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The authors relate the experience in the organization and development of the I Enterostomal Therapy Specialization Course, the pioneer in Brazil. They report the concepts and history about enterostomal therapy as a specialty; discuss the objectives, contents, teaching strategies, and evaluation process of the course.
The author approaches about historical aspects, concepts, etiology and treatment of digestive fistula. The skin care and drainage control are the basis of stomal therapy. So, the author discusses the specific nursing and ET care in this subject, including evaluation, procedures and resources.
Peristomal skin irritation is one of the most frequent complication in the ostomate's rehabilitation process. It can and must be avoid through a specialized care. The author makes a literature revision and approaches the causative and associated factors to the skin damage, its classification and the preventive and therapeutical principles in Nursing Stomal therapy.
The authors show the trajectory of the Brazilian Stomal Therapy Courses since their beginning in 1990 until 1995. Firstly they point out the changes of their contents initially based on medical and biological fields. Nowadays they also involve issues in the other Enterostomal Therapy fields-wounds and incontinence-besides discussions and reflections on the principles of organization and creation of care programmes, services and protocols as well as on the Stomal Therapy as a specialty in Brazilian nursing, society and politics. The 75 students' expectations, perspectives and evaluation related to the courses are presented, showing positive tendencies. The author finishes the study considering the importance of the evaluation process towards the improvement of the course according to the new challenges and discussions about nursing specialties in our country.
Mitomycin C (MMC) is an antineoplastic agent with an antiproliferative effect on fibroblasts. It is routinely used topically in ophthalmology. The goal of this research project is to evaluate if topically applied MMC at the site of a maxillary antrostomy will inhibit the healing process of the mucosa and reduce the risk of postoperative stenosis. Antrostomies were carried out in both maxillary sinuses of 10 rabbits. For each rabbit, MMC is applied at the site of the antrostomy on one side while the other side serves as control. Antrostomies are re-evaluated 3 weeks later and their areas measured precisely. Seven of 10 control antrostomies were closed compared to only 1 of the 10 treated with MMC (p = .014). Comparison of the areas of the control and treated sides also proved to be statistically significant (p = .0039). Topical application of MMC was not associated with any systemic side effects and did not cause any permanent microscopic changes since the mucosa re-epithelialized normally. These results suggest that MMC slows the postoperative healing process of the nasal mucosa of the rabbit without affecting re-epithelialization. This could allow antrostomies to heal with a wider diameter, decreasing the risk of postoperative stenosis. Our next step will be to reproduce these results following functional endoscopic surgery on humans.
OBJECTIVE: To determine hospital proportional morbidity rates (HPMR) for urethral obstructions, urethral plugs or urethroliths, and urethrostomies in cats in veterinary teaching hospitals (VTH) in Canada and the United States between 1980 and 1999. DESIGN: Epidemiologic study. ANIMALS: 305,672 cats evaluated at VTH. PROCEDURES: Yearly HPMR were determined for cats with urethral obstructions, urethral plugs or urethroliths, or urethrostomies from data compiled by the Purdue Veterinary Medical Database. The test for a linear trend in proportions was used. RESULTS: Urethral obstructions were reported in 4,683 cats. Yearly HPMR for urethral obstructions declined from 19 cases/1,000 feline evaluations in 1980 to 7 cases/1,000 feline evaluations in 1999. Urethral plugs or urethroliths affected 1,460 cats. Yearly HPMR for urethral plugs or urethroliths decreased from 10 cases/1,000 feline evaluations in 1980 to 2 cases/1,000 feline evaluations in 1999. A total of 2,359 urethrostomies were performed. Yearly HPMR for urethrostomies decreased from 13 cases/1,000 feline evaluations in 1980 to 4 cases/1,000 feline evaluations in 1999. CONCLUSIONS AND CLINICAL RELEVANCE: Frequency of feline urethrostomies performed at VTH in Canada and the United States declined during the past 20 years and paralleled a similar decline in frequency of urethral obstructions and urethral plugs or urethroliths. These trends coincide with widespread use of diets to minimize struvite crystalluria in cats, which is important because struvite has consistently been the predominant mineral in feline urethral plugs during this period.
We compared the success rate of filtering surgery of a single 5-minute intraoperative application of mitomycin-C (MMC) or 5-fluorouracil (5-FU). Animal experiment and clinical study were done. In animal study, thirty pigmented rabbits (60 eyes) weighing 2.0 to 2.5 Kg were enrolled. We divided into 4 groups, such as BSS, 5-FU 50 mg/ml, MMC 0.2 mg/ml and MMC 0.4 mg/ml subconjunctival soaked group. Each group consisted of 15 eyes. In each group, 10 eyes was for examination of bleb survival and complications, 3 eyes for light microscopic examination and 2 eyes for electron microscopic examination. Bleb was survived 6.1 days (3 to 13 days) for BSS treated group, 16.3 days (9 to 23 days) for 5-FU 50mg/ml treated group, 32.7 days (17 to 55 days) in MMC 0.2 mg/ml treated group, and 64.4 days (49 to 84 days) in MMC 0.4 mg/ml treated group. Duration of bleb survival was significantly prolonged in 5-FU, MMC 0.2 mg/ml and MMC 0.4 mg/ml group respectively. In clinical study, fifty-five eyes of 40 patients were enrolled. 29 eyes of 21 patients were treated with MMC 0.2 mg/ml and 26 eyes of 19 patients were treated with 5-FU 50 mg/ml. The success rate was 89.7% in MMC 0.2 mg/ml treated group and 84.6% in 5-FU 50 mg/ml treated group at postoperative 3 months, and postoperative 6 months 89.7% in MMC 0.2 mg/ml treated group and 76.9% in 5-FU 50 mg/ml treated group. There was no statistical significance at postoperative 3 months (P > 0.05), but statistical significance at postoperative 6 months (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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The objective of this retrospective study was to identify risk factors for screw migration after triple pelvic osteotomy (TPO) in clinical patients. The medical records, radiographs made immediately after surgery, and follow-up radiographs documenting a healed osteotomy were reviewed for 52 dogs treated with unilateral TPO and 38 dogs treated with bilateral TPO. Signalment, surgeon expertise, length of surgery, sequence of surgery in dogs treated bilaterally, use of ischial or ilial wires or both, screw depth in the sacrum, and screw migration were documented for each of the 128 pelvic osteotomies. Screws placed in the first and second plate hole, securing the cranial portion of the plate, loosened most frequently. Factors associated with decreased screw migration included use of an ischial hemicerclage wire and increased depth of sacral purchase with the first and second cranial screws.
Recently, there has been a great deal of interest, argument and debate regarding the extension of nursing roles and the development of nurse practitioner roles in particular. Much of this argument has centred around whether nurses are seeking to gain professional standing by taking on doctors' tasks, but little is heard about the potential benefits to patients and the possibility of developing new patient support services. In this article, the author looks specifically at the area of stoma care and outlines potential advantages and disadvantages to role extension.
This article outlines the proposals contained in the Calman-Hine report (DoH 1995), and then presents the work of a nursing task group set up in response to its recommendations. The authors describe how different agencies collaborated in a network approach to improving the provision of cancer services.
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This article describes the establishment of an independent stoma care service, and the problems the author encountered. Set up just over four years ago, it is one of the few independent stoma care services in the UK. It currently caters exclusively for patients in private hospitals in London and the South-East of England, and the author also holds a clinic in Harley Street. Over 300 patients benefit from the service.
The Daphne Heald Research Unit was set up just over ten years ago to develop the art and science of nursing through research, and to encourage nurses to use research. In the intervening years, four major studies have been published looking at the work of clinical nurse specialists in diabetes and stoma care, nurses' knowledge of sickle cell disorders and management of early discharge after surgery. With three major projects on the way, the Unit is continuing to support the need for rigorous research.
In this article, the author discusses how nurses can identify, prevent and treat the psychological consequences of stoma surgery for patients and their families.