Abstract Within the field of breast reconstruction there is increasing focus on patient-reported outcomes related to satisfaction, body image, and quality of life. These outcomes are deemed highly ...relevant because the primary goal of breast reconstruction is to recreate the appearance of a breast (or breasts) that is satisfying to the patient. Prominent researchers have suggested the need to develop improved standards for outcome evaluation which can ultimately benefit patients as well as physicians. The purpose of this article is to summarize key findings in the area of patient-reported outcomes for breast reconstruction and introduce a theoretical framework for advancing research in this field. We conducted an extensive literature review of outcome studies for breast reconstruction focusing on patient-reported results. We developed a theoretical framework illustrating core patient-reported outcomes related to breast reconstruction and factors associated with these outcomes. Our theoretical model highlights domains and distinguishing features of patient satisfaction, body image, and quality of life outcomes for women undergoing breast reconstruction. This model further identifies a broad range of variables (e.g., historical/premorbid influences, disease and treatment-related factors) that have been found to influence patient-reported outcomes and need to be taken into consideration when designing future research in this area. Additional attention is given to examining the relationship between patient reported outcomes and outside evaluation of breast reconstruction. Our proposed theoretical framework suggests key opportunities to expand research in this area with the goal of optimizing body image adjustment, satisfaction, and psychosocial outcomes for the individual patient.
Family child care (FCC) providers are key suppliers of care and education to young children, yet they often experience stressors that can influence their ability to provide developmentally ...appropriate care. This research sought to understand the direct and indirect associations among FCC providers' relationships with families they serve, relationships with children in care (measured via closeness and conflict), and individual well-being (measured via coping skills). In this study, 888 FCC providers completed questionnaires. After controlling for demographic, job-related, and personal factors, path analysis revealed FCC providers reported higher closeness and lower conflict with the children in their care when they perceived more positive relationships with children's families. In addition, more positive relationships with children's families were associated with stronger FCC provider coping skills, which in turn, were associated with lower conflict and higher closeness within provider-child relationships. Suggestions are offered for future research and support of the well-being of FCC providers.
Bacterial pneumonia remains an important cause of morbidity and mortality worldwide, especially in immune-compromised patients. Cytokines and chemokines are critical molecules expressed in response ...to invading pathogens and are necessary for normal lung bacterial host defenses. Here we show that interleukin (IL)-17, a novel cytokine produced largely by CD4+ T cells, is produced in a compartmentalized fashion in the lung after challenge with Klebsiella pneumoniae. Moreover, overexpression of IL-17 in the pulmonary compartment using a recombinant adenovirus encoding murine IL-17 (AdIL-17) resulted in the local induction of tumor necrosis factor-alpha, IL-1beta, macrophage inflammatory protein-2, and granulocyte colony-stimulating factor (G-CSF); augmented polymorphonuclear leukocyte recruitment; and enhanced bacterial clearance and survival after challenge with K. pneumoniae. However, simultaneous treatment with AdIL-17 provided no survival benefit after intranasal K. pneumoniae challenge. These data show that IL-17 may have a role in priming for enhanced chemokine and G-CSF production in the context of lung infection and that optimally timed gene therapy with IL-17 may augment host defense against bacterial pneumonia.
Innate immunity and pulmonary host defense Zhang, Ping; Summer, Warren R.; Bagby, Gregory J. ...
Immunological reviews,
February 2000, Volume:
173, Issue:
1
Journal Article
Peer reviewed
The lung, in order to facilitate gas exchange, represents the largest epithelial surface area of the body in contact with the external environment. As normal respiration occurs, the upper and lower ...airways are repeatedly exposed to a multitude of airborne particles and microorganisms. Since these agents are frequently deposited on the surface of the respiratory tract, an elaborate system of defense mechanisms is in place to maintain the sterility of the lung. Innate defenses are primarily responsible for the elimination of bacterial organisms from the alveolus. Early bacterial clearance is mediated by a dual phagocytic system involving both alveolar macrophages and polymorphonuclear leukocytes. The recruitment and activation of inflammatory cells at a site of infection involves the orchestrated expression of leukocyte and vascular adhesion molecules, as well as the establishment of chemotactic gradients via the generation of proinflammatory cytokines and chemokines. Immunologic manipulation of innate immunity may serve as an important adjuvant therapy in the treatment of both immunocompromised and immunocompetent patients with severe lung infections. As the complexities of the host-pathogen interaction are further dissected and elucidated, it is likely that the therapeutic benefits from these approaches will be realized.
The discovery of the growth factors stimulating neutrophil production has carried the greatest therapeutic implications. This review focuses on the role of one of these factors, granulocyte ...colony-stimulating factor (G-CSF), which appears to play a vital role in both maintaining the normal blood neutrophil count and determining the neutrophil's response in infectious diseases. Whereas the use of G-CSF to increase neutrophil numbers is well established in the treatment of neutropenic patients, recent evidence indicates that G-CSF exerts significant effects on the physiologic activity of developing and mature neutrophils. Here, we discuss recent insights into the potential therapeutic use of G-CSF in nonneutropenic patients.
Metastatic bone cancer of the foot: a case report Zagrocki, Laura; Ford, Timothy C; Willis, W Summer ...
Journal of the American Podiatric Medical Association,
07/2013, Volume:
103, Issue:
4
Journal Article
Peer reviewed
Metastasis to the foot is rarely presented in the literature. We describe a 56-year-old woman with nonspecific pain in the left foot, ankle, and knee for 3 months. The patient was diagnosed as having ...urothelial carcinoma with metastasis to the left lower extremity, including the foot. This diagnosis was reached through the combined efforts of radiologic techniques and biopsies. This case discusses the importance of paying close attention to the details of the history and physical examination, performing appropriate tests, and obtaining suitable referrals.
Pericardial effusion was noted in 43 of 79 patients (54%) with severe primary pulmonary hypertension. Larger effusion was associated with hemodynamic and echocardiographic evidence of right heart ...failure, impaired exercise tolerance, and a poor 1-year prognosis.
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