An exploration of spousal caregivers' well-being after the death of their partners who were older cancer patients - A phenomenological approach.

PURPOSE: The aim of this study was to gain more insight into the psychosocial well-being of the recently bereaved spouses who took care of their partners with cancer. METHOD: A qualitative study was developed, taking a phenomenological approach. Eleven former caregivers and spouses of patients who died of cancer at, or after, the age of 64, participated in individual in-depth interviews. Only caregivers who were bereaved for a minimum of three months and maximum of one year were interviewed. The analysis of the data was based on the Qualitative Analysis Guide of Leuven. RESULTS: The first moments of bereavement included feelings of disbelief, regret and relief. A feeling of being overwhelmed during this time was reported by some, others sought distraction from their grief. Loneliness, emotional fluctuations and a sense of appreciation for the support of loved ones were dominant themes. Also, gratitude and the importance of consolation played a role in the participants' well-being. When participants addressed the matter of moving forward in life, most explained how they wanted to keep the memories of their partner alive while rebuilding their lives. CONCLUSIONS: The present study offers insight into the experiences of the bereaved spousal caregiver and highlights the need of social support during the bereavement period. All participants expressed loss-oriented and restoration-oriented coping strategies. Also, loneliness is considered a dominant feeling throughout the bereavement period. Social contact can ease these feelings of loneliness through providing either distraction or possibilities to share the burden. This paper emphasized the importance of improving access to healthcare professionals during bereavement.

[Therapy for elderly family members and couples: concerning the viability of relationships in later life, the role reversal and 'finishing' amicably]. / Familie- en paartherapie bij ouderen: over leefbaarheid, rolomkering en finishing well.

BACKGROUND: Research shows that in most countries the number of elderly persons is increasing and that close relationships in late life are playing a more important role. Therefore, it is surprising that there have been so few publications about family therapy for the elderly. AIM: To formulate some guidelines for psychotherapy for family members in their later years and to make suggestions regarding further research. METHOD: We summarise the existing literature and focus on important themes about working with the elderly, supplementing major issues with our own clinical experience. RESULTS: Family therapy with the elderly differs from therapy for younger adults in some respects; for instance, the emphasis in the case of the elderly is more on strengthening the viability of a long/standing relationship. The reversal of roles that often accompanies the ageing process and leads to increasing dependency is another factor that affects the elderly more than the younger adults. If the last stage of life is to finish calmly and amicably, therapists need to tackle any tensions or injustices that patients have experienced in the course of their relationships. CONCLUSION: Psychotherapy for the elderly needs to provide clients with constant opportunities for reflection and should initiate discussions about partners' experiences of tensions and injustices in their earlier relationship. However, the increasing number of elderly persons means that more empirical research needs to be done into systematic psychotherapy.

'Of course he's our child': transitions in social parenthood in donor sperm recipient families.

This study examines transitions and consistencies in the views of donor sperm recipients on 'parenthood' and 'family' over time. A longitudinal qualitative study was carried out with 19 donor sperm recipients. Interviews took place during pregnancy, at birth and 1.5­2 years after birth and were analysed using a grounded theory approach. Participants intending to disclose the donor conception to their offspring (13/19) exhibited a transition from feeling anxious prior to birth to feeling more confident during the toddler stage about their parenthood. Previous anxieties about the lack of biological ties decreased as emerging social ties became more significant. Following birth, these participants (13/19) felt acknowledged by others as parents, which elicited feelings of normalization. Being able to engage in parenting and develop parental relations enhanced their confidence in their parental position. This confidence empowered donor sperm recipients to tackle future challenges and made them more convinced about their disclosure intention. Participants intending not to disclose the donor conception (6/19) reported viewing their parenthood as no different from parenthood experienced by naturally conceiving parents, no transitions were observed and insecurity about physical traits that could reveal the donor conception remained. These findings have implications for counselling throughout specific stages in parenthood.

How couples' experiences prior to the start of infertility treatment with donor gametes influence the disclosure decision.

AIMS: To explore couples' experiences in the preconception phase of infertility treatment with donor gametes and how this may influence the disclosure process to the offspring and/or others. METHODS: In-depth interviews with 10 recipient couples were analyzed using a grounded theory approach. RESULTS: In the context of their infertility and a culture in which definitions of gender and family are fundamentally biologically based, participants reconsidered the significance and meaning of genetics, and social connectedness in family-building and parenthood. When couples emphasized the similarities with the biologically based definitions of parenthood and family, the question of disclosing the donor conception to the offspring seemed less relevant. When couples adapted their view on families and parenthood to an alternative family formation, long-term consequences became more relevant, including the disclosure question. Support from others was needed to manage the challenges of this stage, but this could be in conflict with their decision of non-disclosing the donor conception to the potential offspring. CONCLUSIONS: This study highlights the importance of couples' experiences in the preconception phase for their disclosure process. The treatment of infertility and a future-oriented, family-building approach should be addressed in a fertility program with donor gametes and valued as complementary.

Factors contributing to parental decision-making in disclosing donor conception: a systematic review.

BACKGROUND In recent years, changes in attitudes towards (non-)disclosure of donor conception to offspring and/or others have been observed. Studies have started to identify possible factors that contribute to these changes that are relevant for clinics, counsellors and policy-makers in their approach to the disclosure process. The aim of this systematic review was to integrate the existing knowledge on factors that influence the disclosure decision-making process of donor conception to offspring and/or others in heterosexual couples, and to discuss future trends and concerns. METHODS A bibliographic search of English, French, German and Dutch language publications of five computerized databases was undertaken from January 1980 to March 2012. A Cochrane Database systematic review approach was applied. RESULTS A total of 43 studies met the inclusion criteria, and these represented 36 study populations. The review shows that the parents' disclosure decision-making process is influenced by a myriad of intrapersonal, interpersonal, social and family life cycle features. These influences were not necessarily independent but rather were interwoven and overlapping. Theoretical frameworks have not yet been used to explain how the different factors influenced disclosure. Methodological limitations of the original publications (lack of information, several factors included in one study, descriptive character of studies) and this review (multiple factors that may interact) which hindered integration of the findings are outlined. CONCLUSIONS Intrapersonal, interpersonal, social and family life cycle factors influence the parents' disclosure decision-making process. The review has demonstrated the need for the development of a theoretical model to enable integration of the identified influencing factors. Further research is needed on the role of stigma, confrontation efficacy, extended family, donor siblings' characteristics, cross-border treatment, culture, gender and socio-educational factors.

Parenthood motives, well-being and disclosure among men from couples ready to start treatment with intrauterine insemination using their own sperm or donor sperm.

BACKGROUND: As pregnancy and childbirth have long been considered women's issues and male infertility has long been surrounded by taboo, limited research has focused on the experience of infertile men. The purpose of this study was to compare male motives for parenthood, male well-being and disclosure patterns concerning the method of conception among men from couples starting treatment with IUI using their own sperm (autologous sperm recipient, ASR) or donor sperm (donor sperm recipient, DSR). METHODS: This prospective study included 46 DSR- and 151 ASR-couples. Self-report questionnaires assessing parenthood motives, well-being and disclosure patterns concerning the method of conception were administered to both men and women prior to treatment. Unpaired T-tests and Fisher's exact tests were used to test for significant differences. RESULTS: When compared with ASR-men, DSR-men expect more positive effects from parenthood on relationships and feelings of fulfilment, and report less negative effects of infertility on sexuality, but a lower self-image and more guilt. DSR-men plan to disclose the method of conception less frequently and have so far disclosed to a lesser degree than ASR-men. CONCLUSIONS: DSR-men feel differently about parenthood and infertility compared with ASR-men, and their higher expectations combined with lower self-esteem need (more) attention during counselling.

Patient-centred infertility care: a qualitative study to listen to the patient's voice.

BACKGROUND High-quality care for patients faced with infertility should be patient-centred. Few studies have provided in-depth insights into the patient's perspective on care and, to the best of our knowledge, no study has provided a model of the complex concept 'patient-centred infertility care'. Therefore, a qualitative study aimed at understanding 'patient-centred infertility care' from the patient's perspective was conducted. METHODS Fourteen focus group discussions were organized with patients (n = 103) from two European countries to find out about patients' positive and negative experiences with infertility care. Content analysis of the transcripts and analysis of patients' priority lists were conducted. RESULTS The patient-centredness of infertility care depends on 10 detailed dimensions, which can be divided into system and human factors, and there is a two-way interaction between both kinds of factors. System factors, in order of patient's priority, are: provision of information, competence of clinic and staff, coordination and integration, accessibility, continuity and transition and physical comfort. Human factors, in order of patient's priority, are: attitude of and relationship with staff, communication, patient involvement and privacy and emotional support. CONCLUSIONS This study provides a detailed patient's description of the concept 'patient-centred infertility care' and an interaction model that aids understanding of the concept. Fertility clinics are encouraged to improve the patient-centredness of their care by taking into account the detailed description of the dimensions of patient-centred infertility care, and by paying attention to both system and human factors and their interaction when setting up 'patient-centred improvement projects'.

Circulating antibodies to human and bovine cornea in human keratoplasty.

PURPOSE: To compare anti-human cornea and anti-bovine cornea serum reactivity in corneal transplantation and pathology. METHODS: We investigated the presence of IgG and IgM antibodies to bovine corneal extract (BCE) and human corneal extract (HCE) by ELISA in 48 healthy adults and in 30 corneal allograft recipients before and after grafting. Baseline levels of antibodies in healthy controls served to establish a positivity threshold. Anti-HLA antibodies were investigated in all patients. RESULTS: Preoperatively, five and one patient were positive respectively for IgG and IgM anti-BCE; one and ten patients were positive for IgG and IgM anti-HCE. The presence or absence of antibodies was not modified after grafting, and was not associated with rejection. Anti-HCE of the IgM class were more frequent in patients with keratoconus. Two patients had anti-HLA antibodies. CONCLUSIONS: Antibodies to non-HLA corneal antigens are detectable in corneal allograft recipients. Reactions against bovine and human substrates differ in frequency and class. This reactivity is not modified after grafting or rejection, but is increased in corneal disorders, including keratoconus.

The therapist's inner conversation in family therapy practice: some ideas about the self of the therapist, therapeutic impasse, and the process of reflection.

In this article, a distinction is made between the outer therapeutic conversation and the therapist's inner conversation. The therapeutic conversation is a circle of meaning in which both the therapist and the clients play a part. The therapist's inner conversation is described as a negotiation between the self of the therapist and his role. In this process of negotiation the therapist has to take seriously, not only his observations, but also what is evoked in him by these observations, that is, images, moods, emotions, associations, memories, and so on. Furthermore, therapeutic impasse is conceptualized as a paralysis of the circle of meaning and of the therapist's inner conversation. A process of reflection is proposed as a way out of the impasse. In that process, the inner conversation of the therapist is externalized with the help of an outsider. In the final part of this article, a case study illustrates the importance of these ideas for the family therapy practice.

Malignant peripheral nerve sheath tumor (malignant schwannoma) of urinary bladder in von Recklinghausen neurofibromatosis.

Von Recklinghausen neurofibromatosis occurs in 1 in 3,000 live births; however, urologic manifestations are rare. There have been over 40 reported cases of neurofibroma of the bladder. Malignant degeneration of subcutaneous neurofibroma occurs in about 5 to 10 percent of patients. We believe we present the second reported case of a malignant peripheral nerve sheath tumor involving the bladder in a patient with this disorder.

Experience with 81, 1-stage hypospadias/chordee repairs with free graft urethroplasties.

We performed 81, 1-stage hypospadias/chordee repairs with preputial free graft urethroplasty between January 1981 and July 1988 using a modified Horton-Devine technique. Of the free grafts 37 were fashioned as patches, 42 as tubes, and 4 as a combination patch and tube. Of the patients 58 (72%) underwent single or multiple dorsal plications, in addition to the usual procedures, to correct chordee completely. A total of 35 patients (43%) required a second procedure: 28 (34%) for persistent fistula and 7 (9%) for stricture. These reoperations were typically minor outpatient procedures. All patients had an excellent functional and cosmetic outcome. Although the need for reoperation unfortunately is high, we believe the use of free grafts allows for a better functional and cosmetic outcome because the secondary torsion and bulkiness of the penile shaft caused by the vascular pedicle are eliminated. This is especially noticeable in patients with a small penis.

Gunshot injuries of the ureter.

We reviewed our more recent results in the management of gunshot wounds of the ureter. Sixteen consecutive patient records were reviewed. Two of the patients died from complications not related to their ureteral injuries. The remaining 14 patients had good results. Proper management consists of: 1) early diagnosis and repair; 2) adequate debridement of devitalized tissue; 3) tensionless spatulated watertight anastomosis with absorbable suture; 4) internal stenting; and 5) drainage of periureteral tissues.