The influence of patient and caregiver depression on patient self-care and caregiver contribution to self-care in ostomy: A dyadic analysis.

AIMS AND OBJECTIVES: To explore the association between patient and caregiver depression and patient self-care and caregiver contribution to self-care in the context of ostomy care. BACKGROUND: Self-care is essential for ostomy patients and their caregivers. The ostomy self-care process can be considered a dyadic phenomenon in which the patient and the caregiver interact together and work as a team. The presence of depressive symptoms may limit the patient's ability to perform self-care and caregivers' abilities to engage in caregiving tasks. Research into the dyadic influence of depression on self-care behaviours from the perspective of ostomates and their caregivers is still in its infancy. DESIGN: Secondary analysis of a multicentre, cross-sectional study. The STROBE checklist was used to report the present study. METHODS: Patient-caregiver dyads were recruited from eight ostomy outpatient clinics from February 2017 to May 2018. Depression was assessed with the nine-item Patient Health Questionnaire in both patients and caregivers. Patient self-care was evaluated with the Ostomy Self-Care Index, and caregiver contribution to self-care was assessed with the Caregiver Contribution to Ostomy Self-Care Index. Both instruments measure the dimensions of maintenance, monitoring and management. The actor-partner interdependence model was performed for the dyadic analysis. RESULTS: In total, 252 patient-caregiver dyads (patients: 69.8% male, mean age 70.05; caregivers: 80.6% female, mean age 58.7) were enrolled. Patient depression was positively associated with caregiver contribution to self-care maintenance. Caregiver depression was negatively associated with self-care management. RELEVANCE TO CLINICAL PRACTICE: These findings add a better understanding of the reciprocal influence of dyadic depression on patient and caregiver contributions to self-care in ostomy contexts was found. Patient and caregiver depression influence patient self-care and caregiver contribution to self-care. Therefore, clinicians should assess and treat depression in both members of the dyad to improve self-care.

Caregiver contribution to self-care and its associated variables among caregivers of ostomy patients: Results of a cross-sectional study.

AIMS AND OBJECTIVES: To describe caregiver contribution (CC) to ostomy self-care and identify its associated variables among caregivers of ostomy patients. BACKGROUND: Self-care is essential for ostomy patients, but it can be difficult to perform. In these cases, caregivers play a key role in promoting self-care behaviours. So far, the CC to ostomy self-care has not been investigated thoroughly. DESIGN: This is a cross-sectional and multicentre study conducted at seven outpatient clinics of two Italian regions. METHODS: We recruited 252 caregivers between February 2017-May 2018. The Caregiver Contribution to Ostomy Self-Care Index (CC-OSCI) was used to measure CC to ostomy self-care. Three multivariable linear regression models were fitted to identify variables associated with CC dimensions (maintenance, monitoring and management). The STROBE checklist was used to report the present study. RESULTS: The sample (mean age = 58.73, SD = 13.98) was mostly female (80.60%), unemployed (58.70%) and resided with the patient (81.00%). Caregivers being employed and those declaring more hours of contribution per week were associated with a significantly lower contribution to self-care maintenance. Caregivers with lower levels of education and those residing with the patient were less likely to contribute to CC to self-care monitoring. Spousal caregivers and those with higher preparedness contributed significantly lower to CC to self-care management. CONCLUSIONS: We found a variety of sociodemographic factors associated with CC to ostomy self-care. RELEVANCE TO CLINICAL PRACTICE: Sociodemographic variables associated with CC to ostomy self-care can help clinicians develop more tailored educational interventions for caregivers who find their contribution challenging.

Describing self-care and its associated variables in ostomy patients.

AIMS: To describe self-care in ostomy patients, to identify socio-demographic and clinical variables associated with self-care and to identify the association between self-care self-efficacy and self-care over and above the variables associated with self-care. DESIGN: Longitudinal and multicentre study. Data were collected between February 2017-May 2018. METHODS: In this study, 523 ostomy patients were enrolled at baseline (T0) and 362 were followed-up after 6 months (T1). The Ostomy Self-Care Index was used to measure self-care maintenance, monitoring, management, and self-efficacy. Correlations between self-care dimensions and patient socio-demographic and clinical characteristics were performed with Pearson's or Spearman's correlations. Three separate two-step hierarchical regression analyses were performed to identify variables associated with self-care maintenance, monitoring, and management. RESULTS: Participants' mean age was 69 years (SD 12.4); 63.9% were male and most had enterostomies (38.8% colostomies, 29.3% ileostomies) and permanent ostomies (72.5%). Patients had adequate self-care maintenance and monitoring at T0 and T1, while they had lower self-care management and self-efficacy at baseline. Significant variables associated with better self-care maintenance and self-care monitoring were female gender, more information received during hospitalization and better autonomy in stoma management, while a better level of education was an additional variable associated with self-care monitoring. Self-care self-efficacy produced a significant increase in the explained variance of self-care maintenance and self-care monitoring. None of the selected variables were significantly associated with self-care management. CONCLUSION: Middle-high levels of self-care maintenance, monitoring, management, and self-efficacy were found. The variables associated with ostomy self-care and the role of self-care self-efficacy identified in this study can help in developing tailored nursing interventions. IMPACT: This study found specific variables associated with ostomy self-care which could contribute to guiding future interventions aimed at improving self-care in ostomy patients.

Sociodemographic characteristics and self-care management knowledge of patients with an ostomy.

BACKGROUND: An increasing number of patients worldwide are living with an ostomy. Among them, self-care management skills and stoma self-care abilities are associated with better quality of life. AIMS: To identify the sociodemographic and clinical characteristics of Italian ostomy patients and investigate their knowledge of stoma management. METHODS: A questionnaire was used to gather the sociodemographic and clinical data of 433 adult patients. Participants responded to a nine-item survey assessing their knowledge of stoma management. FINDINGS: Respondents reported having received extensive or adequate information in 64.4% of cases, and the remaining 35.6% reported receiving little or no information at any time. The health professional who imparted at least adequate information was a stoma nurse specialist in 32.1% of cases, usually during admission (24.0%) or before and during admission (19.6%). CONCLUSION: This study demonstrated that most patients received adequate information regarding the ostomy.

Third-generation tension-free tape for female stress urinary incontinence.

PURPOSE: We reviewed our experience with the TVT-Secur tension-free tape for stress urinary incontinence in females. We evaluated operative time, complications, the continence rate and patient satisfaction at followup. Ethics committee approval was not required. MATERIALS AND METHODS: A total of 32 hammock-shaped tape interventions were performed between November 2006 and April 2008 at our hospital. All patients had stress urinary incontinence, which was pure in 20 and associated with prolapse of other pelvic organs in 12. Each patient underwent urogynecological assessment with urodynamic evaluation and performed a quality of life questionnaire. We excluded from analysis all patients with intrinsic sphincteric deficiency. Patients were followed for continence and satisfaction. Therapeutic failure was defined as persistent urinary stress incontinence affecting quality of life, as reported by patients and on clinical examination. RESULTS: None of the 32 women had any surgical complication, postoperative pain or blood loss greater than 100 cc. Some minor complications were recorded and the sling eroded in 1 case. Urinary continence was achieved in all patients after surgery and at assessments 12 to 18 months later. All patients confirmed immediate satisfaction with continence and pain on the questionnaire. CONCLUSIONS: TVT-Secur is a minimally invasive, safe and easy surgical technique for stress urinary incontinence in females. To compare this procedure to other tension-free techniques longer and more detailed followup is necessary in more patients. However, this tape may be associated with fewer complications.

Conservative Therapy in Two Cases of Non-Hodgkin Lymphoma of the Penis: Case Reports With Review of the Literature.

The malignant lymphomas rarely occur in the genito-urinary tract and particularly penis lymphomas are extremely uncommon. Frequently they do not have any specific symptoms and the diagnosis is delayed even in presence of a penis node. In our hospital we observed two patients affected by Non-Hodgkin Lymphoma (NHL), one of them with a primitive disease. Both cases were sexually active men who did not accept a radical surgery. A conservative polichemotherapy treatment by ciclophosphamide, vincristine and prednisone has been proposed and performed for both cases and a complete resolution of disease was demonstrated. At the same time we assessed the erectile function by the IIEF score, before and after treatments.

Mucinous adenocarcinoma of the urinary bladder.

BACKGROUND: Mucinous adenocarcinoma of the urinary bladder is a rare primary urologic disease, poorly responsive to radiation or chemotherapy as first-line treatment. CASE REPORT: After trans-urethral resection of the bladder, a 62-year-old woman was diagnosed with mucinous adenocarcinoma of the urinary bladder. An upper gastro-intestinal endoscopy and a colonoscopy excluded any primary site of origin from those gastro-intestinal tracts. After whole-body CT staging scans, an anterior pelvectomy was performed, confirming a mucinous adenocarcinoma of the bladder, with no extra-vesical spreading. Some onco markers were sampled before surgery, and Ca 19-9 showed very high values, with a decreasing trend after pelvectomy. Six month after surgery, bilateral inguinal lymph node dissection was performed because of bilateral palpable masses - histologic examination showed a single metastatic node. The patient also received external radiotherapy of the inguinal area. Twenty-eight months after pelvectomy, the patient appears healthy. CONCLUSIONS: Early radical surgery with or without adjuvant radio-chemo-therapy appears to be the best option for mucinous adenocarcinoma of the bladder, and a good outcome is likely to be related with a confined disease and small tumor size. In addition, Ca 19-9 sampling proves to be useful in tumors that produce markers.