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Huelsboemer L, Stögner VA, Hosseini H, Hauc S, Boroumand S, Parikh N, Blood A, Mookerjee V, Kauke-Navarro M, Nizzi MC, Pomahac B. An update on long-term mental health in eight face transplant recipients - A single center experience. Int J Psychiatry Med 2023:912174231225764. [PMID: 38152028 DOI: 10.1177/00912174231225764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE Face transplantation is a groundbreaking and complex surgical intervention offering profound physical and psychological benefits to patients with severe facial disfigurements. This report provides an update on the long-term psychosocial outcome of eight face transplant recipients. METHOD All transplant recipients were initially transplanted at Brigham and Women´s Hospital (Boston, USA) between 2011 and 2020 and are seen as outpatient patients at Yale New Haven Hospital (New Haven, USA). A mixed-methods approach was used to assess the psychological well-being of these patients. The Short-Form 12, Brief-COPE, EQ-VAS and CES-D were administered between October 2022 and October 2023. RESULTS Older age of face transplant recipients was significantly and positively associated with better mental health and increased use of both emotional and instrumental support (Brief-COPE). The initial enhancement in patients' self-reported quality of life, as assessed by the EQVAS, declined on the EQ-VAS score at the last follow-up period. Similarly, an increase in depression score was observed (CES-D score) up through the last follow-up assessment. Both of the latter results, however, did not reach statistical significance. CONCLUSIONS These results underscore the importance of ongoing psychological support throughout the long-term journey of recovery for face transplant recipients. They emphasized the need for a comprehensive, patient-centered approach that also addresses the complex psychological dimensions and contributes to our understanding of the mental health dynamics involved in face transplantation, underscoring the need for guidelines and continued research in this evolving field.
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Affiliation(s)
- Lioba Huelsboemer
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Viola A Stögner
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Helia Hosseini
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Sacha Hauc
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Sam Boroumand
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Neil Parikh
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
- University of Boston, Boston, MA, USA
| | - Alexa Blood
- Transplant Department, Yale New Haven Hospital, New Haven, CT, USA
| | - Vikram Mookerjee
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Martin Kauke-Navarro
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Bohdan Pomahac
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
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Chang LWK, Buising KL, Jeremiah CJ, Cronin K, Poy Lorenzo YS, Howden BP, Kwong J, Cocks J, Blood A, Greenough J, Waters MJ. Managing a nosocomial outbreak of carbapenem-resistant Klebsiella pneumoniae: an early Australian hospital experience. Intern Med J 2016; 45:1037-43. [PMID: 26178306 DOI: 10.1111/imj.12863] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 06/28/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Carbapenems are traditionally reserved as the last line of defence for treatment of serious infections with multiresistant Gram-negative bacilli. Reports of Klebsiella pneumoniae carbapenemase (KPC)-producing organisms have been emerging globally, but rare in Australasia to date. We describe an outbreak of KPC-2 producing K. pneumoniae at an Australian hospital. METHODS After initial detection in October 2012, a retrospective review of patients with meropenem-resistant K. pneumoniae to June 2012, and ongoing prospective surveillance, was undertaken. Included patients were admitted to the hospital after June 2012 and had meropenem-resistant K. pneumoniae isolated from any site. Available isolates underwent detection of the KPC-2 gene by polymerase chain reaction and molecular typing was performed to determine genetic relatedness between isolates. Point-prevalence screening was performed on selected wards to detect asymptomatic carriage. Infection control procedures were implemented to contain the outbreak. RESULTS Ten cases were identified in the initial cluster. Eight were localised to a single inpatient ward. Point-prevalence screening revealed one extra case. After temporary containment, re-emergence of KPC-producing isolates was observed post October 2013 with 18 further cases identified. Four K. pneumoniae isolates in the 2012 cluster and 16 from the 2013-2014 cluster were referred for further testing. All carried the KPC-2 beta-lactamase gene. The 2012 isolates were genetically similar to the 2014 isolates. CONCLUSION KPC-2 mediated resistance is an emerging threat in Australia. The re-emergence of KPC despite initial containment emphasises the need for constant vigilance in the microbiology laboratory and ongoing maintenance of infection control and antimicrobial stewardship activity.
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Affiliation(s)
- L W K Chang
- Department of Microbiology, Dorevitch Pathology, Melbourne, Victoria, Australia
| | - K L Buising
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Infectious Diseases Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - C J Jeremiah
- Infectious Diseases Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - K Cronin
- Department of Microbiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Y S Poy Lorenzo
- Pharmacy Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - B P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - J Kwong
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - J Cocks
- Infection Prevention and Control Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - A Blood
- Infection Prevention and Control Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - J Greenough
- Infection Prevention and Control Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - M J Waters
- Department of Microbiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Reisner AT, Khitrov MY, Chen L, Blood A, Wilkins K, Doyle W, Wilcox S, Denison T, Reifman J. Development and validation of a portable platform for deploying decision-support algorithms in prehospital settings. Appl Clin Inform 2013; 4:392-402. [PMID: 24155791 DOI: 10.4338/aci-2013-04-ra-0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/13/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Advanced decision-support capabilities for prehospital trauma care may prove effective at improving patient care. Such functionality would be possible if an analysis platform were connected to a transport vital-signs monitor. In practice, there are technical challenges to implementing such a system. Not only must each individual component be reliable, but, in addition, the connectivity between components must be reliable. OBJECTIVE We describe the development, validation, and deployment of the Automated Processing of Physiologic Registry for Assessment of Injury Severity (APPRAISE) platform, intended to serve as a test bed to help evaluate the performance of decision-support algorithms in a prehospital environment. METHODS We describe the hardware selected and the software implemented, and the procedures used for laboratory and field testing. RESULTS The APPRAISE platform met performance goals in both laboratory testing (using a vital-sign data simulator) and initial field testing. After its field testing, the platform has been in use on Boston MedFlight air ambulances since February of 2010. CONCLUSION These experiences may prove informative to other technology developers and to healthcare stakeholders seeking to invest in connected electronic systems for prehospital as well as in-hospital use. Our experiences illustrate two sets of important questions: are the individual components reliable (e.g., physical integrity, power, core functionality, and end-user interaction) and is the connectivity between components reliable (e.g., communication protocols and the metadata necessary for data interpretation)? While all potential operational issues cannot be fully anticipated and eliminated during development, thoughtful design and phased testing steps can reduce, if not eliminate, technical surprises.
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Blood A, Edwards CJ, Ishii HH, Pat BK, Bryson G, Sculley TB, Gobe GC. Epstein-Barr virus-mediated protection against etoposide-induced apoptosis in BJA-B B cell lymphoma cells: role of Bcl-2 and caspase proteins. Arch Virol 2003; 149:289-302. [PMID: 14745596 DOI: 10.1007/s00705-003-0212-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2003] [Accepted: 08/13/2003] [Indexed: 10/26/2022]
Abstract
Epstein-Barr virus (EBV)-infected B cell lymphomas are resistant to apoptosis during cancer development and treatment with therapies. The molecular controls that determine why EBV infection causes apoptosis resistance need further definition. EBV-positive and EBV-negative BJA-B B cell lymphoma cell lines were used to compare the expression of selected apoptosis-regulating Bcl-2 and caspase proteins in EBV-related apoptosis resistance, after 8 hr or 18-24 hr etoposide treatment (80 microM). Apoptosis was quantified using morphology and verified with Hoechst 33258 nuclear stain and electron microscopy. Fluorescence activated cell sorting (FACS) was used to analyse effects on cell cycle of the EBV infection as well as etoposide treatment. Anti-apoptotic Bcl-2 and Bcl-XL, pro-apoptotic Bax, caspase-3 and caspase-9 expression and activation were analysed using Western immunoblots and densitometry. EBV-positive cultures had significantly lower levels of apoptosis in untreated and etoposide-treated cultures in comparison with EBV-negative cultures (p < 0.05). FACS analysis indicated a strong G2/M block in both cell sublines after etoposide treatment. Endogenous Bcl-2 was minimal in the EBV-negative cells in comparison with strong expression in EBV-positive cells. These levels did not alter with etoposide treatment. Bcl-XL was expressed endogenously in both cell lines and had reduced expression in EBV-negative cells after etoposide treatment. Bax showed no etoposide-induced alterations in expression. Pro-caspase-9 and -3 were seen in both EBV-positive and -negative cells. Etoposide induced cleavage of caspase-9 in both cell lines, with the EBV-positive cells having proportionally less cleavage product, in agreement with their lower levels of apoptosis. Caspase-3 cleavage occurred in the EBV-negative etoposide-treated cells but not in the EBV-positive cells. The results indicate that apoptosis resistance in EBV-infected B cell lymphomas is promoted by an inactive caspase-3 pathway and elevated expression of Bcl-2 that is not altered by etoposide drug treatment.
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Affiliation(s)
- A Blood
- Dept of Molecular and Cellular Pathology, School of Medicine, University of Queensland, Brisbane, Australia
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Blood A. International Year of the Child. Australas Nurses J 1979; 8:9-11. [PMID: 107948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
The trend toward increasing specialization in the medical wards of teaching hospitals has important implications for future health care delivery and student teaching. A study of the likely implications of a change to a specialty oriented medical admission system at the Royal Adelaide Hospital has shown that already the general physicians are seeing little renal and endocrine disease and, that work satisfaction is greater on the specialty units than on the general medical units. Patient satisfaction marginally favoured the specialty units. A peer review audit method was introduced to try and discern whether the quality of care was significantly different on the two types of units. Most physicians cooperated in at least one or two audits which involved them in judgements about adequacy of casenotes, management decisions, follow-up arrangements, length of stay and investigations in randomly assigned specialty pairs of patients (cared for by specialist or general units). No clear-cut trend was discerned favouring specialist or generalist care amongst 17 randomly selected pairs, but this part of the study was never completed, perhaps partly because of lack of enthusiasm for it by busy clinicians. The importance of maintaining a model of generalism for medical students on the teaching hospital campus is discussed discussed in the light of the decline of the role of general physicians.
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Blood A. Maternal and child health in China. Australas Nurses J 1978; 7:27-9. [PMID: 98151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Blood A. North American Interview Board. West J Med 1968. [DOI: 10.1136/bmj.1.5585.186-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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