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Background: Colostomy formation can solve complications of bowel management following spinal cord injury (SCI). Newly injured patients at this spinal unit have chosen colostomy as a preferred option for bowel management. Objectives: To discover the reasons patients choose colostomy formation early following SCI and make comparison with those choosing it later, and to establish whether early colostomy is safe and advisable. Methods: Medical and nursing records of patients with SCI who chose to have a colostomy during the period 2005–2016 were examined retrospectively. Data were gathered concerning reasons for choosing a colostomy, early and later complications, the need for further surgery, and independence with bowel care before and after surgery. Patients were divided into two groups: those who chose a colostomy “early” during inpatient rehabilitation and those who chose it “later” as is traditional. Results: Reasons for choosing colostomy differed. Reducing reliance on caregiver and independence were of more importance to the early group; the later group chose colostomy to solve bowel care problems. Early complication rates in both groups were low. Longer term complications were higher in the early group, with the most common complication being rectal discharge. Parastomal hernia rates were low in both groups, as was the need for further surgery. Colostomy formation led to 20.8% of all patients gaining independence with bowel care. Conclusion: This study found colostomy to be a safe and effective option when performed early after SCI and demonstrates colostomy can be a means of gaining independence and making bowel care easier and more acceptable to the newly injured patient.

Vitamin B12 deficiency can be misdiagnosed as a variety of other illnesses, and if left untreated can lead to irreversible damage to the brain and nervous system. This article discusses the case of a 70-year-old female with a urostomy, well known to the stoma care department, who shortly after a routine parastomal hernia repair developed severe confusion, immobility and was unable to communicate. Subsequent investigations ruled out a cerebrovascular accident (CVA) and a diagnosis of rapidly progressing vascular dementia was made. An incidental finding of a low vitamin B12 level was identified and treatment commenced. She was transferred to a community hospital and her family were told to ‘prepare for the worst’. It was, in fact, the vitamin B12 deficiency that was causing her symptoms of vascular dementia, and once treatment was established she underwent a ‘miraculous’ improvement, returning to normal life. This article discusses vitamin B12 deficiency and why patients with a urostomy are at risk of developing it; highlights the key role of the stoma care nurse and his or her knowledge of the patient; explores the importance of testing vitamin B12 levels in this group of patients; and discusses key learning and recommendations for practice.

As student diversity becomes the norm in U.S. schools, future teachers must be comprehensively prepared to work with the increasingly diverse student population through application of informed instruction that enhances general and individual student learning and outcomes. Teacher Education programs increasingly promote student teaching in international settings as a substantive step to develop teachers who embody these new competencies and instructional practices. The proposed paper presentation offers a framework and analysis highlighting similarities and differences between two groups of student teachers in Belize (2005 and 2008). Findings are comparative and relate to the type and degree of (1) cultural-, professional-, and character-development influences on student teachers, and (2) emergent common intergroup patterns.

This article explores the history and management of large abdominal wounds and the importance of a multi-disciplinary team approach to wound healing. It identifies the difficulties of using negative pressure wound therapy (NPWT) in a patient with a large abdominal wound, which is further complicated by an ileostomy. NPWT is increasingly used for large wounds with positive outcomes, however, the case study demonstrates the many difficulties involved and how they were overcome. Cavity wounds can take weeks, or even months to heal and many patients become frustrated. This can have a significant impact on their quality of life. Prolonged hospitalization is not only devastating to the patient and family both physically, psychologically and financially, but is also costly in terms of nursing time and resources.

The most well known fact about sleep is that humans need it - while we are asleep our metabolic processes slow down and during long periods of sleep our bodies repair the damage that the stress our bodies have undergone throughout the day. Throughout the day our bodies are bombarded by signals from the environment, and undergoes biological changes in response to external and internal stimuli. Sleep is a period of time to restore the body to optimum condition to continue the process all over again the next day. The human body regulates stress by producing glucocorticoid steroid hormones, which also function as immune response suppressants. During sleep cortisol levels are decreased as they inhibit the body’s period of restoration. The production of immunoglobulin A, an antibody associated with mucosal membranes, is inhibited by glucocorticoids, and thus shows a relationship with sleep and other factors associated with stress. This experiment focused on correlations between sleep and stress found on the campus of Radford University. Our groups recorded the amount of sleep participants acquired the previous night and how long they had been awake, and correlated these with the concentration of salivary IgA. According to our initial data collection there was no significant correlation between the amount of sleep (p=0.305) or hours awake (0.670) to IgA levels. Additional sampling later in the semester will be used to supplement this data set and mapped using geospatial coordinates.

The goal of this project is to test students and faculties stress levels in their saliva compared between the beginning of this semester and the end of the semester. IgA levels are influenced by many physiological factors, including the hormones associated with stress. The findings conclude that there is significance between IgA levels in a student or faculty based on hours since they had left class and hours until they have class. Students and faculty showed a correlation between IgA and time since being in class or work (p-value = 0.03), however no significance of the duration of the expected rest period (p-value = 0.71). The significance of this finding is that students and faculty tend to be more stressed after being in class/work based on IgA levels in their saliva.

Our study is to determine and compare human IgA levels to self reported stress levels of college students and faculty at the beginning of the college semester, when stress levels are expected to be low, as compared to a later point in the semester, when stress levels are expected to be higher. This study is significant because the data will provide us with information regarding whether or not people are as biologically stressed as they report at different periods of the semester. Individuals are expected to be at a lower stress level at the beginning of the semester than at the end of the semester. Biological stressors are indications that the psychological and physical aspects of an organism are attempting to maintain an equilibrium in order to function properly. We are interested in quantifying biopsychological stressors between mental and physical stress responses and the effect of psychosomatic influence. To analyze samples for IgA molecules levels in comparison to proclaim stress levels to determine if students are as physically stressed as they are mentally feeling stressed. Stress was reported on a zero to ten scale and these reports will be compared to actual levels of human IgA attained from saliva samples. Geospatial coordinates have been taken to relate the data to location across campus. After a regression test, showing a P value of 0.206, it was clear that there was no significant correlation in the data. This tells us that, overall, the levels of IgA, and therefore stress, did not relate to the reported level of stress from the participants.

An enhanced recovery programme was implemented at Salisbury NHS Foundation Trust for elective patients undergoing colonic surgery with a stoma in October 2007. The programme is a multimodal approach first described by Professor H. Kehlet in 2000. In order for ERP to be successful in reducing length of stay and promoting earlier stoma independence, there was a need to educate, inform and prepare patients comprehensively in the pre-operative phase to enhance their understanding. A change of practice was necessary as, traditionally, the majority of practical and psychological care was promoted in the postoperative phase. A retrospective audit was carried out on 20 patients before undertaking the enhanced recovery programme, and 20 patients afterwards, which demonstrated a reduction in the patients’ mean length of stay from 20 to 7 days, with 60% being discharged at 5 days or less after the programme. The mean number of days until stomaindependent decreased from 12 to 5 days as a result of the enhanced recovery programme. A further 40 patients have been audited

Most hemolytic transfusion reactions result from administration of ABO-incompatible blood. Even a small amount of incompatible blood may initiate a reaction and cause devastating consequences leading to death. Careful monitoring of the anesthetized patient is important in recognizing symptoms of a transfusion reaction so that the reaction may be promptly detected and treatment quickly initiated. Many factors contribute to blood transfusion errors resulting from the misidentification of either the patient or the blood product. Nursing has opportunities to establish policies and procedures, design nursing practices, and educate staff to help avoid blood transfusion errors.

This, the first in a series of two articles, will explore how an integrated care pathway was developed to improve care delivery for patients with breast cancer in Salisbury. This approach can be adapted to benefit both the patient and the multidisciplinary team in other disease areas and addresses NHS targets for increasing efficiency and promoting patient-centred care.