Now, let's get into the answer for Support rod in a shower crossword clue most recently seen in the USA Today Crossword. Support rod in a shower Crossword Clue Answer is… Answer: RAIL Higgins JP, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed.). 2011;343:d5928. https://doi.org/10.1136/bmj.d5928. Zindel J, et al. A sustaining rod increases necrosis of loop ileostomies: a randomized controlled trial. International journal of colorectal disease. 2017;32:875–81. https://doi.org/10.1007/s00384-017-2813-9. Franklyn J, et al. A prospective randomized controlled trial comparing early postoperative complications in patients undergoing loop colostomy with and without a stoma rod. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2017;19:675–80. https://doi.org/10.1111/codi.13600.

Odds ratio (OR), weight mean difference (WMD), and standardized mean difference (SMD) presented with 95% confidence interval (CI) were used to pool analysis dichotomous and continuous variables, respectively. The difference was statistically significant when the P value was less than 0.05. Wu X, et al. Loop ostomy following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy. European journal of medical research. 2018;23:24. https://doi.org/10.1186/s40001-018-0325-x.Oh HK, et al. Is the use of a support bridge beneficial for preventing stomal retraction after loop ileostomy? A Prospective Nonrandomized Study. J Wound Ostomy Continence Nurs. 2015;42:368–73. https://doi.org/10.1097/won.0000000000000131. It was not specified length of the rod that has been placed in the study of Zindel et al. [ 13]. The duration of rod use was short being only 3.5 days in the study of Whiteley et al. [ 11], but in another two studies [ 9, 14], the rod was removed on the 7–8th day after surgery, while in the RCT performed by Franklyn et al. [ 12], the rod was left in place until the 10–14th day after surgery, and even more, according to the study of Oh et al. [ 10], the rod was braced until the 4–28th day after surgery. Butler DL. Early postoperative complications following ostomy surgery: a review. J Wound Ostomy Continence Nurs. 2009;36:513–9; quiz 520-511. https://doi.org/10.1097/WON.0b013e3181b35eaa. Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP. Stoma complications: a multivariate analysis. Am Surg. 2002;68:961–6; discussion 966. Ferlay J, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International journal of cancer. 2015;136:E359–86. https://doi.org/10.1002/ijc.29210.

Liu J, Bruch HP, Farke S, Nolde J, Schwandner O. Stoma formation for fecal diversion: a plea for the laparoscopic approach. Techniques in coloproctology. 2005;9:9–14. https://doi.org/10.1007/s10151-005-0185-6. In summary, we think that although some surgeons are still keen to use support rods to prevent retraction, given that this meta-analysis shows that it does not reduce the rate of stoma retraction, and even adding a device that increases complications [ 30, 31]. Thus, it is an unfounded surgical dogma to worry about increasing the incidence of stoma retraction without rods, we do not recommend routine use of support rods to prevent stoma retraction. Stoma rods and stoma necrosisAlso, the insertion of stoma support rods during operation can directly lead to accidental surgical complications (intestinal wall injury and perforation during insertion). Some studies also suggested that the application of a support rod can increase the incidence of intestinal obstruction after loop stoma. However, in this systematic review, most of the patients in one study (> 90%) had the exhaust on the third day after the operation, and the stoma was functioning well. BMI and stoma retraction Enterostomy is a common operation in colorectal surgery, which refers to leading a section of intestinal tube to the body surface to make an opening through surgery, to achieve the purpose of diverting intestinal contents. According to Chinese statistics [ 1], the total number of enterostomy patients in China has exceeded one million, and this number is still growing at the rate of 100,000 per year, of which malignant tumor patients are the main stoma patients, while colorectal cancer ranks first. Furthermore, the global incidence of colorectal cancer is increasing year by year [ 2], and the number of patients undergoing enterostomy continues to increase. At present, surgical resection is still the main treatment for colorectal cancer, and the occurrence of postoperative anastomotic leakage is a difficult problem for surgeons. To reduce the occurrence of postoperative anastomotic leakage and reduce the clinical symptoms caused by anastomotic leakage, for patients with low tumor location and high risk of postoperative anastomotic leakage, most operators will choose preventive loop enterostomy after radical tumor resection [ 3]. Atkinson SW, Bentley PG. Subcutaneous bridge support for defunctioning loop colostomy. The British journal of surgery. 1996;83:1458. https://doi.org/10.1002/bjs.1800831042. Inclusion criteria based on PICOS principles are as follows: (1) studies of patients with loop enterostomy over 18 years old, (2) compared the use of stoma support rods with non-rods in loop enterostomy, (3) both included loop ileostomy and colostomy, (4) revealed adequate data of the incidence of stoma retraction and other stoma complications, (5) any randomized controlled trials (RCTs) and cohort studies. Whiteley I, Russell M, Nassar N, Gladman MA. Outcomes of support rod usage in loop stoma formation. International journal of colorectal disease. 2016;31:1189–95. https://doi.org/10.1007/s00384-016-2569-7.

Cochrane RA, Hay DJ, Jones AF. A better bridge for loop stomas. The British journal of surgery. 1996;83:365. https://doi.org/10.1002/bjs.1800830322. Baloyiannis I, et al. Loop stomas with a subcutaneously placed bridge device. Tech Coloproctol. 2010;14(Suppl 1):S75–6. https://doi.org/10.1007/s10151-010-0627-7. And meanwhile, an observational cohort study of Whiteley et al. [ 11] showed that 91.4% of enterostomies used support rods in 2003, while in 2012, only 10% of enterostomies used rods to prevent retraction, and in the process of significant reduction in the use of stoma support bars, the incidence of retraction did not change significantly, which also proved from the side that the occurrence of stoma retraction was not significantly related to the use of support rods. Pisarska M, et al. Defunctioning ileostomy reduces leakage rate in rectal cancer surgery - systematic review and meta-analysis. Oncotarget. 2018;9:20816–25. https://doi.org/10.18632/oncotarget.25015.The purpose of the systematic review and meta-analysis is to analyze the application value of the stoma support rods in loop enterostomy. Methods A total of 1131 patients with loop enterostomy in six studies were included in this study; there were 569 cases in the experimental group and 562 cases in the control group. All six studies analyzed the effect of support rods on the incidence of stoma retraction; the meta-analysis showed that in a total of 32 patients, stoma retraction occurred, with a total incidence of about 2.8% in 1131 patients. The incidence of stoma retraction in the rod group was not significantly lower than that in the non-rod group, and the difference was not statistically significant (OR = 0.65, 95% CI 0.32~1.32, I 2 = 0%, P = 0.23), and the studies were homogeneous. The incidences of stoma necrosis (OR = 6.41, 95% CI 2.22~18.55, I 2 = 0%, P = 0.0006), peristomal dermatitis (OR = 2.93, 95% CI 2.01~4.27, I 2 = 0%, P< 0.00001), and mucocutaneous separation (OR = 2.14, 95% CI 1.03~4.47, I 2 = 0%, P = 0.04) were significantly increased in the rod group. Conclusions However, other studies have shown that BMI itself is not a factor affecting the incidence of stoma retraction [ 18, 36]. Considering that a large proportion of patients are overweight or obese [ 16, 29, 37, 38], this paper also analyzed the effect of BMI on stoma retraction, but our study did not find that 32 patients with stoma retraction had obvious characteristics on BMI, which indicated that there may be no significant relationship between high BMI and the incidence of stoma retraction. And meanwhile, there were two included studies reported that the incidence of stoma retraction was also low in patients with low BMI, and the support rod had no significant effect on the incidence of stoma retraction. From this, we may conclude that the effect of support rods on the incidence of stoma retraction in people with different BMI is not significant. Limitations We used the Newcastle-Ottawa scale [ 8] to evaluate the quality of cohort studies, which consisted of three categories (selection, comparability, and outcome) and eight elements with a maximum score of nine, which was used to evaluate the quality of enrolled observational research. Studies graded with 7 or above were considered as high quality. The above assessment was performed independently by three authors (R.D, J.Z, and F.W). If there are inconsistencies, the article is re-examined and discussed to reach an agreement. Summary measures and data analysis Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2010;12:958–64. https://doi.org/10.1111/j.1463-1318.2009.02006.x.

One of the unique features of the USA Today Crossword is its use of a non-standard grid, which can include circles or other shapes. This can make the puzzle even more challenging and interesting to solve. The puzzle also includes a variety of themed sections, which can add an extra layer of complexity to the solving experience.Kann BR. Early stomal complications. Clin Colon Rectal Surg. 2008;21:23–30. https://doi.org/10.1055/s-2008-1055318. Poticha SM. A new technic for loop colostomy with use of a plastic bridge. American journal of surgery. 1974;127:620–1. https://doi.org/10.1016/0002-9610(74)90333-x. Branco AM, Saraiva AC. Loop colostomy with a suprafascial bridge device. Digestive surgery. 2009;26:282–4. https://doi.org/10.1159/000227788. Speirs M, et al. Ileostomy rod--is it a bridge too far? Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2006;8:484–7. https://doi.org/10.1111/j.1463-1318.2005.00923.x.