Proefschrift Maastricht. / Met lit. opg. - Met samenvatting in het Nederlands.

Qualified assistance for stoma patients in Lithuania is insufficient. Failure to provide preoperative information to patients results in not only physical, but also psychological trauma, which negatively affects the patients’ postoperative quality of life. Physicians and nurses have insufficient information about stoma care. In Lithuania, there have been no studies that would evaluate the organization of assistance for stoma patients. The aim of the performed study was to identify the drawbacks in the assistance for stoma patients in hospitals, and to propose measures for the elimination of these drawbacks. Methods and results. During the study, several investigations were performed, including questionnaire-based inquiry of patients for the evaluation of their post-operative quality of life following stoma formation, and the inquiry of patients for the comparison of the importance of preoperative and postoperative training on stoma care. The inquiry was performed using standardized quality of life questionnaires EORTC QLQ-C30 (version 3), EORTC QLQ-CR38, and additional questionnaires aimed at the evaluation of the convenience of the stoma site and the influence of preoperative and postoperative training on the quality of life during the distant postoperative period. For the second inquiry, three groups of subjects were formed. The first group included patients in whom optimal site of the stoma was selected before the operation, who were provided with full information on... [to full text]

Fat supplementation is a common practice to increase caloric intake in the performance horse. The effects of fat on fiber digestibility is unknown. Understanding of digestibility in the equine digestive tract is limited by sampling technique. While cecal and ileal cannulations have previously been utilized to determine equine nutrient digestibility and gastrointestinal physiology, the current research has been limited to singular portions of the equine digestive tract. The objectives of this dissertation were to determine the effects of dietary fat supplementation on nutrient digestibility and blood insulin, glucose, and fatty acid concentrations using dual cannulated ponies. The first step to this objective was establishment of a dual cannulated pony herd for research. This study resulted in a post-operation survival rate of 63%. Five of the dual cannulated ponies were fed hay and pelleted alfalfa and supplemented with vegetable oil at 0, 5, 10, or 15 % of total diet. Ileal, cecal, fecal, and blood samples were taken with blood samples analyzed for glucose, insulin and fatty acids. There was a treatment by time effect (P < 0.1) for apparent ileal and cecal fat digestibility and apparent cecal digestibility of crude protein. Apparent total tract digestibility of NDF, ADF and fat was affected by time (P < 0.1). Adding fat increased (P < 0.1) apparent total tract digestibility of fat. At 0 h post feeding apparent total tract digestibility of protein was greatest (P < 0.1) compared to other time periods. Plasma concentration of insulin increased (P < 0.1) over time. Ponies consuming 0 % fat diet had increased C14:0 compared to 5, 10, and 15 % diet. Adding fat at 5, 10, and 15 % of the diet increased C18:2 n-6 when the ponies were fed 0 % fat. Further research using a dual cannulated equine research herd is needed to more completely understand digestibility of other components of the equine diet.

Universiẗat, Diss.--Jena, 2007.

The benefits of physical activity for cancer survivors are numerous and well-substantiated. However, it is unclear how to accommodate specific cancer treatments, such as a stoma as part of treatment for rectal cancer, in order to be physically active. To bridge this gap, this study undertook an interpretive phenomenological analysis to explore the experience of 15 rectal cancer survivors' engagement in physical activity with a stoma. Overall, three themes were found: 1) understanding the drive and the motivation to be physically active, 2) despite being motivated to be physically active with a stoma it can be challenging, and 3) how to be physically active with a stoma: lessons learned. The findings suggest rectal cancer survivors with a stoma require motivational support and enhanced competence and self-efficacy in order to engage in greater physical activity. Incorporating these skills into current information and supportive services targeting rectal cancer survivors with a stoma may help promote physical activity in this population.

In vorliegender Studie wurden die Narbenhernieninzidenz nach Stomarückverlagerung und mögliche Risikofaktoren an insgesamt 147 Patienten untersucht. Es ergab sich eine Narbenhernieninzidenz von 23,1 % bei dem untersuchten Patientenkollektiv. Als Risikofaktoren konnten Übergewichtigkeit, die Stomamorphologie, das Operationsverfahren sowie postoperative Komplikationen ermittelt und diskutiert werden. / In this retrospective cohort study, the incidence of incisional hernias after stoma reversal and other risk factors of 147 patients were analysed. The incidence of incisional hernias was 23,1 %. Analysed and discussed risk factors are obesity, the morphology of the stoma, the different surgical treatments, and postsurgical complications.

Abstract Reality of cooperation of a stoma nurse with shift nurses Pernicious diseases of intestines and rectum often lead to creation of a temporary or permanent intestinal outlet alias stoma. Having been diagnosed, the patient is confided to the care of healthcare workers, in particular nurses, who endeavour to provide the patient with the highest possible quality care in the most intensive manner. At present, almost every hospital has a specially trained stoma nurse who should play the role of an advisor or coordinator in the nursing team. Regrettably, non-cooperation between shift nurses and the stoma nurse harm in particular the patient. Five hypotheses were raised. The first hypothesis was to confirm whether the shift nurses on surgical wards cooperate with the stoma nurse more efficiently than the shift nurses in other than surgical wards. This hypothesis was confirmed. The second hypothesis was to confirm whether the stoma nurse provides the shift nurses with regular information on developments in the concerned area. This hypothesis was not confirmed. The third hypothesis was to confirm whether the shift nurses cooperate with the stoma nurse as early as in the period before the operation; this hypothesis was aimed at surgical nurses and was not confirmed. The fourth hypothesis was to verify whether the shift nurses have sufficient information from the stoma nurse so that they could substitute her adequately when she is absent. This hypothesis was not confirmed. The fifth hypothesis verified whether the shift nurses ask the stoma nurse to provide them with information concerning correct handling of the stomal equipment. This hypothesis was not confirmed. The data were collected in the quantitative research supplemented with an interview with the stoma nurse. The shift nurses in surgical and non-operational wards obtained anonymous questionnaires. The research was conducted in seven hospitals in the Region of South Bohemia. The objectives were fulfilled. The information will be provided to deputy managers for the nursing care and stoma nurses. We believe that our results may contribute to higher efficiency of the cooperation between nurses, which will have a positive impact on provision of comprehensive care of patients with a stoma.

The aims of the studies was to evaluate the short and long term effects on the development of parastomal hernia and stoma complications of a prophylactic prosthetic mesh placed in a sublay position at the index operation.  Also the purpose was to validate a definition of parastomal hernia at clinical examination and a method and a definition of parastomal hernia at CT-scan. In the first two studies 27 patients were randomized to a conventional stoma or to a stoma with the addition of a partly absorbable low weight large pore mesh in sublay position. Patients were examined after one and five years.  After five years the rate of parastomal hernia was 80% with a conventional stoma and 14% with the addition of a mesh.  A prophylactic mesh did not increase the rate of complications. In the third study a prophylactic mesh was intended at stoma formation in 93 consecutive patients in routine surgery. In 75 patients provided with a mesh the rate of parastomal hernia after one year was 13%. Complication rates were not increased in 19 severely contaminated wounds. In the fourth study 27 patients with ostomies were examined by tree surgeons and parastomal hernia was defined as any protrusion in the vicinity of the stoma. CT-scans with patients examined in the supine and prone positions were assessed by three radiologists. Herniation was then defined as any intra abdominal content protruding beyond peritoneum or the presence of a hernia sac. Kappa was 0.85 for surgeons and 0.85 for radiologists with CT-scan in the prone position. Kappa was 0.80 for surgeons and radiologists collectively, with CT-scan in the prone position. Four parastomal hernias detected at CT-scan in the prone position could not be detected in the supine position. A parastomal hernia diagnosed at clinical examination was always detected at CT-scan in the prone position. Conclusions: A prophylactic mesh placed in a sublay position at the index operation reduces the rate of parastomal hernia without increasing the rate of complications. Parastomal hernia should at clinical examination be defined as any protrusion in the vicinity of the stoma with the patient straining in the supine and erect positions.  At CT-scan, with the patient examined in the prone position, herniation should be defined as any intra abdominal content protruding beyond peritoneum or the presence of a hernia sac. / Embargo, publiceras 2011-05-01

Person with stoma is any handicapped human with temporarily or permanently drawn hollow organ out onto body surface. The most common it concerns colon, small intestine or urinal system. Uncontrollable emptying of faecal matter or urine happens by innatural way with necessary use of stoma appliances. In stomas sphere the most important factor is informedness not only of the patient himself but of nurses as well. Sufficient education of a patient and ability of a nurse to treat stoma is the base of good nursing care. The aim of the thesis was to find out to what degree the stoma patients are informed on ways of stoma treatment and how they are satisfied with the quality of given nursing care. The work is divided on contemporary state and methodological procedures. Contemporary state includes especially pre-operation, post-operation, home and out-patient care, clients´ education, importance of stoma nurse and association of stoma patients, kinds of stoma appliances, specifics of stoma patients´ nutrition, social problems of stomas etc. For the research part six hypotheses were established. They concerned the quality of nursing care, problems of stomas treating, cooperation with nurse and club of stoma patients. It was found out that 81% addressed people are satisfied with the quality of given nursing care, 98% are familiar with problems of stomas treating, 99% were able after six months after setting of stoma to take care of stoma themselves,72% are members of the club and 90% cooperate with a stoma nurse. On the base of the research all hypotheses were confirmed and the aim of the thesis was fulfilled.In the thesis a method of quantitative research was chosen. The research proceeded in Hospital České Budějovice, Inc. in clubs of stoma patients in Tábor and Příbram. The technique of data collecting was anonymous questionnaire established for clients with a stoma. 100 respondents were addressed. The research proceeded on the base of personal contact and cooperation with stoma patients, therefore the return of questionnaires was 100%. Two questionnaires were from the reason of incompleteness taken out. The results are given in percentages and diagrammatized.

A hernia frequently complicates abdominal stoma formation. The aetiology of parastomal herniation is claimed to be multi-factorial but currently only age and trephine diameter have been shown to independently predict its development. Open or laparoscopic repair of a symptomatic parastomal hernia is frequently challenging and is associated with unsatisfactory recurrence rates. As a result, many affected patients are managed non-operatively. Prevention of parastomal herniation by prophylactic mesh reinforcement of the stoma site is a new strategy that may reduce its incidence. Manual mesh implantation, however, is thought to increase the operating time and is considered cumbersome, particularly in laparoscopic surgery. As a result, routine reinforcement of the stoma site is not currently standard practice within the National Health Service. Thus, there is a need for a simple and quick technique for stoma formation which avoids creating an oversized defect and simultaneously reinforces the trephine with mesh. The aims of this thesis included: (i) understanding the aetiopathogenesis of parastomal herniation, assessing its impact on patients’ quality of life and examining the outcomes associated with current therapeutic strategies in order to find novel therapies that may lead to its prevention; (ii) assessing the safety, reproducibility and efficacy of the Stapled Mesh stomA Reinforcement Technique (SMART) in preventing parastomal herniation and (iii) investigating the contribution of the rectus abdominis muscle to the development of herniation. A detailed literature review of PubMed and Medline databases confirmed that stoma formation through the rectus muscle is complicated by parastomal herniation in 50%-80% of 4 cases. Surgeons have underestimated its impact on patients’ quality of life. There is no conclusive evidence that alternative techniques (e.g. extraperitoneal, lateral rectus abdominis positioned stoma) are superior. Open and laparoscopic parastomal hernia repair have similar recurrence rates up to 50%. Prophylactic reinforcement of the stoma trephine with mesh in the sublay or subperitoneal position is safe and appears to reduce the herniation rate but it is difficult laparoscopically and does not address the issue of trephine size when a defect <25mm is associated with a reduced herniation risk. The Stapled Mesh stomA Reinforcement Technique (SMART) obviates the technical issues associated with routine stoma formation and reinforcement. In a pilot study with patients at high risk for herniation, SMART was found to be safe and reproducible and reduced the herniation rate to 18%. Preliminary results of the international multicentre randomised controlled trial in all patients undergoing permanent stoma formation show that SMART reduces the herniation rate compared to the standard technique, without added morbidity and minimal impact on the operating time. A radiological study assessing the contribution of the rectus abdominis muscle into the development of parastomal herniation showed that the abdominal musculature undergoes postoperative changes consistent with atrophy with postoperative muscle density being higher in patients without parastomal herniation. In conclusion, at this moment in time, prophylactic mesh reinforcement should be offered to all patients undergoing elective permanent stoma formation. The SMART procedure has the potential to change current surgical practice. The contribution of the rectus muscle to the development of herniation warrants further research since improving muscle repair and regeneration may result in therapeutic benefits.