Pre- and Post-Operative Nutrition Assessment in Patients with Colon Cancer Undergoing Ileostomy.

INTRODUCTION: Patients undergoing ileostomy surgery often experience electrolyte disturbances and dehydration, especially during the first post-operative period. Recently, research has also begun on how the newly constructed ileostomy affects the patient's nutritional status. AIM: The aim of the present pilot study was to assess the nutritional status of patients before and after the construction of the ileostomy as well as nutrition-related factors. MATERIAL AND METHOD: This was a pilot study. The sample consisted of 13 adult patients diagnosed with colorectal or colon cancer who underwent scheduled ileostomy surgery. The evaluation tool used was "Original Full Mini Nutritional Assessment (MNA)". Patients underwent nutritional assessment before the surgery (time 0), on the 7th post-operative day (time 1), and on the 20th post-operative day (time 2). The statistical significance level was set at p < 0.05. RESULTS: All patients had a drop in MNA score on the 7th and 20th post-operative days. Factors associated with MNA were weight loss, mobility, body mass index (BMI), number of full meals consumed per day, portions of fruits and vegetables consumed per day, and mid-arm circumference, p < 0.05, respectively. Pre-operatively, 38.5%, of patients had severe weight loss (>3 kg), 23% moderate weight loss and 38.5% minimal weight loss. Pre-operatively, 92.3% of participants were able to move on their own and 69.2% on the 20th post-operatively day. Furthermore, BMI >23 kg/m2 had 84.6% of participants pre-operatively and 30.8% on the 20th post-operative day. In terms of portions of fruits and vegetables consumed per day, 30.8% of patients consumed at least 2 times, pre-operatively and no one (0%) on the 20th post-operative day. Moreover, pre-operatively all participants (100%) had arm circumference >22 cm while on the 20th post-operative day, only 38.5% of participants had arm circumference >22 cm. CONCLUSIONS: In the first 20 days after the construction of an ileostomy, the nutritional status of the patients is significantly affected. Decreased patient nutrition in both quantity and ingredients and reduced fluid intake appear to adversely affect the patient's nutritional status.

Quality of Life in Diabetic Foot Ulcer: Associated Factors and the Impact of Anxiety/Depression and Adherence to Self-Care.

Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus that needs a multidisciplinary approach. The purpose of this study was to assess the impact of patients' characteristics, anxiety/depression, and adherence to guidelines on the QoL of patients with diabetic ulcer. The sample of the study consisted of 195 patients. Data collected by the completion of SF-36 Health Survey, the Hospital Anxiety and Depression Scale, and a questionnaire that measured adherence to self-care activities. Patients had moderate- to high-quality levels in emotional well-being, pain, social functioning, and energy/fatigue (median: 68, 68, 63, and 60, respectively), while they had low levels of quality in physical functioning, role physical, and role emotional (median: 21, 0, and 33, respectively). In their general health, patients had moderate levels (median: 50). High levels of anxiety and depression were observed in 13.8% and 20.0% of the participants, respectively. After multiple regression, regarding general QoL, patients living in the capital city had 9.89 points worse general health than patients living in Attica (ß = -9.89, 95% confidence interval [CI] = -16.86 to 2.93, P = .006). Patients with moderate or high levels of anxiety had 9.37 and 16.08 points, respectively, worse general health than those with low levels (ß = -9.37, 95% CI = -17.04 to 1.70, P = .017, and ß = -16.08, 95% CI = -26.65 to -5.51, P = .003, respectively). Clinically, these findings may help health professionals attain effective treatment of emotional burden to DFU patients and increase adherence to self-care.

Assessment of quality of life and anxiety in heart failure outpatients.

INTRODUCTION: Heart failure (HF) is a chronic disease associated with increased morbidity and mortality. HF prevalence is expected to expand enormously, largely due to population ageing, rising incidence of HF risk factors and increased survival after cardiovascular events. The aim of the study was to assess levels of quality of life (QOL) and anxiety in HF outpatients and the associated factors as well as to explore the impact of anxiety on QOL. MATERIAL AND METHODS: One hundred HF outpatients were enrolled in the study. Data collection was performed by completion of the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Self-rating Anxiety Scale (SAS) and a questionnaire including patients' characteristics. RESULTS: Of the 100 HF outpatients, 64% were men and 66% above 70 years old. Regarding QOL, at least 50% of patients scored above 68 (median) in the total score of MLHFQ and in terms of anxiety, 50% scored above 46 (median) in the SAS. These values indicate a large impact of HF on QOL and a moderate impact of HF on anxiety. Furthermore, a statistically significant correlation was observed between QOL and anxiety in HF outpatients (rho > 0.6, p < 0.001). An increase in anxiety score by one unit implies a statistically significant increase in QOL by 1.22 points (95% CI: 0.91-1.52, p < 0.001), after adjustment for potential confounders. CONCLUSIONS: The present findings emphasize the importance of alleviating the emotional burden of anxiety, thus improving patients' QOL.

Assessment of fatigue in patients with a permanent cardiac pacemaker: prevalence and associated factors.

INTRODUCTION: Fatigue is a debilitating symptom of subjective nature which lacks effective therapy. The aim of the study was to assess levels of fatigue and the associated factors among patients with permanent cardiac pacemaker (PCM). MATERIAL AND METHODS: This was a cross-sectional study carried out in Athens. The study sample consisted of 250 patients with a PCM. RESULTS: Data indicated moderate to low levels of fatigue. Furthermore, women (median: 24, p = 0.001), those with primary school education (median: 21, p = 0.001), those who were "a little-not at all" informed about PCM (median: 31, p = 0.001), those who had someone to help them in daily activities (median: 23, p = 0.001), those who did not believe that PCM solved their cardiac problem (median: 36, p = 0.001), and those who did not believe that their quality of life was improved (median: 35, p = 0.001) had high levels of fatigue. Moreover, high levels of fatigue were felt by those who characterized themselves as anxious and those who reported to be very anxious about their heart rate and the proper function of PCM (medians: 21.5, 25 and 25 respectively). Additionally, more fatigue was felt by participants who did not smoke after implantation and did not exercise at all (medians: 20 and 24 respectively). Finally, older patients felt more fatigue (rho = 0.248) while the later the implantation device was inserted the more fatigue the patients felt (rho = 0.274). CONCLUSIONS: The present results will help clinicians to acquire an in-depth knowledge of factors associated with fatigue after implantation.

Correlation Between the Type of Acute Coronary Syndrome With the Needs of Hospitalized Patients.

INTRODUCTION: Acute Coronary Syndromes (ACS) comprise life-threatening health problems that demand emergency care and immediate intervention. As patients are abruptly transitioning from healthy state into suffering, they consequently experience several needs, mainly attributed to the type of the syndrome including the therapeutic regimen. OBJECTIVES: To access the correlation between the type of acute coronary syndrome (ACS) with the needs of hospitalized patients. METHODS: A sample of 454 hospitalized patients with ACS, recruited from 4 hospitals in Greece, was enrolled in the study. Data were collected by the completion of questionnaire which apart from socio-demographic and clinical characteristics, it also included the questionnaire "Needs of hospitalized patients with coronary artery disease" which is consisted 6 subscales: a) need for support and guidance, b) need for information from the medical-nursing staff, c) need for being in contact with other patient groups and ensuring communication with relatives, d) need for individualized treatment and for the patient's personal participation to his/her treatment e) need to meet the emotional and physical needs f) need to trust the medical-nursing staff. Statistical methods used were Kolmogorov-Smirnov test, chi2 test of independence, Kruskal wallis-test and multiple regression. RESULTS: The type of ACS was statistically significant correlated with the place of residence (p=0.002), management of disease (p<0.001) and prior experience of hospitalization (p=0.003). All six needs were statistically significantly correlated with the type of ACS, (p<0.001 for the need for support and guidance, p<0.001 for the need to be informed from the medical and nursing staff, p<0.001 for the need for being in contact with other patient groups, and ensuring communication with relatives, p<0.001 for the need for individualized treatment and for the patient's personal participation to his/her treatment, p<0.001 for the need to meet the emotional needs and physical needs and p=0.010 for the need to trust the medical and nursing staff). More specifically, patients with angina considered all six needs to be less significant than patients with unstable angina and myocardial infarction. These results were confirmed by the multiple linear regression after controlling for potential confounders. CONCLUSIONS: Needs of hospitalized patients should be assessed in daily clinical practice according to the type of the syndrome.