Facial transplantation: historical developments and future directions

2015 ◽  
Vol 129 (3) ◽  
pp. 206-211 ◽  
Author(s):  
G L Garrett ◽  
I Beegun ◽  
A D'souza
Keyword(s):  
Functional Outcomes ◽  
Ethical Issues ◽  
Infectious Complications ◽  
Future Directions ◽  
Facial Transplantation ◽  
The Social ◽  
Bibliographic Search ◽  
Historical Developments

AbstractObjective:To present the clinical outcomes obtained by the first facial transplant teams worldwide, reviewing current practice and addressing controversies.Methods:A bibliographic search of Medline and Embase databases was performed, and a comparative analysis of all articles published from 1980 to the present was conducted. Two independent investigators screened the manuscripts in accordance with pre-defined criteria.Results:A total of 12 partial and 5 full facial transplants were recorded in the literature. Procedures included partial and near-total facial myocutaneous flaps, and complex osteomyocutaneous grafts. Fifteen patients had fully vascularised grafts, and two patients died of transplant-related and infectious complications.Conclusion:Facial transplantation can restore quality of life and enable the social re-integration of recipients. Results published by the first facial transplant teams are promising. However, long-term reports of aesthetic and functional outcomes are needed to more precisely define outcomes. In addition, significant technical, medical and ethical issues remain to be solved.

scholarly journals Long-term Quality of Life and Gastrointestinal Functional Outcomes After Pancreaticoduodenectomy

2018 ◽  
Vol 268 (4) ◽  
pp. 657-664 ◽  
Author(s):  
Casey J. Allen ◽  
Danny Yakoub ◽  
Francisco Igor Macedo ◽  
Austin R. Dosch ◽  
Jessica Brosch ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Outcomes

Neurologic Complications in Patients with Cancer

2021 ◽  
Vol 41 (05) ◽  
pp. 588-605
Author(s):  
Kathryn B. Holroyd ◽  
Daniel B. Rubin ◽  
Henrikas Vaitkevicius
Keyword(s):  
Functional Outcomes ◽  
Malignant Lesion ◽  
Neurologic Complications ◽  
Systemic Complications ◽  
Neurologic Symptoms ◽  
Patients With Cancer ◽  
Mechanistic Approach ◽  
Underlying Pathophysiology

AbstractNeurologic symptoms are commonly seen in patients with cancer and can be among the most challenging to diagnose and manage. It is often difficult to determine if new neurologic symptoms are secondary to direct effects of a malignant lesion, systemic complications of disease, paraneoplastic disorders, or side effects of cancer treatment itself. However, early diagnosis and treatment of each of these conditions can improve patients' quality of life and long-term functional outcomes. In this review, we describe a systematic approach to the diagnosis of new neurologic symptoms in patients with known malignancy. We have categorized the neurologic complications of cancer through a mechanistic approach, with an emphasis on ascertaining underlying pathophysiology to guide treatment choice. This review focuses on the acute neurologic complications of cancer that require hospital admission.

Oncofertility

2021 ◽  
pp. 136-150
Author(s):  
Bruno Ramalho de Carvalho ◽  
Jhenifer Kliemchen Rodrigues ◽  
Teresa K. Woodruff
Keyword(s):  
Ethical Issues ◽  
Survival Rates ◽  
Ethical Considerations ◽  
Death Rates ◽  
Functional Failure ◽  
Personal Level ◽  
After Cancer ◽  
Reproductive Consequences

Advances in cancer treatment, particularly chemotherapeutics, are expected to lead to significant improvements in survival rates. While cancer incidence and death rates are decreasing, quality of life after cancer may be reduced due to early functional failure of the gonads and, consequently, infertility, resulting from either the disease itself or its treatment. This chapter introduces clinicians to the new field of oncofertility and the ethical issues it raises. It will consider the situation of young cancer patients facing reproductive consequences globally, the retrieval of gametes or gonadal tissue from minors, and the use of these tissues long term. The field of oncofertility is new, but ethical considerations regarding reproductive interventions are old. Understanding how we approach these issues on a personal level and from the public’s perspective will be assessed in this chapter.

Transanal Ileal Pouch-Anal Anastomosis for Ulcerative Colitis has Comparable Long-Term Functional Outcomes to Transabdominal Approach: A Multicentre Comparative Study

2019 ◽  
Vol 14 (6) ◽  
pp. 726-733 ◽  
Author(s):  
Pramodh Chandrasinghe ◽  
Michele Carvello ◽  
Karin Wasmann ◽  
Caterina Foppa ◽  
Pieter Tanis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Functional Outcomes ◽  
Ileal Pouch ◽  
Cohort Analysis ◽  
Ileal Pouch Anal Anastomosis ◽  
Global Quality Of Life ◽  
Anal Anastomosis

Abstract Background The transanal approach to ileal pouch-anal anastomosis [Ta-IPAA] provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis [UC]. The aim of this study was to assess the long-term functional outcomes after Ta-IPAA vs transabdominal IPAA [Abd-IPAA] in UC. Methods A multicentre cohort analysis was performed between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL [Cleveland global quality of life] score at 12 months with a functioning pouch was considered the primary end point. Results A total of 374 patients [100 Ta-IPAA vs 274 Abd-IPAA] were included. Ta-IPAA demonstrated a comparable overall quality of life [CGQL score] to Abd-IPAA [0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p = 0.1]. Quality of life [7.71 ± 1.17 vs 7.30 ± 1.46; p = 0.04] and energy-level items [7.16 ± 1.52 vs 6.66 ± 1.68; p = 0.03] were significantly better after Ta-IPAA, while the quality of health item was comparable [7.68 ± 1.26 vs 7.64 ± 1.44; p = 0.96]. Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies [>10/24 h: 22% vs 21%; p = 1.0] and the rate of a single episode of major incontinence during the following 12-month period [27% vs 26%; p = 0.89] were similar. The differences in 30-day morbidity rates [33% vs 41%; p = 0.2] and anastomotic leak rates were not significant [6% vs 13%; p = 0.09]. Conclusions This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.

scholarly journals Polish Transition towards Circular Economy: Materials Management and Implications for the Construction Sector

Materials ◽  
2020 ◽  
Vol 13 (22) ◽  
pp. 5228 ◽  
Author(s):  
Justyna Tomaszewska
Keyword(s):  
Construction Industry ◽  
Circular Economy ◽  
Resource Depletion ◽  
Construction Sector ◽  
Materials Management ◽  
Future Directions ◽  
The Social ◽  
Eu Policies ◽  
Energy Consuming

Poland’s economy as the sixth largest economy in the EU is painfully experiencing the effects of natural resource depletion, which extend to increasing prices and the growing dependence on foreign suppliers. The situation is particularly unfavorable in the construction sector, which is among the most resource- and energy-consuming areas of the economy. This paper juxtaposes the situation of Polish construction industry in the context of the national economy with the context of the evolving EU policies promoting green solutions. The resulting changes in Polish legislation, industry and society are identified. The implementation of selected Circular Economy (CE) aspects, outcomes, emerging challenges and future directions are discussed. The social aspects related to this transformation were analyzed based on a survey carried out among construction industry consumers. The results clearly highlight that individuals are aware of the need to protect the environment, but also indicate a strong necessity to educate the populace about the consequences of the excessive exploitation of the environment and the long-term benefits of CE solutions.

The long-term impact of preoperative psychological distress on functional outcomes, quality of life, and patient satisfaction after total knee arthroplasty

2020 ◽  
Vol 102-B (7) ◽  
pp. 845-851 ◽  
Author(s):  
Graham S. Goh ◽  
Ming Han Lincoln Liow ◽  
You Wei Adriel Tay ◽  
Jerry Yongqiang Chen ◽  
Sheng Xu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Psychological Distress ◽  
Functional Outcomes ◽  
Knee Score ◽  
Sf 36 ◽  
Total Knee

Aims While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years’ follow-up. Methods Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and Physical Component Summary (PCS) which were derived from the 36-Item Short-Form Health Survey questionnaire (SF-36). Patients were stratified into those with psychological distress (MCS < 50, n = 51) and those without (MCS ≥ 50, n = 71). Multiple regression was used to control for age, sex, BMI, Charlson Comorbidity Index (CCI), and baseline scores. The rate of expectation fulfilment and satisfaction was compared between patients with low and high MCS. Results There was no difference in the mean KSKS, KSFS, OKS, and SF-36 PCS at two years or ten years after TKA. Equal proportions of patients in each group attained the minimal clinically important difference for each score. Psychologically distressed patients had a comparable rate of satisfaction (91.8% (47/51) vs 97.1% (69/71); p = 0.193) and fulfilment of expectations (89.8% vs 97.1%; p = 0.094). The proportion of distressed patients declined from 41.8% preoperatively to 29.8% at final follow-up (p = 0.021), and their mean SF-36 MCS improved by 10.4 points (p < 0.001). Conclusion Patients with poor mental health undergoing TKA may experience long-term improvements in function and quality of life that are comparable to those experienced by their non-distressed counterparts. These patients also achieved a similar rate of satisfaction and expectation fulfilment. Undergoing TKA was associated with improvements in mental health in distressed patients, although this effect may be due to residual confounding. Cite this article: Bone Joint J 2020;102-B(7):845–851.

scholarly journals Ethical issues related to eHealth: An integrative review

2020 ◽  
pp. 096973302094576
Author(s):  
Anu Jokinen ◽  
Minna Stolt ◽  
Riitta Suhonen
Keyword(s):  
Social Care ◽  
Ethical Issues ◽  
Empirical Studies ◽  
Cochrane Library ◽  
Service Users ◽  
The Social ◽  
User Access ◽  
Ehealth Services ◽  
Academic Search

Background: Identifying and safeguarding ethics in eHealth services from the service users’ perspective in social care and healthcare is important. The use of eHealth services should not prejudice the quality of services or the social interaction required in care. There is a lack of studies about the ethics of eHealth services from the service users’ perspective. Aim: The aim of this study is to identify and analyse ethical issues related to eHealth in social care and healthcare from the service users’ perspective. Research design: An integrative literature review. Ethical considerations: The review followed good scientific conduct. Research context and data sources: A systematic literature search was performed using CINAHL, Scopus, PubMed/MEDLINE, Web of Science, Cochrane Library and Academic Search Premier to find relevant empirical studies published in English from their earliest up to 30 November 2018. In addition, reference lists from the identified research papers were searched. A quality appraisal of each paper included in the review was conducted before thematic analysis. Results: In total, 26 studies were included in the review, and from these four ethical themes were identified: (1) privacy in eHealth, (2) beneficence and nonmaleficence in eHealth, (3) justice in eHealth and (4) trust in eHealth. The ethical issues within these themes were related to information sharing; ownership; access to information and data protection; informed consent; defence of rights; and equity, equality and proportionality of response. Conclusion: eHealth inequality occurs in social care and healthcare. eHealth service designers and social care and healthcare professionals need to act to maintain and improve user access and data accuracy and provide different levels of security in eHealth services, relative to the information stored. There is a need for further research about ethical issues of eHealth from the user’s perspective, including the customer-oriented availability and usability of eHealth services which avoid discrimination.

scholarly journals Long-term functional outcomes and quality of life in adult survivors of childhood extremity sarcomas: a report from the St. Jude Lifetime Cohort Study

2016 ◽  
Vol 11 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Israel Fernandez-Pineda ◽  
M. M. Hudson ◽  
A. S. Pappo ◽  
M. W. Bishop ◽  
J. L. Klosky ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Functional Outcomes ◽  
Adult Survivors
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