Professional holistic care of the person with a stoma: online learning

The Impact of Health Technologies on Ostomy Care: A Systematic Review of Health Technologies Impact on Ostomy Care

PURPOSE

The purpose of this systematic review was to evaluate studies in which health information technology was used to improve ostomy care and management.

METHODS

Systematic literature review.

SEARCH STRATEGIES

The review was performed according to PRISMA Guidelines. Three scientific databases, Scopus, PubMed, and Web of Science, were searched with no time limitation using key words related to information technology and ostomy. The selection of articles and data collection were carried out by 2 reviewers and disagreements were resolved via discussion with a third, independent reviewer.

FINDINGS

The initial search of electronic databases retrieved 1679 elements; following removal of duplicate records, title and abstract review, and articles read in full for inclusion/exclusion criteria, 10 articles were included in the review. Analysis of findings from studies included in our review addresses technologies used to care for persons living with an ostomy. Elements were divided into 2 categories: (1) sensor-based wearable technologies, which were mostly used to assess the fecal output and fullness of ostomy pouching system, and (2) computer-based, tablet based, and smartphones platforms, which were used for teaching and learning. The most significant outcomes were increasing patients' knowledge and awareness of ostomy, enhancing patient's participation in self-care processes, and improving self-efficacy levels.

IMPLICATIONS FOR PRACTICE

We found limited research regarding the effectiveness of technology-based interventions on the management of ostomy patients. Findings of this systematic review suggest that the application of technologies has created a positive effect on the management of an ostomy, provided opportunities for enhancing self-efficacy, self-care, and self-management. The results of this study can be a basis for designing efficient technology-based systems for the management of ostomy.

Whether stoma support rods have application value in loop enterostomy: a systematic review and meta-analysis

Purpose

The purpose of the systematic review and meta-analysis is to analyze the application value of the stoma support rods in loop enterostomy.

Methods

The studies on the application of stoma rods in loop enterostomy published from January 2000 to January 2020 were searched in the databases of PubMed, Embase, Cochrane library, and Clinical trials. All randomized controlled trials (RCTs) and cohort studies that observed the value of stoma rods were included according to inclusion criteria. The RevMan5.3 software was used for statistical analysis.

Results

A total of 1131 patients with loop enterostomy in six studies were included in this study; there were 569 cases in the experimental group and 562 cases in the control group. All six studies analyzed the effect of support rods on the incidence of stoma retraction; the meta-analysis showed that in a total of 32 patients, stoma retraction occurred, with a total incidence of about 2.8% in 1131 patients. The incidence of stoma retraction in the rod group was not significantly lower than that in the non-rod group, and the difference was not statistically significant (OR = 0.65, 95% CI 0.32~1.32, I² = 0%, P = 0.23), and the studies were homogeneous. The incidences of stoma necrosis (OR = 6.41, 95% CI 2.22~18.55, I² = 0%, P = 0.0006), peristomal dermatitis (OR = 2.93, 95% CI 2.01~4.27, I² = 0%, P < 0.00001), and mucocutaneous separation (OR = 2.14, 95% CI 1.03~4.47, I² = 0%, P = 0.04) were significantly increased in the rod group.

Conclusions

It is not recommended to routinely use stoma support rods in the clinical practice.

Outcomes of support rod usage in loop stoma formation

AIM

Traditionally, support rods have been used when creating loop stomas in the hope of preventing retraction. However, their effectiveness has not been clearly established. This study aimed to investigate the rate of stoma rod usage and its impact on stoma retraction and complication rates.

METHOD

A prospective cohort of 515 consecutive patients who underwent loop ileostomy/colostomy formation at a tertiary referral colorectal unit in Sydney, Australia were studied. Mortality and unplanned return to theatre rates were calculated. The primary outcome measure of interest was stoma retraction, occurring within 30 days of surgery. Secondary outcome measures included early stoma complications. The 10-year temporal trends for rod usage, stoma retraction, and complications were examined.

RESULTS

Mortality occurred in 23 patients (4.1 %) and unplanned return to theatre in 4 patients (0.8 %). Stoma retraction occurred in four patients (0.78 %), all without rods. However, the rate of retraction was similar, irrespective of whether rods were used (P = 0.12). There was a significant decline in the use of rods during the study period (P < 0.001) but this was not associated with an increase in stoma retraction rates. Early complications occurred in 94/432 patients (21.8 %) and were more likely to occur in patients with rods (64/223 versus 30/209 without rods, P < 0.001).

CONCLUSIONS

Stoma retraction is a rare complication and its incidence is not significantly affected by the use of support rods. Further, complications are common post-operatively, and the rate appears higher when rods are used. The routine use of rods warrants judicious application. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: It remains unclear whether support rods prevent stoma retraction. This study, the largest to date, confirms that stoma retraction is a rare complication and is not significantly affected by the use of rods. Consequently, routine rod usage cannot be recommended, particularly as it is associated with increased stoma complications.