Background: An ostomy is an artificial opening in the abdomen of a person as a response to a bowel disease, tumour or other issues affecting the bowels. Approximately 43 000 people live with a stoma in Sweden presently. Patients need to be offered information, education and psychological support linked to the stoma procedure. Purpose: The purpose of the literature review was to synthesize patients' experience of how their lives have changed as well as their need for support after receiving a stoma. Method: The study is a literary analysis, using databases PubMed and CIHNAL. Nine articles were reviewed utilising a qualitative content analysis. Results: The first category were Change in quality of life, with sub-categories New normal and Changed self-image. The second category was Need for support with sub-categories Support from the healthcare system and General support. Results showed that patients experienced worsen quality of life due to their stoma and importance support to be able to handle the situation. Conclusion: Life after stoma influences a patient's self-image, quality of life and the patient's sociallife. A difference in experience for a patient can be attributed to how well healthcare providers provide support, information, and education.

Patients of stoma caused by the colorectal disease or trauma are increasing and most of the patients are keen to have their stoma closed as early as possible to lower the burdens in their life. However, stoma often associated with complications such as wound. The interval between constructing and closing of stoma is still controversial. This study will figure out a way to predict an appropriate timing of stoma closure to get better outcome by using NHI database, from January 1, 2007 to December 31, 2008, in Taiwan. In 463 stoma closure patients, mean age: 65.94 years, ratio of male to female: 1.66, 70.19% Colostomy, 29.81% Ileostomy, mean timing: 156.73 days, mean length of stay: 10.81 days, mean fees: 57,698.06 TWD, only one death in hospital, 35 readmission within 30 days after discharged; with £\ = 0.05 level, the timing is significant in comorbidity, primary diagnosis; the outcomes are associated with the timing of stoma closure, comorbidity, patients¡¦ age and gender, hospital ownership and physician annual volume. Through this study, a perfect timing of stoma closure should be determined by the characteristics of patient and physician. Physicians could predict the timing through the stratified analysis and well organize the resource of hospital to improve the quality of medical care.

SUMMARY Management of Public Health MANAGEMENT OF LIFE QUALITY OF PEOPLE AFTER STOMA FORMATION Ina Ščepanskienė Supervisor Ilona Bučiūnienė, Assoc. prof., Kaunas University of Technology. Kaunas University of Medicine The Faculty of Public Health The Department of Social medicine- Kaunas, 2005.- P.44 The purpose of the study. To survey the treatment of rehabilitation-sanatorium, its involvement into social organizations of people after the stoma forming operations also the influence of post-operative treatment to the quality of life of people after the stoma forming operation. Methods. The research was a questionnaire. The questionnaires were posted off to 250 respondents, 96 answers were received – the rate of answering 38,9%. The data of questionnaires was wrought using the statistical package of data analysis SPSS 9.0. Results. 1.Patients outlive more rarely after the sanatorium treatment (63,2%“rarely“ had a sanatorium treatment, 47,9%-had no sanatorium treatment), they are able to manage the sewer of dejecta more properly. The sewer rarely effuses for them 84,4% and without the sanatorium treatment rarely effuses – 75%, more often have problems of appetite (8,6% with the treatment, and 23,8% without it).2.The patients, who belong to the Association of people after the stoma forming operation more rarely feel fatigue („rarely 45,5% who belong to the Association and 34,5% do not belong). They more rarely feel discomfort because of the strong smell and sound from the sewer... [to full text]

Pasaulyje, taip pat ir Lietuvoje kasmet vis didėja stomuotų pacientų skaičius. Lietuvoje per pastarąjį dešimtmetį pagerėjo chirurginė technika, stomos priežiūros priemonės, tačiau pacientų paruošimas stomos suformavimo operacijai ir pooperacinė priežiūra vis dar nepakankama. Stomos formavimo operacijos ir toliau išlieka aktualia problema fizinėse, socialinėse, finansinėse, seksualinėse ir psichologinėse gyvenimo srityse. Kol kas dar mažai žinoma apie pacientų mokymą, apie slaugytojo vaidmenį, rengiant pacientus stomos formavimo operacijai, nors pastaruoju metu į tai yra atkreipiamas vis didesnis dėmesys. Būtent todėl mes ir nutarėme įvertinti slaugytojo vaidmenį rengiant pacientus stomos formavimui. Tyrimo tikslas - Įvertinti slaugytojo vaidmenį rengiant pacientus gyvenimui su stoma. Tyrimo uždaviniai. Nustatyti slaugytojo vaidmenį parenkant optimalią stomos vietą. Nustatyti slaugytojo vaidmenį informuojant pacientus apie stomą prieš operaciją. Nustatyti slaugytojo vaidmenį mokant pacientus stomos priežiūros pagrindų, mitybos ir maudymosi ypatumų, kasdieninių įpročių pokyčius pooperaciniame laikotarpyje. Įvertinti slaugytojo vaidmenį, sprendžiant pacientų psichologines problemas. Tyrimo populiacija. VšĮ VU ligoninėje „Santariškių klinikose“ Pilvo chirurgijos centre gydyti 46 pacientai. Tyrimo metodai. Tyrimo objektas - slaugytojo vaidmuo rengiant pacientus stomos formavimui. Šiam tyrimui buvo naudojamas anketinės tiesioginės apklausos metodas. Apklausai atlikti buvo... [toliau žr. visą tekstą] / A number of stoma patients is increasing both in the world and in Lithuania. Although there has been a considerable progress in surgery techniques and stoma care instruments in Lithuania during the last decade, the preparation of patients for stoma surgery and after-surgery care is still insufficient. Stoma surgery still remains an urgent issue in the physical, social, financial, sexual and psychological aspects. So far the investigation of patients education and the role of medical nurses in preparing patients for stoma surgery was scarce, although lately it is receiving more attention. For this reason, we decided to evaluate the role of medical nurse in preparing patients for stoma surgery. Object of study: to evaluate the role of medical nurse in preparing patients for life with stoma. Tasks of study. To establish the role of a medical nurse in selecting the optimum stoma location. To define the role of a medical nurse in providing patients with information about stoma during pre-surgery period. To define the role of a medical nurse in educating patients on the basic care of stoma, nutrition and bathing peculiarities, also changes in daily habits during the post-surgery period. To define the role of a medical nurse in solving psychological problems of patients. Population of study. 46 patients treated in the Abdominal Surgery Centre of Vilnius University Hospital “Santariškių Clinics“. Methods of study. Object of study: the role of a medical nurse in preparing patients for... [to full text]

Stoma nurses and their contribution to work with self-help groups of patients. The diploma thesis dealt with the cooperation of stoma nurses with self-help groups of stoma patients in ten regions of the Czech Republic. The aim was to find out if stoma nurses recognize the importance of self-help groups for stoma patients, how their work contributes to self-help groups, if stoma nurses cooperate with self-help groups and if they inform stoma patients about the existence of self-help groups. Another objective was to determine the level of significance stoma patients give to self-help groups. The goals of the work were met. The theoretical section addresses the issues of self-help groups, the history, benefits, risks, stoma nurses and their education. Cooperation between doctors, stoma nurses and the club of patients is also mentioned. The contexts of a stoma - preoperative and postoperative care, nursing care complications, the stoma aids - are involved in the conclusion of the thesis. In the practical section an investigation through qualitative in-depth interviews with stoma nurses on the base of five research questions was carried out. Do stoma nurses consider self-help groups important in the life of a stoma patient? What information do stoma patients ask for when stoma nurses participate in self help groups? What is the cooperation of stoma nurses with self-help groups in individual regions? Do stoma patients take part in activities within self-help groups? Which age groups of patients, according to stoma nurses´ opinion, prefer to work in self-help groups? On the basis of a qualitative research hypotheses were established for a quantitative investigation. This quantitative research survey through questionnaires was conducted in patients with a stoma, also in ten regions. H1: Stoma nurses recognize the importance of self-help groups for patients with a stoma. H2: Stoma nurses cooperate with self-help groups of stoma patients. H3: Stoma nurses inform stoma patients about self-help groups. H4: The biggest benefit of stoma nurses for stoma patients in self-help groups is giving information about the use of aids. H5: Stoma patients consider self-help groups very important. All hypotheses were confirmed. Stoma nurses as well as stoma patients consider self-help groups very important in their lives. Currently stoma nurses cooperate with self-help groups in all regions, they inform new stoma patients about opportunities to take part in self-help groups and do not forget to give advice about aids and stoma nursing, which is the most valuable information for the stoma patient especially at the beginning of treatment. The results were consistent in both investigations and will be offered to individual stoma nurses for improvement of mutual cooperation. And in the regions where self-help groups do not exist yet or are being established, I firmly believe that the results of this thesis will help in self-help groups activities. The research survey has proved that the stoma nurses´ work is meaningful owing to its results and goals. Stoma nurses have a large share of the self-help groups work.

Background Parastomal hernia is a common stoma complication causing the patient considerable inconvenience. The patient becomes aware of a bulge around the stoma, but a bulge is not always a parastomal hernia and diagnostics must be performed to enable differential treatment. It is difficult to distinguish between a bulge and a hernia. Results based on clinical examination and computerised tomography (CT) in the supine position, have not been convincing. Three-dimensional intrastomal ultrasonography (3D US) is a novel technique shown to be promising in the assessment of stoma complaints. Two studies were performed to determine inter- and intra-observer reliability as well as the validity of 3D US as an alternative to CT when assessing stoma complaints. There are numerous options for the treatment of parastomal hernia, but none has been shown superior. In the recent decades the use of mesh in the repair of incisional and inguinal hernia has become routine. New materials must be evaluated as there are potential morbidity and even mortality risks with mesh repair. As recurrence of a parastomal hernia is an even greater challenge, the method of choice should have a low risk for recurrence. A prospective multicenter study was performed to evaluate safety and recurrence rate when using Parastomal Hernia Patch BARDTM (PHP), a mesh specially designed for parastomal hernia repair. A stoma has a profound impact on the patient´s daily life, both physical and psychological. A parastomal hernia with its associated risk for leakage and incarceration worsens the situation. Patient driven assessment of healthcare outcome is important if we are to improve medical care. A quality of life (QoL) survey was performed to assess the impact of parastomal bulging and hernia on the patient´s daily life. Methods Forty patients were investigated and the 3D US images were twice evaluated by two or three physicians to assess inter- and intra-observer reliability. Totally 20 patients with stoma complaints requiring surgery were examined with CT and 3D US prior to surgery. The findings were compared with the intraoperative findings – regarded as the true outcome. Fifty patients with parastomal hernia requiring surgery were enrolled from three hospitals. Patients were followed up one month and one year after repair using PHP. Patients still alive in 2008 who had been operated between1996 and 2004 for rectal cancer in Uppsala/Örebro-, Stockholm/Gotland-, and Northern Regions (986 patients) and registered in the Swedish Rectal Cancer Registry (SRCR) were invited to fill in four QoL questionnaires. Results Inter-observer agreement using 3D US reached 80% for the last 10 patients examined, with a kappa value of 0.70. Intra-observer agreement for two examiners was 80% and 95%. The learning curve levelled out at 30 patients. Both CT and 3D US showed high sensitivity and specificity when compared with intraoperative findings. After surgery for parastomal hernia with a PHP, the complication rate at one month was 30% and recurrence rate at one year was 22%. Twelve patients were reoperated within one year. In the QoL study, 31.5% of the patients with a stoma reported a bulging or a hernia. 11.7% had been operated for parastomal hernia. A hernia or a bulge gave rise to significantly more pain and impaired stoma function. Overall QoL was inferior in patients with a permanent stoma compared to a group without a stoma.

<p>Abstract</p><p>The aim of this literature review was to describe the quality of life in stoma patients after stomasurgery. Different combinations of the keywords “stoma”, “Quality of Life”, “stomasurgery” were used when searching in the databases Medline, Cinahl, Academic Search Elite and PubMed. A total of nineteen articles were used in the result. Fifteen studies had comparing design and four studies had describing design. Eighteen studies used questionnaires and one study used interviews for data collecting. Five studies did not concern the instruments' validity or reliability, fourteen studies referred to previously performed reliability's/validity tests. The sample sizes varied from 7 to 704 patients. Long-term quality of life in stoma patients shows contradictory results. Four studies showed that a brook uniting reservoir/pouch more or less did not change the quality of life. But that the body perception became better. One study showed that men´s Quality of Life was not effected by having a stoma, while women were effected to a greater extent, which led to a changed lifestyle and self-image among the women. Three studies showed that patients that are fecal incontinent has better social quality of life if they undergo stomasurgery. Four studies showed that patients with colon or rectal cancer and stoma had poorer quality of life than non-stoma cancer patients. Four studies showed that more therapy such as colostomy irrigation and relaxation gives better quality of life.</p><p>Keywords; “Quality of Life”, “stoma” and “stomasurgery”</p> / <p>Sammanfattning</p><p>Syftet med litteraturstudien var att beskriva människors upplevelse av livskvalitet efter en stomioperation. Olika kombinationer av sökorden ”stoma”, ”quality of life”, ”stomasurgery” användes vid sökning i databaserna Medline, Cinahl, Academic Search Elite och Pub Med. Totalt användes 19 artiklar i resultatet. Resultatet visade att samtliga studier hade som syfte att undersöka livskvaliteten hos stomiopererade patienter. Femton studier hade jämförande design och fyra studier hade beskrivande design. Arton studier använde sig av enkäter och en studie använde sig av intervjuer för datainsamling. Fem studier berörde inte instrumentens validitet eller reliabilitet, fjorton studier refererade till tidigare utförda reliabilitets/validitetstester. Undersökningsgruppernas storlek varierade från 7 till 704 patienter. Resultatet var motstridigt inom långsiktig livskvalitet hos stomiopererade. Fyra studier visade att en bäckenreservoar/pouch i stort sett inte förändrade livskvaliteten, men att kroppsuppfattningen blev bättre. En studie visade att mäns livskvalitet inte påverkades av att ha stomi, medan kvinnor påverkades i större utsträckning, vilket ledde till en förändrad livsstil och självbild hos kvinnorna. Tre studier visade att patienter som är avföringsinkontinenta får bättre social livskvalitet om de genomgår en stomioperation. Fyra studier visade att patienter med tjock eller ändtarmscancer och stomi hade sämre livskvalitet än de med endast cancer. Fyra studier visade att mer terapi i form av tarmsköljning eller avslappning ger bättre livskvalitet.</p><p>Nyckelord; ”livskvalitet”, ”stomi” och ”stomioperation”</p>

<p>The study aimed to evaluate the information and training the stoma therapist at Uppsala University Hospital has given to patients who have recently undergone stoma surgery. The study was a descriptive cross-sectional study using qualitative and quantitative design. A total of 22 patients who completely or partially took care of their stomas and recently had undergone stoma surgery participated by answering a questionnaire. At discharge most of them experienced they were relatively well-informed but they wanted more information. Before the revisit they weren’t especially safe or comfortable. The participants felt they were better informed and more safe and comfortable three weeks to six months after surgery. Whether the patients had undergone a planned or acute surgery did not influence how wellinformed, safe and comfortable in stoma management they were. No differences were found regarding how safe and comfortable in stoma management the patients were related to how long time ago they underwent the operation. Patients wanted additional information about diet, intestinal function and stoma care and more practice in changing stoma materials. Recently operated stoma patients need information and training until they feel sufficiently well-informed, safe and comfortable in order to better manage their stoma at home after discharge.</p> / <p>Studien syftade till att utvärdera den information och utbildning som stomiterapeuten vid Akademiska sjukhuset har gett till patienter som nyligen genomgått en stomioperation. Studien var en deskriptiv tvärsnittsstudie med såväl kvalitativ som kvantitativ design. Sammanlagt 22 patienter som helt eller delvis skötte sin stomi och nyligen genomgått en stomioperation deltog i studien genom att svara på ett frågeformulär. Vid utskrivning upplevde de flesta av deltagarna att de var relativt välinformerade men de önskade mer information. Innan återbesöket var de varken särskilt säkra eller trygga med stomiskötseln. Patienterna upplevde att de var mer välinformerade, trygga och säkra tre veckor till sex månader efter operation. Huruvida de hade genomgått en planerad eller akut operation påverkade inte hur välinformerade, trygga och säkra på stomiskötseln de var. Det kunde inte heller påvisas någon skillnad mellan hur trygga och säkra på stomiskötseln patienterna var relaterat till hur länge sedan de genomgick operationen. Patienterna önskade ytterligare träning på att byta stomimaterial samt mer information kring kost, tarmens funktion samt stomiskötsel innan utskrivning. Nyopererade stomipatienter skulle behöva information och utbildning tills de känner sig tillräckligt välinformerade, trygga och säkra för att bättre kunna sköta sin stomi i hemmet efter utskrivning.</p>

The study aimed to evaluate the information and training the stoma therapist at Uppsala University Hospital has given to patients who have recently undergone stoma surgery. The study was a descriptive cross-sectional study using qualitative and quantitative design. A total of 22 patients who completely or partially took care of their stomas and recently had undergone stoma surgery participated by answering a questionnaire. At discharge most of them experienced they were relatively well-informed but they wanted more information. Before the revisit they weren’t especially safe or comfortable. The participants felt they were better informed and more safe and comfortable three weeks to six months after surgery. Whether the patients had undergone a planned or acute surgery did not influence how wellinformed, safe and comfortable in stoma management they were. No differences were found regarding how safe and comfortable in stoma management the patients were related to how long time ago they underwent the operation. Patients wanted additional information about diet, intestinal function and stoma care and more practice in changing stoma materials. Recently operated stoma patients need information and training until they feel sufficiently well-informed, safe and comfortable in order to better manage their stoma at home after discharge. / Studien syftade till att utvärdera den information och utbildning som stomiterapeuten vid Akademiska sjukhuset har gett till patienter som nyligen genomgått en stomioperation. Studien var en deskriptiv tvärsnittsstudie med såväl kvalitativ som kvantitativ design. Sammanlagt 22 patienter som helt eller delvis skötte sin stomi och nyligen genomgått en stomioperation deltog i studien genom att svara på ett frågeformulär. Vid utskrivning upplevde de flesta av deltagarna att de var relativt välinformerade men de önskade mer information. Innan återbesöket var de varken särskilt säkra eller trygga med stomiskötseln. Patienterna upplevde att de var mer välinformerade, trygga och säkra tre veckor till sex månader efter operation. Huruvida de hade genomgått en planerad eller akut operation påverkade inte hur välinformerade, trygga och säkra på stomiskötseln de var. Det kunde inte heller påvisas någon skillnad mellan hur trygga och säkra på stomiskötseln patienterna var relaterat till hur länge sedan de genomgick operationen. Patienterna önskade ytterligare träning på att byta stomimaterial samt mer information kring kost, tarmens funktion samt stomiskötsel innan utskrivning. Nyopererade stomipatienter skulle behöva information och utbildning tills de känner sig tillräckligt välinformerade, trygga och säkra för att bättre kunna sköta sin stomi i hemmet efter utskrivning.

Abstract The aim of this literature review was to describe the quality of life in stoma patients after stomasurgery. Different combinations of the keywords “stoma”, “Quality of Life”, “stomasurgery” were used when searching in the databases Medline, Cinahl, Academic Search Elite and PubMed. A total of nineteen articles were used in the result. Fifteen studies had comparing design and four studies had describing design. Eighteen studies used questionnaires and one study used interviews for data collecting. Five studies did not concern the instruments' validity or reliability, fourteen studies referred to previously performed reliability's/validity tests. The sample sizes varied from 7 to 704 patients. Long-term quality of life in stoma patients shows contradictory results. Four studies showed that a brook uniting reservoir/pouch more or less did not change the quality of life. But that the body perception became better. One study showed that men´s Quality of Life was not effected by having a stoma, while women were effected to a greater extent, which led to a changed lifestyle and self-image among the women. Three studies showed that patients that are fecal incontinent has better social quality of life if they undergo stomasurgery. Four studies showed that patients with colon or rectal cancer and stoma had poorer quality of life than non-stoma cancer patients. Four studies showed that more therapy such as colostomy irrigation and relaxation gives better quality of life. Keywords; “Quality of Life”, “stoma” and “stomasurgery” / Sammanfattning Syftet med litteraturstudien var att beskriva människors upplevelse av livskvalitet efter en stomioperation. Olika kombinationer av sökorden ”stoma”, ”quality of life”, ”stomasurgery” användes vid sökning i databaserna Medline, Cinahl, Academic Search Elite och Pub Med. Totalt användes 19 artiklar i resultatet. Resultatet visade att samtliga studier hade som syfte att undersöka livskvaliteten hos stomiopererade patienter. Femton studier hade jämförande design och fyra studier hade beskrivande design. Arton studier använde sig av enkäter och en studie använde sig av intervjuer för datainsamling. Fem studier berörde inte instrumentens validitet eller reliabilitet, fjorton studier refererade till tidigare utförda reliabilitets/validitetstester. Undersökningsgruppernas storlek varierade från 7 till 704 patienter. Resultatet var motstridigt inom långsiktig livskvalitet hos stomiopererade. Fyra studier visade att en bäckenreservoar/pouch i stort sett inte förändrade livskvaliteten, men att kroppsuppfattningen blev bättre. En studie visade att mäns livskvalitet inte påverkades av att ha stomi, medan kvinnor påverkades i större utsträckning, vilket ledde till en förändrad livsstil och självbild hos kvinnorna. Tre studier visade att patienter som är avföringsinkontinenta får bättre social livskvalitet om de genomgår en stomioperation. Fyra studier visade att patienter med tjock eller ändtarmscancer och stomi hade sämre livskvalitet än de med endast cancer. Fyra studier visade att mer terapi i form av tarmsköljning eller avslappning ger bättre livskvalitet. Nyckelord; ”livskvalitet”, ”stomi” och ”stomioperation”