Crohn’s disease is a chronic inflammatory bowel disease with unknown origin. This study investigates the combined use of surgery and immuno modulation in Crohn’s disease. The outcome of medication and surgery in 371 operations on 237 patients between 1989 and 2006 were evaluated. Moreover the effects of prednisolone, azathioprine and infliximab on the healing of colo-colonic anastomosis in 84 mice with or without colitis were evaluated. The use of thiopurines after abdominal surgery in selected cases of severe Crohn’s disease was found to prolong the time to clinical relapse of the disease from 24 to 53 months. Patients on postoperative maintenance therapy with azathioprine had a decreased symptomatic load over time and needed fewer steroid courses. The use of thiopurines was found to be a risk factor of anastomotic complications in abdominal surgery for Crohn’s disease together with pre-operative intra-abdominal sepsis and colo-colonic anastomosis. The risk for anastomotic complications increased from 4 % in those without any of these risk factors to 13 % in those with any one and 24 % if two or three risk factors were present. In patients with two or more of these, or previously established, risk factors prior to surgery one should consider refraining from anastomosis or doing a proximal diverting stoma. Another possibility is to use a split stoma in which both ends of a future delayed anastomosis are brought out in the same ostomy hole of the abdominal wall. This method was found to significantly decrease the number of risk factors prior to the actual anastomosis as well as decreasing the risk of anastomotic complications, without increasing the number of operations or the time spent in hospital. In the animal model all three medications had an ameliorating effect on the colitis compared with placebo. Only prednisolone was found to interfere with the healing of the colo-colonic anastomoses with significantly decreased bursting pressure compared with placebo as well as azathioprine and infliximab. The association between azathioprine therapy and anastomotic complications may be due to a subgroup of patients with a more severe form of the disease who have an increased risk of such complications and also are more prone to receive intense pharmacological therapy. / Crohns sjukdom är en kronisk inflammatorisk tarmsjukdom av oklar orsak. Huvudsyftet med denna avhandling var att undersöka den kombinerade behandlingen med kirurgi och immunhämmare vid Crohns sjukdom. Utfallet av medicinsk och kirurgisk behandling vid 371 operationer på 237 patienter mellan 1989 och 2006 utvärderades. Därutöver studerades effekterna av kortison, immunhämmare och behandling med inflammationsdämpande antikroppar på läkning av tjocktarms-skarv på 84 möss med eller utan inflammation i tarmen. Vid utvalda fall med svårare form av Crohns sjukdom visade sig förebyggande behandling med immunhämmare efter kirurgi förlänga tiden till återfall av symptom från 24 till 53 månader. Patienter med immunhämmare som underhållsbehandling hade också minskade symptom under uppföljningstiden med ett minskat behov av kortison. Immunhämmande behandling inför kirurgi visade sig, liksom pågående infektion i bukhålan och sydd skarv på tjocktarmen, vara en riskfaktor för att drabbas av komplikationer vid bukkirurgi på grund av Crohns sjukdom. Risken för infektionskomplikationer i bukhålan ökade från 4 % hos dem utan någon av dessa riskfaktorer till 13 % hos dem med någon och 24 % hos dem med två eller tre riskfaktorer inför operationen. Hos patienter med två eller fler kända riskfaktorer bör man överväga att avstå från att sy en skarv på tarmen vid kirurgi eller möjligen skydda skarven med en avlastande stomi. Ett alternativ till detta är att anlägga en delad stomi där bägge ändarna av den framtida skarven tas ut genom en och samma stomiöppning i bukväggen. Denna metod med en fördröjd skarv på tarmen visade sig minska antalet kirurgiska riskfaktorer inför själva skarvningen och dessutom minska risken för tidiga infektiösa komplikationer i bukhålan, utan att vare sig öka antalet kirurgiska ingrepp eller förlänga vårdtiden på sjukhus. I en djurmodell visade sig alla tre läkemedlen ha en lindrande effekt på tarminflammation jämfört med placebo. Endast kortison visade sig påverka läkningen negativt med en sänkning av bristningstrycket i den sydda skarven på tjocktarmen, jämfört med placebo såväl som med immunhämmare och antikropps-behandling. Kopplingen mellan immunhämmare och komplikationer efter sydda skarvar på tarmen behöver alltså inte vara en direkt läkemedelseffekt. Orsaken kan istället vara att en undergrupp av Crohnpatienter har en svårare sjukdomsform som ger både ökad komplikationsrisk och större behov av intensiv medicinsk behandling.

Tidigare studier visar att delaktighet är en förutsättning för lärande. Det finns olika sätt att främja delaktighet men mest framträdande är inverkan av personal och individuell anpassning. Syftet med denna studie var att identifiera och beskriva olika sätt som personer som fått en stomi uppfattar egen delaktighet under stomiträning på sjukhus. Syftet kunde besvaras med hjälp av intervjuer med öppna frågor och fenomenografisk analys av insamlat data. Elva personer som har fått stomi och stomitränat intervjuades. I analysen framkom fyra olika kategorier som beskriver uppfattning av delaktighet under stomiträning: A) Att få vara med och se, B) Att få göra själv, C) Att bli handledd av en kunnig personal, D) Att ha möjlighet att få bestämma själv. De olika sätten att uppfatta delaktighet på visar en variation från att vilja inta en passiv roll i stomiträningen till att vara aktiv och själv fatta beslut om hur stomiträningen skall planeras. Resultatet visar också att personen själv kan ha ett eller flera sätt att uppfatta sig delaktig på men där ett av dem är mer dominant än de andra. / Previous studies showed that participation is a prerequisite for learning. There are various ways to promote participation but the most prominent is the influence of caregivers and individual adaptation.The aim of this study was to identify and describe different ways which persons who underwent a surgery resulting into a stoma to understand theirs own participation during training with the stoma in a hospital. Interviews with open questions and phenomenography analysis was used to answer the aim. Eleven persons who have got an ostomy and stoma trained was interviewed.The analyse resulted in four different categories of describing understanding of participation during training with a stoma: A) To participate by watching, B) To do it myself, C) To be supervised by competent caregivers, D) To have the possibility to decide for myself. These different ways to understand participation shows a variety from wanting to have a passive role in the training with a stoma till being active and make own decisions in planning for the training. The result also shows that one person can have one or more ways of understanding participation but one of those ways is more dominant than other.

Basic theoretical background: Stoma as a part of the surgical treatment of digestive tract diseases usually radically affects the life of the patient and his relatives. The patient has to face not only the severe diagnosis but also the result of the surgery concerning one of the most intimate human spheres. A significant part in the return to a full life is the acceptance of the stoma by the patient and his ability of being active when taking care of stoma. The theoretical part in the introduction describes the Theory of self-care deficit. The second part of the theoretical work summarizes basic information regarding the issue of derivation of intestinal stoma and the issue of acceptance of the changed body image and self-care. Objectives and hypotheses: The aim of this work is to find out differences in the acceptance of stoma and care for stoma among patients after intestinal surgery. To achieve the objective of the work, there were set three hypothesis. H1: Patients with a permanent stoma experience major changes in the psychosocial area than patients with temporary stoma. H2: In the postoperative period, women approach practising the stoma care differently than men. H3: Patients under 55 have more information about living with stoma than older patients. Methodology: The research part of the work has been carried out through quantitative research. The form of data gathering was an anonymous questionnaire. The only criterion of the selection of the respondents was the state of health after the intestinal surgery with the subsequent stoma. During the search of the respondents were addressed organizations joining the patients with stoma, stoma and proctologic ambulances of selected hospitals, hospices and homes for elderly people. The obtained data were processed by descriptive statistics in graphs by the help of Microsoft Office Excel 2010. Further on, the statistical evaluation of hypotheses was carried out. Hypotheses were tested by chi-square test in a PivotTable, the average values were compared by T-test. The chosen significance level was 5 %. Conclusion: The work provides a comprehensive look at the issue of acceptance of stoma self-care after intestinal surgery. Creating of stoma, regardless of age or sex of the patient and also regardless of its eventual duration radically influences the patient's life. This is necessary to remember all the time from the long lasting preoperative preparation to aftercare when the stoma patient should be provided by comprehensive care by nurses. The nurse should also help the patient to return to a normal life.

Surgical procedures of gastrointestinal diseases often lead to the creation of an ostomy. The number of clients with an ostomy is increasing as the Czech Republic ranks among the countries with the largest incidence of malignant colon disease. Health care professionals in any field can often encounter the client with a stoma. Therefore, it is essential for them to understand and manage this issue well. Nursing care of such individuals is very extensive and specialized. Nursing team usually focuses only on physical care but other problems associated with stomas are pushed aside. The only highly knowledgeable and qualified expert in this area is a stoma nurse specialist (an ostomy nurse). This thesis deals with the importance of the role of the stoma nurse specialist in the postoperative phase from the perspective of nurses from surgical departments as well as from the perspective of patients with a colostomy. The thesis is divided into theoretical and empirical part. The theoretical part is further divided into four chapters: colostomy, care about stoma patients, life with a colostomy, an ostomy nurse. Two objectives were determined for processing of the empirical part. We used a combination of quantitative and qualitative research to achieve our goals. The first objective was to determine whether general nurses have the knowledge to care for a client with colostomy in the postoperative phase. To obtain data for the quantitative part of the survey the method of anonymous interviews using a questionnaire, in which the research group was formed by general nurses, was selected. The survey results revealed that nurses have sufficient knowledge to treat and educate clients with a stoma. Although not all general nurses encounter colostomy patients, they widely believe the knowledge of this issue is important for the occupation of a nurse. For the quantitative part three hypotheses were selected and tested statistically. Hypothesis 1: General nurses have the knowledge to treat the client with a colostomy. It was confirmed. Hypothesis 2: General nurses have enough knowledge to educate the client with a colostomy. It was confirmed. Hypothesis 3: General nurses positively evaluate the benefits of an ostomy nurse in care for stoma patients in the postoperative phase in the surgical department. It was confirmed. The second objective was to determine the significance of the stoma nurse for clients with a colostomy. For the qualitative part of the survey the method of direct questioning by means of a semi-structured interview with open questions was chosen. The study group consisted of patients with a colostomy. For this part of the survey a research questions was specified: What is the importance of an ostomy nurse for the stoma patient in the postoperative period? We concluded that the ostomy nurse is viewed as an educator, counselor and psychological support. The ostomy nurse is the only one who can provide stoma clients with coherent and comprehensive information they need to live with a colostomy. Both groups of respondents agree that the stoma nurse is the irreplaceable specialist. Shift nurses fail to provide comprehensive care stoma patients need. An ostomy nurse needs to be a part of nursing care not only in the postoperative phase, but also in the preoperative period. There is need for closer cooperation between general nurses and the ostomy nurse. Nurses indicate their willingness to be educated in this area, while preferring seminars, lectures and conferences. The results also led us to create information material Care of the client with colostomy, as the nurses indicated that they would welcome a brief, clear, visual information material.

Under 2015 uppskattades det finnas 43 000 individer med stomi i Sverige och denna siffra har sedan 2006 ökat successivt i hela landet. Stomin inverkar på individens sociala och intima liv och påverkar vardagliga aktiviteter och dagliga rutiner. Litteraturstudiens syfte är att beskriva upplevelser av att leva med en tarmstomi. Resultatet presenteras utifrån tre teman: upplevelser av stöd och information, upplevelser av att vara annorlunda och upplevelser av en ny livssituation. Nio underteman bildades utifrån dessa rubriker. Resultatet visar att tarmstomi innebär en stor förändring som påverkar individernas liv på olika sätt. Det konstateras att tarmstomi har en negativ inverkan i de flesta fall. Familj, närstående och sjuksköterskor har en betydelsefull roll för att individerna ska uppnå hälsa och välbefinnande.

No description available.

Bakgrund: Det finns flera sjukdomar som kan orsaka att en person behöver gå igenom en stomioperation. De personer som går igenom en stomioperation kan behöva anpassa sitt liv utifrån nya förutsättningar. Att få adekvat information, stöd och omvårdnad från sjuksköterskan kan vara till en stor hjälp för de personer som nyligen fått en stomi. Syfte: Syftet var att beskriva hur det är att leva med stomi. Metod: En litteraturöversikt utfördes där elva vetenskapligt granskade artiklar söktes fram i tre databaser. Artiklarna analyserades, granskades och sammanställdes. Skillnader och likheter som framgått i tidigare forskningen eftersöktes och bildade underlaget till resultat. Resultat: Fyra teman identifierades: Det första var Livsförändringar, den andra Sexualitet och intimitet, den tredje Stöd från sjuksköterskor och närstående och den sista Acceptera att leva med stomi. Diskussion: I ljuset av Katie Erikssons teorier gällande vårdrelationer och hälsa bör aspekter som lidande och medvetenhet om att ökad kunskap och förståelse om människors egna upplevelser, känslor och tankar bidrar till att främja hälsan och lindra lidandet. / Background: There are several diseases that may cause a person to undergo a stoma surgery. Those who get a stoma surgery may need to adjust their lives based on new conditions. Getting adequate information, support and care from the nurse can be of great help to those people who recently received a stoma. Aim: The aim was to describe how it is to live with a stoma. Method: A literature review was conducted where eleven peer reviewed articles were sought from three databases. The articles were analysed, reviewed and compiled. Differences and similarities identified in the previous research were sought and formed the basis for results. Results: Four themes were identified: The first was Life changes, the second: Sexuality and intimacy, the third: Support from nurses and allied and finally: Accept living with the stoma. Discussion: In the light of Katie Eriksson`s theories regarding health care and health, aspects such as suffering and awareness that increased knowledge and understanding of people`s own experiences, feeling and thoughts should help to promote health and relieve suffering.

O objetivo deste estudo foi investigar a qualidade de vida do paciente com estoma intestinal secundário ao câncer cólon-retal na cidade de Aracaju-Se. Trata-se de estudo descritivo-exploratório, na vertente quantitativa, utilizando-se um instrumento contendo três partes, dados sócio-demográficos e clínicos, itens referentes à Escala de Qualidade de Vida de Flanagan (EQVF), e EORTC-QLQ-C-30. A amostra constou de 18 pacientes atendidos no Centro de Oncologia Dr Oswaldo Leite, localizado na cidade de Aracaju – Sergipe no período de janeiro a dezembro de 2005. Os instrumentos mostraram propriedades psicométricas satisfatórias quanto à consistência interna e validade do construto. Quanto às características sócio-demográficas e clínicas, 50% eram do sexo feminino, e 50% masculino. A média de idade foi de 51,3 anos. Quanto à localização do tumor, 38,9% tumor de reto, seguida de cólon-retal 33,3% e cólon 27,8%. 83,3% apresentavam metástase e 16,7% não apresentavam. Em relação ao tipo de estoma, 72,2% tinham colostomia definitiva e 27,8% colostomia provisória. 77,8% dos pacientes apresentaram menos de um ano de estoma e 22,2% mais de um ano de estoma. A análise de qualidade de vida da amostra mostra para EQVF média de 52,3 (DP=1,40) para EQVF Geral. Para EORTC QLQ-C30, a média estado geral de saúde foi de 35,64 (DP=12,39). Foram estatisticamente significativos os resultados obtidos nas escalas: relações com outras pessoas, atividades sociais e desenvolvimento pessoal e realização. Pacientes com menos de um ano de estoma, apresentam maior atividade social,desenvolvimento pessoal e realização do que aqueles com mais de um ano de estoma. Foram estatisticamente significativas as escalas: função física, dor, estado geral de saúde, dificuldades financeiras, dispnéia, fadiga, náusea e vômito, constipação e função emocional. A função física teve como variável estatisticamente significante o estado civil, com maior média entre pessoas casadas, assim como a escala dor, porém com maior média entre as pessoas viúvas. A função física entre as pessoas casadas foi maior. No sintoma dor, a presença desta, foi maior entre o grupo de pessoas viúvas e separadas. Na escala estado geral de saúde, foram estatisticamente significativos o sexo e complicações do estoma, com médias superiores entre aqueles do sexo masculino e com presença de complicações. Na escala dificuldades financeiras, a procedência e as complicações do estoma foram estatisticamente significantes. Com maiores médias entre aqueles da área rural e com presença de complicações do estoma. No sintoma dispnéia, a variável estatisticamente significante foi a presença ou não de metástase, com maior média entre aqueles com metástases. Já os sintomas fadiga, náusea e vômitos e constipação, apresentou como única variável estatisticamente significante o tempo de estoma. Na escala função emocional, a variável complicações do estoma foi estatisticamente significante, havendo maior média entre aqueles com presença de complicações do estoma. A escala relações com outras pessoas foi influenciada pelas variáveis: sexo, tempo de estoma e estado de origem, conforme cálculo de Regressão Linear Múltipla. As escalas função emocional, dispnéia, dificuldade financeira e estado geral de saúde tiveram influência das variáveis sexo, estado civil, estado de procedência, metástase, tempo de estoma e complicações. / The objective of this study was to investigate the quality of life of the patient with secondary intestinal estoma to the cancer colo-retal in the city of Aracaju-Se. This is an description-exploratory study, in the quantitative source, using an instrument contends three parts, given partner-demographic and clinical, itens referring to Scale of Quality of Life of Flanagan (EQVF), and EORTC QLQ-C30. The sample consisted of 18 patients taken care of in the Center of Oncologia Dr Oswaldo Leite located in the city of Aracaju - Sergipe in the period of January to December of 2005. The instruments had shown to satisfactory psicometrics properties such as the internal consistency and validity of construct. About the partner-demographic and clinical characteristics, 50% were of the feminine sex, and 50% masculine. The age average was 51,3 years. About the localization of tumor, 38,9% tumor of rectum, followed 33,3% colo-rectum and colon 27,8%. Metastase were presented by 83,3% and 16.7% didn’t present. In relation to the type of stoma, 72,2% had definitive colostomia and 27,8% provisory colostomia. 77,8% of the patients had presented less than 1 year of stoma and 22,2% more than 1 year of stoma. The analysis of quality of life of the sample shows for average EQVF of 52,3 (DP=1,40) for general EQVF. For EORTC QLQ-C30, the been average general of health was of 35,64 (DP=12,39). The scales had been statisticaly significant: social relations with other people, activities and personal development and accomplishment. Patients with less than one year of stoma, present greater social activity, personal development and accomplishment of that those with more than one year of stoma. The scales had been statistically significant: physical function, pain, general state of health, financial difficulties, dispneia, fatigue, nausea and vomit, constipation and emotional function. The physical function had as changeable statistically significant the civil state, with average greater between married people, as well as the scale pain, however with average greater between the people widowers. The physical function between the married people was bigger. In the symptom pain, the presence of this, it was bigger enters the group of people separate widowers and. In the scale general of health, the sex and complications of stoma had been statisticaly significant, with superior averages between those of the masculine sex and with presence of complications. In the scale financial difficulties, the origin and the complications of stoma they had been statisticaly significant. With average greaters between those of the agricultural area and with presence of complications of stoma. In the dispneia symptom, the statisticaly significant variable was the presence or not of metastase, with average greater it enters those with metastases. Already the symptoms fatigue, nausea and vomits and constipation, the stoma time presented as only statisticaly significant variable. In the scale emotional function, the variable complications of stoma was statisticaly significant, having bigger average between those with presence of complications of stoma. The scale Relations with other people was influenced by the variable: sex, time of stoma and state of origin, as calculation of Multiple Linear Regression. The scales emotional function, dispneia, financial difficulty and general state of health had had influence of the variable sex, civil state, state of origin, metastase, time of stoma and complications.

Bakgrund: En stomi är en konstgjord öppning som skapas på buken för att eliminera avföring när inte mag-tarmkanalen fungerar som den ska.  Att få en stomi kan innebära stora förändringar i livssituationen och påverka livskvaliteten. Genom ökad kunskap och förståelse för personers upplevelser kan sjuksköterskan bidra med god omvårdnad och främja hälsa.   Syfte: Att beskriva män och kvinnors upplevelser av att leva med stomi. Metod: Studien har genomförts som en litteraturöversikt där 15 vetenskapliga artiklar har använts i resultatet.  Resultat: Fyra huvudteman framkom i denna litteraturöversikt som har betydelse för män och kvinnors upplevelse av att leva med stomi. Förändrad kroppsbild, Relationer, Sex och intimitet och acceptans.   Slutsats: Litteraturöversiktens resultat visade att alla män och kvinnor är unika och att ett liv med stomi innebar stora omställningar fysiskt, psykiskt och socialt. Familj och närstående hade en betydande roll där emotionellt stöd bidrog till att personerna lättare accepterade sin stomi och anpassade sig till den förändrade livssituationen. Sjuksköterskan blev ett viktigt stöd där de bidrog med information, rådgivning och förståelse inför patientens upplevelse. Individens egen inställning till stomin och tillräckligt med stöd kunde bidra till en bättre livskvalitet. / Background: An ostomy, also called stoma is an opening created in the abdomen to eliminate defecation when the gastrointestinal tract does not function properly. Obtaining a stoma means major changes in one´s life situation and thus affecting the quality of life. Through increased knowledge and understanding people's experiences, the nurse can help with good care and promote health.   Aim: To describe men and women's experiences of living with an ostomy  Method: The study has been conducted as a literature review were 15 scientific articles have been used in the results  Results: Four main themes emerged in this literature review. These were significance for men and women's experience of living with an ostomy; Altered body image, Relationships, Sex and intimacy and acceptance.  Conclusion: The literature review results showed that all men and women are unique and that a life with a stoma meant major adjustments physically, mentally and socially. Family and close relatives had a significant role in terms of emotional support that helped people to accept their stoma and adapt to the changed life situation. Support from the nurse became crucial for providing information, advice and understanding patients experience. The individual's own attitude towards the stoma and sufficient support could contribute to a better quality of life.

SAMMANFATTNING Bakgrund   Idag finns det runt 43 000 personer i Sverige som lever med stomi och sedan 2006 har antalet patienter ökat i alla regioner och landsting. Operationen förändrade patientens livssituation och dess upplevelse om den nya vardagen efter stomioperationen påverkade individens livskvalitet. Sjuksköterskans roll i möten med denna patientgrupp är att lindra deras lidande och främja deras livskvalitet. Patienters förändrade välbefinnande och livskvalitet efter stomioperationen ställer krav på sjuksköterskans kapacitet till att främja livskvaliteten.    Syfte Syftet var att beskriva utmaningar, livskvalitet hos patienter efter stomioperation samt behov av stöd av sjuksköterskan.  Metod Denna litteraturöversikt grundar sig på 15 vetenskapliga artiklar, både kvalitativa och kvantitativa studier. Databassökningen genomfördes i databaserna PubMed och CINAHL. De inkluderade artiklarna kvalitetsgranskades enligt Sophiahemmets bedömningstabell och analyserades med stöd av Integrerade analys. Resultat I studien framkom tre kategorier vilka ansågs viktiga för att beskriva patientens utmaningar, livskvalitet hos patienter efter stomioperation samt behov av sjuksköterskans stöd.  Slutsats Sammanfattningsvis visar resultatet att patienter som får stomi upplever negativ i större utsträckning som har sämre inverkan på deras livskvalitet. Sjuksköterska stöd genom rådgivning, stomiutbildning och egenvård kan minska problem och komplikationer i vardagen som har bättre inverkan på livskvalitet. / ABSTRACT Background Today, there are around 43,000 people in Sweden living with an ostomy and since 2006 the number of patients has been increased in all over the country. Changing the patient's life situation and their experience of the new everyday life after the ostomy operation affects the individual's quality of life. The nurse's role in meetings with this group of patients is to alleviate their suffering and promote their quality of life. Patients' changed well-being and quality of life after the ostomy operation lies demand on the nurse's capacity to promote quality of life. Aim The purpose was to describe challenges, quality of life in patients after ostomy surgery and the need for support from the nurse. Method This literature review is based on 15 scientific articles, both qualitative and quantitative studies. The database search was carried out in the databases PubMed and CINAHL. The included articles were peer-reviewed according to Sophiahemmet's assessment table and analyzed with support from Integrated analysis. Results The study identified three categories that were considered important to describe the patient's challenges, the quality of life of patients after ostomy surgery and the need for nurse support. Conclusions In summary, the results show that patients who have an ostomy experience negatively to a greater extent that have a lower impact on their quality of life. Nurse support through counseling, ostomy education and self-care can reduce problems and complications in everyday life that have a better impact on quality of life.