The purpose of this study was to establish an evaluation scale for stoma management． We retrospectively reviewed 120 patients with an ostomy in terms of the quality of stoma management．Patients were classified into three categories（A to C）according to the duration of time during which the faceplate could be used with no leakage of the evacuated material．Each category group was further divided into two or three subgroups．We assessed correlations between the assigned classification and seven risk factors related to the quality of stoma management． Strong correlations were found，suggesting that this classification system could be useful in evaluating stoma management.

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The outcomes of patients with advanced cancer have improved with the advent of targeted molecular therapy．Yet，such therapies are associated with characteristic skin reactions，such as hand-foot syndrome，and the treatment of these skin lesions can be challenging．Here we report the case of an intractable and painful peristomal ulcer，suspected to have resulted from sunitinib use．A 53-year-old man underwent left nephrectomy for renal cell carcinoma and was subsequently administered sunitinib for multiple metastases．Perforation of rectal diverticulum was associated with peritonitis；sigmoid loop colostomy was performed．The patient developed an intractable and painful peristomal ulcer postoperatively．The skin lesion was confined to the circumference of the stoma（less than 2.5 cm from the margin），corresponding to the region covered by the fixing plate．The ulcer appeared to have developed from a minute wound caused by harness exchange that disturbed skin barrier function．

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Odor is a serious problem in patients with stoma．We developed a novel stoma－pouch covering bag made of fiber with deodorizing function．We first compared deodorizing function between the new bag and a conventional bag made of cotton（control）in 12 patients with ileostomy or colostomy just after surgery．Significant deodorizing effects of the new bag were demonstrated only in patients with colostomy．We then performed a randomized study to further assess the deodorizing effects of the new bag in 34 patients with colostomy．The effects of the new bag were significantly more pronounced compared to the conventional bag．In conclusion，the new stoma－pouch covering bag has positive effects on odor improvement in patients with colostomy．

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After 50 years experience of SR clinic and research，SR literacy extends past local care of wound and incontinence into the realm of holistic medicine． A theorem or principle is inducted through analysis of clinical experiences．Then it shall be deducted in your case with looking at the reverse side．
　Expatiation of the phenomeno“Two sides of A thing” leads to the Q－theory：A space－time transcendental continuum continues permanently toward the pivot by changing and wondering as a total unity．Clinical application of this philosophy is extended：Doctor/nurse’s　unifying Patient/family completes SR medicine．

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　In Japan，where one in two people are expected to suffer from cancer，the incidence of colorectal cancer has increased significantly．As many patients with colorectal cancer need to undergo ostomy surgery，more specialized medical and nursing services should be provided，highlighting the importance of education in this field．
　The training program for specialists in stoma care was first established at the Cleveland Clinic in the United States．These specialists were called Enterstromal Therapy（ET）nurses，and provided care for patients with stomas during their hospital stay．ET nurses now play a major role as Wound Ostomy Continence（WOC）nurses in the management of patients with stomas．In Japan，education for ET nurses，and later for WOC nurses，has been initiated by the Japanese Nursing Association．Prefectural nursing associations，as well as many other organizations，are now providing educational programs in WOC nursing．

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Pediatric ostomy care in Japan dates back to 1980，when the first stoma-rehabilitation training course in Japan was included in the list of training lectures，or 1987，when the first scientific meeting of the Japanese Pediatric Stoma Therapy Society（JPSTS）was held．The first outpatient clinic for pediatric ostomates was opened in 1982 at National Children’s Hospital in Tokyo．With an increase in the number of presentations on pediatric ostomy at annual JPSTS meetings，pediatric ostomy clinical training seminars have been taking place，and stomal devices for pediatric ostomates developed for better clinical applications．Moreover，communities of pediatric ostomates and their families have been organized．My future expectations for pediatric stomal medicine include the establishment of guidelines that list permanent stoma as a proper therapeutic goal for neonates with certain diseases，as well as smooth lifelong follow－up and support systems for pediatric ostomates．

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Significant efforts have been made by highly motivated clinicians，ETs，and nurses since the 1970s，contributing to the progress of stoma care and establishment of the current methods of stoma and continence rehabilitation．As a major turning point in the healthcare system is to occur with aging of the population in Japan，stoma and continence rehabilitation must also adapt to the changes in social needs．Hence，we need to pass down the history of stoma care to the next generations，remembering that doctors and nursing staff at that time together contributed to social reintegration of ostomized patients on an equal footing．This symposium will focus on the considerable efforts made during the pre‐dawn era of stoma care and describe their approaches，including the opening of the school，and establishment and origin of JAET．

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Half a century has passed since skin barriers became commercially available for the purpose of protecting peristomal skin.Dr.Turnbull of the Clevel and Clinic in the United States reported that he uses karaya gum in stoma care．When karaya gum is used in peristomal skin management，it substantially reduces problems with peristomal skin in ostmates．Skin disorders are one of the significant challenges faced by ostmates that affects quality of life．Karaya gum is a water soluble gum that is weakly acidic，with a pH of 4.5.It has several properties that render it suitable as a skin barrier．Karaya gum also has strong buffering action and deactivates digestive juices，as well as bacteriostatic action that inhibits the proliferation of indigenous bacteria．Previous silicon-based skin barriers quickly disappeared from the market given that they lacked qualities required in skin barriers．In general，skin barriers must be adjusted to be weakly acidic，given that this reduces irritation of the skin and supports their physiological functions on the skin surface．Ideal skin barriers should not only protect the skin surface，but also allow for adjusting the conditions of the peristomal region to support satisfactory skin management．Ideal skin barriers in the future of ostomy rehabilitation will be those that are tailored to the needs of individual patients．

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Patients undergoing stoma surgery often experience significant problems，including skin disorders and psychological distress．Fifty years ago，medical professionals involved in stoma care started to address these problems．Numerous trial-and-error efforts have been made over the years．
Through participation in an ostomate meeting，the author came to realize that there is an urgent need to improve stoma care，and believes that the first priority is to improve nurses’ perceptions of stoma care．Three major areas that require improvements in terms of nursing education are 1）explanations for patients，2）care planning，and 3）knowledge and skills regarding prostheses．Stoma care education started in the 1980s．Concurrently，considerable advances in stoma care have been made in the areas of medical support，prosthesis technology，activities of the Japan Ostomy Association， social system supports，and relevant legislation．Despite these changes，the importance of the quality of nursing remains the same．Nurses are responsible for good stoma care．

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