Recovery from Intimate Partner Violence: A Difficult Journey

In this existential-phenomenological investigation 15 women were interviewed about their experience of recovering from intimate partner violence (IPV). The purpose of the study was to examine the healing process from IPV from the perspective of those who have experienced it. Transcribed interviews were analyzed using a hermeneutic process. The thematic structure of a woman's journey is comprised of three distinct but connected phases of her life: the abusive past, the struggles of freeing herself physically and emotionally from the abuse/past, and finally the healing/growth that occurs as a woman releases herself from the bitterness and anger of the past. Most of the women in this study were able to experience the peace and healing that occurs with recovery, although a few remained emotionally stuck and unable to free themselves from the past. Thus, there are two stories that are told in this study. The first story is about a journey of recovery. Sadly, the second story is about nonrecovery.     

Interoperability—Making Information Systems Work Together

Disaster literature suggests that children's and adolescents’ post-disaster reactions vary according to their developmental levels. Preschool children show less psychological problems as compared to older children and adolescents, but they have a higher incidence of trauma-specific fears and behavioral problems (e.g., dependency, clinging). School-age children's disaster responses include sleep and eating disturbances, behavioral problems, and poor school performance. Adolescents tend to exhibit symptoms such as posttraumatic stress disorder, depression, anxiety, belligerence, and pessimistic views about the future (Korol, Green, &; Gleser, ).     

A randomised trial of nursing interventions supporting recovery of the postmastectomy patient

Aims and objectives. This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown. Background. Surgical removal of the breast may lead to activity limitation, self‐image issues, discomfort and later complication of lymphoedema. Design. This study used experimental and longitudinal design. Methods. One hundred and forty‐five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty‐six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2‐way anova s were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p‐values are two sided. All statistical analyses were performed using sas 9.2 for Windows. Results. The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge. Conclusions. Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients.     

Philadelphia chromosome-negative chronic myelogenous leukaemia: a morphological reassessment

Morphological re-examination of 25 cases classified as Ph1-negative chronic myelogenous leukaemia (CML), with particular attention to the recent French-American-British (FAB) group proposals for the diagnosis of the myelodysplastic syndromes, led to reclassification of all but one of these cases. Upon review of pretreatment material, seven of the 25 cases (28%) were considered to represent myeloproliferative and reactive conditions other than CML. Of the remaining 18 cases, 17 (94%) were reclassified as myelodysplastic syndromes (MDS). These included one case of refractory anaemia (RA), three of refractory anaemia with excess of blasts (RAEB), four of RAEB in transformation (RAEBT), and nine of chronic myelomonocytic leukaemia (CMMoL). Haematological findings in these 17 patients were compared to those in 50 randomly selected patients with Ph1-positive CML. Whereas an absolute basophilia in the peripheral blood was a nearly constant feature in the Ph1-positive group, it was lacking in all but one of the patients with myelodysplastic syndromes. Differences in the pattern and degree of dysplasia were also noted. Only one of the 25 cases studied was considered morphologically and clinically indistinguishable from Ph1-positive CML. It appears that Ph1-negative CML constitutes a heterogeneous group of prognostically distinct disorders and that, in most instances, careful morphologic examination will permit precise classification.     

Outpatient Laparoscopic Gastric Banding: Initial Experience

Background: Laparoscopic adjustable gastric banding (LAGB) has usually been performed as an inpatient procedure with an average hospital stay of 2-4 days. The aim of this study was to assess the feasibility of LAGB as an ambulatory procedure in selected patients. Methods: Potential candidates for ambulatory LAGB were recruited from patients consulting for obesity surgery. The main inclusion criteria were BMI >35 kg/m² with co-morbid conditions, living within a reasonable distance from the hospital, and adult company at home. The patients were admitted at 0700 hours on the day of surgery, underwent laparoscopic placement of a Lap-Band^? system and were discharged home that evening. Results: 9 women and 1 man underwent outpatient LAGB. Mean age was 36 (range 18-52) years and mean BMI was 38.4 kg/m² (range 35.1-43.3). Co-morbidities included functional dyspnea (6), osteoarthritis (4), arterial hypertension (4), type 2 diabetes (2) and dyslipidemia (1). 7 patients had undergone previous abdominal surgery: cesarian section (4), appendectomy (3), cholecystectomy (1) and hysterectomy (1). All patients had an American Society of Anesthesiologists (ASA) classification of II. The average operating time was 87 minutes (range 65-115). The mean time lapse between the end of the operation and discharge from hospital was 9.6 hours. There were no readmissions, and no complications were noticed at 1 month postoperatively. The patients' satisfaction with the ambulatory LAGB procedure was high. Conclusion: The present study demonstrates that LAGB for obesity may be performed on an ambulatory basis without complications.     

Development and evaluation of an interactive Web-based breast imaging game for medical students

RATIONALE AND OBJECTIVES: The purpose of this study was to develop and evaluate by student survey an interactive computer tool for teaching breast imaging to 4th-year medical students. MATERIALS AND METHODS: An interactive computer game was designed for competitive play between two students or between one student and one of two cyber players. Content was determined from a survey of faculty members in breast imaging, and the survey results were grouped into 10 learning objectives. Pre-existing knowledge of these objectives in 16 4th-year medical students was tested by a quiz. On the basis of the learning objectives, case scenarios and questions were incorporated into the game, which was programmed in JavaScript and available on a Web site. Preliminary and final versions of the game were used for teaching 55 4th-year medical students. A subgroup of 42 students received an informational handout. Student surveys were performed. RESULTS: Mean quiz score for pre-existing knowledge of the learning objectives was 45% (range, 13%-67%). Survey results showed that images contributed to educational value (92%), the Web site was more interesting to students than the handout (93.6%), and the Web site provided additional reinforcement of learning beyond that of the handout or lecture (88.8%). Students liked the Web site accessibility (96%), and more than 70% agreed the Web site was also appropriate for other medical specialties. An Internet search identified no other Web-based computer games for medical students. CONCLUSION: Students surveyed found the Web site to be worthwhile, convenient, and applicable to other specialties.