Adjustment to colostomy: stoma acceptance, stoma care self-efficacy and interpersonal relationships

‘The definitive version is available at www.blackwell-synergy.com.’ Copyright Blackwell Publishing. DOI: 10.1111/j.1365-2648.2007.04446.xThis paper is a report of a study to examine adjustment and its relationship with stoma acceptance and social interaction, and the link between stoma care self-efficacy and adjustment in the presence of acceptance and social interactions.Peer reviewe

Differences between computed tomoghaphy and surgical findings in acute complicated diverticulitis

Summary Background/Objective: A preoperative reliable classification system between clinical and computed tomography (CT) findings to better plan surgery in acute complicated diverticulitis (ACD) is lacking. We studied the inter-observer agreement of CT scan data and their concordance with the preoperative clinical findings and the adherence with the intraoperative status using a new classification of diverticular disease (CDD). Methods: 152 patients operated on for acute complicated diverticulitis (ACD) were retrospectively enrolled. All patients were studied with CT scan within 24 h before surgery and CT images were blinded reanalyzed by 2 couples of radiologists (A/B). Kappa value evaluated the inter-observer agreement between radiologists and the concordance between CDD, preoperative clinical findings and findings at operation. Univariate and multivariate analysis were used to evaluate the predicting values of CT classification and CDD stage at surgery on postoperative outcomes. Results: Overall inter-observer agreement for the CDD was high, with a kappa value of 0.905 (95% CI Z 0.850e0.960) for observers A and B, while the concordance between radiologica

Laparoscopic peritoneal lavage. Our experience and review of the literature

NTRODUCTION: Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery. AIM: This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis. MATERIAL AND METHODS: We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy. RESULTS: The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%. CONCLUSIONS: Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage

The effect of preoperative stoma site marking on quality of life in patients undergoing ostomy surgery

The purpose of this study was to determine if preoperative stoma site marking by a Wound, Ostomy, Continence (WOC) nurse affects patient quality of life. This study used a descriptive design with a convenience sample of 25 ostomy patients. Sixty-three surveys were mailed to study participants and the response rate was 40%. Ten subjects (40%) had their stoma site marked by a WOC nurse preoperatively and fifteen subjects did not. Eleven participants reported that their ostomy was permanent (44%), while fourteen of the participants (56%) state they had a temporary stoma. Thirteen of the subjects had elective ostomy surgery (52%) and twelve (48%) had an ostomy created under emergent conditions. Overall quality of life scores did not differ between the marked and unmarked subjects. However, subjects who did not have their stoma site marked preoperatively had greater problems with pouch leakage (p=.0055) than those who were marked preoperatively

Emergency treatment of complicated colorectal cancer

Aim: To find evidence to suggest the best approach in patients admitted as an emergency for complicated colorectal cancer. Methods: The medical records of 131 patients admitted as an emergency with an obstructing, perforated, or bleeding colorectal cancer to Noble’s Hospital, Isle of Man, and the Umberto I University Hospital, Rome, were retrospectively evaluated. Patients were divided in 3 groups on the basis of the emergency treatment they received, namely 1) immediate resection, 2) damage control procedure and elective or semielective resection, and 3) no radical treatment. Demographic variables, clinical data, and treatment data were considered, and formed the basis for the comparison of groups. Primary endpoints were 90-day mortality and morbidity. Secondary endpoints were length of stay, number of lymph nodes analyzed, rate of radical R0 resections, and the number of patients who had chemoradiotherapy. Results: Forty-two patients did not have any radical treatment because the cancer was too advanced or they were too ill to tolerate an operation, 78 patients had immediate resection and 11 had damage control followed by elective resection. There was no statistically significant difference between immediate resections and 2-stage treatment in 90-day mortality and morbidity (mortality: 15.4% vs 0%; morbidity: 26.9% vs 27.3%), number of nodes retrieved (16.6±9.4 vs 14.9±5.7), and rate of R0 resections (84.6% vs 90.9%), but mortality was slightly higher in patients who underwent immediate resection. The patients who underwent staged treatment had a higher possibility of receiving a laparoscopic resection (11.5% vs 36.4%). Conclusion: The present study failed to demonstrate a clear superiority of one treatment with respect to the other, even if there is an interesting trend favoring staged resection

A Case of Recurrent Dissociative Episodes in a Patient with Congenital Defects

Case Report Marie, a 30 year old American-born Hispanic female, was first seen in the emergency room with suicidal ideation (the impulse to jump in front of an oncoming car), depression, anxiety, and distress about always getting attacked so much

The Accessible Toilet Design Resource

This Accessible Toilet Design Resource has been produced from new primary research carried out within VivaCity 2020, a large university-based research consortium that is developing tools and resources to support the design of socially inclusive cities. The consortium is funded by the Engineering and Physical Sciences Research Council (EPSRC). It was set up in 2003 and will complete its work in 2008. The Resource is concerned primarily with the design of the accessible toilet cubicle that should be provided for customer or public use wherever there is standard toilet provision. Though it may make reference to other types of toilet cubicles, urinals, automatic public conveniences (APCs) or grouped toilet provision, the location and design of these facilities are not addressed in great detail here. The location and design of accessible toilet facilities merits this independent, detailed scrutiny because it is essential to provide these facilities and to design them correctly, so that disabled people can participate on equal terms to able-bodied people in every aspect of city life

The Accessible Toilet Resource

Extract: This Accessible Toilet Design Resource has been produced from new primary research carried out within VivaCity 2020, a large university-based research consortium that is developing tools and resources to support the design of socially inclusive cities. The consortium is funded by the Engineering and Physical Sciences Research Council (EPSRC). It was set up in 2003 and will complete its work in 2008. The Resource is concerned primarily with the design of the accessible toilet cubicle that should be provided for customer or public use wherever there is standard toilet provision. Though it may make reference to other types of toilet cubicles, urinals, automatic public conveniences (APCs) or grouped toilet provision, the location and design of these facilities are not addressed in great detail here. The location and design of accessible toilet facilities merits this independent, detailed scrutiny because it is essential to provide these facilities and to design them correctly, so that disabled people can participate on equal terms to able-bodied people in every aspect of city life