Improving aesthetic outcomes after head and neck reconstruction.

PURPOSE OF REVIEW: Tremendous advancements have been made in head and neck reconstruction following oncologic resection. Despite this, many patients are left with disfiguring postoperative changes. The focus of this review highlights various techniques aimed at improving aesthetic outcomes following head and neck cancer therapy, with a focus on liposuction and fat augmentation. RECENT FINDINGS: Over the past decade, the use of liposuction in treating lymphedema after head and neck cancer therapy has showed promising results. Owing to great improvements in harvesting and purification techniques, fat augmentation has been effectively utilized in correcting a wide array of defects. Although free tissue transfer is frequently used in head and neck reconstruction, there is a scarcity of literature on the indications for flap revision procedures. SUMMARY: Head and neck reconstructive surgery can lead to significant cosmetic and functional morbidity. Several tools are available to help improve aesthetic outcomes in this patient population. A thorough understanding of the various techniques and their indications is essential for achieving optimal results.Video abstract available: See the Video Supplementary Digital Content 1, http://links.lww.com/COOH/A34.

Analytically exploiting noise correlations inside the feedback loop to improve locked-oscillator performance.

We introduce concepts from optimal estimation to the stabilization of precision frequency standards limited by noisy local oscillators. We develop a theoretical framework casting various measures for frequency standard variance in terms of frequency-domain transfer functions, capturing the effects of feedback stabilization via a time series of Ramsey measurements. Using this framework, we introduce an optimized hybrid predictive feedforward measurement protocol that employs results from multiple past measurements and transfer-function-based calculations of measurement covariance to improve the accuracy of corrections within the feedback loop. In the presence of common non-Markovian noise processes these measurements will be correlated in a calculable manner, providing a means to capture the stochastic evolution of the local oscillator frequency during the measurement cycle. We present analytic calculations and numerical simulations of oscillator performance under competing feedback schemes and demonstrate benefits in both correction accuracy and long-term oscillator stability using hybrid feedforward. Simulations verify that in the presence of uncompensated dead time and noise with significant spectral weight near the inverse cycle time predictive feedforward outperforms traditional feedback, providing a path towards developing a class of stabilization software routines for frequency standards limited by noisy local oscillators.

Coupled optical resonance laser locking.

We have demonstrated simultaneous laser frequency stabilization of a UV and IR laser, to coupled transitions of ions in the same spectroscopic sample, by detecting only the absorption of the UV laser. Separate signals for locking the different lasers are obtained by modulating each laser at a different frequency and using lock-in detection of a single photodiode signal. Experimentally, we simultaneously lock a 369 nm and a 935 nm laser to the (2)S(1/2) → (2)(P(1/2) and (2)D(3/2) → (3)D([3/2]1/2) transitions, respectively, of Yb(+) ions generated in a hollow cathode discharge lamp. Stabilized lasers at these frequencies are required for cooling and trapping Yb(+) ions, used in quantum information and in high precision metrology experiments. This technique should be readily applicable to other ion and neutral atom systems requiring multiple stabilized lasers.

Prevalence and clinical presentation of HIV positive female psychiatric inpatients.

OBJECTIVE: Literature on the prevalence and clinical presentation of South African psychiatric HIV positive patients as well as their management is lacking. This study was performed to investigate these parameters. METHOD: A prospective study to investigate the prevalence and clinical presentation of HIV positive psychiatric female patients admitted to an acute ward (female psychiatric ward Cecilia Makiwane Hospital, East London Hospital Complex) was undertaken for a one year period from June 2009 to May 2010. Additional factors such as demographic profile, associated substance abuse, pre-existing psychiatric disorders and management were also studied. RESULTS: During this one year period 158 female patients were admitted to the acute female psychiatric ward for assessment and treatment. Of these 158 admissions 21 (13%) were HIV positive, but only 19 (12%) consented to the study. Ten of the 19 HIV positive patients (53%) had an Axis I diagnosis of a psychiatric disorder secondary to HIV, most commonly mood disorder (mania) with psychotic symptoms. Nine of the 19 HIV positive patients (47%) had a pre-existing primary psychiatric diagnosis, most commonly Bipolar Disorder, recent episode mania with psychotic symptoms. The most common psychotic symptoms were grandiose delusions followed by auditory hallucinations, paranoid delusions and visual hallucinations. The most common mood symptom was euphoria. Substance abuse was uncommon amongst the patients in the study group. Sixteen of the 19 patients (84%) were on antipsychotics, 14 of these 16 patients were on haloperidol. The most commonly used mood stabilizer was sodium valproate. CONCLUSION: In this study mania with psychotic symptoms was the most common presentation in both the group with a pre-existing primary psychiatric disorder and in the group without a primary psychiatric disorder. The prevalence of HIV positive admitted psychiatric females in this study was 12%. Co-morbid substance abuse was uncommon. Most patients tolerated low doses of typical antipsychotics in combination with a mood stabilizer (valproate being the most common).

Phase-coherent detection of an optical dipole force by Doppler velocimetry.

We report phase-coherent Doppler detection of optical dipole forces using large ion crystals in a Penning trap. The technique is based on laser Doppler velocimetry using a cycling transition in 9Be+ near 313 nm and the center-of-mass (COM) ion motional mode. The optical dipole force is tuned to excite the COM mode, and measurements of photon arrival times synchronized with the excitation potential show oscillations with a period commensurate with the COM motional frequency. Experimental results compare well with a quantitative model for a driven harmonic oscillator. This technique permits characterization of motional modes in ion crystals; the measurement of both frequency and phase information relative to the driving force is a key enabling capability--comparable to lockin detection - providing access to a parameter that is typically not available in time-averaged measurements. This additional information facilitates discrimination of nearly degenerate motional modes.

Decoherence due to elastic Rayleigh scattering.

We present theoretical and experimental studies of the decoherence of hyperfine ground-state superpositions due to elastic Rayleigh scattering of light off resonant with higher lying excited states. We demonstrate that under appropriate conditions, elastic Rayleigh scattering can be the dominant source of decoherence, contrary to previous discussions in the literature. We show that the elastic-scattering decoherence rate of a two-level system is given by the square of the difference between the elastic-scattering amplitudes for the two levels, and that for certain detunings of the light, the amplitudes can interfere constructively even when the elastic-scattering rates from the two levels are equal. We confirm this prediction through calculations and measurements of the total decoherence rate for a superposition of the valence electron spin levels in the ground state of 9Be+ in a 4.5 T magnetic field.

Organ donation and transplantation within the Zulu culture.

Greater knowledge and technological advancement in the field of transplantation has increased the demand for organ donation beyond the supply of organs, especially among the black communities. This imbalance arises from the few sources of organs, limitations on the techniques of organ retrieval, disparities in the allocation of organs and socio-cultural factors. The aim of this study was to investigate the extent to which Zulu cultural norms and social structures influence an individual's decision to donate an organ or to undergo transplantation. A qualitative approach using an ethno-nursing method was selected. Semi-structured interviews were conducted with a transplant co-ordinator representing the professional sector, with traditional healers and religious leaders representing the folk sector, and with the general public representing the popular sector of the health care system. Both urban and rural settings were used. Conclusions arrived at showed that knowledge was lacking among Zulu speaking people about organ donation and transplantation and misconceptions about the topic were related to Zulu life patterns, beliefs about death, burial and life hereafter, and values and social structures. Recommendations with regard to the promotion of organ donation and transplantation among Zulu speaking people were made based on culture-sensitive and culture-congruent principles.

Organ donation: attitude and knowledge of nurses in South Africa.

Various factors influence the process of organ donation. As a result, there is a shortage of organs for transplant. Poor communication and cooperation between transplant coordinators and intensive care nursing staff can lead to the non-referral of potential organ donors, which is detrimental to the process. The purpose of this research was to ascertain the attitude and knowledge of the transplant coordinators and intensive care nursing staff that work in intensive care units during organ donation. Contextual descriptive research was carried out by compiling literature-based questionnaires, one each for the transplant coordinators and intensive care nursing staff, and then analysing responses. The indications are that problem areas exist between the role players in the organ transplant process. Guidelines were drawn up for the improvement of communication and cooperation between them in order to promote organ donation.

Malaria. A challenge for the haemodialysis and intensive care nurse.

Malaria is the world's most important tropical parasitic disease. In many developing countries, and Africa in particular, malaria exacts an enormous toll in lives, medical costs, and days of lost labour. Through the use of case studies, this paper explores the effects of malaria and the patient management by the haemodialysis and intensive care nurse. All malaria cases admitted to an intensive care unit, and treated by means of haemodialysis or continuous-veno-veno-haemodiafiltration were analysed. Specific problems identified were impaired fluid and biochemical control, acid-base imbalance, disseminated intra vascular coagulation, adult respiratory distress syndrome, and haemodynamic instability. Guidelines were compiled for the nursing management of these complicated malaria cases.

Leadership development in a nursing service. A South African ethnographic perspective.

Leadership development at operational level in a nursing service is important to cope with all the transformation required. The purpose with this study is to explore and describe the views of black professional nurses on leadership behaviour, within the context of an operating theatre department, and to determine the influence of their occupational history on these views. An exploratory and descriptive research design, with an ethnographic perspective, was employed by means of semi-structured interviews (views on leadership) and questionnaires (occupational history). The results compare positively with the theoretical description of leadership behaviour. Guidelines for leadership development of these nurses were formulated, and should be followed by the necessary capacity building regarding leadership practice by professional nurses.

[Nurses' and patients' experience of combined health service delivery to all population groups in a hospital]. / Verpleegkundiges en pasiënte se belewenis van gesamentlike gesondheidsdienslewering aan alle bevolkingsgroepe in 'n hospitaal'.

In a community hospital in Gauteng, the hospital management had, on short notice, to provide combined health services to all population groups. In the past different health services were delivered to each population group. The integration of health service delivery was a sudden change. Based on this, research questions arose, namely: how do nurses and patients experience this change, and how could they be assisted to adjust to the change. The research objectives were twofold, namely: to explore and describe nurses and patients' experience of combined health delivery to all population groups and based on the results to make recommendations to assist them with adjustment to a combined health delivery system. An exploratory, descriptive and contextual research design was followed. Trustworthiness was ensured by applying Guba's approach. Phenomenological and individual focus interviews were conducted with forty nurses and patients who were selected purposively. Field notes were written after completion of each interview. The transcribed data was analysed by using Giorgi's and Kerlinger's methods combined. Results were discussed and a literature control completed. The most important conclusions reached were: there was an insufficient administrative structure in the hospital as a result of insufficient preparation for the combined health service delivery for all population groups; the whites' perception of different populations groups is based on an ethnocentric Western approach. This led to their experience of culture shock that resulted in feelings of anger/frustration, fear and sadness; the willingness of other populations groups to adjust to combined health service delivery led to their experience of happiness; there exists communication problems between population groups because of their not being able to communicate in their own language and the difference in communication styles; the verbalised Christian viewpoint and values of whites nurses and patients are not congruent with their prejudiced perception of people of other population groups and cultures, and the different population groups do not know each other's lifeworlds and that leads to prejudices that block open communication. Several recommendations were made based on these conclusions.

[Support systems for patients with coronary bypass]. / Ondersteuningstelsels vir koronêre vaatomleidingspasiënte.

The rehabilitation of the coronary artery bypass patient should be a continuation of the contact which exists during the hospitalisation phase, with specific reference to the pre-discharge phase. As a member of the health team, the nurse makes the most input during this phase because she is the one who is in constant contact with the patient and his family. The purpose of this study is to determine, by means of set criteria and within a nursing perspective, the contributions that are made by various support groups to the rehabilitation of persons who have undergone coronary artery bypass surgery. The study is based on a contextual, descriptive method. The inputs and importance of available support groups in the community have been determined by means of a survey method. Results of pre-discharge preparation programmes showed that no structured programme is followed by health institutions and that existing support groups are not fully utilised. Nursing staff also contribute very little towards such a programme.

[The effect of preoperative teaching on the emotional attitude of patients undergoing coronary bypass surgery]. / Die uitwerking van pre-operatiewe onderrig op die emosionele ingesteldheid van pasiënte wat koronêre vaatomleidingchirurgie ondergaan.

It appears that the emotions of patients in the process of undergoing coronary artery bypass graft surgery have an influence on the rate of mortality. The purpose of this study is to determine if the life-style functioning of the patients can be improved by means of a pre-operative rehabilitative educational programme introduced by the professional nurse. A conceptual framework of reference was compiled after completion of the literature review. This served as the preliminary structure of the pre-operative educational programme. The programme consists of three components, viz. an educational booklet, an educational evaluating model and the educationist. A quasi-experimental study was performed on 4 groups (2 experimental groups and 2 control groups) to determine the effect of the structured pre-operative educational programme on the following three factors: satisfaction with self, others and life; safe-guarding hope and anticipation of a future. An analysis of the data indicated a significant difference between the groups that followed the programme and the groups that did not follow the programme. The primary recommendation of the study is that all patients in the process of undergoing coronary artery bypass graft surgery should follow a pre-operative educational programme. This programme has a positive influence on the life-style functioning of the patient and will thus promote the process of rehabilitation.

A personnel profile of professional nurses in the J.D. Allen Operating Theatre Complex of Baragwanath Hospital.

In this exploratory descriptive study an attempt was made to develop a profile of professional nurses in the J.D. Allen operating theatre complex of Baragwanath hospital. Aspects of significance have been extracted from the analysed data and highlighted as trends, not only of demographic nature but also in nursing education and practice, with specific reference to operating theatre nursing. Problem areas have been indicated and recommendations suggested. This profile could be used as a staff development tool. It also would be possible to plan more rational staff structure considering future advances.