Origin of adhesive tape can be traced back to the usage of plasters in around 2000 B.C. In the eighteenth century, rubber adhesive was developed for medical purposes. Rubber adhesive consists mainly of natural rubber and resins, and also additives that may cause irritation on the skin. To solve this problem of irritation, synthetic rubber and purer components were introduced. On the other hand, acrylic adhesive, which is produced synthetically and gives substantial adhesion without any additives, causes little irritation. For that reason, acrylic adhesive has become the main adhesive for medical tape. Furthermore, acrylic adhesive has far more vapor permeable characteristic than rubber adhesive, which also contributes to less irritation. And acrylic adhesive is widely used as medical tape.
　A wide variety of vinyl tape products are manufactured from many kinds of materials mostly for industrial use. Vinyl tape generally gives low moisture permeation, and that causes maceration of skin and may increase the introduction of irritation-causing ingredients into the skin.
　Damage of stratum corneum, which is one of the major causes of irritation by removal of tape from the skin, occurs when adhesion of tape is stronger than strength of interaction between stratum corneum cells. The stimulation by this damage causes not only irritation but also pain on the patients, and development of new technology had been expected for reduction of this adverse effect from the QOL point of view. Recently, a new kind of oil based gel adhesive was developed which gives moderate adhesion achieved by increase in contact area. This adhesive (Yuki-ban^®, gentle-on-skin adhesive) reduces damage of stratum corneum and induces less irritation on the skin than the conventional adhesive.

　This center was newly opened as a regional central hospital in May, 1994 by Kawaguchi city’s integration of two hospitals. However, in August, 1994 the surgery and urology department, plastic and reconstructive surgeons, and ET nurses, etc., established the pressure ulcer care specialty team and the joint pressure ulcer outpatient clinic in the stoma outpatient clinic had started the activities. In 1996, the plastic surgery department began managing the pressure ulcer outpatient clinic. Up to now, we have conducted support for medical treatment of over 1000 pressure ulcer cases of which hospital inpatients or home care patients in Kawaguchi city including neighbor cities and areas. In time of establishing these organizations, the nurse’s role was clarified so that they cooperated with physicians and provided in house education as well as actively doing extramural education in the related area. However, because of the shortage of nursing we have found deterioration and family burden issues. Those make us feel the limited outpatient treatment options. Therefore, this paper elucidates pressure ulcer outpatient clinic activities, the actual home care patient situation, and their future prospects.

　Purpose: To obtain basic data on “Meaning of Life”, which promote continuous care for the patients who had undergone stoma surgery.
　Method: Survey of “Meaning of Life” of those who had Intestinal and/or urinary stoma (ostomates) by self rating questionnaire, including Purpose in Life-A Test.
　Result: Subjects were one hundred and twelve (112) ostomates, 68 males, and 44 females. Mean age was 62.9 (SD13.6, range 29-90) years. The mean post-operative period was 6.7 years. The mean PIL-A score was 104.6 (SD 19.4, range 47-139), male was 105.7 (SD 19.4), female was 103.0 (SD 19.5). Average adaptation was suggested. Categorizing by disease, the mean for carcinoma of the colon and rectum group was 107.7 (SD 18.2), the mean for bladder-prostatic cancer group was 99.3 (SD 11.9), the mean for uterine cancer group was 99.3 (SD 23.9), the mean for Crohn's Disease group was 89.2(SD 24.0), the mean for emergency stoma performed group was 88.7 (SD 5.9).
　Conclusion: Purpose in Life score showed by ostomy group is a middle range of “Meaning of Life”， also symptom controlled group had good adaptation score, but Crohn’s Disease and emergency stoma surgery group had poor PIL-A score. Special importance is continuous physical-mental care by ostomates support team, pre-operative to end of their life span.

　Surgical therapy has been aggressively conducted for ulcerative colites (UC) in recent years because it provides a radical cure and enables an early return of the patient to social activities. In fractinated surgery, however, an ileostomy, which is transiently created, often causes skin troubles due to the elimination of a large volume of digestive enzyme-rich, watery stool through it. Prevention of skin troubles is important because once they arises, they are difficult to manage and are liable to become exacerbated since patients often receive a large dose of steroids in preoperative medical therapy. In the present study, we identified etiological factors that contribute to the onset of peristomal skin disorders in 148 patients who had ileostomy to deal with ulcerative colitis.
　Peristomal erosion occurred in 48% of these patients during one-month after the operation. The incidence of these disorders was studied with regard to those clinical factors. Significant differences in the incidence were observed with regard to the age, sex, the severity of the ulcerative colitis, the urgency of surgery, dosage of steroids the day before surgery, type of ileostomy, and the amount of feces. ET nurses' intervention was affect in the case of sever UC and urgent operation patients who had peristomal erosion.

　This experimental study is aimed to confirm how materials used for pressure ulcer effect the decompression on the sacral region under the certain conditions. The procedures of the experiment were as follows: 10 conditions were examined. One is no dressing on the sacral region. The other conditions were nine different dressings; ①5 pieces of gauze, ②10 pieces of gauze, ③20 pieces of gauze, all folded into quarters; ④20 pieces of gauze folded in half, ⑤hydrocolloid dressing; ⑥hydrophilic polyurethane dressing; and ⑦5 pieces of gauze folded into quarters, ⑧hydrocolloid dressing, ⑨hydrophilic polyurethane dressing, these were soaked with 10 ml of 5% saline solution. The pressure was measured under above conditions on a bed with two different types of mattresses. These were standard mattress and decompression mattress (Maxifloat^®, Paramount). The subject group included 30 healthy male and female adults between the ages of 32-66. The results indicated that the pressure rose significantly with the use of dressings in all nine dressing conditions, when the subject used a decompression mattress, compared to the none use of dressing. The results also indicated that there were no rise of pressure using less than 10 pieces of gauze on both standard and decompression mattress. Therefore, it was not effective to use gauze, hydrocolloid, or hydrophilic dressing when we use the decompression mattress for the purpose of decreasing pressure. Pressure might rather increase on ulcers in the sacral region. Further study is needed to identify these indications using other decompression mattresses.

　Objective: To assess the present condition of stoma care subjects using non-adhesive ostomy appliances.
　Method: Survey of Tokai ostomy patients by using a questionnaire administered by Japanese Association of Enterostomal Therapy Nurses (JAET) Tokai block members.
　Results: Eighteen ostomates (8 male, 10 female) were using non-adhesive appliances. The mean of post operative period was 19.4 (range: 5-35) years. The type of ostomy appliances included 16 colostomy and 2 urostomy. Feacul appliances included 4 Kyoto-University system, 3 Matsumoto system, 3 Ishida system, 2 home made, 1 lacolo system and 3 other system. Urinary appliance was VPI system. There were 3 major complaints listed, leakage, peri stomal skin trouble and odour in 88.9% of eighteen long-term survivors. Also, skin problem was observed in 77.8% of them. These things suggest shortage of stoma care. Although all the 18 patients had experienced problems, they still preferred to continue using non-adhesive appliances. Currently, it is difficult to obtain non-adhesive appliances. With this current situation, it is necessary to select adhesive appliances and coach patients to use them, in adition to skin care education.

　In order to treat pressure ulcer of home care patients, caregivers cooperation is essential. And it is quite important that caregivers acquire sufficient and right knowledge of pressure ulcer to prevent and cure of it. We have educated caregivers in a group by audio-visual media tools and studied its effect through questionnaires. We have selected 8 caregivers, whose patients are receiving home care of our hospital. The contents of the education, emphasizing the cause and prevention of pressure ulcer, aim at learning basic knowledge about the treatment for slight pressure ulcer (stage I to II) and the way to use the care products. In order to be understood easily by elderly people and those who are not familiar with medical field, we have lectured using slides of actual case, and original models and have practiced demonstrations of care method. In the end of the lecture, we have asked the feedback of the study. We have sent questionnaires twice, just after the opportunity and 2 months after, regarding the caregivers’ level of understanding pressure ulcers, their consciousness, and their practical changes and their patients’ situations. As a result, we have recognized the caregivers had better understanding and 87% of their patients improved their prevention and treatment. We can conclude that it is quite effective to carry out the group education for the caregivers in order to prevent and improve the condition of the pressure ulcer of home care patients.