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Watford, United Kingdom

Burch J.,St. Marks Hospital
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2014

Stoma formation is common and may be necessary in the management of certain diseases and as a result of surgery to the gastrointestinal tract or urinary tract. Because stomas provide an alternative route for the excretion of faeces and urine, they can have a significant effect on the individual's physical, psychological and social functioning. Stomas require careful management and patients need to be taught how to self-care for the stoma and how to recognise common complications. This article focuses on the signs, symptoms and management of peristomal skin complications. Source

Burch J.,St. Marks Hospital
Nursing times | Year: 2011

As nurses in any clinical setting may see patients with a stoma, it is vital they develop a basic understanding of stoma care. This article outlines the three main types of stoma, the specific appliances used for each type, examples of operations that might lead to stoma formation and the reasons for forming them. Source

Baker M.L.,Royal Infirmary | Williams R.N.,Royal Infirmary | Nightingale J.M.D.,St. Marks Hospital
Colorectal Disease | Year: 2011

Aim: Patients with a high-output stoma (HOS) (>2000ml/day) suffer from dehydration, hypomagnesaemia and under-nutrition. This study aimed to determine the incidence, aetiology and outcome of HOS. Method: The number of stomas fashioned between 2002 and 2006 was determined. An early HOS was defined as occurring in hospital within 3weeks of stoma formation and a late HOS was defined as occurring after discharge. Results Six-hundred and eighty seven stomas were fashioned (456 ileostomy/jejunostomy and 231 colostomy). An early HOS occurred in 75 (16%) ileostomies/jejunostomies. Formation of a jejunostomy (defined as having less than 200 cm remaining of proximal small bowel; n=20) and intra-abdominal sepsis? obstruction (n=14) were the commonest causes identified for early HOS. It was possible to stop parenteral infusions in 53 (71%) patients treated with oral hypotonic fluid restriction, glucose-saline solution and anti diarrhoeal medication. In 46 (61%) patients, the HOS resolved and no drug treatment was needed, 20 (27%) patients continued treatment, six (8%) of whom went home and continued to receive parenteral or subcutaneous saline, and nine died. Twenty-six patients had late HOS. Eleven were admitted with renal impairment and four had intermittent small-bowel obstruction. Eight patients were given long-term subcutaneous or parenteral saline and two also received parenteral nutrition. All had hypomagnesaemia. Conclusion Early high output from an ileostomy is common and although 49% resolved spontaneously, 51% needed ongoing medical treatment, usually because of a short small-bowel remnant. © 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland. Source

Fearon K.C.,Royal Infirmary | Jenkins J.T.,St. Marks Hospital | Carli F.,McGill University | Lassen K.,University of Tromso
British Journal of Surgery | Year: 2013

Background: Although surgical resection remains the central element in curative treatment of gastrointestinal cancer, increasing emphasis and resource has been focused on neoadjuvant or adjuvant therapy. Developments in these modalities have improved outcomes, but far less attention has been paid to improving oncological outcomes through optimization of perioperative care. Methods: A narrative review is presented based on available and updated literature in English and the authors' experience with enhanced recovery research. Results: A range of perioperative factors (such as lifestyle, co-morbidity, anaemia, sarcopenia, medications, regional analgesia and minimal access surgery) are modifiable, and can be optimized to reduce short- and long-term morbidity and mortality, improve functional capacity and quality of life, and possibly improve oncological outcome. The effect on cancer-free and overall survival may be of equal magnitude to that achieved by many adjuvant oncological regimens. Modulation of core factors, such as nutritional status, systemic inflammation, and surgical and disease-mediated stress, probably influences the host's immune surveillance and defence status both directly and through reduced postoperative morbidity. Conclusion: A wider view on long-term effects of expanded or targeted enhanced recovery protocols is warranted. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Source

Ahmad O.F.,Whittington Hospital | Akbar A.,St. Marks Hospital
British Medical Bulletin | Year: 2015

Introduction Food is a recognized trigger for most patients with irritable bowel syndrome (IBS). In recent years, an emerging evidence base has identified dietary manipulation as an important therapeutic approach in IBS. Sources of data Original and review articles were identified through selective searches performed on PubMed and Google Scholar. Areas of agreement Randomized controlled trials have supported the use of a diet that restricts a group of short-chain carbohydrates known collectively as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). There is evidence that specific probiotics may improve symptoms in IBS. Areas of controversy The role of a high-fibre diet remains subject to ongoing debate with a lack of high-quality evidence. The long-term durability and safety of a low FODMAP diet are unclear. Growing points A paradigm shift has led to a focus on the relationship between diet and pathophysiological mechanisms in IBS such as effects on intestinal microbiota, inflammation, motility, permeability and visceral hypersensitivity. Areas timely for developing research Future large, randomized controlled trials with rigorous end points are required. In addition, predictors of response need to be identified to offer personalized therapy. © 2014 The Author. Source

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