IN THIS ISSUE OF JWOCN
The concept of statistical significance is well-known to readers of the Journal of Wound, Ostomy and Continence Nursing (JWOCN). Inferential statistical analysis may be used to calculate the likelihood that differences observed when comparing 2 or more groups occurred because of some intervention rather than by chance. In contrast, the concept of a clinically meaningful difference (CMD) may be less well-known; the CMD is an evaluation of whether an intervention improves outcomes perceived as important to our patients. This issue of the JWOCN opens with an article from Teresa Kelechi, Mary Dooley, Martina Mueller, Mohan Madisetti, and Margie Prentice that examined the efficacy of a self-administered cooling treatment on symptoms associated with chronic venous disease. Do not be fooled by my brief explanation of the CMD. The finding reported by Kelechi's group is a well-designed, expertly executed, and rigorously analyzed study of an alternative metric for determining efficacy. Read on in this issue to determine whether the cooling intervention described in this study creates a CMD as perceived by patients when compared to a sham intervention.
Jitendra Bharucha, Linda Seaman, Michele Powers, Erica Kelly, Rodney Seaman, Lea Forcier, Janice McGinnis, Isabel Nodiff, Brooke Pawlak, Samantha Snyder, Susan Nodiff, Rohan Patel, Rafael Squitieri, and Lansheng Wang report findings of a randomized clinical trial that compared a noninvasive perfusion enhancement system versus beds with integrated alternating pressure capabilities for prevention of hospital-acquired sacral pressure injuries in a high-risk, acute care patient population. This article qualifies as must read for all WOC nurses tasked with prevention of facility-acquired pressure injuries. Should you incorporate the technology described in this randomized clinical trial into your practice? Read on and find out!
Fareed Iqbal, Valerie Van der Ploeg, Franklin Adaba, Alan Askari, Jamie Murphy, R. John Nicholls, and Carolynne Vaizey describe psychosocial and health-related quality-of-life outcomes in individuals following ostomy surgery for severe, chronic constipation. This article qualifies as must read because it provides new knowledge concerning the impact of ostomy surgery in a group not often perceived to be candidates for fecal diversion. Read on to learn more about this intervention and its effects on individuals with chronic and debilitating constipation.
The Journal has a tradition of publishing executive summaries of clinical guidelines pertinent to WOC specialty practice nursing. In this issue, Gabriele Roveron, Mario Antonini, Maria Barbierato, Vita Calandrino, Giancarlo Canese, Lucio Fernando Chiurazzi, Gesualdo Coniglio, Gabriele Gentini, Mara Marchetti, Andrea Minucci, Laura Nembrini, Vanessa Neri, Paola Trovato, and Francesco Ferrara present guidelines for patients with gastrostomy and jejunostomy tubes used to deliver nutrition and/or drugs. You will want to read this article to ensure your practice is up to date in this important aspect of ostomy care.
I am confident that every WOC nurse would concur that acquisition of self-management skills is an essential component of adjustment following creation of a fecal or urinary stoma. Eladio Collado, Francisco Machancoses, and Maria Dolores Temprado describe development and validation of the Specific Self-Care for Ostomized Patients Questionnaire (CAESPO) instrument. You will want to read this cutting-edge article to determine whether you should incorporate this instrument into your clinical practice.
Over the past several issues, we have published a number of articles focusing on the science and technology behind the construction, design, selection, use, and evaluation of absorbent incontinence products. As WOC nurses, we are especially interested in the proper use of these products, given their potential impact on skin dryness and moisture-associated skin damage. Sabrina Falloon, Shabira Abbas, Chatrine Stridfeldt, and Alan Cottenden provide a masterful and lucid integrative review of current research and knowledge into the impact of absorbent products for incontinence on the microclimate of the skin covered by or in contact with these products. Read on to improve your insights into the effects of absorbent products on this essential component of skin health.
While a detailed understanding of the relationships between pressure, friction, shear, moisture, and skin damage remains elusive, research in the past 5 years has advanced our appreciation of the complex relationships among incontinence, incontinence-associated dermatitis, and pressure injuries. Building on their prior work, Michelle Barakat-Johnson, Catherine Barnett, Michelle Lai, Timothy Wand, and Kathryn White report findings of their study of relationships among incontinence-associated dermatitis use of incontinence products, mobility, and pressure injury. You will want to read this insightful article to enhance your understanding of these complex relationships and how high-quality, preventive nursing management can protect our patients from multiple forms of skin damage.
Added to these insightful articles, this issue contains not 1 but 3 Clinical Challenges feature articles. Lisa Owens, Tonnie Warfield, Ryan MacDonald, and Erudina Krenzischek describe use of an alternate light source to enhance visual assessment of deep tissue pressure injuries. This article qualifies as must read for its innovative application of a method used in forensic science to WOC specialty nursing practice. Victoria Munoz, Carmen Martinex, Begona Echevarria, M[feminine ordinal indicator] Isabel Fernandez, Ander Pino, and Eduardo Anitua also adopted an innovative approach for management of a foot wound in a young adult male. You will want to read their description of intradermal injection and topical use of an autologous formulation containing plasma-rich growth factor therapy to promote healing and a return to ambulation despite extensive tissue damage from a gunshot wound. This issue's third Clinical Challenges feature article reports a case of mortality caused by metformin-associated lactic acidosis in a patient with diabetes mellitus and a temporary ileostomy. Given the prevalence of type 2 diabetes mellitus, the lessons in this article easily qualify as must read for any WOC nurse managing patients with diabetes and fecal ostomies.
This issue's Getting Ready for Certification feature article focuses on incontinence in aged adults with frailty. Read the narrative, answer the practice questions, and always remember, you are a continence nurse!
The 2018 July/August issue closes with an Executive Summary from the WOCN Society. Authored by Kathleen Lawrence, Carole Bauer, Therese Jacobson, Jody Scardillo, Patricia Slachta, and Phyllis Bonham, the Wound, Ostomy, and Continence Nursing: Scope and Standards of Practice, 2nd Edition, is the defining resource promoting excellence in our professional practice, provision of quality care, and improved patient outcomes.