journals from 3 different continents was conducted between 2002 and 2012. Based on the ISI Web of Knowledge Journal Citation Reports, 2 urologic journals with similar impact factors (IFs) in 2013 were selected from Europe ('British Journal of Urology International', 'World Journal of Urology'), Asia ('International Journal of Urology', 'Asian Journal of Andrology') and North America ('Urologic Oncology-Seminars and Original Investigations', 'Urology'). The home continent of the journal, the workplace continental affiliation of the last author, article type (clinical, experimental or review) as well as the IF were documented. Most authors published their manuscripts in journals from the same continent in which they worked. However, a significant increase in cross-continental publishing was apparent from 2002 to 2012. Asians publishing in North America increased from 17% in 2002 to 35% in 2012. Europeans also increased the number of articles they published in North American journals, while publications from North American authors were shifted towards both European and Asian journals. Experimental and clinical articles showed significant increases in cross-continental publishing, while review publishing showed no significant change. The average IF for authors from all 3 continents increased from 2002 to 2012 (p < 0.001). The largest increase in the IF was found for Asian authors (0.11 per year). Cross-continental publication significantly increased during the period from 2002 to 2012. The impact that the Asian authors have experienced was found to be gradually impacting the North American and European colleagues. © 2015 S. Karger AG, Basel.

  3. Isotopic evidence of boron in precipitation originating from coal burning in Asian continent

    International Nuclear Information System (INIS)

    Sakata, Masahiro; Natsumi, Masahiro; Tani, Yukinori

    2010-01-01

    The boron concentration and isotopic composition (δ 11 B) of precipitation collected from December 2002 to March 2006 at three sites on the Japan Sea coast were measured. Those sites have been considerably affected by the long-range transport of air pollutants from the Asian continent during winter and spring when the airflows from the Asian continent are predominant. The boron concentration in the precipitation increased primarily during winter whereas the δ 11 B decreased during winter or spring. It is assumed that this decrease in δ 11 B is not associated with a Rayleigh distillation process, because the previous δD values of the precipitation collected at a site on the Japan Sea coast did not decrease in the same manner. A weak correlation (r 2 =0.13-0.24, P 11 B and the nonsea-salt sulfate (nss-SO 4 2- )/B ratio at each site, suggesting that boron in the precipitation originate primarily from two sources. The first source, which is characterized by high δ 11 B and nss-SO 4 2- /B=0, is seawater. At the northern site, the enrichment factor for boron in the precipitation relative to seawater approached unity during winter. This implies that much of the boron in the precipitation is derived from unfractionated sea salts rather than gaseous boron evaporated from seawater. The second source is characterized by low δ 11 B and high nss-SO 4 2- /B ratio. Most of the nss-SO 4 2- in the precipitation originates from anthropogenic combustion activities in the Asian continent based on the previous model calculations. Coal accounts for a major portion of the total primary energy supply in China. Moreover, coal enriches boron and represents generally negative δ 11 B values. Hence, we propose that the emission of boron from coal burning is the most likely second source. Thus, boron isotopes may be useful as tracers of coal-burning plumes from the Asian continent. (author)

  4. Runes around the North Sea and on the Continent AD 150-700; texts & contexts

    OpenAIRE

    Looijenga, Jantina Helena

    1997-01-01

    Het onderzoek naar de oudste runeninscripties van het Europese continent, Engeland en Denemarken voerde onderzoekster van Liverpool aan de Ierse Zee naar Constanza aan de Zwarte Zee; van Zürich naar Bergen; van Parijs naar Stockholm. In dit enorme gebied kende men reeds bij het begin van de vroege middeleeuwen het runenschrift (rond 500 AD). Ergens in dit gebied moet een kern gelegen hebben, waar het begon - vermoedelijk in de eerste eeuw AD. Het localiseren van dat oorsprongsgebied begon me ...

  5. Hybrid metaheuristic optimization algorithm for strategic planning of {4D} aircraft trajectories at the continent scale

    OpenAIRE

    Chaimatanan , Supatcha; Delahaye , Daniel; Mongeau , Marcel

    2014-01-01

    International audience; Global air-traffic demand is continuously increasing. To handle such a tremendous traffic volume while maintaining at least the same level of safety, a more efficient strategic trajectory planning is necessary. In this work, we present a strategic trajectory planning methodology which aims to minimize interaction between aircraft at the European-continent scale. In addition, we propose a preliminary study that takes into account uncertainties of aircraft positions in t...

  6. On the determination of the carbon balance of continents (Vladimir Ivanovich Vernadsky Medal Lecture)

    Science.gov (United States)

    Dolman, Albertus J. Han

    2013-04-01

    The carbon balance of regions, the size of continents, can be determined, albeit with significant uncertainty, by combining several bottom up and top down methods. The bottom up methods use eddy covariance techniques, biometric inventory measurements and modeling, while the top down methods use atmospheric observations and inverse models. There has been considerable progress in the last few years in determining these balances through more or less standard protocols, as highlighted for instance by studies of the REgional Carbon Cycle Assessment and Processes (RECAPP) project of the Global Carbon Project. Important areas where uncertainty creeps in are the scaling of point measurements in the bottom up methods, the sparseness of the observation network and the role of model and other errors in the inversion methods. Typically these balances hold for periods of several years. They therefore do not resolve the impact of anomalies in weather and climate directly. The role of management in these balances also differs for different continents. For instance in Europe management plays a strong role in the carbon balance, whereas for the Russian continent this is less important. Management in the European carbon balance may potentially override climatically driven variability. In contrast, for Russia, the importance of the role of forest is paramount, but there the vulnerability of the Arctic regions and permafrost is a key uncertainty for future behaviour. I hope to show the importance of these different aspects of the terrestrial carbon balance by comparing the two continents, and also discuss the significant uncertainty we still face in determining the carbon budgets of large areas. I will argue that we need to get a clearer picture of the role of management in these budgets, but also of the time variability of the budgets to be able to determine the impact of anomalous weather and the vulnerability in a future climate.

  7. [Stoma care in patients with malignant disease].

    Science.gov (United States)

    Egawa, Akiko; Suwa, Katsuhito

    2013-12-01

    The aim of stoma care and rehabilitation is improving the quality of life of the patient with a stoma. There are more than 1,700 stoma specialist nurses in Japan, eg, enterostomal therapists(ET)and wound, ostomy, and continence nurses(WOCN), who are involved in the care of patients with stomas. In this manuscript, we describe our role in the care of patients with temporary/permanent stomas created for emergency disease and/or palliative care, and the adverse effects of various current chemotherapies.

  8. Longitudinal Study of Intestinal Symptoms and Fecal Continence in Patients With Conformal Radiotherapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Geinitz, Hans; Thamm, Reinhard; Keller, Monika; Astner, Sabrina T.; Heinrich, Christine; Scholz, Christian; Pehl, Christian; Kerndl, Simone; Prause, Nina; Busch, Raymonde; Molls, Michael; Zimmermann, Frank B.

    2011-01-01

    Purpose: To prospectively assess the intestinal symptoms and fecal continence in patients who had undergone conformal radiotherapy (CRT) for prostate cancer. Methods and Materials: A total of 78 men who had undergone definitive CRT for prostate cancer were evaluated. The patients were assessed before, during (treatment Weeks 4 and 6), and 2, 12, and 24 months after CRT completion. The intestinal symptoms and fecal continence were evaluated with comprehensive standardized questionnaires. Results: The intestinal symptoms were mostly intermittent, with only a small minority of patients affected daily. Defecation pain, fecal urge, and rectal mucous discharge increased significantly during therapy. Defecation pain and rectal mucous discharge had returned to baseline levels within 8 weeks and 1 year after CRT, respectively. However, fecal urge remained significantly elevated for ≤1 year and then returned toward the pretreatment values. The prevalence of rectal bleeding was significantly elevated 2 years after CRT. Fecal continence deteriorated during CRT and remained impaired at 1 year after treatment. Incontinence was mostly minor, occurring less than once per week and predominantly affecting incontinence for gas. Conclusion: Intestinal symptoms and fecal incontinence increased during prostate CRT. Except for rectal bleeding, the intestinal symptoms, including fecal incontinence, returned to baseline levels within 1-2 years after CRT. Thus, the rate of long-term late radiation-related intestinal toxicity was low.

  9. Pattern recognition receptor-mediated cytokine response in infants across 4 continents.

    Science.gov (United States)

    Smolen, Kinga K; Ruck, Candice E; Fortuno, Edgardo S; Ho, Kevin; Dimitriu, Pedro; Mohn, William W; Speert, David P; Cooper, Philip J; Esser, Monika; Goetghebuer, Tessa; Marchant, Arnaud; Kollmann, Tobias R

    2014-03-01

    Susceptibility to infection as well as response to vaccination varies among populations. To date, the underlying mechanisms responsible for these clinical observations have not been fully delineated. Because innate immunity instructs adaptive immunity, we hypothesized that differences between populations in innate immune responses may represent a mechanistic link to variation in susceptibility to infection or response to vaccination. Determine whether differences in innate immune responses exist among infants from different continents of the world. We determined the innate cytokine response following pattern recognition receptor (PRR) stimulation of whole blood from 2-year-old infants across 4 continents (Africa, North America, South America, and Europe). We found that despite the many possible genetic and environmental exposure differences in infants across 4 continents, innate cytokine responses were similar for infants from North America, South America, and Europe. However, cells from South African infants secreted significantly lower levels of cytokines than did cells from infants from the 3 other sites, and did so following stimulation of extracellular and endosomal but not cytosolic PRRs. Substantial differences in innate cytokine responses to PRR stimulation exist among different populations of infants that could not have been predicted. Delineating the underlying mechanism(s) for these differences will not only aid in improving vaccine-mediated protection but possibly also provide clues for the susceptibility to infection in different regions of the world. Copyright © 2013 The Authors. Published by Mosby, Inc. All rights reserved.

  10. Contrasting introduction scenarios among continents in the worldwide invasion of the banana fungal pathogen Mycosphaerella fijiensis.

    Science.gov (United States)

    Robert, S; Ravigne, V; Zapater, M-F; Abadie, C; Carlier, J

    2012-03-01

    Reconstructing and characterizing introduction routes is a key step towards understanding the ecological and evolutionary factors underlying successful invasions and disease emergence. Here, we aimed to decipher scenarios of introduction and stochastic demographic events associated with the global spread of an emerging disease of bananas caused by the destructive fungal pathogen Mycosphaerella fijiensis. We analysed the worldwide population structure of this fungus using 21 microsatellites and 8 sequence-based markers on 735 individuals from 37 countries. Our analyses designated South-East Asia as the source of the global invasion and supported the location of the centre of origin of M. fijiensis within this area. We confirmed the occurrence of bottlenecks upon introduction into other continents followed by widespread founder events within continents. Furthermore, this study suggested contrasting introduction scenarios of the pathogen between the African and American continents. While potential signatures of admixture resulting from multiple introductions were detected in America, all the African samples examined seem to descend from a single successful founder event. In combination with historical information, our study reveals an original and unprecedented global scenario of invasion for this recently emerging disease caused by a wind-dispersed pathogen. © 2012 Blackwell Publishing Ltd.

  11. Left-colon antegrade continence enema (LACE) procedure for fecal incontinence.

    Science.gov (United States)

    Churchill, Bernard M; De Ugarte, Daniel A; Atkinson, James B

    2003-12-01

    Antegrade continence enemas (ACE) are an efficacious therapeutic option for patients with fecal incontinence. The authors review their institution's experience with a variation of the Monti-Malone ACE procedure using the left colon as a source of an intestinal conduit and enema reservoir. From 2000 to 2002, 18 patients with fecal incontinence or intractable constipation underwent left-colon ACE (LACE) procedure. Concomitant Mitrofanoff appendicovesicostomy was performed in 15 patients and bladder augmentation in 9. The majority of patients had neural tube defects. A segment of left colon was tubularized, tunneled into the muscular wall of the distal colon, and exteriorized through the left upper quadrant or midabdomen. Stomal catherization and enema installation were started one month postoperatively. Fifteen patients (83%) achieved fecal continence, 2 remain incontinent of stool, and 1 experienced stomal closure (mean follow-up was 24 +/- 9 months). Two patients had stomal stenosis that required revision. The mean enema volume in patient's achieving continence was 360 +/- 216 mL, and the mean transit time was 18 +/- 12 minutes. LACE is an efficacious procedure for fecal incontinence that can be performed safely at the time of major urologic reconstruction. Administration of enemas into the left colon has several physiologic advantages that result in predictable bowel evacuation.

  12. Striking Seasonality in the Secular Warming of the Northern Continents: Structure and Mechanisms

    Science.gov (United States)

    Nigam, S.; Thomas, N. P.

    2017-12-01

    The linear trend in twentieth-century surface air temperature (SAT)—a key secular warming signal— exhibits striking seasonal variations over Northern Hemisphere continents; SAT trends are pronounced in winter and spring but notably weaker in summer and fall. The SAT trends in historical twentieth-century climate simulations informing the Intergovernmental Panel for Climate Change's Fifth Assessment show varied (and often unrealistic) strength and structure, and markedly weaker seasonal variation. The large intra-ensemble spread of winter SAT trends in some historical simulations was surprising, especially in the context of century-long linear trends, with implications for the detection of the secular warming signal. The striking seasonality of observed secular warming over northern continents warrants an explanation and the representation of related processes in climate models. Here, the seasonality of SAT trends over North America is shown to result from land surface-hydroclimate interactions and, to an extent, also from the secular change in low-level atmospheric circulation and related thermal advection. It is argued that the winter dormancy and summer vigor of the hydrologic cycle over middle- to high-latitude continents permit different responses to the additional incident radiative energy from increasing greenhouse gas concentrations. The seasonal cycle of climate, despite its monotony, provides an expanded phase space for the exposition of the dynamical and thermodynamical processes generating secular warming, and an exceptional cost-effective opportunity for benchmarking climate projection models.

  13. Clinical application of continent anal plug in bedridden patients with intractable diarrhea.

    Science.gov (United States)

    Kim, J; Shim, M C; Choi, B Y; Ahn, S H; Jang, S H; Shin, H J

    2001-08-01

    Some patients bedridden from various causes such as stroke or spinal cord injury experience poor control of bowel movement. This causes fecal leakage and diarrhea, increases the risk of perianal excoriation and bed sores, and is a burden on caregivers. To evaluate the efficacy of fecal evacuation and the prevention and treatment of skin complications in intractable diarrhea patients using a new device. A continent anal plug (US Patent No. 5 569 216) comprises an inner balloon surrounded by an outer balloon, both of which are mounted on a silicone tube containing a pair of air passages and an enema fluid inlet. The tube is secured in place in the rectum by the inflatable outer balloon and is designed to drain fecal matter through a thin collapsible hose situated in the anal canal. Thirty-two patients (21 male; median age 61 (range, 28-76) years) were evaluated after fully informed consent. Median duration was 12 (range, 3-37) days. The continent anal plug evacuated efficiently in those patients with loose or watery stools who only required irrigation once daily or not at all. Skin excoriations improved in three to seven days. Minimal leakage was seen around the anus. There was no anorectal mucosal injury noted over 37 days. The continent anal plug is an efficient method of treating patients with loss of bowel control and incontinence because it enables controlled fecal evacuation and helps reduce skin complications without causing anorectal mucosal injury.

  14. Sn-wave velocity structure of the uppermost mantle beneath the Australian continent

    Science.gov (United States)

    Wei, Zhi; Kennett, Brian L. N.; Sun, Weijia

    2018-06-01

    We have extracted a data set of more than 5000 Sn traveltimes for source-station pairs within continental Australia, with 3-D source relocation using Pn arrivals to improve data consistency. We conduct tomographic inversion for S-wave-speed structure down to 100 km using the Fast Marching Tomography (FMTOMO) method for the whole Australian continent. We obtain a 3-D model with potential resolution of 3.0° × 3.0°. The new S-wave-speed model provides strong constraints on structure in a zone that was previously poorly characterized. The S velocities in the uppermost mantle are rather fast, with patterns of variation generally corresponding to those for Pn. We find strong heterogeneities of Swave speed in the uppermost mantle across the entire continent of Australia with a close relation to crustal geological features. For instance, the cratons in the western Australia usually have high S velocities (>4.70 km s-1), while the volcanic regions on the eastern margin of Australia are characterized by low S velocities (<4.40 km s-1). Exploiting an equivalent Pn inversion, we also determine the Vp/Vs ratios across the whole continent. We find that most of the uppermost mantle has Vp/Vs between 1.65 and 1.85, but with patches in central Australia and in the east with much higher Vp/Vs ratios. Distinctive local anomalies on the eastern margin may indicate the positions of remnants of mantle plumes.

  15. A study on the birth and globalization of sports originated from each continent.

    Science.gov (United States)

    Lee, Byung Jin; Kim, Tae Young

    2016-02-01

    The purpose of this research is to see how continent specific sports rose to its modern-day status through globalization. This research focuses on the historical background of how England's football, America's national pastime, baseball, Japan's Judo, and Korea's Taekwondo developed into sports in addition to the reasoning behind its globalization. Promoted by England and the rest of the European continent, Soccer is considered to be one of the world's most popular sports and has served its function as a form of cultural imperialism. It has also advanced alongside commerce, missionary work and other types of cultural clashes. In America, baseball was used to integrate its multicultural society and developed so that the team captain leads the rest of his team. The sports of Oriental countries were reborn through modernization that was influenced by the modern rationality, education etc. of its Western counterparts. Judo and Taekwondo were introduced globally through the Olympic Games. As mentioned above the birth of sporting events has a close connection to a nation's cultural background and globalization has taken different forms depending on which continent it originated from.

  16. A study on the birth and globalization of sports originated from each continent

    Science.gov (United States)

    Lee, Byung Jin; Kim, Tae Young

    2016-01-01

    The purpose of this research is to see how continent specific sports rose to its modern-day status through globalization. This research focuses on the historical background of how England’s football, America’s national pastime, baseball, Japan’s Judo, and Korea’s Taekwondo developed into sports in addition to the reasoning behind its globalization. Promoted by England and the rest of the European continent, Soccer is considered to be one of the world’s most popular sports and has served its function as a form of cultural imperialism. It has also advanced alongside commerce, missionary work and other types of cultural clashes. In America, baseball was used to integrate its multicultural society and developed so that the team captain leads the rest of his team. The sports of Oriental countries were reborn through modernization that was influenced by the modern rationality, education etc. of its Western counterparts. Judo and Taekwondo were introduced globally through the Olympic Games. As mentioned above the birth of sporting events has a close connection to a nation’s cultural background and globalization has taken different forms depending on which continent it originated from. PMID:26933653

  17. Integrated Mid-Continent Carbon Capture, Sequestration & Enhanced Oil Recovery Project

    Energy Technology Data Exchange (ETDEWEB)

    Brian McPherson

    2010-08-31

    A consortium of research partners led by the Southwest Regional Partnership on Carbon Sequestration and industry partners, including CAP CO2 LLC, Blue Source LLC, Coffeyville Resources, Nitrogen Fertilizers LLC, Ash Grove Cement Company, Kansas Ethanol LLC, Headwaters Clean Carbon Services, Black & Veatch, and Schlumberger Carbon Services, conducted a feasibility study of a large-scale CCS commercialization project that included large-scale CO{sub 2} sources. The overall objective of this project, entitled the 'Integrated Mid-Continent Carbon Capture, Sequestration and Enhanced Oil Recovery Project' was to design an integrated system of US mid-continent industrial CO{sub 2} sources with CO{sub 2} capture, and geologic sequestration in deep saline formations and in oil field reservoirs with concomitant EOR. Findings of this project suggest that deep saline sequestration in the mid-continent region is not feasible without major financial incentives, such as tax credits or otherwise, that do not exist at this time. However, results of the analysis suggest that enhanced oil recovery with carbon sequestration is indeed feasible and practical for specific types of geologic settings in the Midwestern U.S.

  18. Parallel Evolution of Copy-Number Variation across Continents in Drosophila melanogaster

    Science.gov (United States)

    Schrider, Daniel R.; Hahn, Matthew W.; Begun, David J.

    2016-01-01

    Genetic differentiation across populations that is maintained in the presence of gene flow is a hallmark of spatially varying selection. In Drosophila melanogaster, the latitudinal clines across the eastern coasts of Australia and North America appear to be examples of this type of selection, with recent studies showing that a substantial portion of the D. melanogaster genome exhibits allele frequency differentiation with respect to latitude on both continents. As of yet there has been no genome-wide examination of differentiated copy-number variants (CNVs) in these geographic regions, despite their potential importance for phenotypic variation in Drosophila and other taxa. Here, we present an analysis of geographic variation in CNVs in D. melanogaster. We also present the first genomic analysis of geographic variation for copy-number variation in the sister species, D. simulans, in order to investigate patterns of parallel evolution in these close relatives. In D. melanogaster we find hundreds of CNVs, many of which show parallel patterns of geographic variation on both continents, lending support to the idea that they are influenced by spatially varying selection. These findings support the idea that polymorphic CNVs contribute to local adaptation in D. melanogaster. In contrast, we find very few CNVs in D. simulans that are geographically differentiated in parallel on both continents, consistent with earlier work suggesting that clinal patterns are weaker in this species. PMID:26809315

  19. [Physics of materials and female stress urinary continence: New concepts: I) Elasticity under bladder].

    Science.gov (United States)

    Guerquin, B

    2015-09-01

    Improving the understanding of the adaptation to stress of urinary continence. A transversal analysis between physics of materials and the female anatomy. Laws of physics of the materials and of their viscoelastic behavior are applied to the anatomy of the anterior vaginal wall. The anterior vaginal wall may be divided into two segments of different viscoelastic behavior, the vertical segment below the urethra and the horizontal segment below the bladder. If the urethra gets crushed on the first segment according to the hammock theory, the crushing of the bladder on the second segment is, on the other hand, damped by its important elasticity. The importance of this elasticity evokes an unknown function: damping under the bladder that moderates and delays the increase of intravesical pressure. This damping function below the bladder is increased in the cystocele, which is therefore a continence factor; on the other hand, it is impaired in obesity, which is therefore a factor of SUI. It is necessary to include in the theory of stress continence, the notion of a damping function below the bladder. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. Nursing in Turkey.

    Science.gov (United States)

    Baumann, Steven L

    2006-10-01

    The current discussion on the nursing shortage needs to focus as much on nursing job satisfaction and retention as on nursing recruitment and education. Selected aspects of the motivational psychology of Abraham Maslow, Mihaly Csikszentmihalyi, and Frederick Hertzberg are here discussed in light of the challenges-opportunities of nursing in Turkey and elsewhere. Also discussed is an innovative program to support the application of nursing theory and professional development in Toronto, Canada.

  1. Left behind and left out: The impact of the school environment on young people with continence problems.

    Science.gov (United States)

    Whale, Katie; Cramer, Helen; Joinson, Carol

    2018-05-01

    To explore the impact of the secondary school environment on young people with continence problems. In-depth qualitative semi-structured interviews. We interviewed 20 young people aged 11-19 years (11 female and nine male) with continence problems (daytime wetting, bedwetting, and/or soiling). Interviews were conducted by Skype (n = 11) and telephone (n = 9). Transcripts were analysed using inductive thematic analysis. We generated five main themes: (1) Boundaries of disclosure: friends and teachers; (2) Social consequences of avoidance and deceit; (3) Strict and oblivious gatekeepers; (4) Intimate actions in public spaces; and (5) Interrupted learning. Disclosure of continence problems at school to both friends and teachers was rare, due to the perceived stigma and fears of bullying and social isolation. The lack of disclosure to teachers and other school staff, such as pastoral care staff, creates challenges in how best to support these young people. Young people with continence problems require unrestricted access to private and adequate toilet facilities during the school day. There is a need for inclusive toilet access policies and improved toilet standards in schools. Addressing the challenges faced by young people with continence problems at school could help to remove the barriers to successful self-management of their symptoms. It is particularly concerning that young people with continence problems are at higher risk of academic underachievement. Increased support at school is needed to enable young people with continence problems to achieve their academic potential. Statement of Contribution What is already known on this subject? Continence problems are among the most common paediatric health problems Self-management of continence problems requires a structured schedule of fluid intake and bladder emptying Inadequate toilet facilities and restricted access make it difficult for young people to manage their incontinence What does this study add

  2. Seismotectonic features of the African plate: the possible dislocation of a continent

    Science.gov (United States)

    Meghraoui, Mustapha

    2014-05-01

    The African continent is made of seismically active structures with active deformation in between main substratum shields considered as stable continental interiors. Seismically active regions are primarily located along rift zones, thrust and fold mountain belts, transform faults and volcanic fields. The active tectonic structures generated large and destructive earthquakes in the past with significant damage and economic losses in Africa. Although some regions of the continent show a low-level of seismic activity, several large earthquakes (with M > 7) have occurred in the past. The presence of major active faults that generate destructive earthquakes is among the most important geological and geophysical hazards for the continent. National and International scientific projects dealing with the seismic hazards assessment are increasing in seismically active regions in Africa. The UNESCO-SIDA/IGCP (Project 601 http://eost.u-strasbg.fr/~igcp601/) support the preparation and implementation of the "Seismotectonic Map of Africa". Therefore, new seismotectonic data with the regional analysis of earthquake hazards became necessary as a basis for a mitigation of the earthquake damage. A database in historical and instrumental seismicity, active tectonics, stress tensor distribution, earthquake geology and paleoseismology, active deformation, earthquake geodesy (GPS) and gravity, crustal structure studies, magnetic and structural segmentation, volcanic fields, collision tectonics and rifting processes is prepared to constrain the geodynamic evolution of the continent. Taking into account the geological, tectonic and geophysical characteristics, we define six seismotectonic provinces that characterize the crustal deformation. With the previously identified Somalia tectonic block, the seismotectonic and geophysical framework of the continent reveal the existence of the Cameroon volcanic line, the South African tectonic block with transform faulting and Cape folding system

  3. Evolution of the Adria-Europe plate boundary in the northern Dinarides: From continent-continent collision to back-arc extension

    Science.gov (United States)

    Ustaszewski, Kamil; Kounov, Alexandre; Schmid, Stefan M.; Schaltegger, Urs; Krenn, Erwin; Frank, Wolfgang; Fügenschuh, Bernhard

    2010-12-01

    The Sava Zone of the northern Dinarides is part of the Cenozoic Adria-Europe plate boundary. Here Late Cretaceous subduction of remnants of Meliata-Vardar oceanic lithosphere led to the formation of a suture, across which upper plate European-derived units of Tisza-Dacia were juxtaposed with Adria-derived units of the Dinarides. Late Cretaceous siliciclastic sediments, deposited on the Adriatic plate, were incorporated into an accretionary wedge that evolved during the initial stages of continent-continent collision. Structurally deeper parts of the exposed accretionary wedge underwent amphibolite-grade metamorphism. Grt-Pl-Ms-Bt thermobarometry and multiphase equilibria indicate temperatures between 550°C and 630°C and pressures between 5 and 7 kbar for this event. Peak metamorphic conditions were reached at around 65 Ma. Relatively slow cooling from peak metamorphic conditions throughout most of the Paleogene was possibly induced by hanging wall erosion in conjunction with southwest directed propagation of thrusting in the Dinarides. Accelerated cooling took place in Miocene times, when the Sava Zone underwent substantial extension that led to the exhumation of the metamorphosed units along a low-angle detachment. Footwall exhumation started under greenschist facies conditions and was associated with top-to-the-north tectonic transport, indicating exhumation from below European plate units. Extension postdates the emplacement of a 27 Ma old granitoid that underwent solid-state deformation under greenschist facies conditions. The 40Ar/39Ar sericite and zircon and apatite fission track ages from the footwall allow bracketing this extensional unroofing between 25 and 14 Ma. This extension is hence linked to Miocene rift-related subsidence in the Pannonian basin, which represents a back-arc basin formed due to subduction rollback in the Carpathians.

  4. Double breasting of bladder neck and posterior urethra for continence in isolated peno-pubic epispadias.

    Science.gov (United States)

    Bhat, Amilal; Upadhayay, Ravi; Bhat, Mahakshit; Kumar, Rajiv; Kumar, Vinay

    2015-05-01

    The objectives of surgical repair of epispadias include the achievement of urinary continence, cosmetically acceptable genitalia with correction of curvature and normal genital function. To achieve all the aforementioned objectives, patients usually undergo two- or multiple-stage surgeries. Traditionally, the patients undergo epispadias repair in the first stage through modified Cantwell-Ransley or Mitchell-Bagli procedure. Subsequently, in the second stage, bladder neck repair is performed to achieve continence, the most common procedure being modified Young-Dees-Leadbetter. There is no reported single-stage technique of epispadias repair achieving both cosmesis and continence in isolated incontinent epispadias. The objectives of the study were to assess continence and cosmesis with partial penile disassemble and double breasting of bladder neck and posterior urethra in isolated peno-pubic epispadias. A retrospective analysis of surgical outcome of seven cases of primary isolated incontinent peno-pubic epispadias repair from July 2008 to July 2012 was carried out. Patients' age varied from 10 months to 16 years. Penile de-gloving is done with mobilization of urethral plate from ventrum to dorsum, distally till mid-glans and proximally up to pubic symphysis with preservation of blood supply at both ends. Partial mobilization of corporal bodies from its attachment and division of peno-pubic ligament are done to lengthen the penis. A mucosal strip of 5-7 mm is excised to denude the mucosa for double breasting. Tubularization of urethral plate with double breasting from the region of bladder neck to posterior urethra is done to increase the outlet resistance and then tubularization of distal urethral plate. Approximation of mobilized pelvic floor muscles is done to complete sphincteroplasty. Spongioplasty along the entire length and corporoplasty with medial rotation of corporeal bodies is done. Glanuloplasty with meatoplasty is done to bring the meatus ventrally and

  5. Sexual harassment of nurses and nursing students.

    Science.gov (United States)

    Bronner, Gila; Peretz, Chava; Ehrenfeld, Mally

    2003-06-01

    Nursing has dealt with sexual harassment long before the term was coined during the 1970s. The current study investigated sexual harassment of nurses and nursing students in Israel following new legislation against sexual harassment in the workplace. A self-report questionnaire was administered to 281 nurses and 206 nursing students (80% women) from five medical centres in Israel. Seven types of sexual harassment behaviour patterns were evaluated. Frequency of sexual harassment decreased as the behaviour became more intimate and offensive. Ninety percent of subjects reported experiencing at least one type of sexual harassment and 30% described at least four types. A significant difference was found between nurses and nursing students. Furthermore, "severe" types of behaviour were experienced by 33% of nurses, in comparison with 23% of nursing students. Women were significantly more exposed than men to "mild" and "moderate" types of sexual harassment, while 35% of men vs. 26% of women were exposed to "severe" types of harassment. However, women responded significantly more assertively than men to "severe" sexual harassment. Particular attention is needed when sexual harassment occurs to male students and nurses because they may be subjected to the more offensive sexual conducts and at the same time may lack the ability to respond assertively.

  6. A urinary incontinence continuing education online course for community health nurses in South Korea.

    Science.gov (United States)

    De Gagne, Jennie C; Park, Sunah; So, Aeyoung; Wu, Bei; Palmer, Mary H; McConnell, Eleanor S

    2015-04-01

    Although urinary incontinence is prevalent among older women living in rural Korea, a lack of awareness and education exists in this population and among health professionals. Geographic isolation and limited resources also contribute to having few educational offerings for rural nurses. The authors' aim was to develop an online continuing education course on continence care for community health nurses and to examine its effectiveness. A one-group, pretest-posttest design was used to detect changes in knowledge and attitudes after taking the online education course. Participant satisfaction was also measured at the end of the training. A significant improvement in knowledge and attitudes toward continence care was noted. More than 95% of participants responded that they would recommend the online program to other health care providers and indicated the program would be helpful regarding continence care in their practice. The continuing education online course is a feasible strategy to support rural community health nurses' learning to improve knowledge and attitudes toward urinary incontinence management and care. Copyright 2015, SLACK Incorporated.

  7. The correlation between ostomy knowledge and self-care ability with psychosocial adjustment in Chinese patients with a permanent colostomy: a descriptive study .

    Science.gov (United States)

    Cheng, Fang; Meng, Ai-feng; Yang, Li-Fang; Zhang, Yi-nan

    2013-07-01

    A colostomy can have a negative impact on patient quality of life. Research suggests that psychosocial adaptation is positively associated with quality of life, but few reports address this adaptation and its related factors in patients with a permanent colostomy. A 4-month, descriptive study was conducted to assess the impact of ostomy knowledge and ability to self-care on the psychosocial adjustment of 54 Chinese outpatients (47 men, 14 participants 40 to 50 years old, 40 participants 50 to 70 years old) with a permanent colostomy to investigate the correlation between stoma knowledge, self-care ability, and psychosocial adjustment. Assessment instruments included a sociodemographic data questionnaire and a Chinese translation of the Ostomy Adjustment Inventory-23 that comprises 20 items in three domains (positive emotions, negative emotions, and social life). Participants rated statements on a scale from 0 (totally disagree) to 4 (totally agree); a score of 40 indicates a low level of psychosocial adjustment. Participants also completed the Stoma-related Knowledge Scale, comprising 14 5-point Likert scale questions where low scores indicate low knowledge, and they answered one question regarding self-care ability. Data were analyzed using statistical software for social science. The average stoma-related knowledge score suggested moderate levels of knowledge (45.112 ± 13.358). Twenty (20) participants managed all stoma care aspects independently, 30 required some assistance, and four (4) required care by someone else. The three domains of psychosocial adjustment scores (positive emotions, negative emotions, and social life) were 17.60 ± 4.093,12.92 ± 3.440, and 19.15 ± 6.316, respectively. Knowledge and the three domains of psychosocial adjustment were positively correlated with positive emotion (r = .610, P = 0.001), negative emotion (r = .696, P = 0.000), and social life adjustment (r = .617, P = 0.001). A significant difference in psychosocial adjustment

  8. Factors Influencing Registered Nurses' Perceptions of Their Professional Identity: An Integrative Literature Review.

    Science.gov (United States)

    Rasmussen, Philippa; Henderson, Ann; Andrew, Nicky; Conroy, Tiffany

    2018-05-01

    This review synthesizes contemporary research investigating the factors influencing RNs' perceptions of their professional identity. The method used was an integrative literature review. Factors influencing RNs' perceptions of their professional identity were synthesized into three categories: the self, the role, and the context. The self is the nurse who enacts the role in practice, and the context is the practice setting. Poor alignment of these categories leads to stress, tension, and uncertainty affecting work-force retention. Strong alignment leads to satisfaction with the nursing role, increased staff retention, and improved quality of care and patient outcomes. These three categories should be considered when planning nursing professional development activities. This integrative review identified a lack of research addressing how nurses' perceptions of their professional identity change over time. A deeper understanding of their perspective is needed to establish whether career longevity and continued professional development are influences. J Contin Educ Nurs. 2018;49(5):225-232. Copyright 2018, SLACK Incorporated.

  9. Doctorate of Nursing Practice Students' Impressions of Uses for Visual Thinking Strategies.

    Science.gov (United States)

    Hensel, Desiree; Moorman, Margaret

    2017-08-01

    Visual Thinking Strategies (VTS) is a structured art-viewing technique designed to teach critical thinking and aesthetic appreciation. Literature on how VTS might be used in nursing is just emerging. This qualitative descriptive study examined written responses to how 14 doctorate of nursing practice students thought they might use VTS in their practice after engaging in a classroom session. Three themes emerged for how nurses might use VTS: Facilitating Interpersonal Relationships, Changing Thinking in Practice, and As a Teaching Tool. This study contributes to the growing body of literature that suggests that art and VTS and can be used in nursing with practitioners of all levels to promote conversations that involve listening intently and considering other possibilities. J Contin Educ Nurs. 2017;48(8):365-368. Copyright 2017, SLACK Incorporated.

  10. Inertia in nursing care of hospitalised patients with urinary incontinence.

    Science.gov (United States)

    Artero-López, Consuelo; Márquez-Hernández, Verónica V; Estevez-Morales, María Teresa; Granados-Gámez, Genoveva

    2018-04-01

    To assess the existence of therapeutic inertia in the nursing care of patients with urinary incontinence during the patient's time in hospital, together with the sociodemographic and professional variables involved. Inertia in care is a problem which appears in the nursing care process. Actions related to inertia can be attributed to not adhering to protocols, clinical guidelines and the lack of prevention measures which have undesirable effects on the efficiency of care. This was a prospective observational study. A total of 132 nursing professionals participated over two consecutive months. Data were collected randomly through the method of systematic, nonparticipative observation of medical practice units and patients' medical records. The results showed a pattern of severely compromised action in the assessment of the pattern of urinary elimination, in actions related to urinary continence, in therapeutic behaviour and in patient satisfaction and were found to be consistent with professional experience (p inertia exists in nursing care in the hospital environment while the patient is hospitalised, in prevention care, in the treatment of urinary incontinence and in the management of records. Contributing to the understanding of the existence of inertia in nursing care raises questions regarding its causes and interventions to predict or monitor it. © 2018 John Wiley & Sons Ltd.

  11. Meals in nursing homes

    DEFF Research Database (Denmark)

    Kofod, Jens Erik; Birkemose, A.

    2004-01-01

    Undernutrition is present among 33% of nursing home residents in Denmark. Hence, it is relevant to examine the meal situation at nursing homes to single out factors that may increase or reduce the residents' food intake. in the ongoing Danish nursing home debate it is claimed that a new type...... of nursing home improves the residents' meal situation with a positive effect on nutrition. The aim of this work is to test the general hypothesis that (i) residents appreciate the meal situation in these nursing homes and (ii) nutritional status of the residents is improved in this type of nursing home....... This study was carried out in four Danish nursing homes at various locations in Denmark. The methods used are qualitative interviews and observations at four nursing homes in combination with measurement of body mass index (BMI) at two of the four nursing homes. Undernutrition is defined as a BMI below 20...

  12. A concept analysis of holistic nursing care in paediatric nursing

    OpenAIRE

    A.A. Tjale; J. Bruce

    2007-01-01

    Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative a...

  13. Ostomy Home Skills Program

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