Coloplast (United Kingdom)

Cauda equina syndrome is a rare, severe spinal condition requiring urgent evaluation and co-ordinated care. This article addresses educational priorities and care practices for nurses managing cauda equina syndrome, based on a survey of patients with the syndrome. The aim was to review literature, Getting It Right First Time guidelines, Freedom of Information surveys, and a patient survey conducted by support group Cauda Equina Spinal Cord Injury regarding bladder and bowel dysfunction following cauda equina syndrome diagnosis and surgery. Delays in diagnosis, variations in care and unmet patient needs were researched. An anonymous online survey, including multiple choice and open-ended questions, was developed and hosted on the Enalyzer platform from 11 August to 3 September 2023. The online survey collected data on diagnosis, management and quality of life for those living with cauda equina syndrome. Participants were recruited via a members-only Facebook page. Data from 137 responses was collected and analysed. This article integrates Getting It Right First Time national reports, Freedom Of Information responses from NHS trusts and published literature, highlighting roles for nurses and specialist services. Responses indicated diagnostic inconsistencies, low adoption of the cauda equina pathway, and suggested that there had been significant impact on patients' bladder, bowel and sexual function, as well as mental wellbeing. Nurse-led specialist services, improved training in neurogenic management, guideline adherence, clear referral pathways and patient information are recommended.

Abstract Background Most people with a stoma worry about leakage, and a quarter experience leakage of stomal effluent outside baseplate on a monthly basis. Leakage has additional physical and psychosocial consequences, for instance peristomal skin complications, feeling unable to cope and self-isolation. Method An interventional, single-arm, multi-centre, study was undertaken in United Kingdom, to evaluate a novel digital leakage notification system for ostomy care including a Support Service (=Test Product) for 12 weeks in patients with a recent stoma formation (≤9 months). Patients completed questionnaires at baseline and after 4, 6, 8, 10 and 12 weeks, evaluating leakage episodes, Ostomy Leak Impact (tool containing three domains) and patient self-management (by PAM-13). Additionally, mental well-being (by WHO-5) and quality of life (QoL) (by EQ-5D-5L) were assessed. Outcomes between baseline and final evaluation were compared by generalised linear- and linear mixed models. Results 92 patients (ITT population) were recruited with a mean age of 49.4-years (range 18-81 years). 80% had an ileostomy and 53% were female. After 12 weeks use of the Test Product, a significant decrease in mean episodes of leakage outside the baseplate (1.57 versus 0.93, P <0.046) was observed. Ostomy Leak Impact scores improved across all three domains ( P <0.001), indicating less embarrassment, increased engagement in social activities, and increased control. Patient self-management also improved significantly (PAM-13 score: Δ6.6, P <0.001), as did the WHO-5 well-being index (Δ8.0, P <0.001). Lastly, EQ-5D-5L-profile-scores tended to improve ( P =0.075). Conclusion A new digital leakage notification system demonstrated strong improvements to patients’ stoma self-care, mental well-being, and QoL. What does this paper add to the literature? Sensor technology embedded in supporting ostomy solutions can notify users about leakage seeping underneath the baseplate and thus secure a timely change of the baseplate before effluent may reach outside the baseplate soiling clothes or bedsheets. The technology showed potential in increasing quality of life for people with a stoma.

Abstract Urinary tract infections (UTIs) are the main complication associated with clean intermittent catheterization (CIC) and are facilitated by post-void residual urine and trauma to the mucosa during voiding. The risk of UTI may be diminished by reducing the residual volumes and preventing microtrauma caused by mucosal suction through the eyelets of conventional eyelet catheters (CEC). A new micro-hole zone catheter (MHZC) was developed and tested in an ex vivo porcine lower urinary tract model and in vivo, in pigs, against a CEC. It was shown that, irrespective of the micro-hole diameter, the new catheter ensured increased flowrates and significantly lower residual volumes at the first flow-stop. Furthermore, with a micro-hole diameter of 0.4 mm, mucosal suction was virtually eliminated, regardless of the insertion depth or simulated intra-abdominal pressure mimicking sitting or standing humans. Pressure profile experiments and endoscopy studies indicated that the bladder gradually folds against the drainage tip of the new catheter, without blocking the flow, and, unlike with the CEC, sharp pressure variations and flow-stops did not occur during voiding. The MHZC outperformed the CEC in all tested scenarios and decreased residual volumes, thus potentially decreasing the risk of UTIs.

<p> </p> <p>O CIL é a introdução de um cateter na bexiga, através da uretra ou conduto cateterizável, com o objetivo de drenar o volume retido após uma micção, ou substituir a micção espontânea, em indivíduos incapazes de fazê-la devido a alguma condição clínica. Para o CIL, utiliza-se técnica limpa, não estéril, podendo ser realizada pela própria pessoa que tem a disfunção, no domicílio ou demais locais de seu cotidiano.</p> <p>É indicado para pessoas que apresentam esvaziamento vesical incompleto, com seus riscos inerentes de infecção do trato urinário (ITU) ou disfunção renal por refluxo e hidronefrose. É um procedimento simples, de baixo custo e grande efetividade na prevenção das complicações provenientes do esvaziamento incompleto, bem como no ganho da autonomia.</p> <p>O enfermeiro desempenha um papel de grande relevância na indicação do procedimento, na capacitação do usuário e no seu acompanhamento. Assim, é fundamental que saiba relacionar as condições clínicas que podem levar a falhas no esvaziamento vesical, identificar sintomas de esvaziamento incompleto, utilizar testes diagnósticos para confirmação do quadro e estratégias educativas que extrapolem os aspectos técnicos, fisiológicos e consigam contemplar os impactos emocionais e sociais oriundos dessa realidade, promovendo assim, adesão ao procedimento ao longo da vida.</p> <p>Esse manual visa apresentar as bases teóricas e práticas para enfermeiros generalistas ou especialistas que atuam na atenção a pacientes com condições que configuram risco para esvaziamento vesical incompleto, como é o caso das Lesões Medulares, Acidentes Vasculares Encefálicos, aumento benigno da próstata e Diabetes Mellitus. Ele foi elaborado por enfermeiras especialistas nas áreas de estomaterapia, reabilitação e saúde da mulher, com base em anos de experiência na capacitação de usuários para CIL e demais atuações na área de Disfunções do Assoalho Pélvico, bem como nas melhores evidências científicas extraídas da literatura nacional e internacional que subsidiam essa prática.</p> <p><strong>Objetivo</strong>:</p> <ul> <li>Orientar os enfermeiros sobre o cateterismo intermitente limpo (CIL) quanto a avaliação dos pacientes elegíveis, processo de treinamento do procedimento, seguimento do paciente, motivação e adesão ao longo da vida.</li> <li>Secundariamente, espera-se maior divulgação do procedimento e, consequentemente, ampliação das respectivas políticas públicas em todos os níveis de atenção.</li> </ul>

PURPOSE:The purpose of this study was to validate time frames for postoperative care following stoma surgery and to determine participants' current practice with convex pouching systems during the postoperative period.DESIGN:A Cross-sectional survey.SUBJECTS AND SETTING:The sample comprised 332 ostomy care specialists practicing in the United States. Most (n = 220; 66%) had more than 10 years' experience caring for patients with ostomies, 82% (n = 272) were certified WOC or ostomy care nurses (CWOCN and COCN), and 7% (n = 23) were board-certified colorectal surgeons.METHODS:A 23-item online questionnaire was created for purposes of the study. Items in the questionnaire queried professional background and experience caring for patients with an ostomy. A single item was used to identify postoperative care periods following ostomy surgery. Additional items queried current practice patterns related to use of convex pouching systems and the timing of their use. Data were collected from January 18 to February 8, 2021.RESULTS:Most respondents (n = 270; 90%) agreed with the following postoperative periods after ostomy surgery: immediate postoperative period (days 0-8); postoperative period (days 9-30); and transition phase (days 31-180). Most respondents (n = 274; 95%) indicated they would use a convex pouching system when clinically appropriate during the first 30 days following ostomy surgery and 79% (n = 228) indicated using a convex pouching system regardless of when the surgery was performed. Less than 1% (n = 2) indicated never using convexity within the first 30 days following stoma surgery, and only 3% (n = 8) indicated avoidance of convexity pouching systems in the immediate postoperative period.CONCLUSIONS:Findings indicate that use of convexity during the postoperative period is prevalent to provide a secure seal and predictable wear time.

Evidence indicates that a common problem for the person with an ostomy is pouch leakage and the development of peristomal skin irritation, which can negatively affect quality of life. While it is clear that the pouching system seal leakage can cause profound problems for the person with an ostomy, little information is available on interventions that focus on leakage. To address this gap, an international group of ostomy nurse experts was convened to develop consensus-based practice guidelines to assist ostomy nurses in determining the best pouching system for the patient. The outcomes of these guidelines for the person with a stoma are to decrease leakage and increase security and confidence leading to an increased quality of life. A large-scale Modified Delphi Consensus-Building Process was used to identify key factors in assessing body and stoma profiles to determine the best pouching system. The resulting consensus provides practice guidelines on how to assess body and stoma profiles, engage and educate patients, and when to follow up with patients after hospital discharge or product change.

Objetivo: descrever o processo cicatricial de feridas cirúrgicas infectadas com a utilização de espuma de poliuretano com prata iônica e sulfadiazina de prata. Métodos: trata-se de estudo observacional, descritivo, prospectivo do tipo série de dados, realizada em um ambulatório de curativos de um hospital público, no município do Rio de Janeiro. Os 4 participantes possuíam infecção de ferida operatória. A coleta de dados ocorreu de março a maio de 2016, após aprovação no Comitê de Ética em Pesquisa CAAE n° 53562516.600005259. O instrumento de coleta de dados foi o PUSH. Resultados: evidenciaram que todos os participantes do estudo acompanhados do início ao término do tratamento apresentaram alterações significativas em relação ao tamanho da lesão com rápido processo de cicatrização, diminuição da quantidade de exsudato e surgimento dos tecidos de granulação e epitelial. Conclusão: a espuma apresentou melhores resultados por apresentar todas as propriedades de um curativo ideal.