南海市造口病人生活质量调查研究

目的：提高南海市造口病人生活质量。方法：发放自行设计的调查表，内容包括造口病人个人情况，造口及营养情况，造口病人社交及家庭生活情况，调查了南海市160例造口病人，逐一上门访视，召开联谊会。结果：113例占70．6％造口病人基本能自理造口；144例占90％家庭能接受造口病人，相处较好；104例占65％有造口周围皮肤问题；98例占61．2％对造口用品认识较少；131例占81．9％营养不均衡。已婚142例，其中70例配偶健在，只有20例有夫妻性生活；69例占43．1％参加社交活动。结论：160例造口病人生活质量较低，必须加强镇（区）社区护士对造口护理知识培训，定期访视并适时组织造口病人联谊活动，提供社会支持，才能提高造口病人生活质量。     

An ostomy information clinic. A community resource.

This article has included some facets of discussions that take place at the Ostomy Information Clinic in Milwaukee. All types of ostomates attend one or more clinics to obtain information and help with management of their ostomies. Topics explored are management of drainage, odor control, use of the cone irrigation, digestion, nutrition and diet, and travel tips. In addition to ostomates, nurses often attend the clinics with or without their patients. Consultation is also provided to the Visiting Nurses' Association and local hospital nursing staffs. I would like to encourage other nurses to consider conducting ostomy information clinics in conjunction with the American Cancer Society. Not only is there a great need, but it is a personally rewarding and satisfactory experience.     

Untreated peristomal skin complications among long-term colorectal cancer survivors with ostomies

This ethnography of family caregiving explored why peristomal skin complications are common and undertreated among colorectal cancer survivors with intestinal ostomies. Data were collected through in-depth interviews with 31 cancer survivors and their family caregivers, fieldwork, structured assessments, and medical records review, and analyzed with qualitative theme and matrix analyses. Survivors who received help changing the skin barrier around their stoma had fewer obstacles to detection and treatment of peristomal skin complications. Half of the survivors received unpaid help with ostomy care, and all such help came from spouses. Married couples who collaborated in ostomy care reported that having assistance in placing the ostomy appliance helped with preventing leaks, detecting skin changes, and modifying ostomy care routines. In addition, survivors who struggled to manage ostomy care independently reported more obstacles to alleviating and seeking treatment for skin problems. Oncology nurses can improve treatment of peristomal skin problems by asking patients and caregivers about ostomy care and skin problems, examining the peristomal area, and facilitating routine checkups with a wound, ostomy, and continence nurse.     

Overall quality of life and difficulty paying for ostomy supplies in the Veterans Affairs ostomy health-related quality of life study: an exploratory analysis

PURPOSE: To explore whether there was a significant relationship between difficulty paying for ostomy supplies and overall quality of life among a sample of ostomates receiving care from the Veterans Health Administration (VHA). METHODS: The data were collected as part of the Veterans Affairs (VA) Ostomy Health-Related Quality of Life Study, in which 511 respondents (239 cases, 272 controls) completed a survey instrument that included the modified City of Hope Quality of Life (mCOH-QOL) Ostomy questionnaire, SF-36V, and sociodemographic items. Responses from the 239 cases (ie, patients with intestinal stomas) were used in this analysis. The modified City of Hope Quality of Life Ostomy questionnaire item, "How good is your overall quality of life?," was the dependent variable for this analysis. The primary independent variable was the response (yes/no) to the item, "If you pay for any of the (ostomy) costs, is it difficult for you?" A hierarchical regression model was used to examine whether difficulty paying was significantly related to overall quality of life after adjusting for age, income, race/ethnicity, and physical health. RESULTS: After accounting for the proportion of variance explained by age, income, race/ethnicity, and physical health, the additional proportion of variance explained by difficulty paying was statistically significant. Individuals reporting difficulty paying had a roughly 1 point lower (ie, beta-coefficient = -1.052; SE = 0.481) overall quality of life score on the 11-point scale. CONCLUSIONS: We found a significant association between difficulty paying for ostomy supplies and overall quality of life. Although the cross-sectional study design does not allow causal inference, the results suggest a relationship that merits further examination.     

PS1-09: Comparing the Greatest Challenges of Long-Term Rectal Cancer Survivors with Anastomosis Versus Ostomy

Background Patients surgically treated for rectal cancer receive either an intestinal ostomy (externalization of the bowel to the abdominal wall) or, more frequently, an anastomosis (reconnection) of the rectum. While the challenges of intestinal ostomies have been previously described by this research team, much less is known about the long-term challenges of living with an anastomosis. Understanding the challenges of long-term rectal cancer survivors with both types of surgeries is important for informing and improving current practice. Methods We mailed our survey to 1000 long-term (at least 5 years post-diagnosis) rectal cancer survivors in KP Northern California and KP Northwest during 2010-2011. Our overall response rate was 57.7% (577/1000). The survey contained an open-ended question that asked respondents to write about the greatest challenge they experienced after their cancer surgery. Seventy-three percent of respondents provided a response to this "greatest challenge" question. Responses were analyzed qualitatively to compare the challenges reported by patients with anastomosis vs. ostomy. Results Challenges related to managing bowel function and output were found in both groups. Ostomy patients reported challenges to managing ostomy equipment that were unique to their condition-ostomy appliance failures, skin breakdown around the ostomy, and finding suitable places to empty, clean, and reconnect their appliance. Other notable differences in the greatest challenges among ostomy and anastomosis patients included: patients with an ostomy reported a range of psychosocial challenges relating to depression, shame, stigma, and post-operative psychological trauma about having an ostomy and such psychosocial impacts were notably absent among anastomosis patients; patients with ostomies reported regret about having an ostomy, but patients with anastomosis did not report regret about the surgery they received; and, anastomosis patients mentioned more challenges from radiation after effects, including pain, fistulae, and strictures. Discussion Our findings about rectal cancer survivors with ostomies mirror previously published reports. Even in the face of impaired bowel function, rectal cancer survivors with anastomoses express little psychological distress or regret about treatment choice. The lasting effects of radiation therapy, however, are of special concern to this group.     

Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status

Purpose

Research examining effects of ostomy use on sexual outcomes is limited. Patients with colorectal cancer were compared on sexual outcomes and body image based on ostomy status (never, past, and current ostomy). Differences in depression were also examined.

Methods

Patients were prospectively recruited during clinic visits and by tumor registry mailings. Patients with colorectal cancer (N?=?141; 18 past ostomy; 25 current ostomy; and 98 no ostomy history) completed surveys assessing sexual outcomes (medical impact on sexual function, Female Sexual Function Index, International Index of Erectile Function), body image distress (Body Image Scale), and depressive symptoms (Center for Epidemiologic Studies Depression Scale—Short Form). Clinical information was obtained through patient validated self-report measures and medical records.

Results

Most participants reported sexual function in the dysfunctional range using established cut-off scores. In analyses adjusting for demographic and medical covariates and depression, significant group differences were found for ostomy status on impact on sexual function (p?<?.001), female sexual function (p?=?.01), and body image (p?<?.001). The current and past ostomy groups reported worse impact on sexual function than those who never had an ostomy (p?<?.001); similar differences were found for female sexual function. The current ostomy group reported worse body image distress than those who never had an ostomy (p?<?.001). No differences were found across the groups for depressive symptoms (p?=?.33) or male sexual or erectile function (p values?≥?.59).

Conclusions

Colorectal cancer treatment puts patients at risk for sexual difficulties and some difficulties may be more pronounced for patients with ostomies as part of their treatment. Clinical information and support should be offered.     

Influence of intestinal stoma on spiritual quality of life of u.s. Veterans

Purpose: To examine spiritual quality of life (QOL) of veterans with intestinal ostomies. Design: Mixed-method cross-sectional. Methods: Male veterans with total scores in the upper (n = 59) and lower (n = 61) quartiles of the City of Hope Quality-of-Life-Ostomy survey provided spiritual QOL data. Analyses included chi-square and analysis of variance with significance set at p < .05. Content analysis was used to explicate narratives and focus groups. Results: The high spiritual QOL group was more likely to be married, older, and report more years since surgery (each p < .0001). Upper quartile participants had more favorable scores for several spiritual QOL domains (all p < .0001). Qualitative comments reflected high or low total QOL scores. Conclusions: Spiritual QOL is influenced by an intestinal stoma. Qualitative comments lend insight into the meaning of spirituality items. Findings can assist in the provision of holistic care in this population.     

Acceptance of ostomy and the visitor role in a self-help group for ostomy patients

The helper therapy principle, which underscores the benefits from helping another person, has been relatively unexplored in the self-help movement. This study examined whether persons enrolled in the United Ostomy Association, a self-help group for ostomates, who functioned in a helping role as visitors demonstrated a greater level of acceptance of their ostomy than those persons enrolled in the same group who have not served in the visitor role. Results indicated that visitors' acceptance of their own ostomies was significantly higher than nonvisitors'. The length of time since visitors and nonvisitors had their first ostomy surgery was not a significant factor in the person's acceptance of ostomy. There was a significant relationship between the person's level of acceptance of ostomy and the length of time the individual had served in the visitor role. Serving in the visitor role contributed significantly to predicting a higher level of acceptance of the ostomy. The length of time since surgery was a significant predictor to serving in the visitor role. Factors of age, sex, type of ostomy, and length of time since surgery did not contribute significantly to predicting a higher level of acceptance of the ostomy.     

Sexual Orientation and Demographic,Cultural, and Psychological Factors Associated with the Perpetration and Victimization of Intimate Partner Violence among Hispanic Men

Hispanics are disproportionately affected by intimate partner violence (IPV). Most of the research describing factors associated with intimate partner violence among Hispanics has focused on Hispanic women or Hispanics in heterosexual relationships. The purpose of this study was to explore the relationship among sexual orientation (heterosexual, homosexual, and bisexual), and demographic, cultural, and psychological factors and intimate partner violence among Hispanic men. A cross sectional questionnaire was administered to 160 Hispanic heterosexual men and men who have sex with men. Demographic factors (age, education, and income), acculturation, depressive symptoms, and self-esteem were assessed using standardized instruments. Data was analyzed using ANOVA, and simple and multiple logistical regression. Differences in education, income, and self-esteem were noted across participants identifying as heterosexual, homosexual, and bisexual. Bisexual Hispanic men had almost four times greater odds of reporting the perpetration of IPV than homosexual Hispanic men, even when differences in education, income, and self-esteem were controlled for (AOR = 3.92, 95%CI = 1.11, 14.19). This study suggests the importance of specifically targeting bisexual Hispanic men in IPV research and services.     

The basics of ostomies.

Basic ostomy care can be intimidating because nurses don't often see colostomies, ileostomies, or urostomies. While there are as many different ostomies as there are people who have them, there are some commonalities in the care of the stoma. These can be generalized to all stomas, regardless of the type of output. Some care, however, is specific to the placement of the stoma and the type of effluent flowing from the opening. This article will provide the gastroenterology nurse an overview of the basic features of ostomies as well as routine ostomy care.     

Sex education, relationships, and sexuality in young adults with spina bifida

OBJECTIVES: To assess the adequacy of sex education and to determine the incidence of various difficulties encountered in relationships and sexual contact by young adults who have spina bifida (SB) with and without hydrocephalus (HC) in the Netherlands. DESIGN: Cross-sectional. SETTING: Community. PARTICIPANTS: Patients with SB occulta or aperta (N=157; 41% male; mean age, 20.8 y; age range, 16-25 y). Interventions Not applicable. MAIN OUTCOME MEASURES: Structured interview on sex education, relationships, sexual activities, and sexual functioning. RESULTS: Although sex education had been provided to almost all patients, fewer than a quarter received information specific to people with SB. Of all patients, 25% had a partner, 70% desired sexual contact, 47% had had sexual contact, and 22% had had sexual intercourse during the last year. Only 52% were satisfied with their present sex life. Incontinence and lack of self-confidence were important obstacles. Compared with patients without HC (HC-), patients with HC (HC+) less often had a partner, were sexually less active, and more often had problems with sexual functioning. Predictors of not having sexual contact were having HC and being male. CONCLUSIONS: Relationships and sexuality are important for young adults with SB. HC+ patients are less active and perceive more problems than HC- patients. Counseling in relationships and sexuality should be part of the regular care for this group.     

From diagnosis through survivorship: health-care experiences of colorectal cancer survivors with ostomies

Purpose

The journey from diagnosis through treatment to survivorship can be challenging for colorectal cancer (CRC) survivors with permanent ostomies. Memories of both the positive and negative health-care interactions can persist years after the initial diagnosis and treatment. The purpose of this paper is to describe the health-care experiences of long-term (>5 years) CRC survivors with ostomies.

Methods

Thirty-three CRC survivors with ostomies who were members of Kaiser Permanente, an integrated care organization, in Oregon, southwestern Washington and northern California participated in eight focus groups. Discussions from the focus groups were recorded, transcribed, and analyzed for potential categories and themes.

Results

Health-care-related themes described CRC survivors’ experiences with diagnosis, treatment decision-making, initial experiences with ostomy, and survivorship. Participants discussed both positive and negative health-care-related experiences, including the need for continued access to trained nurses for ostomy self-care, access to peer support, and resources related to managing persistent, debilitating symptoms.

Conclusions

Long-term CRC survivors with ostomies have both positive and negative health-care experiences, regardless of health-related quality of life (HRQOL) and gender. Long-term support mechanisms and quality survivorship care that CRC survivors with ostomies can access are needed to promote positive adjustments and improved HRQOL.

Structured abstract

The current literature in CRC survivorship suggests that HRQOL concerns can persist years after treatment completion. The coordination of care to manage persistent late- and long-term effects are still lacking for CRC survivors living with an ostomy. Findings from this qualitative analysis will aid in the development of support strategies that foster more positive adjustments for CRC survivors living with an ostomy and support their ongoing ostomy-related needs.     

Testosterone replacement therapy--perceptions of recipients and partners

BACKGROUND: The androgenic hormones are important determinants of sexual behaviour in men. Testosterone replacement is important treatment for pituitary disease to maintain normal functioning. Although the physical effects of testosterone replacement have been well documented, little is known about the effects on relationships, particularly from the point of view of the sexual partners of men receiving testosterone replacement. AIMS: This paper reports a study exploring the perceptions of testosterone replacement on well-being and sexual functioning. METHODS: Semi-structured interviews were conducted with five men receiving testosterone implants (recipients), their permanent partners, and five recipients without partners. Recipient serum testosterone concentration was measured at 0, 1 and 4 months after testosterone implantation. RESULTS: The three groups reported similar effects of testosterone on well-being and sexual functioning. Recipient and partner ratings were also similar. Strength was less affected by decreasing testosterone concentration than energy in men with partners, but both strength and energy declined in men without partners. Decreased testosterone levels had a statistically significantly different effect on libido at time zero between men with and without partners (P < 0.015) and on ability to sustain an erection, but the ability to achieve an erection persisted over the 6 months in both male groups. Intercourse frequency increased from once per week at time 0 to > or =3 per week between 1 and 4 months after implant in men with partners. There were important effects of testosterone deficiency on general and sexual relationships, and these differed between men with partners and those without. CONCLUSIONS: Testosterone has important physical and psychological benefits that may be related to the age at which testosterone replacement commences and the indications for its use. The small sample size may limit the ability to generalize the findings outside the study.     

Coping styles of older adults with ostomies

Various clinical studies throughout the years have shown that individuals with ostomies are a unique group facing adjustment demands. One of the most important challenges for an individual with an ostomy is coping with the physiological and psychological changes. The purpose of this study was to describe coping styles of older adults after undergoing ostomy surgery and to explore its helpfulness in dealing with the stressors related to having an ostomy. Lazarus and Folkman's theory on stress and coping was used as the framework to guide this study. A sample of 27 participants ranging from age 50 to 84 years was obtained from an ostomy association in southeastern Louisiana. Participants were asked to complete a demographic data form and the Revised Jalowiec Coping Scale. This revised scale measured eight coping styles related to Use and Effectiveness. Findings revealed significant differences existed among the means of the eight measures for both Use and Effectiveness at p < .01. Results demonstrated that the optimistic and self-reliant styles of coping were the most frequently used as effective styles for coping with an ostomy. This indicated a positive outlook and dependence on oneself rather than dependence on others when coping with the stressors of having an ostomy. There were no statistically significant differences related to gender or ostomy type. Also, aging did not appear to be a factor when considering coping styles of older adults with ostomies. The nursing role should include assessment of the individual preoperatively to identify fears, concerns, and stressors related to having an ostomy. Also, nurses can provide education on disease management, assist with identification of ineffective coping mechanisms, and promote effective coping skills and stress management techniques.     

PS1-10: Spiritual Well-being and the Challenges of Living With an Ostomy: Resilience, Adaptation and Loss Among Colorectal Cancer Survivors

Background Spiritual well-being (SpWB), defined as hopefulness, inner peace, and sensing a reason to be alive, is integral to health related quality of life (HRQOL). It is only partially related to spirituality and religiosity. The challenges of colorectal cancer (CRC) and subsequent bodily changes can affect SpWB. We explored expressions of SpWB reported by CRC survivors with ostomies. Methods We recruited all adult CRC survivors (>=5 years) with permanent ostomies who were members of Kaiser Permanente Northwest, Northern California, or Hawai'i during 2000-2006 to complete a mailed survey (n=283). We asked participants to respond to an open-ended question about the greatest challenge they encountered in having an ostomy. Responses from the 62% (176 of 283) of patients who answered this question were analyzed based on the City of Hope HRQOL model for content related to SpWB, and to identify and categorize the SpWB themes found. Results The responses of 51% (90 of 176) of participants contained SpWB content. Seventeen SpWB themes were identified, reflecting positive, negative, and ambivalent dimensions. Some responses contained multiple themes but each theme was coded only once for each person. Fifty-three of 90 people (59%) expressed positive themes which included "positive attitude" "appreciate life more" "helping others helps me" "strength through religious faith" "leading an active life" and "I am fortunate." Negative themes included "struggling to cope" "not feeling 'normal'" and "loss" and were least common, expressed by only 28 of 90 people (31%). Ambivalent themes were most common (67%; 60 of 90 individuals) and included "learning acceptance" "ostomy is the price for survival" "reason to be around despite suffering" and "continuing to cope and function despite challenges." Discussion These CRC survivors with ostomies infrequently cited negative SpWB as a major challenge, though the greatest number of SpWB responses were ambivalent. More commonly, SpWB themes were mentioned as a source of resilience or part of the struggle to adapt to their altered body after cancer surgery. SpWB interventions should be broadly constructed to include the many types of SpWB, as opposed to narrowly defining SpWB only in terms of spirituality or religiosity.     

Body Image Perceptions of Women Veterans With Military Sexual Trauma

The researchers were invited to a transitional home for homeless women veterans to help veterans with body image issues. Convenience sampling was used to recruit 12 veterans who perceived they had a physical difference due to military service. Data were obtained in focus groups where the veterans were invited to share stories. Ricoeur's hermeneutic phenomenology guided the study. The research team learned early in the data collection stage that 11 of the 12 participants suffered military sexual trauma (MST). Three structures emerged in the data: (a) to speak up or not to speak, (b) from military pride to shameful anguish, and (c) invisible scars versus visible scars. A phenomenological interpretation of these invisible scars uncovered that viewing self in a mirror was depicted as viewing a stranger. Being with others, including family, was described as wearing a fake face. The phrase I am broken defined intimate relationships which were non-existent or strained. Shame permeated all body image structures. As the veterans listened to each other, they began to see themes in their stories. There was a shared sense of identity and a movement toward greater self-understanding and resolving. In addition to the recommendations the participants had regarding prevention of MST and recovery care of those with MST, implications for research and practice are provided.     

Satisfaction with sexual life among persons with traumatic spinal cord injury and meningomyelocele

PURPOSE: To study satisfaction with sexual life and self-assessed sufficiency of sexual counselling in persons with traumatic spinal cord injury (SCI) and meningomyelocele (MMC). METHOD: A postal questionnaire on aspects of health and functioning was answered by 190 persons with traumatic SCI who had been treated in the Spinal Injuries Unit in Sahlgrenska University Hospital, G?teborg, Sweden and 41 persons with MMC who were admitted to the Young Adult Teams in G?teborg, Bor?s and Sk?vde, Sweden. RESULTS: On a numerical scale from 0 (dissatisfied) to 10 (satisfied) the median of satisfaction with sexual life was 3 for the men and 4 for the women among the persons with traumatic SCI. In the MMC group the median of satisfaction with sexual life was 5 for the men and 8 for the women. Sexual dissatisfaction increased with increasing age in both groups. Inconvenience caused by urinary and faecal incontinence, as well as neuropathic pain increased sexual dissatisfaction in the men with traumatic SCI. A total of 69% of the men with traumatic SCI and 56-59% of the participants in other subgroups reported that the sexual counselling they had received was sufficient. CONCLUSIONS: The results corroborate findings from earlier studies that satisfaction with sexual life is rather low among persons with SCI. Especially ageing men with traumatic SCI who have sustained injury at an older age are a challenge for rehabilitation. The high satisfaction with sexual life in the women in comparison with the men with MMC is a finding not reported earlier. Our results suggest that adequate treatment of incontinence and pain might improve even sexual satisfaction. Sexual counselling should be given to all individuals with SCI and to their partners. Sexual counselling for young adults with MMC is an important part of the rehabilitation process.     

The impact of an ostomy on sexuality

Creation of an ostomy results in physiological and psychological changes that affect sexuality. Major physiological complications for men include erectile dysfunction and ejaculatory difficulties. For women, dyspareunia is the most common physiological complication. The presence of an ostomy can alter a person's body image, which, in turn, influences the desire for sexual activity. Sexuality concerns should be addressed with all patients undergoing ostomy placement. The PLISSIT model, which outlines four stages of interventions used in sexual counseling, can be used to guide nursing care.     

Stress,workload, sexual well‐being and quality of life among physician residents in training

Objectives: To assess the impact of stress and workload on sexual health and quality of life (QOL) of the medical residents in training. Design and subjects: A total of 339 male and female medical residents from 11 specialties were surveyed. Level of stress, sexual health and QOL were measured using validated questionnaires. Results: Overall, 49% of the female and 11% of male residents had sexual dysfunction, and 47% and 34% respectively indicated being very to mostly dissatisfied with their sexual life. Both the frequency of sexual activity and quality of relationship with partner decreased during residency compared with the time immediately prior to residency. This decline was irrespective of gender, specialty or year of residency. A majority of residents (75% of women and 54% of men) were identified to be at high levels of stress using a validated questionnaire. In women, stress negatively influenced most domains of sexual health including desire, arousal and satisfaction; in men, satisfaction was significantly affected by high levels of stress. Long hours of work (> 70 h per week) impacted sexual health less profoundly than did stress. Among both male and female residents, QOL was significantly lower among residents who experienced sexual dysfunction and dissatisfaction compared with those with normal sexual functioning. Conclusions: Our results highlight the importance of stress‐management efforts in residency programmes and provide evidence that limiting work hours alone may not lead to significant improvement in sexual health and QOL during residency.