RESUMEN
INTRODUCTION: This systematic review aims to examine surgical and non-surgical treatments and identify those procedures that are most effective in terms of patient satisfaction. MATERIALS AND METHODS: A systematic review protocol was developed a priori in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. The search was conducted in accordance with the PRISMA guidelines, the Cochrane handbook. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, and Cochrane databases was performed to identify studies on hair loss causes and hair loss treatment with different surgical and non-surgical techniques RESULTS: Our search generated a total of 781 articles; 646 studies were excluded based on the content of the abstracts, and an additional 105 studies were excluded based on the content of the complete article. We performed a review of the 30 remaining studies, which had sufficient data for inclusion, and met all the aforementioned inclusion criteria. Of the 30 studies, four were about minoxidil, four about finasteride, two about dutasteride, three about phototherapy, six about platelet-rich plasma injection, four about follicular unit transplantation technique, six about follicular unit extraction technique, and one about patient satisfaction following surgical treatment without a specified surgical technique. Only three studies used a patient-reported outcome measurement. CONCLUSIONS: Our study is the first comprehensive systematic review of hair loss, looking at the problem from different points of view, and focusing on finding the best solution for the patient. In the literature, there is currently no algorithm for the management of patients who go to a plastic surgeon for a solution to the problem of hair loss. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Asunto(s)
Alopecia/terapia , Satisfacción del Paciente , Alopecia/cirugía , Humanos , Resultado del TratamientoRESUMEN
INTRODUCTION: The objectives of the current study were: (1) to perform a systematic review of the existing scientific literature on appearance and any subsequently related disorders and (2) to research in the literature the correlation between the role of appearance and patient's disease. MATERIALS AND METHODS: A systematic review protocol was developed a priori in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidance. A multistep search of the PubMed, MEDLINE, PreMEDLINE, Embase, Ebase, CINAHL, PsychINFO and Cochrane databases was performed to identify studies on patient satisfaction, quality of life, and body image. RESULTS: Our search generated a total of 347 articles. We performed a systematic review of the 18 studies, which had sufficient data and met all inclusion criteria. All studies identified from the literature review were assessed to determine the utilization of validated patient satisfaction questionnaires. The questionnaires were analyzed by reviewers to assess adherence to the rules of the US Food and Drug Administration and the Scientific Advisory Committee of the Medical Outcomes Trust. We identified 27 individual questionnaires. We summarized development and validation characteristics and content of the 27 validated measures used in the studies. CONCLUSIONS: This is the first systematic review to identify and critically appraise patient-reported outcome measures for appearance and body image using internationally accepted criteria. DAS59 was deemed to have adequate levels of methodological and psychometric evidence. We also introduced the concept of Appearance-Pain which consists of the recomposed systematic view of the experimental indicators of suffering, linked to one of the dimensions of appearance. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Imagen Corporal/psicología , Dolor/fisiopatología , Apariencia Física , Calidad de Vida , Cirugía Plástica/métodos , Encuestas y Cuestionarios , Bioética , Femenino , Humanos , Masculino , Dolor/psicología , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente/estadística & datos numéricos , PsicometríaRESUMEN
INTRODUCTION: The aims of our study were to identify studies that evaluated patient satisfaction following post-bariatric surgery, analyse existing questionnaires, and summarise their development, psychometric properties, and content. PATIENTS AND METHODS: A multistep search was undertaken on the web-based PubMed database from the National Library of Medicine to identify studies on patient satisfaction and quality of life following post-bariatric surgery. The authors summarised all the questionnaires used in every study and categorised them as generic, surgery specific, or ad hoc, and whether they contained either validated or unvalidated measures. RESULTS: Our search generated a total of 1754 articles. We performed a systematic review of the 12 remaining studies, because these had sufficient data and met the inclusion criteria. All the studies identified from the literature review were assessed to determine the type of surgery used, and whether or not the questionnaire used to analyse patient satisfaction had been validated. The questionnaires were analysed by reviewers to assess adherence to the rules of the US Food and Drug Administration and the Scientific Advisory Committee of the Medical Outcomes Trust. We identified 20 individual questionnaires that included 10 generic instruments that assessed quality of life, six instruments specific for post-bariatric surgery, three instruments specific for breast surgery. CONCLUSIONS: In post-bariatric patients, the BODY-Q was shown to be a more objective and confident measure for evaluating the quality of life of patients following post-bariatric surgery. LEVEL OF EVIDENCE III: For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Cirugía Bariátrica/métodos , Cirugía Bariátrica/psicología , Obesidad Mórbida/cirugía , Medición de Resultados Informados por el Paciente , Encuestas y Cuestionarios , Adulto , Imagen Corporal/psicología , Índice de Masa Corporal , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , PsicometríaRESUMEN
INTRODUCTION: The objectives of this study are: (1) comparison of long-term outcomes after correction of severe gynecomastia using different techniques; (2) apply the Italian version of the BODY-Q; (3) present the role of intercostal perforator flap (ICAP) after massive weight loss for correction of severe gynecomastia. MATERIALS AND METHODS: Between January 2008 and March 2016, we performed surgical correction of bilateral severe gynecomastia in 80 men (160 breasts) following massive weight loss. Patients answered the Italian version of BODY-Q postoperative module. All patients had experienced substantial weight loss (> 30 kg), presented with bilateral severe tissue ptosis of the breast, follow-up of almost 2 years and had a good understanding of the Italian language, and signed consents were included in the study. The sample was studied about age, BMI, comorbidity, bariatric surgical procedure, follow-up, type of post-bariatric surgical procedure, complications and secondary procedures. RESULTS: We performed 487 severe gynecomastia corrections from 2008 to 2016; 80 patients adhered to the inclusion criteria and formed our study group. This cross-sectional study compared three cohorts: 52 access using a circumareolar scar, 18 with an inframammary fold scar, 10 with an inframammary fold scar using intercostal perforator flaps. There were 16 secondary procedures in group one, 2 in group two and 1 in group three. We compared the secondary procedures of group 1 with the other groups, and we obtained a significant difference with a P = 0.04. The mean patient age was 36.5 years, and the average body mass index was 27.5 kg/m2 at the time of surgical correction of gynecomastia. From the BODY-Q analysis, the group of patients undergoing adenomammectomy with inframammary fold scar using intercostal perforator flaps has achieved significantly better results regarding the satisfaction with chest, psychosocial function, satisfaction with outcome and better body image. CONCLUSIONS: This is the first study that used the BODY-Q to analyze the correction of severe gynecomastia following massive weight loss with long-term results. The use of this patient-reported outcome measure underlined that the intercostal artery perforator flap, used in the correction of severe gynecomastia following massive weight loss, is a safe and effective technique with good outcomes and high patient satisfaction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Cirugía Bariátrica/métodos , Ginecomastia/cirugía , Mamoplastia/métodos , Medición de Resultados Informados por el Paciente , Colgajo Perforante/trasplante , Pérdida de Peso , Adulto , Imagen Corporal/psicología , Estudios Transversales , Bases de Datos Factuales , Estética , Ginecomastia/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/cirugía , Satisfacción del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
The literature still lacks a review regarding PROs applied for rhinoplasty. Thus, we performed a systematic review of the literature to identify PROMs that assess patient satisfaction and quality of life after rhinoplasty. The aim of our study was to identify existing questionnaires and to summarize their development, psychometric properties, and content. A multi-step search of the web-based PubMed database from the National Library of Medicine was performed to identify PROMs that are designed to evaluate satisfaction and quality of life following rhinoplasty. Each potential PROM was examined by three independent reviewers for adherence to inclusion/exclusion criteria. Questionnaires included in the analysis were appraised for their adherence to international guidelines for the development and validation of health outcome questionnaires, as outlined by the Scientific Advisory Committee of the Medical Outcome Trust and the U.S. Food and Drug Administration. Our search generated a total of 457 articles, 351 that were retrieved in the primary search, and 106 that were found in the references of the first set of articles. The process of development and validation of each of the included PROMs was examined. Only ten of these were identified as surgery-specific questionnaires about rhinoplasty. These were divided into three categories: (1) functional self-assessment (Nasal Surgical Questionnaire, Nasal Obstruction Symptoms Evaluation Scale, and Nasal Obstruction Septoplasty Effectiveness); (2) aesthetic self-assessment (Utrecht Questionnaire, FACE-Q rhinoplasty module, Glasgow Benefit Inventory); and (3) aesthetic and functional self-assessment (Rhinoplasty Outcomes Evaluation), Functional Rhinoplasty Outcome Inventory 17, RHINO Scale, and Evaluation of Aesthetic Rhinoplasty Scale).
Asunto(s)
Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Rinoplastia , Estética , Humanos , Obstrucción Nasal/etiología , Nariz/cirugía , Complicaciones Posoperatorias , Calidad de Vida , Encuestas y CuestionariosRESUMEN
BACKGROUND: The aims of our study were to identify studies that evaluated patient satisfaction after transsexual surgery, analyze existing questionnaires, and summarize their development, psychometric properties, and content. METHODS: A systematic review of the English-language literature was performed. Patient-reported outcome measures designed to assess patient satisfaction and quality of life following transsexual surgery were identified. Qualifying instruments were assessed for content and adherence to international guidelines for development and validation. RESULTS: From 796 articles, 19 studies had sufficient data and met the inclusion criteria. Included were a total of 2299 patients and 17 patient-reported outcome measures: 10 generic instruments that assessed quality of life, 4 specific for female genital or sexual satisfaction, 2 specific for transsexual body image or gender dysphoria, and 1 specific for plastic surgery. The questionnaires were analyzed by reviewers to assess the adherence to the rules of the US FDA and the Scientific Advisory Committee of the Medical Outcomes Trust. We identified 17 individual questionnaires that were included. All measures were limited by either their development, their validation, or their content. CONCLUSIONS: There is a need for a new self-assessment tool, which should include functional, psychorelational, and cosmetic components, to measure satisfaction and quality of life of patients who have undergone transsexual surgery. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Imagen Corporal , Medición de Resultados Informados por el Paciente , Calidad de Vida , Cirugía de Reasignación de Sexo/métodos , Personas Transgénero , Femenino , Feminidad , Humanos , Italia , Masculino , Masculinidad , Satisfacción del Paciente/estadística & datos numéricos , Cirugía de Reasignación de Sexo/psicologíaRESUMEN
The Article deals with the ethical issues around the therapeutic utilization of stem cells (SC), particularly facing with factors of morality: i.e., object of the human action, aims and circumstances. Crucial ethical questions are recognized in the last factor (circumstances), particularly: the origin and the availability of SC, the consequences of the therapeutic action through SC, the diffusion/communication of scientific data around the clinical use of SC. The paper assumes the perspective of the ethics considered as practical-normative science, centered on the human person (as a whole) as the value of reference.
Asunto(s)
Análisis Ético , Teoría Ética , Principios Morales , Trasplante de Células Madre/ética , Células Madre , Adulto , Investigaciones con Embriones/ética , Células Madre Embrionarias , Células Madre Fetales , Células Madre Hematopoyéticas , HumanosRESUMEN
AIMS: We must pay attention to character formation of Medical Doctors because it could build a good or bad relationship with colleagues and patients: it is not a merely "humanistic" goal but a necessary component of professional excellence. The first endpoint of this study is to identify how to improve the quality of the outpatient visit. MATERIALS AND METHODS: We tested a user-friendly questionnaire, distributed to 100 patients. RESULTS AND CONCLUSIONS: The most important behavioral characteristics desired by patients from physicians are: 1. to have the physician's attention without feeling hurried (such as without the physician answering a phone call during the office visit); 2. to have continuity of care even in the ambulatory setting; 3. to find a relationship of empathy, participation and sharing; 4. to have a peaceful relationship of collaboration with the nurses and other health care personnel; 5. to find the physician appropriately groomed and dressed; 6. to receive the full diagnosis with clarity and at the most appropriate moment of communication.
Asunto(s)
Atención Ambulatoria/normas , Pacientes/estadística & datos numéricos , Relaciones Médico-Paciente , Médicos/normas , Calidad de la Atención de Salud/normas , Adulto , Anciano , Atención , Continuidad de la Atención al Paciente , Conducta Cooperativa , Empatía , Femenino , Personal de Salud , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Participación del Paciente , Proyectos Piloto , Encuestas y Cuestionarios , Revelación de la VerdadRESUMEN
The aim of the present study is to propose legal reform limiting surgeons' criminal liability in high-accuracy and high-risk surgery such as endoscopic sinus surgery (ESS). The study includes a review of the medical literature, focusing on identifying and examining reasons why ESS carries a very high risk of serious complications related to inaccurate surgical manoeuvers and reviewing British and Italian legal theory and case-law on medical negligence, especially with regard to Italian Law 189/2012 (so called "Balduzzi" Law). It was found that serious complications due to inaccurate surgical manoeuvers may occur in ESS regardless of the skill, experience and prudence/diligence of the surgeon. Subjectivity should be essential to medical negligence, especially regarding high-accuracy surgery. Italian Law 189/2012 represents a good basis for the limitation of criminal liability resulting from inaccurate manoeuvres in high-accuracy surgery such as ESS. It is concluded that ESS surgeons should be relieved of criminal liability in cases of simple/ordinary negligence where guidelines have been observed.
Asunto(s)
Endoscopía , Responsabilidad Legal , Mala Praxis/legislación & jurisprudencia , Senos Paranasales/cirugía , Endoscopía/normas , Humanos , Italia , Medición de RiesgoRESUMEN
Background: Patients with haematological malignancies are often hospitalized in protective isolation until full neutrophil recovery in order to prevent infections. This descriptive pilot study evaluate the level of isolation-related distress and the use of free time in a sample of Italian onco-haematological patients who were hospitalized in protective isolation. Materials and Methods: Participants were 18 patients hospitalized in hematologic ward to receive induction therapy (n=12) or autologous stem cell transplant (n=6). They completed a self-report questionnaire before discharge. Results: Participants reported a moderate level of isolation-related distress, anxiety, and boredom: the more the anxiety and the boredom, the more the distress (r=.77; P<.001), (r=.79; P<.001), respectively. The activities performed during isolation were: watching TV (72.2%), reading (55.6%), thinking (33.3%), surfing in Internet or using PC (33.3%), and playing games or making cross-words (16.7%). Participants who reported pessimistic thinking had higher isolation-related distress (P=.004) as well as anxiety (P<.001) and boredom (P=.001). Conclusion: Haematology Units should support isolated patients in spending their time in recreational activities, allowing more contacts with immediate relatives and friends, providing free TV and Wi-Fi connection inside the room. In addition, patients should have to keep themselves physically active. Isolation-related distress could also be reduced by providing psychological support.
RESUMEN
The article deals with some issues of forensic medicine relevance, as well as ethical one, about HIV+/AIDS condition, which still represent open problems in regulations and in the case-law. Particularly, in the light of the specific Italian regulations (namely, the Law 5 June 1990 no. 135), the Authors address the juridical fundaments of the care of HIV+/AIDS patients, reaffirming the obligation for all the healthcare professionals to give care in every case of infection from HIV. Secondly, the issue of the diagnostic tests and the screenings is faced, sustaining the obligatoriness to gain an adequate previous consent by the subject and, however, only for clinical necessity and in his/her best interest. Finally, the delicate matter of the professional secrecy is examined, of the guardianship of confidentiality and of the partner notification is examined. In general, although the doctrine and jurisprudence not justify the transmission of HIV+/AIDS patient's personal data, yet the specific matter is not easily resolvable exclusively in juridical terms, because it is necessary remind also the extra-juridical--that is ethical--nature of deontological norms.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Discusiones Bioéticas , Legislación Médica/ética , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Trazado de Contacto/ética , Trazado de Contacto/legislación & jurisprudencia , Humanos , ItaliaRESUMEN
The ethical debate regarding the AIDS is very rich both at the theoretical and practical level, but--unlike what it is happening for other sectors, e.g. the euthanasia--these two aspects are integrated, shaping a true interdisciplinary job of ethical evaluation, in which clinicians, medical examiners, ethicists, nurses, clinical psychologists, economists and politicians are met. The utilized methodology will be to identify the human act in the light of the patient's good and the common good of the society. These are strong references and broadly shared in general sense, but they become problematic if we want to identify, and we should have to do it, the contents of such "goods". The authors intend to appraise the quality of a Centre for Research and Healthcare for AIDS patients, also considering the "performance measures".
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/terapia , Ética , Derechos del Paciente , HumanosRESUMEN
OBJECTIVE: The Derriford Appearance Scale (DAS) 59 was specifically designed to measure psychosocial adjustment in patients with appearance problems. Previous studies using the DAS59 have proven it to be a reliable method of assessing the appearance-related quality of life after plastic surgery procedures. The aim of this study was to develop a valid and reliable Italian version of the DAS59. PATIENTS AND METHODS: The first Italian translation of this questionnaire was conducted according to the DAS59 protocol that was designed by the original authors of the questionnaire. Eight hundred patients participated in this study and filled out three questionnaires (DAS59, General Health Questionnaire (GHQ)12 and Beck's Depression Inventory (BDI)-II). There were 400 adult patients with a history of previous plastic surgeries and 400 adult patients without any personal history of previous plastic surgery procedures. A total of 50 patients were selected randomly for test-retest analysis. RESULTS: The overall internal consistency was excellent (α = 0.95) and equal to that of the original article that first described the scale. There was a good correlation between all the items. Domains demonstrated good internal consistency (Cronbach's alpha) and correlation within themselves. The construct validity of the Italian DAS59 was assessed under convergent validity that confirmed the correlation with scales related to other psychological conditions. GHQ12 showed relevant correlation with DAS59, while BDI-II did not. CONCLUSIONS: A valid and reliable Italian DAS59 version was developed that can be used for research and clinical assessment of patients with appearance problems and concerns, especially before and after plastic surgery procedures.
Asunto(s)
Motivación , Calidad de Vida , Cirugía Plástica , Adolescente , Adulto , Anciano , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Adulto JovenRESUMEN
The ethical evaluation of a clinical case is the application of general ethical principles to a real situation. Epicheia and Prudence are required to realized this goal. The moral sources of an human action are: a) the object of the action; b) the agent's intentions; c) general conditions. In this way, the ethical evaluation requires: a) the appropriate knowledge of the medical action; b) the knowledge of the ethical principles; c) the evaluation of the agent's intentions; d) to consider the global relational reality.
Asunto(s)
Ética Médica , HumanosRESUMEN
The technique used in invasive cardiology, in special way in the PTCA, is here considered technique of first and second order (Donati's classification). This kind of technique is a chance to improve the physician-nurse relationship with patient and the knowledge of the patient on his/her own body. We must use this technique in order to get better the relation with the patient trough an excellent information during all the procedure.
Asunto(s)
Angioplastia Coronaria con Balón , Bioética , Procedimientos Quirúrgicos Cardíacos , Relaciones Enfermero-Paciente , Relaciones Médico-Paciente , Estudios de Seguimiento , Humanos , Cuidados Posoperatorios , Cuidados PreoperatoriosRESUMEN
The caretaking of the patient in coma requires an anthropological and clinical approach. The ethics of well-done work suggests to reject futile medical treatment and euthanasia but, at the same time, to perform a correct palliative care and to support the family.
Asunto(s)
Coma/terapia , Ética Médica , Familia , Inutilidad Médica , Cuidados Paliativos , Apoyo Social , Eutanasia , Humanos , Italia , Voluntad en VidaRESUMEN
The Viktor E. Frankl's thought has found wide application in many areas of the Clinic, not limited to the neuropsychiatric area. If the franklian work is known worldwide for being a theory and a practice within neurotic disorders, we must not forget how logotherapy has been put at the disposal of the sufferer in its broadest sense. Especially in the context of care and care of the chronically and evolutionary ill (cancer, heart disease, degenerative diseases, etc.), the thought and practice logotherapy have made and continue to make a valuable contribution. In this review we will cover in more detail the application of logotherapy in clinical-care, pausing to examine the international literature.
Asunto(s)
Psicoterapia/métodos , Enfermedad Crónica , Cardiopatías/terapia , Humanos , Neoplasias/terapiaRESUMEN
The aim of this work is to address the question of reduction in the scientific method, to evaluate its legitimacy as well as its pro and contra from an epistemological point of view. In the first paragraph we classify some kinds of reductionism, analysing their presuppositions and epistemological status and showing some examples of scientific reduction. The presentation includes a classificatory table that shows some of the different forms of biological reductionism. In the second paragraph we study the epistemology of science starting from its modern beginning: the Vienna Circle, focusing on the meaning of methodological reductionism. What did it mean for science to define itself mainly as method, which effects did this new concept of science have on methodology and what kind of problems did this movement bring about. In the third paragraph we examine the reactions triggered by methodological reductionism, we analyze the theoretical consistency of these answers, trying to offer a balanced view. We show how complexity can be seen as a paradigm of the anti-reductionism effort, and we study its epistemological basis. In the fourth paragraph we outline our operative proposal: the reduction that is both aware and cooperative. We point out the main reasons why science cannot avoid being reductive in some way, and therefore how we need to deal with this feature in order to prevent it to degenerate into reductionism. We show some examples of this new proposal taken from the practical realm and from literature, where it is possible to discern the spirit of this alternative methodology.