In the first patient with high levels of anticardiolipin antibodies (aCL) treated with ultraviolet-A1 (UV-A1; 320-400 nm) radiation, eight months of twice-weekly low-dose (10 J/cm2) irradiation was ...accompanied by the decrease of aCL levels to normal, cessation of clinical and positron emission tomographic (PET) scanning evidence of cognitive decline, and reversal of livedo reticularis. All occurred within the framework of an improving Revised Systemic Lupus Activity Measure (SLAM-R) score. Further studies in systemic lupus erythematosus (SLE) patients with elevated aCL are indicated.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background: Intractable feeding intolerance in children with severe neurological impairment (SNI) is poorly defined and understood. Objectives: (1) To describe 9 children with SNI, where intractable ...feeding intolerance was thought to be a contributor to their deterioration or death. (2) To consider terminology to describe the severe end of the spectrum of feeding difficulties in children with SNI. Results: Mean age at death was 10.3 years (range: 5 – 15.6), and median time from palliative care referral to death was 3.1 months. Location of death was home (n = 3), hospice (n = 1), and hospital (n = 5) with 1 death in intensive care. Gastrointestinal “failure” or “dysfunction” were documented for 7 children, (median time between documentation and death was 3.9 months (range: .1 to 13.1)). All children were fed via a gastrostomy tube during their life (median age of insertion 2.5 years (range: 1.2 to 6.8 years)), and 7 via the jejunal route (median age of insertion 9.2 years (range 2.4 to 14.7 years)). Children lived a median of 9 percent of their lives after jejunal tube feeding was commenced. No child had home-based parenteral nutrition. Multiple symptom management medications were required. Conclusion: ‘Intractable feeding intolerance’ describes a clinical crossroads in a child’s life where there is an opportunity to consider the appropriateness of further interventions. Further work should explore predictors of intractable feeding intolerance and the delicate balance between cause or contributor to death. The importance of clinician-family prognostic conversations and goal-concordant care both during life and in the terminal phase is highlighted.
BACKGROUND:It is presumed that plastic surgery residents experience various social problems, just as do their peers in other specialty training programs and in the general public. These issues can ...occasionally disrupt the resident’s personal training experience and sometimes the program as a whole. A survey was performed to assess the magnitude of the problem, and the issues revealed were assessed to assist the program director and the resident in reaching successful completion of the residency.
METHODS:A survey was designed by the executive committee and staff of the American Council of Academic Plastic Surgeons and sent to all plastic surgery training programs in the United States. A response rate of 66 percent was achieved. The programs reported on the social issues occurring in their residents over the preceding 5 years. The results were presented at a business meeting of the Council.
RESULTS:Thirty-seven percent of programs reported that at least one resident had left their program during the study period. Twenty percent reported that a resident had been asked to leave the program. The frequency of social problems resulting in disruption of the training program was tabulated in the following areasdivorce; pregnancy/parturition; financial, legal, or family issues; drug or alcohol abuse; illness/injury; and interpersonal conflicts.
CONCLUSIONS:Plastic surgery residents experience social problems that can affect the timely completion of their training. Attention to these issues requires patience, creativity, sensitivity, and a commitment to the residents’ ultimate success, and adherence to institutional, legal, and accreditation body mandates.
Pulmonary manifestations of gastrointestinal (GI) diseases are often subtle, and underlying disease may precede overt symptoms. A high index of suspicion and a low threshold for consultation with a ...pediatric pulmonologist is warranted in common GI conditions. This article outlines the pulmonary manifestations of different GI, pancreatic, and liver diseases in children, including gastroesophageal reflux disease, inflammatory bowel disease, pancreatitis, alpha1-antitrypsin deficiency, nonalcoholic fatty liver disease, and complications of chronic liver disease (hepatopulmonary syndrome and portopulmonary hypertension).
Background and Aim
Chronic intestinal failure requiring home parenteral nutrition (HPN) is a disabling condition that is best facilitated by a multidisciplinary approach to care. Variation in care ...has been identified as a key barrier to achieving quality of care for patients on HPN and requires appropriate strategies to help standardize management.
Method
The Australasian Society for Parenteral and Enteral Nutrition (AuSPEN) assembled a multidisciplinary working group of 15 clinicians to develop a quality framework to assist with the standardization of HPN care in Australia. Obstacles to quality care specific to Australia were identified by consensus. Drafts of the framework documents were based on the available literature and refined by two Delphi rounds with the clinician work group, followed by a further two involving HPN consumers. The Oxford Centre for Evidence‐Based Medicine Levels of Evidence was used to assess the strength of evidence underpinning each concept within the framework documents.
Results
Quality indicators, standards of care, and position statements have been developed to progress the delivery of quality care to HPN patients.
Conclusion
The quality framework proposed by AuSPEN is intended to provide a practical structure for clinical and organizational aspects of HPN service delivery to reduce variation in care and improve quality of care and represents the initial step towards development of a national model of care for HPN patients in Australia. While developed for implementation in Australia, the evidence‐based framework also has relevance to the international HPN community.
After studying this article, the participant should be able to: 1. Describe the differential diagnosis of breast tumors in adolescent girls. 2. Compare and contrast surgical options for the ...management of adolescent breast tumors. 3. Recognize the utility of a reduction mammaplasty technique when resecting these larger tumors in adolescents.
Although 99 percent of breast lesions in female adolescents are benign tumors, surgical intervention is commonly required. This article reviews the differential diagnosis, evaluation, and management of these benign tumors. A modified surgical technique for resection of large fibroadenomas and reconstruction of the remaining breast is described. The authors review the approach to five specific breast lesions: fibroadenomas, phyllodes tumors, juvenile hypertrophy, inflammatory processes, and premature breast development.
Plastic surgery demographics are transforming, with a greater proportion of women and younger physicians who desire balance between their career and personal lives compared with previous generations. ...The authors' purpose was to describe the patterns and correlates of satisfaction with work-life balance among U.S. plastic surgeons.
A self-administered survey was mailed to a random sample of American Society of Plastic Surgeons members (n = 708; 71 percent response rate). The primary outcome was satisfaction with work-life balance. Independent variables consisted of surgeon sociodemographic and professional characteristics. Logistic regression was used to evaluate correlates of satisfaction with work-life balance.
Overall, over three-fourths of respondents were satisfied with their career; however, only half were satisfied with their time management between career and personal responsibilities. Factors independently associated with diminished satisfaction with work-life balance were being female (odds ratio = 0.63; 95 percent CI, 0.42 to 0.95), working more than 60 hours per week (versus < 60 hours per week; odds ratio = 0.44; 95 percent CI, 0.28 to 0.72), having emergency room call responsibilities (versus no emergency room call, odds ratio = 0.42; 95 percent CI, 0.27 to 0.67), and having a primarily reconstructive practice (versus primarily aesthetic practice; odds ratio = 0.53; 95 percent CI, 0.30 to 0.93).
While generational differences were minimal, surgeons who were female, worked longer hours, and had emergency room call responsibilities and primarily reconstructive practices were significantly less satisfied with their work-life balance.
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