[Advance of digitalization for specialized care?]

For years the influence of progressive digitalization has become noticeable in the work areas of care experts in ostomy, continence and wounds (PSKW). A few years ago the feasibility of tele-healthcare and the resulting quality of care for ostomates in the out of hospital area were also tested in international studies. The driving forces included the insurance companies in the healthcare system who wanted to build a cost-effective supply structure for the insured people using digital aids. Even before the corona crisis a health insurance service contract included the requirement that service providers also offer stoma care for ostomates via online access. For the first time, the option of remote care for people with an ostomy by service providers in the outpatient area was defined as part of the contract. In this article the possibility of telecare stomatherapy as a supplement to face to face care of ostomates by SKW care experts is presented and the situation under the current corona pandemic is considered.

Creating consensus-based practice guidelines with 2000 nurses

Medical professionals follow evidence-based practice guidelines to achieve effective patient outcomes. Traditionally, to develop guidelines, a small group of experts examine evidence then agree on a set of statements, which are then published in journals. However, more than 7000 primary care journal articles are published monthly. This study examined a different way of drawing up practice guidelines, which involved large numbers of nurses from different countries directly in developing then disseminating the guidelines to speed up acceptance and the implementation of best practice. The results were consensus-based best practice guidelines for the treatment of patients with ostomies, which have received a high level of acceptance and enthusiasm from practitioners in 27 countries.

[Migration speed of uropathogens : Determination in the ureteral splint in a practice-like in vitro model]

BACKGROUND

A urostomy with an ileum conduit or a skin fistula leads to a high infection risk for the kidneys and the ureter of the patient. Therefore, the prevention of retrograde colonization of the artificial drain (splint) with e. g. contaminated urine is the most important objective of infection prevention measurements. We performed an in vitro experiment to determine the migration speed of clinically relevant bacteria in a commercially available splint catheter system.

METHODS

The migration speed of bacteria in commonly used splint catheters was determined in a practice-like in vitro model. Two storage vessels were connected with splints. The second vessel contained a bacterial suspension of the test bacteria Escherichia coli, Proteus mirabilis, and Staphylococcus aureus in artificial urine. The two vessels were incubated at 36 °C for 24-72 h. The microbial count in the catheters was determined after each experiment to investigate the migration distance.

RESULTS

The average migration speed was 0.63 cm/h for E. coli, 0.80 cm/h for S. aureus, and 0.94 cm/h for P. aeruginosa. This results in a colonization distance of approximately 80 cm in 3 days.

CONCLUSION

If the system, e. g., the stoma pouch is contaminated, it can be expected that during the common application time of a splint of 10-14 days, the complete splint will be contaminated due to the high bacteria migration speed. Consequently there is a high infection risk for kidneys and ureters. A return stop feature in the stoma pouch should minimize this risk. However, it is of upmost importance to not applying the splint through the return stop to prevent any contact with potentially contaminated urine.

A note on strong unimodality and dispersivity

A distribution R is ‘more dispersed' than a distribution P if any two quantiles of R are more widely separated than the corresponding quantiles of P. Lewis and Thompson (1981) prove that a non-degenerate distribution P is strongly unimodal if and only if it is ‘dispersive', i.e. if P∗ Q1 is more dispersed than P∗ Q2 whenever Q1 is more dispersed than Q2. For P admitting a positive Lebesgue density, we prove that P is strongly unimodal if and only if P ∗ Q is more dispersed than P for every distribution Q. Hence the latter property also characterizes the dispersivity of P.