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Not every person with a stoma will develop problems or even feel that he or she is unable to manage a stoma independently. However, for the individual who does experience problems and struggles to cope, the stoma nurse is pivotal in providing resources and product experience. He or she can enable the ostomate to adapt to the stoma and maintain their quality of life. This article provides an overview of a solidifying agent and case studies illustrating how it can be used to help patients achieve independence.

Children undergo the formation of a stoma for many reasons and in some cases it can be a life-saving operation. The role of a stoma care nurse caring for babies and children that require a stoma is to teach and support the parents and families how to care for their child’s stoma. Not all hospitals are fortunate enough to have a stoma care nurse specifically trained in the management of paediatric stoma care and so the help and advice of such a speciality is essential in caring for this group of patients safely and effectively. In this article, Rebecca Slater explores the conditions that require the formation of a stoma within a paediatric setting and the care and support that they and their families may need in order to manage the stoma. Emphasis has been placed on the Paediatric Stoma Nursing Group in order to build awareness and collaboration between the two groups within this speciality.

Stoma surgery is an intrusive operation which can have a great impact on daily life. Having a stoma can affect everyday activities that most of us take for granted. The control over bodily functions is fundamental and is pivotal to an individual's ability to function within society. The formation of a stoma will involve an adaptation process, where individuals will have to come to terms with the loss of ‘normal’ control of bodily function. Rebecca C Slater outlines how patients can best learn to manage their stoma while returning to their daily activities and adapting to the alteration in their body image.

Surgery is undergoing revolutionary change as a result of newer approaches to pain control, the introduction of techniques that reduce the post-operative stress response, and the use of minimally invasive operations, such as laparoscopic surgery. As demand for hospital beds continues to escalate, it is paramount that patients recover from surgery quickly and safely; the use of evidence-based interventions to hasten recovery within an enhanced recovery programme (ERP) can play a vital role in achieving this, as well as reducing costs by shortening hospital stay. This article outlines the principles and key elements of an ERP, and discusses how it can help to achieve an improved and safe recovery and shorter hospital stay for patients, thereby reducing the cost to the NHS of inpatient treatment and recovery. The literature surrounding the development of ‘enhanced recovery’ (also called ‘fast-track’) surgery is reviewed to determine whether it is appropriate for patients undergoing elective colorectal surgery.

Patients with inflammatory bowel disease will require support and treatment from a variety of health professionals, and the input from specialist nurses working in this field can have positive effects on patients′ treatment pathway. Achieving an acceptable quality of life (QOL) is a priority to patients and is the main target of nursing intervention. In this literature review, Rebecca Slater discusses how patients with Crohn′s disease may perceive their QOL and how the formation of a stoma may affect or change this perception. This will help specialist nurses in providing a high quality of care specifically tailored for this group of patients.

Enterocutaneous fistulae (ECF) and high-output stomas are challenging to manage, owing to the large volume of loss that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death. Treatment is complex and based on various situations, treatment can be medical/conservative management or surgical. Depending on the site of the fistula and the length of residual intestine contributing as the cause of a high output stoma with the nutritional status of the patient, clinicians have to decide whether parenteral nutrition (PN) or enteral nutrition (EN) should be established. As previously discussed in module 1 and 2 ( Gabe, 2013 ; Gabe and Slater, 2013 ) the theme of nutritional management and appliance/accessory selection to manage patients with ECF and high output stomas was outlined. The aim of providing an understanding of the nutritional needs and the practicalities of maintaining appliance adherence, and in turn, a reduction in the breakdown of the peri-stomal skin was described. Module 3 aims to provide understanding for the reader that may encounter patients undergoing surgery for the management of their ECF or high-output stoma. Lastly it was felt necessary to discuss the subject of intestinal transplantation. This complex surgical option is not available to all patients with intestinal failure and only undertaken at a couple of recognised centres. The process of referring patients that are deemed suitable for intestinal transplantation will be addressed and what the surgery entails with long-term outcomes and the quality of life for the patient.

This article explores the management of patients with high-output stomas fashioned under acute surgical conditions where management may be difficult owing to the presence of a large laparostomy wound. Available products that meet the technical demands required to manage these patients, achieve optimal wound healing, manage high-output stoma and encourage patient independence are considered. A number of strategies to meet the physical and nutritional requirements of these patients are discussed along with the importance of the multidisciplinary team working together to provide holistic care.

Enhanced recovery can be seen as the use of evidence and research that when used for patients undergoing stoma–forming surgery (and other surgery) leads to a better recovery ( Lassen et al, 2009 ; Ahmed et al, 2010 ). Moving patients towards adopting an opinion that ‘up and mobile’ immediately after surgery is the pathway to success, and is an essential element in implementing enhanced recovery after surgery. It can lead to several clinical benefits, including fewer complications (e.g. infection) and a shorter length of time in hospital ( Faiz et al, 2008 ). While having a shorter length of stay is positive, it does result in less time being available to the ostomate (person with a stoma) to become proficient with their stoma care. Changes need to be made to nursing services to encompass this new challenge; for example, the use of preoperative training tools. These changes can result in satisfied ostomates ( Bryan and Dukes, 2010 ) who have fewer post-discharge problems with their stoma. This article outlines the concept of enhanced recovery after surgery and its benefits for patients with a stoma.

Terminally differentiated/non-dividing macrophages contain extremely low cellular dNTP concentrations (20-40 nm), compared with activated CD4(+) T cells (2-5 μm). However, our LC-MS/MS study revealed that the non-canonical dUTP concentration (2.9 μm) is ∼60 times higher than TTP in macrophages, whereas the concentrations of dUTP and TTP in dividing human primary lymphocytes are very similar. Specifically, we evaluated the contribution of HIV-1 reverse transcriptase to proviral DNA uracilation under the physiological conditions found in HIV-1 target cells. Indeed, biochemical simulation of HIV-1 reverse transcription demonstrates that HIV-1 RT efficiently incorporates dUTP in the macrophage nucleotide pools but not in the T cell nucleotide pools. Measurement of both pre-steady state and steady state kinetic parameters of dUTP incorporation reveals minimal selectivity of HIV-1 RT for TTP over dUTP, implying that the cellular dUTP/TTP ratio determines the frequency of HIV-1 RT-mediated dUTP incorporation. The RT of another lentivirus, simian immunodeficiency virus, also displays efficient dUTP incorporation in the dNTP/dUTP pools found in macrophages but not in T cells. Finally, 2',3'-dideoxyuridine was inhibitory to HIV-1 proviral DNA synthesis in macrophages but not in T cells. The data presented demonstrates that the non-canonical dUTP was abundant relative to TTP, and efficiently incorporated during HIV-1 reverse transcription, particularly in non-dividing macrophages.

We biochemically simulated HIV-1 DNA polymerization in physiological nucleotide pools found in two HIV-1 target cell types: terminally differentiated/non-dividing macrophages and activated/dividing CD4(+) T cells. Quantitative tandem mass spectrometry shows that macrophages harbor 22-320-fold lower dNTP concentrations and a greater disparity between ribonucleoside triphosphate (rNTP) and dNTP concentrations than dividing target cells. A biochemical simulation of HIV-1 reverse transcription revealed that rNTPs are efficiently incorporated into DNA in the macrophage but not in the T cell environment. This implies that HIV-1 incorporates rNTPs during viral replication in macrophages and also predicts that rNTP chain terminators lacking a 3'-OH should inhibit HIV-1 reverse transcription in macrophages. Indeed, 3'-deoxyadenosine inhibits HIV-1 proviral DNA synthesis in human macrophages more efficiently than in CD4(+) T cells. This study reveals that the biochemical landscape of HIV-1 replication in macrophages is unique and that ribonucleoside chain terminators may be a new class of anti-HIV-1 agents specifically targeting viral macrophage infection.

Percutaneous endoscopic gastrostomy (PEG) has become one of the most useful and established enteral nutrition techniques available to patients requiring nutritional support worldwide. Good nutrition and the receiving of essential nutrients and electrolytes are vital for growth, healing, repair and delivery of essential energy to carry out daily tasks. The article looks specifically at PEG as a form of enteral nutrition delivery, how it is undertaken, and the care needs of the patient post-insertion of a PEG tube.

Enterocutaneous fistulas (ECF) may be challenging to manage due to the large volume of fluid losses, that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death. ECF treatment is complex and based on various assessments, treatment can be medical/conservative management or surgical. Depending on the site of the fistula and the nutritional status of the patient, clinicians have to decide whether parenteral nutrition or enteral nutrition should be established. Fistuloclysis is a relatively novel procedure in which nutrition is provided via an enteral feeding tube placed directly into the distal lumen of a high output fistula. Although fistuloclysis is not feasible for all patients with ECF, for those that are eligible, the method appears to be an acceptable and safe method of maintaining and improving nutritional status.