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Breast Reconstruction After Mastectomy: Are Patients Making Good Decisions?

An outcomes article in the January 2011 issue of the Journal of Plastic and Reconstructive Surgery asks the question: “Are patients making high-quality decisions about breast reconstruction after mastectomy?”

The objective of the study was to “measure women’s knowledge about reconstruction and to evaluate the degree to which treatments reflected patients’ goals and preferences.” Their conclusion (bold emphasis is mine):

Women treated with mastectomy in this study were not well-informed about breast reconstruction. Treatments were associated with patients’ goals and concerns, however, and patients were highly involved in their decisions. Knowledge deficits suggest that breast cancer patients would benefit from interventions to support their decision making.

Granted the study was small, but it left me wondering if we the medical community fails to educate these women.  

The study involved a cross-sectional survey of early-stage breast cancer survivors from four university medical centers. The survey included measures of knowledge about specific reconstruction facts, personal goals and concerns, and involvement in decision making. Only 84 patients participated (59 percent response rate). Participants answered only 37.9 percent of knowledge questions correctly. Read more »

*This blog post was originally published at Suture for a Living*

The Physical And Metaphorical Heart

Listening to NPR on Saturday morning I caught part of Scott Simon’s interview with brothers Stephen Amidon and Thomas Amidon, M.D. discussing their book “The Sublime Engine: A Biography of the Human Heart.” The interview touched on the story of the human heart in science and medicine, history, and culture: 

It turns out that the classic red heart symbol we see almost everywhere around Valentine’s Day doesn’t look much like a real human heart at all.

“Of all the theories about where that symbol comes from, my favorite is that it is a representation of a sixth century B.C. aphrodisiac from northern Africa,” says Stephen Amidon…”And I kind of like that history because it sort of suggests that early on, people sort of understood the connection between love and the heart.”

Words and how we use them were the focus of Dr. Pauline Chen’s interview by WIHI host Madge Kaplan this past Thursday, February 10th, ”A Legible Prescription for Health“:

On this edition of WIHI, Dr. Chen wants to spend some time talking about language, especially the words doctors use with one another when describing patients; the unintended barriers created the more doctors and nurses don protective, infection-protecting garb; the mounting weight of patient satisfaction surveys; and more.

Back to the NPR interview on the human heart as a “sublime engine,” the authors don’t feel that as our advances in surgical techniques become commonplace that the heart will lose any of its cultural and metaphorical significance. Read more »

*This blog post was originally published at Suture for a Living*

Skin Cancer Risk, Indoor Tanning, And Maternal Influence

teen tanning bedNot all maternal influence on daughter behavior is good. Take for example the influence of the unhealthy use of indoor tanning beds as presented in a recent Archives of Dermatology article (full reference below) which “investigated whether indoor tanning with one’s mother the first time would influence frequency of tanning later in life and whether it was associated with age of initiation.”

Joel Hillhouse, Ph.D., of East Tennessee State University-Johnson City and colleagues published a study the May 2010 issue of the Archives of Dermatology which looked at which health-based intervention worked best in reducing skin cancer risks. They found that “emphasizing the appearance-damaging effects of UV light, both indoor and outdoor, to young patients who are tanning is important no matter what their pathological tanning behavior status.”

For this study, Hillhouse and colleagues randomly selected a total of 800 female students who were then sent a screening questionnaire on their indoor tanning history. Those who reported ever indoor tanning (n = 252) were invited to participate in the study and offered an incentive ($5). A total of 227 (mean age, 21.33 years; age range, 18-30 years) agreed, signed informed consent documents, and completed assessments.

One of the questions asked who accompanied the participant the first time they indoor tanned (i.e. tanned alone, with friend, with mother, or other). Read more »

*This blog post was originally published at Suture for a Living*

Breast Implants: A Geographical Comparison

This article (full reference below, free access) came to my attention via MDLinx. It was interesting to read. The conclusion verified my expectations rather than surprised me.

The authors conducted a retrospective review of patient demographics and implant information from three university settings: Kelowna (British Columbia, Canada), Loma Linda (California, USA), and Temple (Texas, USA). Each cohort included 100 consecutive breast augmentation cases. Characteristics analyzed included age, height, weight, BME, parity, and average implant volume. 

When considering the 300 as one cohort, the average age was 34 years with a height of 163 cm (5’4”), weight of 58.1 (127.8 lb) and parity of 1.7 . The average implant size was 370 ml. Read more »

*This blog post was originally published at Suture for a Living*

Female Wounded Warriors

I am a proud University of Arkansas alumni. The current issue of the alumni magazine has a short segment on Janet Cater and her work with female wounded warriors. Her research on military women amputees earned her a doctoral degree in rehabilitation counseling.

I did a Google search and was happy to find she has a blog: Female Wounded Warriors Posterous. There were only four entries but they allow an understanding of her research project.

The first one, Institutional Review Board Information (November 10, 2009), lays out the goal:

I am seeking to understand the psychosocial adjustment issues experienced by women veterans who have had a traumatic amputation. I am interested in your life experience.

The second one, Volunteer To Help Future Wounded Women Warriors, presented the goal and method again:

My study seeks to understand the adjustment issues faced by American women warriors who experience a traumatic amputation. At the present time there is no published research. As the number of women warriors returning with physical disabilities increases, it is vital that medical and mental health support staff understand the unique challenges these women face. Over 220,000 female soldiers have been deployed to Iraq and Afghanistan for one or more tours of duty. As of August 2009, a total of 121 women warriors have died, and it is estimated over 620 have received serious injuries. This study will use internet interviews using Skype to understand this life experience. Each woman will be invited to tell her story of how she adjusted to life as an amputee with the assurance of confidentiality. Read more »

*This blog post was originally published at Suture for a Living*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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