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Xue J, Xu Z, Wang Q, Hou H, Wei L, Zhang J, Zhao X, Chen L, Ding F, Ma L, Zhao Y, Wang Y, Ma D, Wang T, Liu R, Gan TJ, Robinson N, Frank Y, Su F, Chi Y, Yang D, Liu S, Cui S, Wei Y, Chen Z, Qin Y, Cao L, Chen G, Shu K, Xiao Z, Zhang H, Yu J, Hu Z, Cheng H, Ma W, Liu G, Wang X, Cao X, Gao J, Kong G, Tao Q, Wang B, Wang J, Li H, Lyu C, Zhang Z, Li T, Yang K. Clinical practice guidelines for prevention and treatment of postoperative gastrointestinal disorder with Integrated Traditional Chinese and Western Medicine (2023). J Evid Based Med 2024; 17:207-223. [PMID: 38530771 DOI: 10.1111/jebm.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/29/2024] [Indexed: 03/28/2024]
Abstract
Postoperative gastrointestinal disorder (POGD) was a common complication after surgery under anesthesia. Strategies in combination with Traditional Chinese Medicine and Western medicine showed some distinct effects but standardized clinical practice guidelines were not available. Thus, a multidisciplinary expert team from various professional bodies including the Perioperative and Anesthesia Professional Committees of the Chinese Association of Integrative Medicine (CAIM), jointly with Gansu Province Clinical Research Center of Integrative Anesthesiology/Anesthesia and Pain Medical Center of Gansu Provincial Hospital of Traditional Chinese Medicine and WHO Collaborating Center for Guideline Implementation and Knowledge Translation/Chinese Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Center/Gansu Provincial Center for Medical Guideline Industry Technology/Evidence-based Medicine Center of Lanzhou University, was established to develop evidence-based guidelines. Clinical questions (7 background and 12 clinical questions) were identified through literature reviews and expert consensus meetings. Based on systematic reviews/meta-analyses, evidence quality was analyzed and the advantages and disadvantages of interventional measures were weighed with input from patients' preferences. Finally, 20 recommendations were developed through the Delphi-based consensus meetings. These recommendations included disease definitions, etiologies, pathogenesis, syndrome differentiation, diagnosis, and perioperative prevention and treatment.
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Affiliation(s)
- Jianjun Xue
- Center for Evidence-Based Medicine, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center of Integrative Anaesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
- Anesthesiology and Pain Medicine Center, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Ziqing Xu
- Gansu Province Clinical Research Center of Integrative Anaesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
- Anesthesiology and Pain Medicine Center, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Qiang Wang
- Department of Anesthesiology, Xi'an, China
| | - Huaijing Hou
- Gansu Province Clinical Research Center of Integrative Anaesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
- Anesthesiology and Pain Medicine Center, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Lili Wei
- Center for Evidence-Based Medicine, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- School of Economics and Management, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jie Zhang
- Gansu Province Clinical Research Center of Integrative Anaesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
- Anesthesiology and Pain Medicine Center, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Xiaohong Zhao
- Gansu Province Clinical Research Center of Integrative Anaesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
- Anesthesiology and Pain Medicine Center, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Liping Chen
- Gansu Province Clinical Research Center of Integrative Anaesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
- Anesthesiology and Pain Medicine Center, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Fanfan Ding
- Gansu Province Clinical Research Center of Integrative Anaesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
- Anesthesiology and Pain Medicine Center, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Li Ma
- Gansu Province Clinical Research Center of Integrative Anaesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
- Anesthesiology and Pain Medicine Center, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Yongqiang Zhao
- Gansu Province Clinical Research Center of Integrative Anaesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | | | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
- National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Renyu Liu
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA
| | | | - Yurasek Frank
- Pain Clinic, Acupuncture Services Cook County Health, Stroger Hospital, Chicago, Illinois, USA
| | - Fan Su
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongliang Chi
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dianhui Yang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shujuan Liu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Suyang Cui
- Jiangsu Provincial Hospital of Chinese Medicine, Nanjing, China
| | - Yousong Wei
- Jiangsu Provincial Hospital of Chinese Medicine, Nanjing, China
| | - Zhiqiang Chen
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - You Qin
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Lixing Cao
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Guiping Chen
- Department of Gastrointestinal Surgery, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Kuanyong Shu
- Jiangxi Maternal and Child Health Hospital, Nanchang, China
| | - Zhongqing Xiao
- Jiangxi Maternal and Child Health Hospital, Nanchang, China
| | - Hui Zhang
- Tianjin Hospital of ITCWM Nankai Hospital, Tianjin, China
| | - Jianbo Yu
- Tianjin Hospital of ITCWM Nankai Hospital, Tianjin, China
| | - Zhiqian Hu
- Department of Anorectal Surgery, Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Huakun Cheng
- Department of Neurosurgery, Heilongjiang Provincial Hospital, Harbin, China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Guokai Liu
- Department of Anesthesiology, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xiuli Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinghua Cao
- Department of Anesthesiology, Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, Urumqi, China
| | - Ju Gao
- Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Gaoyin Kong
- Department of Anesthesiology, Hunan Provincial People's Hospital, Changsha, China
| | - Qing Tao
- The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Baohua Wang
- Department of Anesthesiology, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Junlu Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Li
- Department of Anesthesiology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Cuixia Lyu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhiming Zhang
- Gansu Province Clinical Research Center of Integrative Anaesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Kehu Yang
- Center for Evidence-Based Medicine, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Centre for Evidence-Based Social Science/Center for Health Technology Assessment, School of Public Health, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Chinese GRADE Centre, Lanzhou University, Lanzhou, China
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Zhang Q, Sun J, Wang D, Wang Q, Hu H. Knowledge, attitudes, practices and associated factors regarding high output stoma of ileostomy among colorectal surgical nurses: a multicentre cross-sectional study. Support Care Cancer 2023; 32:12. [PMID: 38060050 DOI: 10.1007/s00520-023-08228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE High output stoma(HOS) is one of the most common complications after ileostomy, leading to fluid and electrolyte disturbances and renal dysfunction, and increasing the risk of readmission. Routine health education for HOS should be provided, and nurses, as the primary educators, should have adequate knowledge and skills in this area. However, there is a paucity of research on the knowledge and practice of HOS management. This study used the Knowledge, Attitude and Behavioural Practice Model to assess the management of HOS by colorectal surgery nurses and to explore the factors that influence it. METHOD Using a multi-centre, cross-sectional study design, 398 colorectal surgery nurses from 6 hospitals in 6 cities in 6 provinces were surveyed using a structured electronic questionnaire to assess general information and knowledge, attitudes and management practices and training needs related to HOS of ileostomy. RESULTS Colorectal surgery nurses' knowledge and practice of HOS was low. The presence or absence of training is an important factor influencing nurses' knowledge, attitudes and practice, with most nurses having no training and stoma specialist nurses scoring relatively high on knowledge and practice. CONCLUSIONS Nurses play a very important role in the management of HOS, but this study shows that the current level of knowledge and practice of HOS among colorectal surgery nurses is concerning, and whether or not they have received training is the most critical influencing factor; therefore, training related to HOS is urgently needed.
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Affiliation(s)
- Qing Zhang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Jianan Sun
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Dongxue Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Quan Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Haiyan Hu
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
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Chen Y, Cai Z, Liu Y, Zhong J, Cheng F. Assessment of risk factors and establishment of a nomogram model to predict early high-output ileostomy. Langenbecks Arch Surg 2023; 408:106. [PMID: 36840781 DOI: 10.1007/s00423-023-02850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/21/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE This study evaluated the prevalence and perioperative risk factors for early high-output ileostomy (EHOI) and developed a precise nomogram model to predict the occurrence of EHOI. METHODS 140 patients who underwent ileostomy surgery at three hospitals in Wuhan, Hubei Province, between January 2022 and May 2022 were enrolled in this prospective cohort study. By using univariate and multifactorial logistic regression, independent risk variables for the development of EHOI were examined, and the nomogram model for predicting the risk of EHOI was created by using R software. The calibration curve and area under the receiver operating characteristic curve (ROC AUC) were used to evaluate the calibration and discrimination of the prediction model, Hosmer-Lemeshow to verify the fit of the model. Clinical impact curve (CIC) and decision curve analysis (DCA) were used to assess the model's clinical efficacy. RESULTS A total of 132 patients participated in the study, and the incidence of EHOI was 25.8% (34/132). The nomogram model incorporated 3 risk factors hypertension, drinking habits, and high white blood cell (WBC) count after surgery. The AUC was 0.742, and the nomogram showed great calibration and clinical validity by comparing the calibration curve, DCA, and CIC. CONCLUSIONS Hypertension, drinking, and high WBC was significantly correlated with EHOI. The nomogram model has great clinical value in predicting the EHOI.
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Affiliation(s)
- Ying Chen
- Department of Urology, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, 430060, People's Republic of China
| | - Zhongxiang Cai
- Nursing Office, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Liu
- Nursing Office, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Zhong
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, 430060, People's Republic of China.
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5
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Tsujinaka S, Suzuki H, Miura T, Sato Y, Shibata C. Obstructive and secretory complications of diverting ileostomy. World J Gastroenterol 2022; 28:6732-6742. [PMID: 36620340 PMCID: PMC9813931 DOI: 10.3748/wjg.v28.i47.6732] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/04/2022] [Accepted: 11/25/2022] [Indexed: 12/19/2022] Open
Abstract
This review aimed to highlight the etiology, diagnosis, treatment, and prevention of obstructive and secretory complications associated with diverting ileostomy (DI). Obstructive complications at the stoma site are termed stoma outlet obstruction (SOO) or stoma-related obstruction (SRO). The incidence of SOO/SRO is 5.4%-27.3%, and the risk factors are multifactorial; however, the configuration of the stoma limb and the thickness of the rectus abdominis muscle (RAM) may be of particular concern. Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%. A thick RAM may carry the risk of recurrence. Surgical refinement, including a wider incision of the anterior sheath and adequate stoma limb length, avoids tension and immobility and may decrease SOO/SRO. Secretory complications of DI are termed high output stoma (HOS). Persistent HOS lead to water and sodium depletion, and secondary hyperaldosteronism, resulting in electrolyte imbalances, such as hypomagnesemia. The incidence of HOS is 14%-24%, with an output of 1000-2000 mL/d lasting up to three days. Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction, antimotility and antisecretory drug therapies, and magnesium supplementation. Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration.
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Affiliation(s)
- Shingo Tsujinaka
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Hideyuki Suzuki
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Tomoya Miura
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Yoshihiro Sato
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Chikashi Shibata
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
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6
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Yeung TM, Apte SS, Behrenbruch CC, Heriot AG. Clostridioides difficile infection following ileostomy reversal - can we clean up our act? ANZ J Surg 2022; 92:1982-1983. [PMID: 36097427 DOI: 10.1111/ans.17743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Trevor M Yeung
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sameer S Apte
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Corina C Behrenbruch
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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