After the diseased portions of the bowel have been removed in surgery, the bowel may have to be rested for healing and a bypass of the resting bowel is made through an artificially created opening called a stoma.
This opening (stoma) is made in the abdomen so that faeces can still leave the body. A stoma may be temporary or permanent.
Patients may have an ileostomy, in which an opening made in abdominal wall through which a part of small intestine is brought out, or a colostomy, in which an opening is made to bring out a part of large intestine.
Stomal Therapy Nurse Kate Brereton at St John of God Murdoch Hospital says although it can be hard to adjust to a stoma, it’s not all “doom and gloom”, many stomas are temporary and in some patients, particularly those with inflammatory bowel disease, their quality of life improves with a stoma.
“Often, patients find it difficult to cope as they haven’t had time to prepare for the changes that come with having a stoma, but armed with helpful information and support, it is possible to overcome these challenges,” Ms Brereton says.
Before surgery, a stomal therapist will usually meet with the patient and his or her family to ensure they understand the surgery and the reasons for a stoma. Not all colorectal surgeries will result in a stoma.
An explanation of pre- and post-operative care is provided along with advice about stoma supplies and how to access them. With some stomas, there are some dietary restrictions that the nurse will explain, followed by a visit with the dietician while the patient is in hospital.
The nurse marks the site/s for the stoma position on the patient’s abdomen prior to surgery. This facilitates optimal positioning so the patient can manage their stoma well.
“There are aspects of diet/fluid intake and skin care you will need to learn before you go home from hospital,” Ms Brereton says.
“Once you have fully recovered from the surgery, there are a few limitations on diet for some stomas but you can continue to live a full life.”
August 25, 2015 in Community health. Tags: colorectal surgery, inflammatory bowel disease, stoma, stomal therapy
This week the focus of our Phys. Ed. classes was rolling. Students played Pin Guard, Super Bowling and a few other rolling-type games. We had to say “good-bye” to the curling equipment this week. Hopefully everyone had the opportunity to try it out. Next week we will be shifting our focus to winter/holiday games. We will also be having our Teachers vs. Students Team Handball game on Friday, December 18th during periods 5 & 6. Students from the grade five teams will be squaring off against the staff of ÉRB.
Last week in Phys. Ed. we pulled out the curling equipment. Students had the opportunity to work on their curling skills and also played a few other rolling games. Some classes played Monster Ball and others had the chance to play Knockout Ball. We will have the curling equipment for another week, so most classes will have a few more chances to toss a few rocks.
Last week also marked the end of our Team Handball season. Thanks to all the grade 5 students that came out to participate. It was a short season but you all showed tremendous growth in your handball skills and knowledge. Thanks to M. Koester for taking care of coaching the Girls’ team. After the winter break our next interscholastic sport will be basketball. Grade 5 students that are interested show keep their eyes and ears open in early January for more information.
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Stroke Hospital Characteristics in the Florida–Puerto Rico Collaboration to Reduce Stroke Disparities Study
Although disparities in stroke care and outcomes have been well documented nationally, state-based registries to monitor acute stroke care in Florida (FL) and Puerto Rico (PR) have not been established. The FL-PR Collaboration to Reduce Stroke Disparities (CReSD) was developed to evaluate race-ethnicity and regional disparities in stroke care performance. The objective of this study was to assess and compare hospital characteristics within a large quality improvement registry to identify characteristics associated with better outcomes for acute ischemic stroke care.
Trained personnel from 78 FL-PR CReSD hospitals (69 FL, 9 PR) completed a 50-item survey assessing institutional characteristics across seven domains: acute stroke care resource availability, emergency medical services integration, stroke center certification, data collection and use, quality improvement processes, FL-PR CReSD recruitment incentives, and hospital infrastructure.
The rate of survey completion was 100%. Differences were observed both within FL and between FL and PR. Years participating in Get With The Guidelines-Stroke (8.9 ± 2.6 years FL vs 4.8 ± 2.4 years PR, P < 0.0001) and proportion of hospitals with any stroke center certification (94.2% FL vs 11.1% PR, P < 0.0001) showed the largest variations. Smaller hospital size, fewer years in Get With The Guidelines-Stroke, and lack of stroke center designation and acute stroke care practice implementation may contribute to poorer outcomes.
Results from our survey indicated variability in hospital- and system-level characteristics in stroke care across hospitals in Florida and Puerto Rico. Identification of these variations, which may explain potential disparities, can help clinicians understand gaps in stroke care and outcomes and targeted interventions to reduce identified disparities can be implemented.
The Zika virus epidemic rapidly spread across Brazil and Latin America, gaining international attention because of the causal relationship between Zika and birth defects. The high number of cases in Brazil has been attributed to a failure of the state to contain the epidemic and protect the affected people, especially women. Therefore, the public health crisis created by Zika exposed a stark conflict between Brazil's constitutional right to health and the long-standing violation of reproductive rights in the country.
Although health is considered to be a right of all in Brazil, women struggle with barriers to reproductive services and lack of access to safe and legal abortions. In response to the epidemic, women's rights advocates have filed a lawsuit with Brazil's supreme court that requires the decriminalization of abortion upon the diagnosis of Zika virus.
However, the selective decriminalization of abortion may lead to negative social consequences and further stigmatization of people with disabilities. A solution to the reproductive health crisis in Brazil must reconcile women's right to choose and the rights of people with disabilities.
A fleur-de-lis skin incision pattern was performed for horizontal and vertical abdominal skin and fat resection. A caudally based isosceles triangular flap was created on the central suprapubic region to reduce wound tension at the intersection of the horizontal and vertical incisions. After resection and debulking of the suprapubic region, a lymphaticovenular anastomosis between the efferent lymphatic vessel of the groin node and the superficial inferior epigastric vein was created or vascularized lymph node transfer to the groin region was performed to restore lymphatic flow. Lymphaticovenular anastomosis and lymph node transfer were also performed at the lower extremities to improve lower extremity lymphedema. Perioperative change in limb volume was evaluated using the lower extremity lymphedema index, and lymphatic function was evaluated by lymphoscintigraphy.
Simultaneous abdominoplasty and reconstructive lymphatic microsurgery were performed in 11 patients. The lower extremity lymphedema index improved perioperatively, with a significant difference (p < 0.01). In eight patients who underwent lymphoscintigraphy before and after surgery, the lymphatic function was found to have not deteriorated in any limb.
When simultaneous lymphatic microsurgical procedures and careful observation for complications were performed, abdominoplasty resulted in good outcomes in patients with lower extremity lymphedema and suprapubic lymphedema without worsening of lymphedema.
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