Simaplast Prostheses: Augmentation Mammoplasty

This silicone prosthesis was introduced in France in 1965. It comes in the shape of a balloon and six percent Dextran is utilized to fill these balloons up to the desired size. The advantage of this particular prosthesis is the ease with which it can be inserted, shorter operating time as compared to the insertion of the Cronin prosthesis, the natural feel of the prosthesis in the postoperative period and the fact that we have had very few complications such as serous extravasation, hematomas, infections, wound disruptions and skin necrosis. None have occurred in this particular group.

Patients can return to work within four days with very little discomfort. There has been no report of any carcinogenic effect. All but one of our group of 15 were married and had children. This technique is only of use in women with small atrophic breasts.

The interest to the family practitioner is that augmentation mammoplasty is playing a greater part in modern society. The sex symbol plays a part in this procedure and certainly modern clothing, which uses less and less cloth, makes female contours even more important in the mind of the woman who is less than standard proportion. Most do not want to wear padded brassieres and other built-in supports; they want to have something that appears to be part of their anatomy.

     

It's not football

Summary

Today I am as happy as I could ever be. I have created a lot out of very little, I have worked full time, played full time, got full-time friends, full-time independence, had full-time love and am lucky enough to be with my new full-time love who helps me a great deal both physically and mentally.

It is definitely no fun coughing until your chest is sore in the morning, afternoon and evening. Having wringing night-sweats from cepacia. Wanting to sleep more than Mr Sleep from Sleepland. Taking tablets the size of which sunk the Belgrano. Finding time for physiotherapy, eating the right meals, playing on my Playstation. Depression has got through on previous occasions, but not for long, and it has never resulted in anything more than a ‘wake up and smell the coffee’ call from myself.

Having CF is no ball game (otherwise it would be called football or something!), but I have had a lot of fun and will continue to do so for however long. Two years, five years, 20 years — who's to say, not me. We could all have the same left, I just hope that everyone has as much fun.     

Death visualization: A teaching and learning device

Abstract

Imagining one's own death, we are told, is literally impossible for several cogent reasons. The event has never happened. We cannot have heard about death from anyone who has experienced it. At the time of death we are without a “mind”. If, right now, we use our minds to picture death, we are using an entity that will not be available later on. The logic and common sense of the assertion that death cannot be imagined seems rather secure.     

Reframing the Past: Role of Memory Processes in Emotion Regulation

Background

The ability to modulate undesirable emotions is essential for maintaining mental health. Negative emotions can arise both while experiencing and remembering an unpleasant event, which presents a persistent emotion regulation challenge because emotional memories tend to be particularly vivid and enduring. Despite the central role that memories play in our affective lives, little is known about the memory processes supporting successful regulation of emotions associated with long-term memories, which we refer to as retrospective emotion regulation.

Methods

In this paper, we review the literature on the mechanisms of memory modification, which may contribute to the success of retrospective emotion regulation. In particular, we review rodent and human studies that examine the modification of conditioned fear associations and emotional episodic memories.

Conclusions

Based on this literature, we conclude that memory reactivation plays a crucial role in memory modification. We discuss further the potential role of memory reactivation in mediating the success of cognitive reappraisal, which may be considered a special case of memory modification. We propose that the completeness, or strength, of reactivation during retrospective emotion regulation will be related to the likelihood of updating an episodic memory, reducing its emotional impact upon later recall. Understanding the role of memory processes in emotion regulation can help to inform research on memory-based treatments for affective disorders.

     

Multi-professional and multi-dimensional group education – a key to action in elderly persons

Purpose: This study was intended to evaluate a multi-professional health-promoting and disease-preventive intervention organized as multi-professional senior group meetings, which addressed home-dwelling, independently living, cognitively intact elderly persons (80±), by exploring the participants’ experiences of the intervention. Method: The focus group methodology was used to interview a total of 20 participants. The informants had participated in four multi-professional senior group meetings at which information about the ageing process and preventive strategies for enhancing health were discussed. Results: The overall finding was that the elderly persons involved in the intervention lived in the present, but that the supportive environment together with learning a preventive approach contributed to the participants’ experiencing the senior meetings as a key to action. Conclusions: Elderly persons who are independent may have difficulty accepting information about preventing risks to health. However, group education with a multi-professional approach may be a successful model for achieving an exchange of knowledge, which may possibly empower the participants, give them role models, the opportunity to learn from each other and a sense of sharing problems with people in similar circumstances.

Implications for Rehabilitation

• Since elderly persons these days are expected to live beyond their 80 s, there is still time for interventions aimed at health promotion and disease prevention to have an effect on functional status and the quality of life of their remaining years.

• Elderly persons who are independent may have difficulty accepting information about preventing risks to health.

• Multi-professional health promoting and disease-preventive senior meetings could motivate elderly persons to act on behalf of their own health.

• Multi-professional collaboration combined with the group model made the participants in our study experience the senior meeting as a key to action.

     

Association between COVID-19 and angiotensin-converting enzyme inhibitors with the spotlight on zinc: an opinion

In the setting of the raging COVID-19 pandemic, the search for innovative therapeutics is desperately sought after. As we learn more about the characteristics and metabolic health of patients and as our understanding of COVID-19 pathophysiology and treatment progresses, so is our understanding of medication effects that might increase disease severity. As of late, ACE inhibitors have been under investigation for a potential increase in illness severity due to ACE2 upregulation. Given our knowledge of other nutrient-pharmaceutical interactions, could the ACE inhibitor impact on COVID be due to something else? In this paper, we discuss the possibility that ACE inhibitors might be affecting COVID-19 patients by causing zinc insufficiency.

KEY MESSAGES

1. Zinc deficiency caused by chronic ACE inhibitor usage may exacerbate the pathogenicity of COVID-19 in susceptible patients.
2. A multi-center study is needed to assess the zinc levels of patients with COVID-19 who are taking ACE inhibitors and other medications that may result in low zinc levels.

     

Suicide vs medical assistance in dying (MAiD): A secondary qualitative analysis

Abstract

This is a secondary analysis of three qualitative studies about MAiD in which researchers asked about the differences between suicide and MAiD. In all, researchers interviewed 52 Canadians; 7 were people who had requested MAiD and had been found ineligible, 6 were MAiD providers and 39 were socially and economically marginalized. The overwhelming response was that MAiD is better than suicide in the context of suffering at the end of life. Whereas these people perceived suicide as uncertain, difficult, and something that was usually done alone and without support, they thought MAiD was certain, painless, and more socially acceptable.     

Older adults’ perceptions of wearable technology hip protectors: implications for further research and development strategies

Abstract

Purpose: Hip fractures are an important public health issue. Ninety-five percent of hip fractures are caused by falls, with those at greatest risk including residents of long-term care facilities. Hip protectors can be effective in preventing hip fractures, but levels of acceptance and adherence may be low. We report on work to develop research into a new hip protector that aims to overcome some of the acceptance and adherence challenges.

Methods: We held five patient and public consultation events involving 147 older adults and 10 long-term care sector staff in the Midlands and North West of England. At each event, participants were shown the Fall-Safe Assist hip protector, which includes built-in mobile technology to record information about falls and summon help from caregivers.

Results: Participants were positive about the product’s potential utility and impact upon confidence in moving around. However, many participants held highly personal perceptions of their vulnerability and need, and expressed concerns about the esthetics and practicality of the accompanying underwear. Participants highlighted potential challenges from poor mobile connectivity, and expressed concerns about product cost.

Conclusions: Future research will need to ensure flexible and sensitive approaches to recruitment. Further refinement to the product design may be useful. Individual interviews and questionnaires would help capture participants’ perceptions on personal topics, and measures of changes in confidence. Research sites will need to be compatible with technological functionality. It will be necessary to have a robust protocol in place for withdrawal of the product at the end of any clinical research.

• Implications for Rehabilitation

• Hip protectors can be effective in preventing hip fractures, but levels of acceptance and adherence may be low and may contribute to low-quality research.

• A new type of hip protector has been designed to overcome some of the acceptance and adherence challenges.

• Older adults suggested that the product was potentially useful, but expressed highly personal concerns about perceived need; aesthetics; practical and technological challenges; and cost, all of which may affect future research design.

• Research designs will need to be flexible enough to consider sensitive approaches to recruitment, multiple methods of data collection, site compatibility with technological functionality, and product withdrawal at end of study.

     

Emotional well-being and adjustment to vision loss in later life: a meta-synthesis of qualitative studies

Purpose: To review perceived emotional well-being in older people with visual impairment and perceived factors that inhibit/facilitate psychosocial adjustment to vision loss. Method: The databases of MEDLINE, EMBASE, PsycINFO and CINAHL were searched for studies published from January 1980 to December 2010, which recruited older people with irreversible vision loss, and used qualitative methods for both data collection and analysis. Results sections of the papers were synthesised using a thematic-style analysis to identify the emergent and dominant themes. Results: Seventeen qualitative papers were included in the review, and five main themes emerged from the synthesis: 1) the trauma of an ophthalmic diagnosis, 2) impact of vision loss on daily life, 3) negative impact of visual impairment on psychosocial well-being, 4) factors that inhibit social well-being, and 5) factors that facilitate psychological well-being. We found the response shift model useful for explaining our synthesis. Conclusions: Acquired visual impairment can have a significant impact on older people’s well-being and make psychosocial adjustment to the condition a major challenge. Acceptance of the condition and a positive attitude facilitate successful psychosocial adjustment to vision loss as well as social support from family, friends and peers who have successfully adjusted to the condition.

Implications for Rehabilitation

• Visual impairment can have a profound negative impact on individuals’ psychosocial well-being.

• The emotional needs of those with visual impairment should not to be neglected, particularly those recently diagnosed.

• Referrals to services may be appropriate for individuals with vision loss (e.g. counselling and peer support groups).

• It may also be appropriate to discuss with individuals the factors that inhibit/facilitate psychosocial adjustment to vision loss.

     

The Perception of Women in Rural and Remote Scotland About Intrapartum Care: A Qualitative Study

Background

The views of mothers are important in shaping policy and practice regarding options for intrapartum care. Mothers in rural and remote areas face unique challenges accessing services, and these need to be well understood. Therefore, our aim was to understand the compromises that women who live in remote and rural settings, more than 1 h from a maternity unit, face regarding intrapartum care.

Methods

Qualitative semi-structured telephone interviews (n = 14) were undertaken in rural Scotland with 13 women who had young children and one who was pregnant. Interviews were transcribed and thematically analysed by two researchers.

Results

Key themes identified were women’s perceptions about risk and the safety of different pathways of maternity care and birth locations; the actual and perceived distance between home and the place of birth, and the type of maternity care available at a place of birth. Mothers in rural and remote areas face particular challenges in choosing where to have their babies. In addition to clinical decisions about ‘place of birth’ agreed with healthcare professionals, they have to mentally juggle the implications of giving birth when at a distance from family support and away from familiar surroundings. It was clear that many women from rural communities have a strong sense of ‘place’ and that giving birth in a geographical location, community and culture that feels familiar is important to many of them.

Conclusions

Health care staff need to appreciate the impact of non-clinical factors that are important to mothers in remote and rural areas and acknowledge these, even when they cannot be accommodated. Local and national policy also needs to reflect and respond to the practical challenges faced by rurality.

     

About the nature of design in universal design

Abstract

Purpose: Studies suggest that the concept of universal design (UD) is not widely accepted and that some of its ideas are received rather sceptically. This article confronts the concept of UD with prevailing notions and practices of design. It examines how UD can be situated relative to design in general, and explores whether elements in the nature of design can help us explain this scepticism. Methods: The article confronts writings about how design is understood with the concept and ideas of UD. This confrontation is substantiated with examples from studies of design processes in architectural design practice. Results: The confrontation highlights the ambiguity of how UD is framed and presented, ranging from an attitude over something utopian to a normative design domain. Conclusions: (1) Besides UD other attitudes are thinkable that address the diversity in human abilities and conditions. (2) The impossibility to really design for everyone may be inherent to design rather than characteristic of UD. (3) Even if UD as a normative design domain were a top priority, the question remains how to assess whether a design is universally usable given the nature of design (problems), and prevailing design practices.

• Implications for Rehabilitation

• Understanding disability as originating in the interaction between features of an individual's body and features of his/her environment, as universal design does, implies that rehabilitation specialists need to consider the context in which a person lives.

• Besides striving for independence, self-reliance and individualism, rehabilitation specialists may consider other attitudes to address the diversity in human abilities and conditions.

• Designers do not have direct access to the perspective of the people they design for. Assessing whether a design is universally accessible may benefit from expertise of rehabilitation specialists.

     

A physical exercise programme for palliative care patients in a clinical setting: Observations and preliminary findings

Abstract

Introduction

Reduced physical function and increased dependency have a significant negative impact on the quality of life of people who are terminally ill. Previous research indicates that participation in physical exercise can reduce distressing symptoms and improve physical functioning and quality of life in palliative care patients with a diagnosis of cancer. We describe the preliminary evaluation of an outpatient rehabilitation and exercise programme implemented in a hospice setting specifically designed for patients with a palliative diagnosis, and aimed at improving and maintaining physical functioning.

Methods

Eligible patients completed a programme of 10 gym-based exercise sessions including exercises to strengthen arms, legs, and core muscles, and to improve balance and cardiovascular fitness. This was further supported by a home-based exercise programme. Assessments of physical performance, fatigue, and quality of life were completed at baseline and immediately post-completion of the exercise programme.

Results

Improvements were observed in physical performance, fatigue, and overall quality-of-life scores post-intervention. There were high levels of attrition and many patients were lost to follow-up.

Discussion

While acknowledging the limitations of our design and small sample size, our findings contribute to the literature around the benefits of exercise for patients receiving palliative care. We recommend that exercise programmes implemented in clinical practice for palliative care patients should be individually tailored and supported by educational initiatives promoting the benefits of exercise to patients, families, and healthcare providers, and promoting early referral. Future work should explore the mechanisms by which such programmes might support improvements in quality of life, and how outcomes may differ for patients with different demographic and disease characteristics.     

In Our Own Time: Medical Students’ Informal Social Studying and Learning

Abstract

Phenomenon: Social studying and learning (SSL) is any independent, elective, self-directed and self-organized approach to learning that involves students working with their peers for the purposes of study, learning, or revision. While in-class collaborative learning has been relatively well-explored, very little is known about how medical students engage in informal SSL or about the impacts it can have. The purpose of this study was to explore medical students’ practices and perceptions regarding SSL, and the ways in which this shaped their overall learning experiences. Approach: A constructivist grounded theory study was conducted at the University of Calgary. Data were collected from 23 semi-structured student interviews, which were audio recorded and transcribed. Data were analyzed using iterative data collection, memo-ing, and focused coding. Findings: Despite SSL being a common part of students’ medical school experience and something that was promoted by academic advisors, how students actually engaged with SSL varied substantially, including who made use of SSL, how they made use of it, the size and focus of SSL groups, how these groups functioned, and what individuals sought to get out of them. Some students found SSL helped them to be more efficient and focused in their studying, while others benefited from comparing their knowledge and skills with those of their peers. Not everyone benefited, as some students found SSL stressful, unproductive, or socially uncomfortable. While student engagement in SSL was an enabler of academic success for some it could also be an indicator of social isolation and low self-esteem for others. Insights: Understanding how SSL can influence student experiences has the potential to inform students how and why they might engage in SSL, and it can help educators better support their students, particularly in those schools that actively encourage SSL.     

Enhanced information regarding exercise training as treatment is needed. An interview study in patients with chronic obstructive pulmonary disease

Abstract

Purpose: The purpose of this study is to describe thoughts and attitudes of patients with chronic obstructive pulmonary disease (COPD) when talking about exercise training as treatment. Methods: Semi-structured interviews were performed and analyzed with the grounded theory method. Four men and six women were interviewed (ages 66–84 years), with moderate to severe COPD, and no experience of organized exercise training as treatment for COPD. Results: The analysis resulted in one core category, unknown territory, and three categories, good for those who can, but not for me; fear of future; and mastering. Exercise training as treatment was perceived by the participants as something unknown. It was also described as important for others but not for them. Their perceptions were that they could not perform exercise training, and did not have the knowledge of what or how to perform exercise that was good for them. Conclusions: Patients with COPD, with no previous experience of exercise training as treatment for their disease, describe exercise training as something unknown and unimportant for them. The results provide important knowledge for healthcare professionals regarding how to educate patients with COPD about the content and benefits of exercise training as treatment.

• Implications for Rehabilitation

• Exercise training is effective for patients with chronic obstructive pulmonary disease (COPD) with regard to dyspnea, physical capacity, health-related quality of life, and health care use.

• Patients with COPD perceive a lack of information regarding exercise training as treatment.

• The information and the presentation of exercise training as treatment might be of importance to get better adherence to this treatment.

     

Explanatory models of dementia: links to end-of-life care

We will describe four models used to understand dementia: as a neurological condition; as a neuro-psychiatric condition; as a normal part of ageing; and seeing dementia from a person-centred perspective. Adopting the last of these allows an engagement with palliative care that has the potential to enrich the end-of-life experience of people with dementia, of their families and of the professional care staff who work with them. In this article, it will be argued that our perceptions of what is possible for practising person-centred care at the end of life are constrained by the paradigms we work within. There is developing evidence about how approaches to end-of-life care for people with dementia can move beyond what was, at best, therapeutic pessimism and at worst ill-treatment towards something that optimizes the capacities of those with dementia and mobilizes imaginative care practice.     

Peptic Ulcer Disease

The availability of duodenoscopy and methods to assay serum gastrin have added new dimensions to our clinical assessment of peptic ulcer disease. We are learning more about parietal cells, G-cells, pyloric sphincters, and gastrin, and about the pathogenesis of ulcers, how to differentiate simple ulcers from those associated with gastrinomas, and how to choose a rational approach to therapy.

H₂-receptor blockers and prostaglandins, both strong inhibitors of gastric acid secretion, are on the therapeutic horizon. The incidence of recurrent ulcerations can now be surgically reduced by subselective vagotomy of the fundic gland area, which selectively denervates parietal cell mass without interfering with gastric emptying.—AR     

Return to work in the context of everyday life 7–11 years after spinal cord injury – a follow-up study

Abstract

Purpose: The aim of this follow-up study was to explore experiences of return to work in the context of everyday life among adults 7–11 years after spinal cord injury (SCI).

Methods: This study used in-depth interviews and observations in a qualitative design with eight persons who had previously been interviewed in 2008. A narrative approach was used during data gathering and analysis.

Results: Return to work was experienced as something constantly needing to be negotiated in the context of everyday life. Several years after SCI expectations for work and perceptions of possibilities for meaningful work had changed. Five main themes were identified through the analysis, (1) negotiating the possibilities of working, (2) hope for future work tempered with concern, (3) education as a possible path to employment, (4) paths toward return to work in light of unmet support, and (5) unpaid occupations grounded in interest and competence.

Conclusions: Persons who have no higher education or lack viable employment to return to after SCI seem to be vulnerable in return to work. Early and timely interventions tailored to the person’s interests and competencies, in which the rehabilitation team has a distinct coordinating role, are thus critical in return to work.

• Implications for Rehabilitation

• Tensions between hope and expectations for work and unmet needs of support can lead to barriers in return to work, particularly for those who have no higher education or lack employment to return to after spinal cord injury.

• Rehabilitation after spinal cord injury can benefit from focus on how the balance of work fits into routines in the context of everyday life.

• Early and timely interventions integrating the person’s interests and competencies in return to work after spinal cord injury in combination with having a health care provider who has a distinct coordinating role are critical.

     

Radiologically-guided percutaneous gastrostomy: Three-year follow up and literature review

Summary

Feeding gastrostomy is a well recognized means of nutritional support in patients unable to maintain satisfactory nutrition by the oral route. Access can be achieved at open surgery or using endoscopic or radiological techniques. We describe our experience with the placement of radiologically-guided percutaneous feeding gastrostomies and compare our results with other reported series. Thirty-two patients were offered percutaneous gastrostomy in the study period and their outcome recorded for up to 3 years. The results suggest that we should perhaps be more stringent in our patient selection criteria in view of the poor outcome in elderly high risk patients who have suffered a stroke.     

‘I can’t see any reason for stopping doing anything,but I might have to do it differently’ – restoring hope to patients with persistent non-specific low back pain – a qualitative study

Purpose: To explore the differences in narrative between patients with persistent non-specific low back pain (PLBP) who benefited from a pain management programme, and those who did not benefit. Method: We conducted interviews with 20 patients attending a pain management programme; prior to attending the programme, immediately following the programme and at one year. Our analysis focused on a theoretical sample of patients who either described dramatic life improvements at one year, and who described themselves as much worse. We used the methods of grounded theory. Results: We found that finding hope was central to good outcome. Patients restored hope by making certain changes; (a) deconstructing specific fears, (b) constructing an acceptable explanatory model (c) reconstructing self identity by making acceptable changes. Those who had not restored hope retained fears of loss of self, remained committed to the biomedical model and were unable to make acceptable changes. Conclusions: Our findings may help to operationalise the restoration of hope in patients with PLBP. Firstly, health care professionals need to identify and resolve any specific fears of movement. Secondly, patients need an acceptable explanatory model that fits their experience and personal narrative. Finally our study confirms the centrality of self concept to recovery.

Implications for Rehabilitation

• Explanatory models are likely to have an impact on recovery following pain rehabilitation.

• Adherence to a biomedical model may have a negative impact on recovery.

• Patients need an acceptable explanatory model that fits their experience.

• Defining an acceptable self concept is integral to recovery.

     

Measuring and improving the patient experience in radiology

Recently enacted healthcare legislation and the associated payment reforms have shifted the focus from traditional fee for service models to adding measurable and appreciable value to the patient experience. The value equation links quality to costs, and quality metrics are now directly related to patient outcomes and the patient experience. To participate effectively in this new paradigm requires not only that we provide excellent, timely and appropriate patient-centric care at all times, but that we are able to measure and manage the feedback we obtain from our patients. Of course, in order to provide value-added care, we must know not only who our customers are, but what they value. In this review, we explore factors that impact patient perception and experience with imaging services. We further illustrate different ways that patient feedback can be elicited and provide pros and cons of each approach. Collecting appropriate data is insufficient by itself; such data must be carefully analyzed, and opportunities for improvement must be identified, introduced, and monitored ahead of future surveys.