Superomedial Reduction Mammoplasty Affects Patients’ Ability to Breastfeed in a Distinct Manner: A Multicenter Study of 303 Patients

2021 ◽  
Author(s):  
Mads Gustaf Jørgensen ◽  
Elin Albertsdottir ◽  
Farima Dalaei ◽  
Jørgen Hesselfeldt-Nielsen ◽  
Volker-Jürgen Schmidt ◽  
...  
Keyword(s):  
Reduction Mammoplasty ◽  
Cross Sectional Study ◽  
Demographic Information ◽  
Childbearing Age ◽  
Breast Hypertrophy ◽  
Cross Sectional ◽  
Breast Parenchyma ◽  
Inferior Portion ◽  
Before And After ◽  
Tertiary Hospitals

Abstract Background Breast reduction using the superomedial technique can relieve symptoms related to breast hypertrophy; however, as the lateral and inferior portion of the breast parenchyma is removed and displaced, reduction mammoplasty may lead to an impaired ability to breastfeed. Objectives To assess the patient's ability to breastfeed after superomedial reduction mammoplasty. Methods This was a cross-sectional study including patients treated with superomedial reduction mammoplasty between January 2009 and December 2018 at two tertiary hospitals in Denmark. Patients were stratified into two cohorts, depending on whether they had childbirth before or after their reduction mammoplasty. Patients were sent specific questionnaires regarding maternity, breastfeeding before and after reduction mammoplasty, nipple sensitivity, and current demographic information. Operative details were retrieved from electronic medical records. Results We identified 303 patients eligible for this study (37 patients giving birth after and 266 before reduction mammoplasty). Fewer patients were able to breastfeed exclusively for the recommended six months after reduction mammoplasty (2/37 = 5.41%) compared to before (92/266 = 34.59%, p<0.05). Also, fewer patients were able to breastfeed at all after reduction mammoplasty (18/37 = 48.64%) compared to before mammoplasty (241/266 = 90.60%, p<0.001). Patients unable to breastfeed after reduction mammoplasty had less nipple sensitivity and more breast tissue excised (p<0.05). Conclusions Superomedial reduction mammoplasty seems to impair the patient's ability to breastfeed exclusively for the recommended 6 months. Patients of childbearing age considering reduction mammoplasty should be made aware that reduction mammoplasty reduces their breastfeeding capacity.

scholarly journals Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 747
Author(s):  
Sahbanathul Missiriya Jalal ◽  
Fahima Akhter ◽  
Amal Ismael Abdelhafez ◽  
Ahmed Mansour Alrajeh
Keyword(s):  
Work Experience ◽  
Healthcare Professionals ◽  
Cross Sectional Study ◽  
Demographic Variables ◽  
Cross Sectional ◽  
Biomedical Waste ◽  
Respiratory Therapists ◽  
Global Pandemic ◽  
Before And After ◽  
Knowledge Practice

Biomedical waste (BMW) management is an essential practice of healthcare professionals (HCPs) for preventing health and also environmental hazards. Coronavirus disease (COVID-19) has become a global pandemic, posing significant challenges for healthcare sectors. A cross-sectional study was performed to assess the knowledge, practice, and attitude on BMW management among HCPs when taking care of patients with COVID-19 and associated with demographic variables. From Al-Ahsa healthcare sectors, 256 HCPs were selected randomly, of which 105 (41%) had excellent knowledge, 87 (34%) had good knowledge, and 64 (25%) had poor knowledge with a mean score of 13.1 ± 3.6. A higher mean score was (14.4 ± 3.2) obtained by physicians, and (13.6 ± 3.8) nurses than the other HCPs. Regarding practice, 72 (28.1%) HCPs used and discarded PPE while handling biomedical wastes. Additionally, 88 (34.4%) followed proper hand hygiene before and after each procedure and whenever needed. Physicians, nurses, and respiratory therapists had a more favorable attitude than other HCPs. There was a statistically significant association found among knowledge level and educational qualification (p < 0.0001), gender (p < 0.001), and work experience (p < 0.05). Emphasis is needed to train all HCPs regarding proper BMW management during this pandemic to prevent infection transmission.

scholarly journals 732. Evaulation of Micafungin Treatment at Pediatric Patients: A cross-sectional Study from Tertiary Pediatric Centre

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S416-S417
Author(s):  
Kamile Arıkan ◽  
Nuri Bayram ◽  
İlker devrim ◽  
Ayküke Akaslan-Kara
Keyword(s):  
Amphotericin B ◽  
Liver Function Tests ◽  
Cross Sectional Study ◽  
Resistance Rate ◽  
Sectional Study ◽  
Candida Spp ◽  
Cross Sectional ◽  
Median Serum ◽  
Before And After ◽  
Resistance Patterns

Abstract Background Micafungin is one of three currently available echinocandin for treatment of candidiasis and candidemia. Methods Children who were treated for micafungin for possible or proven invasive Candidia infection between May 2017 and October 2019 were included. Results In this cross-sectional study, totally 78 children with a median age of 3 months (8 days -17 years), 50 (64.1%, F/M: 0.56) male were included. Thirty four (43.6%) patients were neonate, 26 (76 %) of them were premature. Thirty seven patients (47.4%) received micafungin for candidemia and 41 (52.6%) patients received micafungin empirically for IC. Twelve (32.4%) Candida spp cultured were C. albicans, the rest twenty five (67.6%) Candida spp were non-albicans Candida spp. The most commonly cultured Candida spp was Candida parapsilosis (C. parapsilosis) (n=13) followed by C. albicans (n=12), C. glabrata (n=3), C. tropicalis (n=3), C. guilliermondii (n=3), C. krusei (n=2) respectively. Resistance rate of C. parapsilosis (n=13) isolates to fluconazole, voriconazole, amphotericin B, caspofungin, micafungin were as follows respectively; 66.7%, 100%, 69.2%, 90.9%, 37.5% respectively. Resistance rate of C. albicans (n=11) isolates to fluconazole, voriconazole, amphotericin B, caspofungin, micafungin were as follows respectively; 50%, 50%, 12.5%, 42.9%, 0% respectively. None of the C. tropicalis, C. guilliermondii and C. krusei isolates were resistant to micafungin. Culture negativity could not be achieved at the end of 14th day of micafungin treatment in the 15 (16.9%) candidemia episodes. The most commonly isolated Candida spp in patients with treatment failure was C. parapsilosis (n=7), the other species were; C. albicans (n=5), C. guilliermondii (n=1), C. tropicalis (n=1) and C. tropicalis and C. guilliermondii coinfection (n=1) respectively. Median serum AST, ALT and creatinin levels didn’t increase during and at the end of micafungin therapy. None of these patients had experienced an anormal kidney or liver function tests due to micafungin usage. Characteristics of patients who received micafungin.and cultured Candida spp Antifungal resistance patterns of Candida spp. Laboratory change before and after micafungin treatment Conclusion Increase in fluconazole resistant Candida spp makes micafungin a reasonable and effective choice for suspected or proven invasive candidiasis Disclosures All Authors: No reported disclosures

scholarly journals Six ultraviolet minutes for cleaner operating theatres

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Bosco ◽  
S Gambelli ◽  
V Urbano ◽  
G Cevenini ◽  
G Messina
Keyword(s):  
Cross Sectional Study ◽  
Cross Sectional ◽  
Before And After ◽  
Operating Theatres ◽  
Cleaning Procedures ◽  
The Difference ◽  
Contamination Levels ◽  
Different Levels ◽  
Better Than ◽  
Final Cleaning

Abstract Background Sanitizing the operating theatres (OT) is important to minimize risk of post-operative infections. Disinfection procedures between one operation and another is less aggressive than final cleaning procedures, at the end of the day. Aim was assessing the difference of contamination: i) between different levels of disinfection; ii) before and after the use of a UVC Device (UVC-D). Methods Between December 2019/February 2020 a cross sectional study was conducted in OT in a real clinical context. 94 Petri dishes (PD) were used in 3 OT. Three different sanitation levels (SL1-3) were compared pre- and post-use of UVC-D: i) No cleaning after surgery (SL1); ii) after in-between cleaning (SL2); iii) after terminal cleaning (SL3). UVC-D was employed for 6 minutes, 3 minutes per bed side. PD were incubated at 36 °C and colony forming unit (CFU) counted at 48h. Descriptive statistic, Wilcoxon and Mann-Whitney tests were performed to assess the contamination levels in total, pre/post use of UVC-D, and between different sanitation levels, respectively. Results In total we had a mean of 3.39 CFU/PD (C.I. 2.05 - 4.74) and a median of 1 CFU/PD (Min. 0 - Max. 39), after UVC-D use we had a mean of 2.20 CFU/PD (C.I. 0.69 - 5.09) and a median of 0 CFU/PD (Min. 0 - Max. 133). The UVC-D led to a significant reduction of CFU (p &lt; 0.001). Without UVC-D we had a significant CFU drop (p &lt; 0.05) between SL1 and SL3. Using UVC-D, we observed significant reductions of contamination (p &lt; 0.05) between SL3 and SL1. Comparing SL1 (median 0) post UVC-D use vs SL2 pre UVC-D use (median 0.5), and SL2 post UVC-D use (median 0) vs SL3 pre UVC-D use (median 1) we had a significant reduction of contamination (p &lt; 0.05). Conclusions UVC-D improved environmental contamination in any of the three sanitation levels. Furthermore, the use of UVC-D alone was better than in-between and terminal cleaning. Although these encouraging results, the cleaning procedures executed by dedicated staff has to be considered. Key messages UVC are efficient to decrease contamination in operating theatres regardless of sanitation levels. The additional use of UVC technology to standard cleaning procedures significantly improves sanitation levels.

scholarly journals The Impact of Bariatric Surgery on Menstrual Abnormalities—a Cross-Sectional Study

2020 ◽  
Vol 30 (11) ◽  
pp. 4505-4509
Author(s):  
Anna Różańska-Walędziak ◽  
Paweł Bartnik ◽  
Joanna Kacperczyk-Bartnik ◽  
Krzysztof Czajkowski ◽  
Maciej Walędziak
Keyword(s):  
Bariatric Surgery ◽  
Menstrual Cycle ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Obese Women ◽  
Sectional Study ◽  
Cross Sectional ◽  
Contraception Use ◽  
Before And After ◽  
The Impact

Abstract Introduction Obesity is associated with hyperestrogenism along with other hormonal abnormalities affecting the menstrual cycle. The most effective and decisive method of obesity treatment is bariatric surgery. The aim of this study was to analyze the impact of bariatric surgery on menstrual cycle, the incidence of menstrual abnormalities, hyperandrogenism manifestation, and contraception use. Materials and Methods It was a cross-sectional study of 515 pre-menopausal women who had undergone bariatric surgery between 1999 and 2017 in a bariatric center. Data was collected via anonymous questionnaire, and the questions covered a 1-year period before the surgery and the last year before questionnaire completion. Results Before the surgery, 38.6% of the patients reported irregular menstruations in comparison with 25.0% after bariatric surgery (RR = 0.65; 95%CI 0.53–0.79). The mean number of menstruations per year did not differ before and after surgery (10.2 ± 3.9 vs 10.4 ± 3.3; p < .45). There were no statistically significant differences in terms of prolonged menstruations, acne, and hirsutism prevalence. A total of 14.4% of patients before surgery reported estrogen-based contraception use in comparison with 15.0% after the surgery (p < .95). There were no significant differences in the frequency of OC use (11.0% before surgery vs 13.6% 12 months after the surgery vs 11.5% at the moment of survey administration; p < 0.46). Conclusion Bariatric surgery improves the regularity of the menstrual cycle in obese women in reproductive age. The lack of any changes in the combined hormonal contraception (CHC) use, especially OC, before and after bariatric surgery may be a result of a possibly low level of contraception counseling.

What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

2020 ◽  
pp. 019459982096963
Author(s):  
Vanessa F. Torrecillas ◽  
Kaden Neuberger ◽  
Alexander Ramirez ◽  
Paul Krakovitz ◽  
Jeremy D. Meier
Keyword(s):  
Elective Surgery ◽  
Lag Time ◽  
Cross Sectional Study ◽  
Health Claims ◽  
Third Party ◽  
Prior Authorization ◽  
Cross Sectional ◽  
Before And After ◽  
The Mean ◽  
The Impact

Objective Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. Results A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types ( P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time ( P = .98). Conclusion A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

Phototherapy Induced Hypocalcemia in Neonates with Unconjugated Hyperbilirubinemia

2021 ◽  
Vol 11 (1) ◽  
pp. 4-8
Author(s):  
Amna Khan ◽  
Anila Farhat ◽  
Hamayun Anwar ◽  
Sajid Shamim ◽  
Mujeeb Ur Rehman ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
P Value ◽  
Cross Sectional ◽  
Unconjugated Hyperbilirubinemia ◽  
Before And After

Objective: To determine the frequency of hypocalcemia in neonates with unconjugated hyperbilirubinemia receivingphototherapy.Study design and setting: Cross sectional study conducted at neonatal intensive care unit, King Abdullah Teaching Hospital,Mansehra for one year from December 2017 to November 2018.Methodology: Total 213 full term stable neonates of either gender with jaundice were studied in this study. Out of which,143 with unconjugated hyperbilirubinemia were exposed to phototherapy while 70 neonates with exaggerated physiologicalhyperbilirubinemia taken as control were not exposed to phototherapy. Serum calcium level was determined through bloodtest before and after 24 hours of phototherapy. SPSS version 22 was used to analyze the data. Frequency and percentageswere used to describe categorical variables like gender and hypocalcemia. Hypocalcemia was stratified by age and genderto see effect modifiers. Post stratified chi-square test was applied in which p value = 0.05 was considered as significancevalue.Results: In study group, 143 neonates who received phototherapy had mean age of 7 days ± 2.62 SD. Total 65% neonateswere male and 35% neonates were female. Mean serum calcium level of neonates before and after provision of phototherapywas 9.28 mg/dl ± 0.23 and 8.54 mg/dl ± 0.68 respectively, which is statistically significant. The frequency of hypocalcemiawas 40% in neonates with unconjugated hyperbilirubinemia after 24 hours of phototherapy.Conclusion: Hypocalcemia is an important complication in neonates with unconjugated hyperbilirubinemia after continuousphototherapy. Hypocalcemia has clinical impact and adds to morbidity, and if left untreated, can lead to mortality.

scholarly journals Caregiver strain and quality of life 6 - 36 Months post stroke

2013 ◽  
Vol 69 (4) ◽  
Author(s):  
J. Hilton ◽  
W. Mudzi ◽  
V. Ntsiea ◽  
S. Olorunju
Keyword(s):  
Quality Of Life ◽  
High Strain ◽  
Well Being ◽  
Cross Sectional Study ◽  
Caregiver Strain ◽  
Sectional Study ◽  
Demographic Information ◽  
Cross Sectional ◽  
Post Stroke

Background: Caregivers of patients with stroke are central in providing for the patient’s needs post stroke. The well-being and quality of life of the caregiver is important in the rehabilitation of the patient with stroke. This study sought to establish the: functional level of patients, level of strain and quality of life of the caregiver, and the factors that influence caregivers’ quality of life six to 36 months post stroke. Methods: This was a cross-sectional study which included 35 patients six to 36 months post stroke and their primary caregiver utilising a sample of convenience from local clinics/hospitals in Johannesburg. Demographic information was obtained from the patient and the caregiver using a questionnaire. The Barthel Index (BI), Caregiver Strain Index (CSI) and the EQ-5D were also administered. Results: On the BI, 60% of the patients were moderately dependent to independent while 77% of the caregivers were strained. Older caregivers were 81% more likely to experience a decrease in quality of life than younger caregivers. Conclusion: A large proportion of patients are discharged from hospital without receving rehabilitation and are still dependent on caregivers six to 36 months post stroke. Caregivers of patients with stroke need more support from health professionals to mitigate against the high strain and low quality of life that they experience when caring for patients six to 36 months post stroke.

scholarly journals The Reliability of Iodine Concentration in Diaper-Retrieved Infant Urine Using Urine Collection Pads, and in Their Mothers’ Breastmilk

Biomolecules ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 295
Author(s):  
Kjersti Sletten Bakken ◽  
Ingvild Oma ◽  
Synne Groufh-Jacobsen ◽  
Beate Stokke Solvik ◽  
Lise Mette Mosand ◽  
...  
Keyword(s):  
Intraclass Correlation ◽  
Urinary Iodine ◽  
Correlation Coefficients ◽  
Iodine Concentration ◽  
Cross Sectional Study ◽  
Iodine Intake ◽  
Public Healthcare ◽  
Urinary Iodine Concentration ◽  
Childbearing Age ◽  
Cross Sectional

Mild to moderate iodine deficiency is common among women of childbearing age. Data on iodine status in infants are sparse, partly due to the challenges in collecting urine. Urinary iodine concentration (UIC) is considered a good marker for recent dietary iodine intake and status in populations. The aim of this study was to investigate the reliability of iodine concentration measured in two spot-samples from the same day of diaper-retrieved infant urine and in their mothers’ breastmilk. We collected urine and breastmilk from a sample of 27 infants and 25 mothers participating in a cross-sectional study at two public healthcare clinics in Norway. The reliability of iodine concentration was assessed by calculating the intraclass correlation coefficients (ICC) and the coefficient of variation (CV). The ICC for infants’ urine was 0.64 (95% confidence interval (CI) 0.36–0.82), while the ICC for breastmilk was 0.83 (95% CI 0.65–0.92) Similarly, the intraindividual CV for UIC was 0.25 and 0.14 for breastmilk iodine concentration (BIC). Compared to standard methods of collecting urine for measuring iodine concentration, the diaper-pad collection method does not substantially affect the reliability of the measurements.

scholarly journals Serum Levels of Fetal Antigen 1 in Extreme Nutritional States

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Alin Andries ◽  
Andreas Niemeier ◽  
Rene K. Støving ◽  
Basem M. Abdallah ◽  
Anna-Maria Wolf ◽  
...  
Keyword(s):  
Weight Change ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
Metabolic Adaptation ◽  
Weight Changes ◽  
Normal Range ◽  
Cross Sectional ◽  
Restrictive Surgery ◽  
Before And After ◽  
Fetal Antigen

Objective. Recent data suggest that fetal antigen (FA1) is linked to disorders of body weight. Thus, we measured FA1 serum levels in two extreme nutritional states of morbid obesity (MO) and anorexia nervosa (AN) and monitored its response to weight changes. Design. FA1 and insulin serum concentrations were assessed in a cross-sectional study design at defined time points after gastric restrictive surgery for 25 MO patients and 15 women with AN. Results. Absolute FA1 serum levels were within the assay normal range and were not different between the groups at baseline. However, the ratio of FA1/BMI was significantly higher in AN. FA1 was inversely correlated with BMI before and after weight change in AN, but not in MO patients. In addition, MO patients displayed a significant concomitant decrease of FA1 and insulin with the first 25% of EWL, while in AN patients a significant increase of FA1 was observed in association with weight gain. Conclusion. FA1 is a sensitive indicator of metabolic adaptation during weight change. While FA1 serum levels in humans generally do not correlate with BMI, our results suggest that changes in FA1 serum levels reflect changes in adipose tissue turnover.

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