Evaluation of community outreach feasibility programmes on improving cancer-related, preventive, health behaviour.

BACKGROUND: The COVID-19 pandemic had a negative impact on cancer services and will have likely led to delayed early detection and diagnosis. In response, the Irish Cancer Society (ICS) planned and delivered seven cancer roadshow events run on 15 days across seven shopping centres in four deprived areas based on Trinity National Deprivation Index, 2016, in Limerick, Cork, Waterford and Dublin regions in Ireland to educate and promote awareness about cancer signs and symptoms, importance of screening, positive lifestyle changes, and encourage medical care-seeking behaviour. METHODS: ICS nurses and trained ICS volunteers conducted health checks such as blood pressure, BMI, and CO2, monitoring (one health check per person maximum), provided health information and conducted motivational interviews in aforementioned regions. Data were collected via an anonymous questionnaire from participants and volunteers. SPSS was used for descriptive and pre-post event comparative analysis. FINDINGS: 98 people, all adults (54 men and 44 women) participated; 88% (n=86) found the information provided useful, 85% (n=83) approved of the health check and 73% (n=71) stated that they would probably make changes to their current lifestyle to reduce their cancer risk. Moderate or high understanding of cancer signs and symptoms (from 62% to 82%; p<0·0001) and moderate or high awareness of cancer risk factors (from 49% to 61%; p<0·0001) both rose after the events. If symptomatic for cancer, 78% (n=76) of participants would probably visit their general practitioner and 74% (n=72) would probably contact ICS. Younger people (aged ≤40 years) were more likely to consider consulting a health-care professional if symptomatic (p=0·0270) and to contact the ICS (p=0·0070) for more information. High numbers of participants (99%; n=97) and volunteers (95%; n=42) recommended a nationwide roll out. INTERPRETATION: With moderate to high levels of public engagement, volunteers reported people discussed cancer screening, information on making lifestyle changes, and ICS services. Such community outreach programmes to promote cancer-related health are feasible and acceptable and might lead to improved knowledge of cancer prevention, early detection, and improved intention to seek help for health concerns. Determination of effectiveness in preventive behaviour, early diagnosis, and cost effectiveness would require longer term follow up. FUNDING: Irish Cancer Society.

The correlation of matrix metalloproteinase 9-to-albumin ratio in wound fluid with postsurgical complications after body contouring.

BACKGROUND: The authors' earlier retrospective report of surgical complications after abdominal contouring surgery provided evidence that post-bariatric surgery patients are at increased risk of developing wound complications compared with a normal population. This prospective pilot study was designed as a comparative analysis of both surgical and wound healing characteristics between massive weight loss and normal patients who present for abdominal contouring surgery. METHODS: Excisional wounds were created and polytetrafluoroethylene tubing was inserted during the preoperative period for later harvesting in patients undergoing abdominal contouring following Roux-en-Y gastric bypass for weight loss (n = 16) or abdominoplasty (n = 17). Wound fluids were sequentially collected from drains and subjected to matrix metalloproteinase (MMP) analysis. Standard postsurgical complications were documented. RESULTS: Surgical complications were more common in weight loss patients (47 percent) than in control patients (25 percent). MMP analyses showed that MMP-9 levels remained significantly elevated at postoperative day 4 in patients who subsequently experienced complications in either the weight loss group (p = 0.02) or the control group (p = 0.03). Other parameters showed no significant differences between massive weight loss patients and controls. CONCLUSIONS: Although many markers were examined, the ratio of MMP-9 to albumin was the only predictor of postsurgical complications in any group. This lends further support to growing evidence that MMP-9 may be a useful biomarker of postsurgical complications. This pilot work showed no causal factors that explain the higher rates of postsurgical complications in the post-bariatric surgery patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

The impact of reduction mammaplasty on breast sensation: an analysis of multiple surgical techniques.

Our prospective clinical trial collected sensory data using a computerized pressure-specified sensory device comparing 4 procedures for reduction mammaplasty. A total of 48 patients were assessed at baseline, 6 weeks (n = 42), 6 months (n = 15), and 1 year (n = 24) postoperatively. The findings of our study showed pressure sensitivity for women <43 years of age improved by pressure-specified sensory device assessment; whereas, outcome data merely indicated return to baseline in pressure sensitivity for women ≥ 43 years of age. Improved sensitivities for moving and static pressures were found in patients receiving vertical or inferior pedicle reduction mammaplasties. Reductions based on superior pedicles exhibited sensory loss as compared with baseline measurements while those receiving free nipple grafts showed negligible change. Moving and static sensation showed differential return after breast reduction irrespective of the specific surgical approach but sensation was uniquely conserved for the nipple. In the total cohort, the type of breast reduction procedure did not produce significant differences in breast sensation.

Association between preoperative measurements and resection weight in patients undergoing reduction mammaplasty.

Current guidelines used to predict appropriate resection weight for patients undergoing reduction mammaplasty are typically based on relatively nondescript patient characteristics and are most often inaccurate. The determination of patient measurements that correlate with resection weight could enable appropriate resection weight to be predicted more precisely and on an individualized basis. To better elucidate this, data from 348 patients undergoing bilateral reduction mammaplasty (696 breasts) between October 2001 and March 2009 were reviewed retrospectively. The association between resection weight and sternal notch to nipple distance (SNN), inframammary fold to nipple distance (IMFN), and body mass index (BMI) was assessed. Regression analysis demonstrated a strong correlation between resection weight and SNN distance (r = 0.672, P < 0.001), IMFN distance (r = 0.467, P < 0.001), and BMI (r = 0.510, P < 0.001). The strongest correlation was observed after incorporating all 3 parameters (r = 0.740, P < 0.001). This enabled the calculation of a formula to predict resection weight: Predicted weight = 40.0(SNN) + 24.7(IMFN) + 17.7(BMI) - 1443 In conclusion, resection weight correlates strongly with SNN, IMFN, and BMI in patients undergoing reduction mammaplasty. When considered together, resection weight can be predicted with a strong degree of accuracy.

Setting up your office for clinical photography.

Most clinical photographs utilized in a plastic surgical practice are taken in the office setting, primarily to document surgical results. This article will discuss the various ways that the office environment can be optimized for clinical photography.

Clinical photography for the plastic surgery practice--the basics.

Accurate clinical photography is essential in today's plastic and reconstructive surgery practice. Quality photographs are a reflection of the care and attention to detail exhibited in the plastic surgery practice, and there should be no excuse for poor quality clinical photographs. This article presents basic photographic principles. The next article will discuss the office environment and steps to set up a photographic studio.

The effect of weight loss surgery and body mass index on wound complications after abdominal contouring operations.

Abdominal contouring operations are in high demand after massive weight loss. Anecdotally, wound problems seemed to occur frequently in this patient population. Our study was designed to delineate risk factors for wound complications after body contouring. Our retrospective institutional analysis was assembled from 222 patients between 2001 and 2006 who underwent either abdominoplasty (N = 89) or panniculectomy (N = 133). Weight loss surgery (WLS) before body contouring occurred in 63% of our patients. Overall the wound complication rate in these patients was 34%: healing-disturbance 11%, wound infection 12%, hematoma 6%, and seroma 14%. WLS patients had an increase in wound complications overall (41% vs. 22%; P < 0.01) and in all categories of wound complications compared with non-WLS-patients by univariate methods of analysis. In a multivariate regression model, only American Society of Anesthesiologists Physical Status Classification was a significant independent risk factor for wound complications. In conclusion, WLS patients are at increased risk for wound complications and American Society of Anesthesiologists Physical Status Classification is the most predictive of risk.

Autologous breast reconstruction: the Vanderbilt experience (1998 to 2005) of independent predictors of displeasing outcomes.

BACKGROUND: Optimal surgical outcomes are dependent on an appreciation of comorbid conditions that may handicap results. The purpose of this retrospective analysis was to delineate risk factors for complications after autologous breast reconstruction. STUDY DESIGN: An institutional database was constructed of patients who underwent autologous breast reconstruction from 1998 to 2005. Variables captured included age, diabetes and smoking status, prereconstruction radiation therapy, concomitant breast resection, preoperative albumin, flap type, and body mass index (BMI; based on World Health Organization classifications: BMI>25, overweight; >30, obese). The primary outcome was noninfectious wound complications (NIWC), a novel classification based on the extent of tissue derangement and need for operative intervention. Secondary outcomes were wound infection, hematoma, hernia, and fat necrosis. Statistical analysis was performed using chi-square tests and multiple logistic regression. RESULTS: The analysis included 200 flaps (transverse rectus abdominis myocutaneous [TRAM]=171; latissimus dorsi=29) in 180 patients. There were 19 infections (9.5%), 3 total flap losses (1.5%), 14 hematomas (7%), and 11 donor-site hernias (6%). The incidences of fat necrosis and any NIWC were 18% and 36%, respectively. Mean followup was 13.1 months (range 1.1 to 51.7 months). Multiple logistic regression demonstrated that obesity (BMI>30) is a statistically significant independent risk factor for any NIWC (hazards ratio=6.58; 95% CI, 2.85 to 15.18; p < 0.01) and for NIWC requiring operative treatment (NIWC>or=3; hazard ratio=6.23; 95% CI 2.15 to 18.05; p < 0.01). Increased BMI predicts NIWC, NIWC requiring operative intervention, and wound infection (p < 0.01). CONCLUSIONS: These data suggest that obesity is a strong predictor of simple and complex NIWC and of wound infection after autologous breast reconstruction. Obese patients should be counseled about their significantly increased risk of experiencing these unwanted outcomes.

Photography and plastic surgery: part 1.

Plastic surgery and photography are inseparable and with present-day technology, it is much easier and more affordable than ever before to incorporate high-quality and standardized images into clinical practice. Perfecting digital photography can have a learning curve that is many times hindered by old habits from the days of slide photography, macro lenses, and specialized flashes, which made it more difficult and complex to incorporate into a busy plastic surgery practice. With the current digital revolution, many of these barriers have been or can be eliminated and anyone can become a proficient photographer. The purpose of this article, first in a series, is to introduce the plastic surgical nurse to the history of photography and applications and the benefits of digital photography.

Hybrid ventricular assist device: Heartmate XVE LVAD and Abiomed AB5000 RVAD.

The need for a right ventricular assist device following an implantable left ventricular assist device creates a complex situation for the surgeon, nursing staff, and the patient. The purpose of this report is to describe the rationale, technical, and perioperative issues of a hybrid ventricular assist device consisting of a Heartmate XVE (Thoratec, Inc., Pleasonton, CA) left ventricular assist device and Abiomed AB5000 right ventricular assist device (Abiomed, Inc., Danvers, MA).

Argatroban as a primary or secondary postoperative anticoagulant in patients implanted with ventricular assist devices.

BACKGROUND: We describe our experience with argatroban as a primary or secondary postoperative anticoagulant to heparin in patients receiving ventricular assist devices. METHODS: This is a retrospective review of all Abiomed (BVS5000, AB5000) and Thoratec (PVAD and IVAD) ventricular assist devices from May 2003 through May 2006 at a single institution. Postoperatively, patients received either heparin or argatroban as their anticoagulant. Patients in whom heparin-induced thrombocytopenia was suspected or confirmed were converted from heparin to argatroban. RESULTS: There were 33 Abiomed and Thoratec ventricular assist devices implanted. Thirteen patients received heparin as their primary postoperative anticoagulant; 8 of the 13 were converted to argatroban as a secondary anticoagulant (hep-arg), and 5 patients remained with heparin as their only anticoagulant. Twenty patients received argatroban as their primary and only postoperative anticoagulant. Thrombocytopenia occurred in 26 patients (79%) overall, 16 (80%) with argatroban only, 6 (75%) with hep-arg, and 4 (80%) with heparin only. Thromboembolic events occurred in 5 patients (15%) overall, 3 (15%) with argatroban only, 1 (13%) with hep-arg, and 1 (20%) with heparin only. Postoperative bleeding requiring reexploration occurred in 5 patients overall (15%), 1 with argatroban only (5%), 3 (38%) with hep-arg, and 1 (20%) with heparin only. Enzyme-linked immunosorbent assay heparin-induced thrombocytopenia tests were positive in 7 patients overall (21%), 5 (25%) with argatroban only, 2 (25%) with hep-arg, and 0 (0%) with heparin only. CONCLUSIONS: Argatroban is a comparable primary or secondary anticoagulant to heparin postoperatively in patients receiving ventricular assist devices.

Postcardiotomy cardiogenic shock: the role of ventricular assist devices.

Postcardiotomy cardiogenic shock (PCCS) remains a life-threatening complication of cardiac surgery. Although survival rates have doubled in the past decade, PCCS continues to result in significant morbidity and mortality. Factors contributing to improved outcomes include early recognition of shock, early application of ventricular assist device (VAD) technology in cases of refractory shock, better technology, better surgical application (less technical error), application of treatment protocols, and assignment of management to specially trained personnel. A systematic approach to the management of PCCS can facilitate consistent care. This same approach can be applied to all forms of shock. VAD technology provides an opportunity for survival when other medical and surgical options fail.

Cardiogenic shock: collaboration between cardiac surgery and cardiology subspecialties to bridge to recovery.

Acute cardiogenic shock is a lethal condition that results in death from myocardial failure, arrhythmia, or combinations of both. Aggressive medical, surgical, and interventional maneuvers have helped reduce the mortality. For the most advanced cases, ventricular assist devices have been used for persistent shock states. The purpose of this report is to describe the collaboration between cardiac surgery and cardiology subspecialty in an effort to promote native heart recovery in a complex case of cardiogenic shock requiring coronary artery bypass surgery, percutaneous coronary intervention, ventricular ablative therapy, and mechanical cardiac support.

Incorporation of an in-line filter for ultrafiltration or hemodialysis to the Abiomed BVS5000 ventricular assist device.

Multiple organ system dysfunction is an associated finding in patients requiring acute ventricular assist device (VAD) support. In the setting of acute renal failure, percutaneous catheters are placed for hemodialysis and/or ultrafiltration. Incorporation of an ultrafiltration or hemodialysis system in the Abiomed BVS5000 VAD circuit is a simple maneuver that eliminates the need for an additional catheter, thereby reducing the vascular and infectious complications associated with these catheters. We recommend splicing connectors into the outflow tubing of the right VAD circuit for attachment to an ultrafiltration or hemodialysis unit. This technique is a safe, simple, and reliable method by which to perform intermittent or continuous ultrafiltration or hemodialysis.

The Thoratec Implantable Ventricular Assist Device (IVAD): initial clinical experience.

BACKGROUND: The Thoratec Implantable Ventricular Assist Device (IVAD) is the only FDA-approved intracorporeal biventricular cardiac assist device. It is a titanium-coated version of its predecessor, the Paracorporeal Ventricular Assist Device (PVAD). The blood pump is compatible with the portable TLC-II driver, making home discharge feasible. METHODS: Nine consecutive patients were implanted with the IVAD from June 2005 through March 2006. The indications for support were acute heart failure in 6 cases and chronic heart failure in 3 cases. All patients were managed with maximal medical therapies including intravenous inotropic drugs prior to implant. RESULTS: All patients survived the surgical implant. Six patients were considered successful: 3 patients discharged to home and subsequently received transplantation, 2 are awaiting transplantation (1 at home and 1 in-house), and 1 patient was successfully explanted. Three patients expired postoperatively because of multiple organ system failure (2 patients) and pulmonary hemorrhage (1 patient). There were no device malfunctions. There was 1 localized driveline site infection and 1 thromboembolic event with partial visual loss. CONCLUSIONS: The IVAD is a unique device capable of providing uni- or bi-ventricular support for either acute or chronic heart failure conditions. Its versatility permits bridge to transplant or recovery options. Home discharge is feasible.

Effect of augmentation mammaplasty on breast sensation.

BACKGROUND: Studies of alterations in breast sensibility after augmentation mammaplasty have produced conflicting results. Such discrepancies may be attributed to unsophisticated measuring devices used in earlier studies leading to less accurate measurements and to the comparison of results to different surgical techniques. The primary purpose of our study was to conduct a prospective clinical trial to quantify specific sensory outcomes before and after submuscular breast augmentation. METHODS: Preoperative and postoperative questionnaires were used to assess patients' subjective observations on breast sensation. Quantitative data were collected using a very accurate device, the Pressure-Specified Sensory Device, to assess objective breast sensation. Thirty-three micromastia patients underwent quantitative measurements preoperatively (baseline), at 2 to 4 weeks and 6 months postoperatively to assess breast sensitivity. RESULTS: The quantitative data showed similar patterns of sensory change between both the periareolar and the inframammary surgical approach over time. The inferior region was the only region that showed a diminished sensitivity threshold of 9.5 +/- 2.9 gm/mm2 for the inframammary incision, a significantly poorer average than the periareolar incision of 1.7 +/- 0.6 gm/mm2 with p = 0.008 at 6 months. Older patients had significantly higher thresholds of sensitivity compared with younger patients (p < 0.02). CONCLUSIONS: Our study suggests that the periareolar incision may produce less sensory loss in the lower pole of the breast when compared with the inframammary incision. The outcome of this study provides both the surgeon and the patient with concrete information regarding mammary sensation after augmentation mammaplasty and leads to a better informed-consent process.

The lived experience of NCLEX failure.

Educators help coach, focus, and prepare students for the National Council Licensure Examination (NCLEX), but often fall short in providing support when graduates are not successful. Most research to date has focused solely on predicting failure, with little to no attention given to interventions after failure. This study presents the voices of unsuccessful candidates, their responses to failure, their perspectives of the factors that contributed to their failure, and the changes they made that led to subsequent success. The results demonstrate common themes related to the failure experience, successful remediation strategies for retesting, and recommendations for faculty interventions during this vulnerable period. Nurse educators have a responsibility to identify, inform, and intervene with students who are at high risk of failing the NCLEX, and this responsibility is executed capably. However, the role extends beyond graduation. The responsibility to help nursing graduates transition from failure to licensure is the final step of successful undergraduate nursing education.