While respondents had given permission to be contacted, identifying information such as e-mail addresses was deleted from the response data. The institutional review board of the Copernicus Group Durham, North Carolina reviewed and approved study procedures.
IRB approval no. The SF36v2 contains 36 items designed to query the health and well-being of adults 18 years or older. I focused on assessment of social functioning domain that captures the frequency and degree to which health interferes with social activities. I also measured physical and mental health, along with a preference-based health utility index. Health status was assessed as a measure of health utility measured via the SF6D.
It defines 18, health states using preference weights obtained from a sample of the general population using a standard gamble as the valuation technique. The SF6D scores range from 0, indicating worst health, to 1, which indicates best health. In addition to the SF36v2, the Hawthorne Friendship Scale was chosen as a measure of social connectivity.
Social connectivity and the SF36v2 domain of social functioning are defined collectively in this article as social interaction. Peristomal skin condition assessment was based on self-report.
Respondents were asked 2 questions regarding peristomal skin condition: their perception of the usual condition of their skin, and the condition of the skin at the time of the survey. Ranking and cross-tabulating the responses provided 3 stressor levels 2 p90 : level 1 —peristomal skin integrity intact, that is, no presence of irritated skin; level 2 —low to moderate level of reddening and irritation, including occasional but slight blistering; and level 3 —severe irritation and reddening along with severe blistering resulting in denuded skin and ulceration.
Quality-adjusted life-years QALYs is a measure of the quantity and quality of life lived or to be lived. However, peristomal skin irritation is an intermittent condition characterized by duration of days instead of years. I therefore chose to measure QALYs as days per month where a month is defined as 30 days expressed as QALDs; it is calculated as the health utility value weight multiplied by 30 days.
General linear models were used to calculate analysis of covariance to estimate marginal means; covariates were time since ostomy surgery and age. Regression analysis was used to determine the impact of social functioning and social connectivity on peristomal skin integrity levels in regard to health utility. Because the study generated cross-sectional versus longitudinal data, an actual perceived benefit by a patient could not be determined, and I calculated a minimally important social value of peristomal skin health MISVH.
The study sample comprised adults with ostomies residing in the United States. The primary aim of the study was to explore the relationships among peristomal skin condition, social function, and social connectivity as measured by health utility and QALDs.
Study findings indicate that health utility values decreased as the level severity of peristomal skin damage increased. This value is comparable to the SF6D value of 0. The data were then analyzed using a general linear model with the covariates time since ostomy surgery and age. Stoma surgery type was included as a categorical variable in the model due primarily to differences in the reasons for the surgery. The overall adjusted health utility value was 0.
The adjusted health utility score for the respondents indicating level 1 peristomal skin condition was 0. These findings indicated that as the severity of peristomal skin damage worsened, health utility declined. Comparison of the slopes of the regression lines was significantly different from 0 for all levels in both indices. Least squares means were used to compare responses at each level of social index and skin integrity.
Social connectivity is categorized according to levels described by Hawthorne. The average unadjusted QALD for those at peristomal skin level 1 was For respondents indicating level 3 peristomal skin damage, the average unadjusted QALD was Least squares means were utilized to compare responses at each level of social index and skin integrity. A secondary aim of the study was to provide a measure of the concept of MISVH for peristomal skin condition and to link this value to changes in social connectivity and social function. In order to analyze this relationship, the mean difference between levels of peristomal skin irritation was calculated, yielding an overall health utility mean unit difference of 0.
The mean differences between levels of social functioning and social connectivity were then computed, resulting in an overall mean difference for social functioning levels of 0. However, differences in vertical or horizontal movement of data in the tables are less important than differences in diagonal movement. Ideally, the MISVH provides the smallest change in value that is both statistically significant and perceived as beneficial by a given patient. However, because respondents were not directly asked about minimal benefit, this measure remains a hypothetical construct grounded within metrics of this analysis and further research is needed to apply this construct to the clinical setting.
I investigated relationships among social functioning social connectivity vs isolation , health utility, and peristomal skin condition. Analysis revealed that as social connectivity increases, there is a corresponding increase in health utility for the person living with an ostomy. This finding indicates the importance of community to the health of individuals with an ostomy.
Findings also indicate that rises in social interactivity, seen as increased social functioning or connectivity, are linked to an increase in health status independent of the level of the health burden. The correlation between the social constructs and health utility was 0.
Abdominal Stomas and Their Skin Disorders
These findings are consistent with those of Jordan and colleagues, 27 who studied patients with respiratory tract infections and found that a lack of social connectivity social isolation resulted in a significantly increased risk of hospital admission. Social isolation is not specific to those who have geographically withdrawn from society; rather, it is likely to be found in those living within a community or family structure who withdraw from the support that such structures offer.
Multiple studies have demonstrated that social interactivity is a quantifiable factor associated with changes in HRQOL. These findings further suggest that social isolation is a direct cause of decreased health status in some persons. Study findings further suggest that health utility and social functioning are influenced by peristomal skin health stressors such as peristomal moisture-associated skin damage. I found that increasing levels of severity of peristomal skin damage are associated with decreasing health utility values within social functioning or social connectivity levels.
Conversely, effective treatment of peristomal skin damage improves overall health utility. In addition, study findings strongly suggest that an MISVH for peristomal skin condition can be determined. Of even greater importance, the association between the presence of a health stressor peristomal skin condition and social interactivity suggests that as one improves, the other improves, and vice versa.
Identification of an MISVH for patients experiencing peristomal skin damage remains an important goal. The social value of health is considered to be both structural degrees of social connectedness vs isolation and functional the impact that peristomal skin health on social activities. Findings from this study suggest that it is possible to determine an MISVH that can be demonstrated throughout the range of data albeit scale dependent.
From a clinical perspective, findings indicate that a tipping point exists that can be used to demonstrate a clinically relevant clinical effect of an intervention or intervention bundle. I calculated a tipping point based on a minimal number of QALDs. I further assert that the clinical relevance of reaching this tipping point goes beyond a change in peristomal skin condition; it also exerts a positive benefit, enhancing the patient's movement back into society as a contributing member.
Just as health stressors such as peristomal skin damage have the potential to interrupt the networking interactive process, improvements in these stressors enable increases in social interactivity. In return, community involvement offers a protective effect that maximizes health utility and social connectivity.
Thus, whether one is discussing the protective value that social interactivity has on health, or the influence that health has on social interactivity, it must be recognized that health, independent of the form it takes, is a capital asset invested in the community. Health stressor events such as peristomal skin problems decrease the health value, while reduction or elimination of the event increases it, and the return on the investment can be an overall socioeconomic benefit to society.
As noted previously, the cross-sectional data generated in this study limit the ability to determine an MISVH. In addition, it is not possible to definitely determine whether the respondents are truly representative of the target population.
Skin problems from stomas
Finally, I relied on self-reported peristomal skin conditions rather than assessment by a trained health care professional. Study findings provide empirical evidence that as social interactivity increases, there is a corresponding increase in health utility in those who have undergone ostomy surgery. Findings further established that this relationship is influenced by deterioration in peristomal skin condition, which acts as a health stressor.
Of further interest is the health utility change associated with an increase in peristomal skin health accompanied by increases in social interactivity; the result is a corresponding increase in health utility that can be translated into an MISVH. This provides evidence that limitations placed on the individual by peristomal skin problems have consequences that extend to the protective value of social interactivity.
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Support for this study was provided by Hollister Incorporated. National Center for Biotechnology Information , U. Journal of Wound, Ostomy, and Continence Nursing.
Skin problems from stomas | DermNet NZ
J Wound Ostomy Continence Nurs. Published online Jul Thomas Nichols. Author information Copyright and License information Disclaimer. Published by Wolters Kluwer Health, Inc. The work cannot be changed in any way or used commercially without permission from the journal. This article has been cited by other articles in PMC. Abstract PURPOSE: The objective of this study was to examine relationships among social interaction, health utility, and peristomal skin status in adults with ostomies.
RESULTS: Increased social interactivity, defined as social functioning and social connectivity, was associated with increased health utility. Keywords: Health utility, Irritant dermatitis, Peristomal moisture-associated skin damage, Peristomal skin, Quality of life, Social interactions.
Data Analysis Quality-adjusted life-years QALYs is a measure of the quantity and quality of life lived or to be lived. TABLE 1. Open in a separate window.
Peristomal Skin Condition, Social Function, and Social Connectivity The primary aim of the study was to explore the relationships among peristomal skin condition, social function, and social connectivity as measured by health utility and QALDs. TABLE 2. Social Function Levels Impaired Marginal TABLE 3. TABLE 4. TABLE 5. A Minimally Important Social Value of Health for the Peristomal Skin A secondary aim of the study was to provide a measure of the concept of MISVH for peristomal skin condition and to link this value to changes in social connectivity and social function.
Limitations As noted previously, the cross-sectional data generated in this study limit the ability to determine an MISVH. Footnotes Support for this study was provided by Hollister Incorporated. For immediate release. Accessed July 14, Intestinal and Urological Stomas: Surgical Aspects.
Stoma Appliances and the Specialist Nurse. Pre-existing and Coincident Skin Disease. Problems Related to Primary Bowel Pathology. Irritable Bowel Disease and Nutrition. Paediatric Aspects.
Abdominal Stomas and their Skin Disorders: An Atlas of Diagnosis and Management
Appendices: Glossary. Stoma Appliance Terminology. Skin Physiology and Response to Injury. Therapeutics Guide. Diagnostic Flow Chart. Chemotherapy and Oncology. Du kanske gillar. Essential stoma care Jennie Burch Inbunden. Lifespan David Sinclair Inbunden.