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探索结构化教育方法对造口周围皮肤并发症的影响:一项中期分析。

Exploring the Impact of a Structured Educational Approach on Peristomal Skin Complications: An Interim Analysis.

作者信息

Denti Francesco Carlo, Guerra Eliana, Caroppo Francesca, Abruzzese Pietro, Alessi Fabrizio, Barone Filippo, Bernardino Pasqualina, Bergamini Massimiliano, Bernardo Cristina, Bosio Gloria, Carp Paula, Cecconello Manuela, Cerchier Annalinda, Croci Francesca, Detti Rita, Di Pasquale Cristina, D'Ippolito Maria Rosaria, Ditta Simona, Ducci Erica, Belloni Fortina Anna, Frascarelli Stefano, Galante Marianna, Guarino Rita, Leggio Nicola, Livio Elisabetta, Marchetti Alessandra, Marelli Francesca, Mastropaolo Rita, Melis Viviana, Palmiero Nicola, Panarelli Arianna, Pascali Anna Lea, Pizzarelli Francesco, Precisi Laura, Rastello Cinzia, Regaglia Silvia, Rinaldi Rossana Elvira, Rumbolo Nadia, Sansone Claudio, Santelli Angela, Sarritzu Giovanni, Sfondrini Stefano, Stanzani Sara, Stella Mattia, Walterova Margherita, Caruso Rosario

机构信息

Stomacare Service, IRCCS San Raffaele Institute, 20132 Milan, Italy.

Enterostomal Rehabilitation Clinic, ASST Spedali Civili Brescia, 25123 Brescia, Italy.

出版信息

Healthcare (Basel). 2024 Sep 10;12(18):1805. doi: 10.3390/healthcare12181805.

Abstract

This study, employing an interim analysis, investigates the effects of the Dermamecum protocol, a structured educational and tailored approach that stratifies ostomy patients into risk paths (green, yellow, red) based on pre-operative and post-operative characteristics. The green path indicates a low risk of peristomal skin complications (PSCs), focusing on sustaining healthy behaviours and basic stoma care. The yellow path represents a moderate risk, emphasizing the need for patients to self-monitor and recognize early signs of complications. The red path corresponds to high risk, requiring stringent monitoring and immediate access to healthcare support. The study aims to reduce PSCs and improve patient outcomes. Methods include the stratification of 226 patients, with significant differences in gender distribution, BMI categories, and stoma types across the paths. Results show an occurrence rate of PSCs of 5.9% in all risk paths (5.7% green path, 4.7% yellow path, and 7.9% red path, = 0.685), significantly lower than the median rate of 35% reported in the literature. Multiple correspondence analysis validated the stratification, with distinct clusters for each path. Poisson regression models in the exploratory framework of an interim analysis identified male gender as the only significant predictor of PSCs, indicating the need for gender-specific interventions. The findings suggest that the Dermamecum protocol effectively reduces early PSCs, providing a foundation for further research.

摘要

本研究采用中期分析,调查了Dermamecum方案的效果。该方案是一种结构化的教育和个性化方法,根据术前和术后特征将造口患者分为不同风险路径(绿色、黄色、红色)。绿色路径表示造口周围皮肤并发症(PSC)风险较低,重点是维持健康行为和基本造口护理。黄色路径代表中度风险,强调患者需要自我监测并识别并发症的早期迹象。红色路径对应高风险,需要严格监测并能立即获得医疗支持。该研究旨在减少PSC并改善患者预后。方法包括对226名患者进行分层,各路径在性别分布、BMI类别和造口类型方面存在显著差异。结果显示,所有风险路径中PSC的发生率为5.9%(绿色路径为5.7%,黄色路径为4.7%,红色路径为7.9%,P = 0.685),显著低于文献报道的35%的中位数。多重对应分析验证了分层情况,各路径有明显的聚类。在中期分析的探索性框架中,泊松回归模型确定男性是PSC的唯一显著预测因素,表明需要针对性别的干预措施。研究结果表明,Dermamecum方案有效地降低了早期PSC,为进一步研究奠定了基础。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bde9/11431503/49a285b936e8/healthcare-12-01805-g001.jpg

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