Quality of life and self-esteem in patients submitted to surgical treatment of skin carcinomas: long-term results

BACKGROUND:Cancer is a multifactorial disease and skin carcinomas are the most common type of cancer. Assessing quality of life and self-esteem outcomes in skin cancer patients is important because these are indicators of the results of the treatment, translating how patients face their lives and their personal relationships.OBJECTIVE:To assess the late impact of the surgical treatment of head and/or neck skin carcinomas on quality of life and self-esteem of the patients.METHODS:Fifty patients with head or neck skin carcinomas were enrolled. Their age ranged between 30 and 75 years, 27 were men and 23 were women. Patients were assessed with regard to quality of life and self-esteem, preoperatively and five years postoperatively. Validated instruments were used: the MOS 36-item Short-form Health Survey (SF-36) and the Rosenberg Self-esteem/EPM-UNIFESP Scale. The Wilcoxon signed-rank test was used for the statistical analysis.RESULTS:Twenty-two patients completed the five-year follow-up, 54.5% women and 45.5% men. Compared to the preoperative assessment, patients had an improvement in mental health (p=0.011) and in self-esteem (p=0.002). There was no statistical difference with regard to the other domains of the SF-36.CONCLUSION:Patients submitted to surgical treatment of skin carcinoma improved mental health and self-esteem in the late postsurgical testing.Universidade do Vale do SapucaíUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Pesquisa cirúrgica no norte e nordeste do Brasil

PURPOSE: To evaluate the scientific production from the surgical areas from the State University of Para (UEPA), Federal Universities of Para (UFPA) and of Paraiba (UFPB), Brazil. METHODS: The scientific productions of professors in the last five years were classified according to the Qualis system of CAPES-Medicine III (http://qualis.capes.gov.br/webqualis/publico/pesquisaPublicaClassificacao.seam?conversationPropagation=begin) and it was computed the number of guidance of students scientific projects. RESULTS: Seventy-four professors were included, 31 with Master and 43 with PhD degrees. UFPA presented more publications (49% out of the total), which 32% of them in Journals B1 or higher. Otorhinolaryngology presented the greatest number of publications (29% out of the total); however, 98% of them in B3 or lower. Gastroenterological Surgery, which is responsible for 23% out of the total, had 57% of its publications in B1 or higher. The most frequent type of guidance was the one about scientific work of completion of undergraduate course (63%). Gynecology and Obstetrics presented the greatest number of student's guidance (35% out of the total) and Gastroenterological Surgery the largest number of Master's degree and PhD degree supervisions. CONCLUSIONS: The specialties Gynecology and Obstetrics and Gastroenterological Surgery from the State University of Para (UEPA), Federal Universities of Para (UFPA) and of Paraiba (UFPB) presented the greatest number of professors with academic degrees. Gastroenterological Surgery presented the largest scientific productions at higher strata of WebQualis CAPES classification and also the largest number of Master and PhD directed.OBJETIVO: Avaliar titulação e produção de docentes da área cirúrgica das Universidades Estadual do Pará (UEPA), Federal do Pará (UFPA) e Federal da Paraíba (UFPB). MÉTODOS: A produção dos docentes nos últimos cinco anos foi classificada segundo o Qualis da Medicina III da CAPES (http://qualis.capes.gov.br/webqualis/publico/pesquisaPublicaClassificacao.seam?conversationPropagation=begin), e computou-se o número de orientações concluídas. RESULTADOS: Foram incluídos 74 docentes, 31 mestres e 43 doutores. A UFPA apresentou maior produção científica (49% do total de publicações), com 32% destas em periódicos Qualis B1 ou superior. A especialidade com maior número de publicações foi a Otorrinolaringologia (29% do total); entretanto, 98% destas em Qualis B3 ou inferior. Já a Cirurgia Gastroenterológica, responsável por 23% do total, teve 57% de suas publicações em Qualis B1 ou superior. O tipo mais frequente de orientação foi a de trabalhos de conclusão de cursos de graduação (63%). Ginecologia e Obstetrícia apresentou o maior número de orientações concluídas (35% do total), e Cirurgia Gastroenterológica o maior número de orientações de mestrado e doutorado. CONCLUSÕES: As especialidades Ginecologia e Obstetrícia e Cirurgia Gastroenterológica apresentaram o maior número de docentes titulados. A Cirurgia Gastroenterológica apresentou a maior produção nos extratos do Qualis-CAPES, e também o maior número de orientações concluídas de mestrado e doutorado.UEPA Medical SchoolUFPA Medical SchoolUFPB Medical SchoolUNIFESP Plastic Surgery DivisionUNIVÁS Plastic Surgery DivisionUNIFESP Head of Plastic Surgery Division CAPESUNIFESP, Plastic Surgery DivisionUNIFESP, Head of Plastic Surgery Division CAPESSciEL

Compositions created with constraint programming

This chapter surveys music constraint programming systems, and how composers have used them. The chapter motivates and explains how users of such systems describe intended musical results with constraints. This approach to algorithmic composition is similar to the way declarative and modular compositional rules have successfully been used in music theory for centuries as a device to describe composition techniques. In a systematic overview, this survey highlights the respective strengths of different approaches and systems from a composer's point of view, complementing other more technical surveys of this field. This text describes the music constraint systems PMC, Score-PMC, PWMC (and its successor Cluster Engine), Strasheela and Orchidée -- most are libraries of the composition systems PWGL or OpenMusic. These systems are shown in action by discussing the composition process of specific works by Jacopo Baboni-Schilingi, Magnus Lindberg, Örjan Sandred, Torsten Anders, Johannes Kretz and Jonathan Harvey

Dressing wear time after breast reconstruction: study protocol for a randomized controlled trial

Background: One of the major risk variables for surgical site infection is wound management. Understanding infection risk factors for breast operations is essential in order to develop infection-prevention strategies and improve surgical outcomes. the aim of this trial is to assess the influence of dressing wear time on surgical site infection rates and skin colonization. Patients' perception at self-assessment will also be analyzed.Methods/Design: This is a two-arm randomized controlled trial. Two hundred breast cancer patients undergoing immediate or delayed breast reconstruction will be prospectively enrolled. Patients will be randomly allocated to group I (dressing removed on postoperative day one) or group II (dressing removed on postoperative day six). Surgical site infections will be defined by standard criteria from the Centers for Disease Control and Prevention (CDC). Skin colonization will be assessed by culture of samples collected at predefined time points. Patients will score dressing wear time with regard to safety, comfort and convenience.Discussion: the evidence to support dressing standards for breast surgery wounds is empiric and scarce. CDC recommends protecting, with a sterile dressing for 24 to 48 hours postoperatively, a primarily closed incision, but there is no recommendation to cover this kind of incision beyond 48 hours, or on the appropriate time to shower or bathe with an uncovered incision. the results of the ongoing trial may support standard recommendations regarding dressing wear time after breast reconstruction.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)Universidade Federal de São Paulo, Dept Surg, Div Plast Surg, São Paulo, BrazilUniv Vale do Sapucai, Dept Surg, Div Plast Surg, Pouso Alegre, BrazilUniv Vale do Sapucai, Dept Microbiol, Pouso Alegre, BrazilUniv Vale do Sapucai, Sch Med, Pouso Alegre, BrazilUniv Vale do Sapucai, Dept Bioestat, Pouso Alegre, BrazilUniversidade Federal de São Paulo, Div Plast Surg, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Surg, Div Plast Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Div Plast Surg, BR-04024002 São Paulo, BrazilCNPq: 480644/2011-0Web of Scienc

Milky secretion after late breast reconstruction with latissimus dorsi musculocutaneous flap with implant

We present a rare case of a 28-year-old patient with invasive ductal carcinoma who underwent neoadjuvant chemotherapy, modified radical mastectomy, radiotherapy, and late breast reconstruction with latissimus dorsi flap associated with the implant. One year later, she underwent reconstruction of the nipple-areola complex over the cutaneous island of the latissimus dorsi flap with a total skin graft from the thigh and graft from the caudal portion of the contralateral papilla. She became pregnant six months after the reconstruction of the nipple-areola complex and, unexpectedly, presented milk production by the reconstructed breast

Health service quality scale: Brazilian Portuguese translation, reliability and validity

Background: the Health Service Quality Scale is a multidimensional hierarchical scale that is based on interdisciplinary approach. This instrument was specifically created for measuring health service quality based on marketing and health care concepts. the aim of this study was to translate and culturally adapt the Health Service Quality Scale into Brazilian Portuguese and to assess the validity and reliability of the Brazilian Portuguese version of the instrument.Methods: We conducted a cross-sectional, observational study, with public health system patients in a Brazilian university hospital. Validity was assessed using Pearson's correlation coefficient to measure the strength of the association between the Brazilian Portuguese version of the instrument and the SERVQUAL scale. Internal consistency was evaluated using Cronbach's alpha coefficient; the intraclass (ICC) and Pearson's correlation coefficients were used for test-retest reliability.Results: One hundred and sixteen consecutive postoperative patients completed the questionnaire. Pearson's correlation coefficient for validity was 0.20. Cronbach's alpha for the first and second administrations of the final version of the instrument were 0.982 and 0.986, respectively. for test-retest reliability, Pearson's correlation coefficient was 0.89 and ICC was 0.90.Conclusions: the culturally adapted, Brazilian Portuguese version of the Health Service Quality Scale is a valid and reliable instrument to measure health service quality.Universidade Federal de São Paulo, Plast Surg Postgraduat Program, BR-04024900 São Paulo, BrazilUniv Vale Sapucai, Dept Surg, Div Plast Surg, BR-37550000 Pouso Alegre, MG, BrazilIESE Business Sch, Barcelona 08034, SpainAllCells LLC, Emeryville, CA 94608 USAUniversidade Federal de São Paulo, Plast Surg Postgraduat Program, BR-04024900 São Paulo, BrazilWeb of Scienc

Sexuality, depression and body image after breast reconstruction

OBJECTIVES: To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression. METHODS: This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively. RESULTS: The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics. CONCLUSION: Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group

Quality of randomized clinical trials published by plastic surgeons: a long-term follow-up study

Introduction: In two previous studies, the quality of randomized clinical trials (RCTs) with the participation of at least one plastic surgeon was assessed in two periods: from 1966 to 2003 and from 2004 to 2008. The objective is to evaluate the evolution of the quality of RCTs published by plastic surgeons in the subsequent five-year period, from 2009 to 2013. Methods: RCTs published from 2009 to 2013, in English, with the participation of at least one plastic surgeon, were identified by an electronic search and classified according to allocation concealment by two independent evaluators. The quality of the studies with adequate allocation concealment was evaluated by two evaluators using the Delphi List and the Jadad Scale. Results: Of the 6,997 identified studies, 261 were classified according to allocation concealment. Of these, 43 (16.47%) had adequate allocation concealment. According to an assessment conducted using the Delphi List, there was an improvement in the items "most important characteristics of the prognosis" (p < 0.001), "use of an independent evaluator" (p = 0.0029), and "measures of variability and estimation of points for the primary variable" (p = 0.0057) compared to the 1966-2003 assessment ; there was no difference in the assessment of the same items from 2004-2008. Regarding the Jadad Scale, there was an increase in the scores from 2009 to 2013 compared to the 1996-2003 period (p < 0.0004); however, there was no significant difference in the 2004-2008 period. Conclusion: There was no difference in the quality of the RCTs published by plastic surgeons in the 2009-2013 period compared to the previous five-year period (2004 to 2008). However, both periods indicated higher quality compared to the 1966-2003 period