[black small square] In This Issue of JWOCN

This issue of the Journal continues our practice of covering a broad range of clinical topics relevant to WOC nursing practice, including chewing gum for shortening the duration of postoperative ileus in patients undergoing ostomy surgery, pressure ulcer risk factors in ancillary hospital-based services, descending mediastinitis with methicillin-resistant Staphylococcus aureus, assessment and management of moist painful peristomal skin, complications in patients living with end colostomy, best practice recommendations for managing an enterocutaneous fistula, postpartum urinary incontinence, and combined behavioral and pharmacologic treatment of overactive bladder in elderly persons. Professional practice topics are also prominently featured, including techniques for synthesizing evidence in order to determine best practice, incident to services, and networking in a global community. Whether you are interested in learning more about clinical practice or the professional issues that increasingly shape the way we practice, this issue of the Journal contains the must-read articles you need for growing as a clinician and professional.

Deanna M. Vargo shares an excellent synthesis of the evolving concept of incidence to services and reimbursement policies when delivering such services. This article is essential because it dispels myths about changes in US Centers for Medicare & Medicaid Services policies concerning incident to services, while providing lucid descriptions of how these policies affect WOC nursing practice in multiple care settings. Teresa J. Kelechi and Mary K. Naccarato describe techniques for identifying and summarizing current best evidence for production of best practice in this issue's Spotlight on Research section. Whether you are interested in producing a best practice guideline for your facility, or participating in a local, regional, or national panel tasked with producing a best practice document, this article is precisely the guide you need to enrich and inform your participation.

Your Wound Care section focuses on pressure ulcer prevention in the ancillary service setting. Monica S. Messer provides a lucid and focused summary of the setting-specific and unique risk factors associated with patients receiving services in an ancillary care setting such as a magnetic resonance imaging suite or a videourodynamic laboratory. This article contains essential knowledge and insights for all WOC nurses tasked with assisting their facility to prevent facility-acquired pressure ulcers.

Earlier in the context, I described Kelechi and Naccarato's feature article on synthesizing current evidence for best practice. In this issue's Ostomy Care section, Virginia McNaughton, Jean Brown, Jo Hoeflok, Lina Martins, Elise M. Nielsen, Gail Thompson, and Claire Westendorp summarize available evidence for managing enterocutaneous fistulae. These fistulae are frequently the subject of case reports and multiple case series in the Journal. However, thanks to this blue-ribbon panel of experts representing the Canadian Association of Enterostomal Therapists, we now have a comprehensive document summarizing and synthesizing evidence from a variety of sources into a comprehensive and lucid best practice document that is a must-read for all WOC nurses. I am also pleased to inform you that while the printed Journal provides a summary of the document, you must also visit my http://www.jwocnonline.com for access to the entire document including an annotated bibliography and a variety of educational resources for nurses, patients, and families caring for an enterocutaneous fistula.

Young Hee Sung, Ingak Kwon, Sungho Jo, and Seungmi Park report a study of ostomy complications in a group of more than 1,100 patients living with an end colostomy in Korea. This study is especially interesting because of its robust sample population, duration of follow-up (up to 9 years), and exclusive focus on persons living with end colostomies. Sung, Kwon, Sungho, and Park note that peristomal skin problems are the most prevalent complication among patients with end colostomies. Barbara J. Hocevar provides this issue's WOC Nurse Consult, focusing on assessment and management of painful and moist peristomal skin, an ideal companion piece with its focus on critical thinking when faced with painful, moist peristomal skin in a complex patient with an end ileostomy.

This issue's Evidence-Based Report Card focuses on another aspect of ostomy care, prolonged ileus following ostomy surgery. Barbara J. Hocevar, Bruce Robinson, and I summarize current best evidence concerning chewing gum, a form of sham feeding, on the duration of ileus following creation of an intestinal stoma, urostomy, or continent diversion. You will want to read this feature article to gain more insight into this intriguing and underused intervention.

Your Continence Care section opens with a report of women's explanations for urinary incontinence and associated lower urinary tract symptoms following vaginal delivery. Inge Lise Hermansen, Bev O'Connell, and Cadeyrn Gaskin report on lower urinary tract symptoms in 75 women who gave birth within 3 months of data collection. The results of this study are important for all WOC nurses not only because they describe the prevalence of lower urinary tract symptoms in a group of postpartum women but also because they summarize the impact on participants' quality of life. Joan Ostaszkiewicz, Linda Hornby, Lynne Millar, and Cherene Ockerby describe the effects of a bundle of interventions designed to alleviate symptom severity and improve quality of life in community-dwelling adults with constipation and lower urinary tract symptoms. This article qualifies as must-read because it provides a lucid description of a nurse-driven approach to management that combines behavioral interventions with fluid and dietary strategies to alleviate both lower urinary tract symptoms and associated constipation.

Jean Wyman, Gale Harding, Carl Klutke, Kathryn Burgio, Sandra Berriman, Vasudha Vats, Tamara Bavendam, and Karin Coyne close this issue's Continence Care section with a fascinating research report focusing on contributors to satisfaction in patients managed by a combination of behavioral interventions and drug treatment. This article easily qualifies as essential reading because it provides additional knowledge into one of the most clinically relevant ongoing issues in overactive bladder management, "Why is combination treatment with pharmacotherapy and behavioral interventions more effective than monotherapy, and what factors predict success in patients who express dissatisfaction with drug therapy alone?"

In this issue's Challenges in Practice feature, Habeeba Park, Natelege Hickman, Florence Freund, Lynne Skaryak, and Rhonda Fishel report a fascinating case of descending necrotizing mediastinitis in an otherwise healthy 25-year-old woman. You will want to read this case to familiarize yourself with this uncommon and frequently devastating condition and associated wound management.

[black small square] Evidence From Other Publications

Members of the SCALE expert panel, including Diane Krasner, Gary Sibbald, Oscar Alvarez, Elizabeth Ayello, Sharon Baranowski, William Ennis, Nancy Faller, and colleagues, have recently posted their final consensus statement concerning skin changes at life's end.1 The statements from this blue-ribbon expert panel provide a state-of-the-science review of current understanding of the concept of skin failure at the end of life and its impact on skin integrity. While the underlying evidence for these statements varies, their veracity is strengthened by use of a Delphi technique to establish consensus based on the clinical experiences of experts and best available evidence. I strongly encourage you to download the panel's entire statement at http://www.gaymar.com.

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