: Breast enhancement with artificial implants is one of the most frequently performed cosmetic surgeries but is associated with various complications, such as capsular contracture, that lead to ...implant removal or replacement at a relatively high rate. For replacement, we used transplantation of progenitor‐supplemented adipose tissue (cell‐assisted lipotransfer; CAL) in 15 patients. The stromal vascular fraction containing adipose tissue progenitor cells obtained from liposuction aspirates was used to enrich for progenitor cells in the graft. Overall, clinical results were very satisfactory, and no major abnormalities were seen on magnetic resonance imaging or mammogram after 12 months. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Surviving fat volume at 12 months was 155 ± 50 mL (Right; mean ± SD) and 143 ± 80 mL (Left) following lipoinjection from an initial mean of 264 mL. These preliminary results suggest that CAL is a suitable methodology for the replacement of breast implants.
End-of-life discussions with patients can be one of the most difficult and stressful tasks for the oncologist. However, little is known about the discussions that healthcare providers have with ...patients in such situations and the difficulties they face. The primary end points of this study were to describe the contents of end-of-life discussion in the pediatric setting and the barriers to end-of-life discussion for pediatric patients, as perceived by pediatric healthcare providers.
Participants were 10 healthcare providers. Semi-structured interviews were conducted, and the KJ method was performed to analyze the data.
We found 23 barriers against end-of-life discussion with pediatric cancer patients. These barriers were classified as follows: healthcare provider factors, patient factors, parent factors and institutional or cultural factors. In addition to barriers found in previous studies, some unique barriers were uncovered such as, 'Lack of confidence to face the patient after the discussion', 'Uncertain responsibility for treatment decision-making' and 'No compelling reason to discuss'. Healthcare providers actively discussed the purpose of treatment and the patients' wishes and concerns; however, they were reluctant to deal with the patients' own impending death and their estimated prognosis.
End-of-life discussion with pediatric patients differs from that with adult patients. Further studies are required to analyze pediatric cases associated with end-of-life discussion and carefully discuss its adequacy, pros and cons.
ABSTRACT
In the treatment of pressure ulcers, assessment of systemic problems is an important yet difficult step in selecting either conservative or surgical therapeutic intervention. The surgical ...auditing system called the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) and its orthopedic version (O‐POSSUM), which gives a predictive mortality rate for the first 30 postoperative days, may be useful for assessing systemic status, but have yet to be sufficiently validated for patients with pressure ulcers. To assess the validity of POSSUM and O‐POSSUM, 71 procedures on 50 cases were retrospectively statistically analyzed using receiver operating characteristic curves and goodness‐of‐fitness testing with the Hosmer–Lemeshow χ2 test for logistic regression modeling. POSSUM and O‐POSSUM showed satisfactory discriminatory power in receiver operating curve analysis. The validity of the values obtained by POSSUM and O‐POSSUM was also confirmed. O‐POSSUM was superior to POSSUM in both analyses. O‐POSSUM is useful in assessing the systemic status of patients with pressure ulcers. Some patients with pressure ulcers show extreme systemic conditions. Assessment of systemic status with O‐POSSUM contributes to daily clinical practice and future studies of treatments for pressure ulcers.
Purpose
We explored pediatricians’ practices and attitudes concerning end-of-life discussions (EOLds) with pediatric patients with cancer, and identified the determinants of pediatricians’ positive ...attitude toward having EOLds with pediatric patients.
Methods
A multicenter questionnaire survey was conducted with 127 pediatricians specializing in the treatment of pediatric cancer.
Results
Forty-two percent of participants reported that EOLds should be held with the young group of children (6–9 years old), 68% with the middle group (10–15 years old), and 93% with the old group (16–18 years old). Meanwhile, 6, 20, and 35% of participants answered that they “always” or “usually” discussed the incurability of the disease with the young, middle, and old groups, respectively; for the patient’s imminent death, the rates were 2, 11, and 24%. Pediatricians’ attitude that they “should have” EOLds with the young group was predicted by more clinical experience (odds ratio OR 1.077;
p
= 0.007), more confidence in addressing children’s anxiety after EOLd (OR 1.756;
p
= 0.050), weaker belief in the demand for EOLd (OR 0.456;
p
= 0.015), weaker belief in the necessity of the EOLd for children to enjoy their time until death (OR, 0.506;
p
= 0.021), and weaker belief in the importance of maintaining a good relationship with the parents (OR 0.381;
p
= 0.025).
Conclusions
While pediatricians nearly reached consensus on EOLds for the old group, EOLds with the young group remain a controversial subject. While pediatricians who supported EOLds believed in their effectiveness or necessity, those who were against EOLds tended to consider the benefits of not engaging in them.
Although various factors thought to be correlated with anxiety in cancer patients, relative importance of each factors were unknown. We tested our hypothesis that personality traits and coping styles ...explain anxiety in lung cancer patients to a greater extent than other factors.
A total of 1334 consecutively recruited lung cancer patients were selected, and data on cancer-related variables, demographic characteristics, health behaviors, physical symptoms and psychological factors consisting of personality traits and coping styles were obtained. The participants were divided into groups with or without a significant anxiety using the Hospital Anxiety and Depression Scale-Anxiety, and a binary logistic regression analysis was used to identify factors correlated with significant anxiety using a multivariate model.
Among the recruited patients, 440 (33.0%) had significant anxiety. The binary logistic regression analysis revealed a coefficient of determination (overall R(2)) of 39.0%, and the explanation for psychological factors was much higher (30.7%) than those for cancer-related variables (1.1%), demographic characteristics (2.1%), health behaviors (0.8%) and physical symptoms (4.3%). Four specific factors remained significant in a multivariate model. A neurotic personality trait, a coping style of helplessness/hopelessness, and a female sex were positively correlated with significant anxiety, while a coping style of fatalism was negatively correlated.
Our hypothesis was supported, and anxiety was strongly linked with personality trait and coping style. As a clinical implication, the use of screening instruments to identify these factors and intervention for psychological crisis may be needed.
Spas and Symposium on Spas in Peru OSHIMA, Yoshio
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine,
1992, Volume:
55, Issue:
2
Journal Article
Open access
A symposium on spas in Peru was held in Lima on 27-28., May, 1991. Then four spas in Peru, namely Monterrey, Chancos, La Merced, and Oyeros were inspected. All these spas are situated 2500-3000 ...meters above sea level and surrounded by beautiful woods and streams. Monterrey and Chancos have thermal pool and natural vapor bath rooms other than individual bath facilities. Waters of Oyeros are rich in Lithium. Tourist hotels are provided only in Monterrey.
Spas in Greece OSHIMA, Yoshio
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine,
1990, Volume:
53, Issue:
4
Journal Article
Open access
According to EOT report there are 752 mineral springs in Greece, of which 180 are used for external use, 148 for internal use, and 20 for both uses. By EOT's invitation 9 spas: Aedipsos, Thermopylae, ...Platystomo, Ypati, Kammena Vourla, Kylini, Kaiafa, Maudraki (Nisyros), and Calithea (Rhodes) were visited. 7 are situated by the beautiful sea shore and 3 are surrounded by fragrant wood. In Kylini a modernized grand etablissement thermale is going on to accomplish. Calithea is for the present not used for drinking. In Nisyros a plan to develop geothermal energy production is going on which may have influence on thermal spring. Greek spas can and should be more widely used not only for cure treatment but also for tourism.
Spas in Peru OSHIMA, Yoshio
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine,
1990, Volume:
53, Issue:
2
Journal Article
Open access
According to the Peruvian National Tourist Board there are 139 spas with 301 sources in Peru. Most abundant are the Na-Cl springs and Mg-SO4, HCO3 springs. 90% of the hot springs have a water ...temperature above 40°C and 75% are situated over 2000m above sea level. Machu-Picchu Hot Springs and Banos del Inca in Cajamarca were visited. Both springs belong to Na-Cl type and to promote tourism and spa treatment further improvements in traffic conditions, accomodation and cure facilities are expected to develop.
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