Disposable plastic liners for a colostomy appliance: a controlled trial and follow-up survey of convenience, satisfaction, and costs.

PURPOSE: The effectiveness of a disposable liner designed for a 2-piece colostomy appliance pouch was evaluated. DESIGN: Randomized, crossover trial with follow-up surveys. SETTING AND SUBJECTS: Nineteen participants were recruited from the Mayo Clinic in Scottsdale, Arizona, and the surrounding community. INSTRUMENTS: A Daily Colostomy Care Evaluation Record and tally sheet of times for ostomy care were designed by the authors. METHODS: Participants, acting as their own controls, were randomly assigned to use either an unlined or a lined appliance for 9 days. On day 10, participants switched to the opposite regimen, which was maintained through day 18. They recorded the time required for daily colostomy care and perceptions of the lined and unlined appliances. The volume of ostomy supplies and cost were recorded at baseline, 1, 3, and 5 to 9 months after the initial trial. RESULTS: Odor, bother, perceived severity of leakage, and partner acceptance were better with unlined than lined appliances. Half of the participants were using a liner > or =75% of the time 3 months after the trial. There was no difference in cost when lined versus unlined ostomy systems were compared. Participants who chose to use the liners indicated high satisfaction. Problems noted included an inadequate seal with the liner (58%), inadequate liner size (16%), retention of flatus by the liner (11%), and difficulty removing the full liner (11%). CONCLUSIONS: The study supports recommending liners to patients who have a modest amount of fecal output or flatus. However, patients who are unable to manipulate the seal or have a large output volume are unlikely to find the liners a convenience. Satisfaction with the liners was sufficient to warrant investigation and design of a lined device with an improved design, greater capacity, and tighter seal.

A program to increase breast and cervical cancer screening for Cambodian women in a midwestern community.

OBJECTIVE: To determine local screening rates for breast and cervical cancer screening among Cambodian women older than 50 years of age who had used the health-care system, to compare these rates with those for non-Cambodian women, to identify barriers to screening among Cambodians, and to implement community screening. MATERIAL AND METHODS: From review of medical records, cancer screening rates for 1 year among Cambodians (N = 57) were compared with rates for a matched non-Cambodian sample (N = 57). Southeast Asian focus groups identified barriers to screening as a basis for intervention. The intervention included community informational programs in the Cambodian language, group screening appointments, provision of transportation, use of female physicians and interpreters, and an informal clinic setting. Cancer screening rates were compared before and after the intervention. RESULTS: Initial screening rates for Cambodians were significantly lower than for the non-Cambodians. Expressed barriers included lack of knowledge about cancer, shyness at physical examination, lack of transportation, fear of a large, technical medical center, and individual appointments. After the intervention, community screening rates were almost 5 times higher than at baseline. CONCLUSION: The intervention was successful in overcoming organizational, economic, and cultural barriers to cancer screening among older Cambodian women in this setting.

Cancer screening behaviors and attitudes of women in southeastern Minnesota.

OBJECTIVES: To determine the rates at which women received screening Papanicolaou tests, clinical breast examinations, and mammography and to determine the extent to which these women might be expected to respond to screening recommendations from their physicians. DESIGN: Random-digit-dial telephone interviews conducted in January 1993. SETTING: Fifteen counties in southeastern Minnesota. SUBJECTS: A sample of 1019 women who completed the telephone interview. MAIN OUTCOME MEASURES: Self-reported Papanicolaou test, clinical breast examination, and mammography screening rates, with verification from medical records for a randomly selected subsample of 200 respondents who reported having had a test within 1 year of the interview. RESULTS: For women aged 18 years and older, 60% (95% confidence interval, +/- 3.4%) reported having had a Papanicolaou test within the preceding year. For women 40 years of age and older, 57% (95% confidence interval, +/- 3.5%) reported having had a clinical breast examination in the past year, and 46% (95% confidence interval, +/- 3.6%) reported having had a screening mammogram within 1 year. The verified 1-year Papanicolaou test and mammogram rates were 35% and 33%, respectively. More than 90% of the respondents expressed a willingness to have these tests if their physicians were to advise them that the tests were indicated. However, 53% and 54% of the respondents, respectively, said that they either did not care or did not want their physicians to remind them when they were due for a Papanicolaou test or a mammogram. CONCLUSIONS: Although self-reported screening rates in this population meet Healthy People 2000 goals, verified rates were significantly below target levels. A substantial proportion of women in this population remain ambivalent about participating in cancer detection programs.

A multifaceted rehabilitation program for women with cancer.

A multifaceted rehabilitation program for women diagnosed with cancer includes a personal fitness plan, aerobic exercise classes, journaling, and a six-day environmental wilderness experience. The program's purpose is for participants to learn how to cope with uncertainties in life and to promote a wellness concept for living with cancer. This is achieved through successfully meeting the challenges of the program. A descriptive study, using journal entries of the pilot group's 12 women with breast cancer, provides insight into participants' views of the program. Their responses described: personal growth through succeeding at new and difficult experiences; normalization engendered by communicating with others having cancer; exhilaration at focusing on challenging events external to personal health problems; and courage that overrode their fears of facing what seemed impossible.

Language as research data: application of computer content analysis in nursing research.

Statements from clients are valuable research data in nursing. Traditional analysis of such data can be labor intensive and difficult to code reliably or to adapt to group comparisons. The Minnesota Contextual Content Analysis, a computer-assisted analysis program, offers a systematic approach to categorizing and reducing data and to interpreting manifest and latent meaning in linguistic communications. The text is used in entirety, and reliability of coding is ensured, even with great volumes of data and multiple variables. Social context of the communication and emphasized ideas are scored variables, allowing for statistical procedures to further refine the interpretation of meaning. This rigorous method can aid nurse researchers in using language as research data.