Differences between patients and medical professionals in the evaluation of aesthetic outcome following breast reconstruction with implants

BACKGROUND AND AIM

Most studies on breast reconstruction evaluate different surgical techniques, types of implant or time of reconstruction. Moreover, evaluations are usually performed either by surgeons or by patients, but are rarely compared. We conducted a study on aesthetic outcome following breast reconstruction with implants comparing the evaluation by patients versus medical professionals.

METHODS

Forty-seven patients, who had a breast reconstruction with implants between 2001 and 2010 (median follow-up 71 months), underwent a clinical examination, standardized photo documentation and filled out a questionnaire to evaluate their aesthetic result (rate 1 very good to 5 very poor). Photo documentation was independently evaluated by 18 medical professionals using the same evaluation instrument and the results were compared. Gender and patient aspects were taken into account.

RESULTS

We found statistically significant differences between patients and medical professional ratings. The patient evaluation was better through all categories as compared to the evaluation by medical personnel. The degree of medical education or gender aspects did not significantly affect the professional ratings. Age at reconstruction, length of follow-up or primary versus secondary reconstruction did not seem to make a difference in the evaluations of the patients versus the medical professionals..

CONCLUSION

The differences between patient and expert opinion in rating of aesthetic results indicate that patient satisfaction is influenced by multiple factors and not only by good aesthetic outcome. Patient evaluation should therefore be carefully considered in treatment and outcome studies of breast reconstruction..

[Psychometric investigation of Tyrolean patients with primary Raynaud's phenomenon]

Primary Raynaud's phenomenon (PRP) is provoked by digital vasospasm induced by cold and emotional strain. By use of established psychometric test instruments (Freiburger Aggressionsfragebogen (FAF), Fragebogen zur Abschätzung psychosomatischen Krankheitserlebens (FAPK), Stressverarbeitungsfragebogen (SVF 120)) we examined the patients' ways of dealing with aggression and distress as well as their experience of psychosomatic illness. In all psychometric tests performed there were no statistically significant differences between the patients and the controls, indicating that patients with PRP depict no specific ways of dealing with aggression and distress, and do not experience psychosomatic illness. The subgroup of patients with affective disorders and the subgroup of patients with impaired psychological well-being, displayed a 'depressive style' of dealing with life events. Patients with major physical complaints of symptoms of Raynaud's phenomenon showed either an inability or a propensity to deny aggression. Patients with impaired psychological well-being tended to complain more often about severe physical symptoms associated with Raynaud's phenomenon. Psychometric testing in patients with primary Raynaud's phenomenon cannot be recommended without additional psychiatric diagnostic. In patients with primary Raynaud's phenomenon and psychiatric comorbidity psychometric testing can additionally provide useful clinical information.

Post-duty psychomotor performance in young and senior anaesthetists

BACKGROUND AND OBJECTIVE

The level of performance in junior and senior anaesthetists was investigated after 24-h shift working and on-call duties.

METHODS

Pre- and post-duty psychomotor function, influence on response time, cognitive function and well-being in 23 individuals (13 junior and 12 senior anaesthetists) was assessed before and after 24-h in-house on-call duty. Subjective perception of tiredness and concentration abilities was estimated by applying a visual analogue scale.

RESULTS

The self-assessed tiredness prior to duty was high in both age groups and significantly increased in senior anaesthetists after night duty (P = 0.01). Post-duty impairment of concentration abilities was reported in both groups. Comparing results from pre- and post-duty psychometric testing showed a comparable decline in junior and senior anaesthetists as well. Assessment of burnout showed a significant lack of personal accomplishment in junior anaesthetists as compared to their older colleagues (P = 0.038). Senior anaesthetists judged their contribution to patient well-being significantly higher than did their younger colleagues (P = 0.035).

CONCLUSIONS

Although tiredness and subjective impairment of concentration abilities was high in senior anaesthetists after 24-h in-house on-call duty, performance assessed by psychometric testing does not support the hypothesis that senior colleague's performance cannot keep up with routine hospital shift work.

Therapeutic outcome of adjustable gastric banding in morbid obese patients

We examined 77 obese patients treated with bariatric surgery in order to analyse treatment success, and compare those with a good or a poor outcome. The subjects, who were recruited one year after undergoing adjustable gastric banding, were asked questions concerning their sociodemographic status, postoperative course, past and present weight status, eating behaviours and difficulties in changing eating habits. Furthermore, we also used two body image questionnaires, and considered the patients' evaluations of positive and negative changes, as well as their wishes for the future. There were no preoperative differences between the 71% of patients in the good outcome group and the 29% in the poor outcome group. With regard to the postoperative course, the poor outcome group had more problems in adapting to new eating behaviours, experienced significantly more post-surgical complications, and had a persistently negative body evaluation. Both groups were satisfied with their achieved weight loss achieved, and their improved self-esteem and mobility. Adjustable gastric banding seems to be successful in inducing weight loss and allowing a better quality of life. However, factors such as postoperative complications, the ability and willingness to adopt new eating attitudes, and an improved body image seem to be crucial for therapeutic outcome.

[Therapy of fear of flying]

Fear of flying is a widespread phenomenon and therefore, there is no clear-cut borderline between "normal" and "pathological" fear. People who seek help are those whose lives are severely affected by their avoidance behaviour. Fear of flying can be treated, and in particular, procedures for coping with fear, as developed in behavioural therapy are employed in the course of treatment. 'Systematic desensitization' is particularly suitable for dealing with specific flying phobia. 'Exposure according to the reaction management model' is indicated in the case of patients in whom fear of flying is an expression of panic attacks. A variety of pharmacological therapy measures are available which aim at influencing the vegetative reaction to phobic situations (benzodiazepine, antidepressants, beta-blockers). However, the effectiveness of such medications is subject to controversy.

The impact of business cards on physician recognition after general anesthesia

Despite their contribution to overall perioperative treatment of patients, anesthesiologists often remain in anonymity. We evaluated the impact of business cards on physician recognition after general anesthesia. Using a questionnaire, 441 patients were interviewed for recall of the anesthesiologist's name, the surgeon's name, and their overall satisfaction with anesthetic care 6 wk after undergoing surgery during general anesthesia. Of these patients, 155 had and 137 had not randomly received a business card during the preoperative visit, with another 149 patients serving as a control group. Business card recipients responded significantly more frequently than did nonrecipients or patients from the control group (65.8% vs 54.7% vs 53%), with recall of the anesthesiologist's name being significantly more frequent in the Business Card Recipient group (51.5% vs 14.3% vs 11.4%). Patient satisfaction with anesthetic care and recall of the surgeon's name were similar in all groups. The use of a simple tool such as a business card can indeed produce a measurable positive change in physician recognition on the part of the patient.

IMPLICATIONS

Anesthesiologists often remain anonymous in everyday clinical practice. Handing a business card to the patient during the preoperative visit increased the postoperative recall of the anesthesiologist's name from 11% to 51%.

Eating disorders in Austrian men: an intracultural and crosscultural comparison study

BACKGROUND

We compared 30 male university students with eating disorders and 30 male comparison subjects without eating disorders recruited by advertisement at Innsbruck University, Austria.

METHODS

Subjects were interviewed using instruments that we had previously used in a controlled study of college men with eating disorders in the United States.

RESULTS

The Austrian men with eating disorders differed sharply from Austrian comparison subjects, but closely resembled their American counterparts, on prevalence of personal and familial psychopathology, adverse family experiences, and scores on rating scales for eating disorder. Interestingly, dissatisfaction with body image was consistently greater among American subjects regardless of eating disorder status.

CONCLUSIONS

Our data suggest a weak association between eating disorders and homosexual or bisexual orientation in men and no consistent association between eating disorders and childhood sexual abuse.

Life after cystectomy and orthotopic neobladder versus ileal conduit urinary diversion

Patients frequently complain about changes in their everyday life after radical cystectomy and urinary diversion. The aim of this study was to compare subjective morbidity of ileal neobladder to the urethra versus ileal conduit urinary diversion and to elucidate its influence on quality of life. A total of 102 patients who underwent radical cystectomy due to a bladder malignancy were included in the study: 69 patients (67.6%) with an orthotopic neobladder and 33 patients (32.4%) with an ileal conduit. The compliance was 99% and mean follow-up was 37 months. All patients completed two retrospective quality-of-life questionnaires, namely the QLQ-C30 and a questionnaire developed at our institution to elucidate specific items regarding urinary diversion. The questioning was performed by a nonurologist. The results obtained from the validated (QLQ-C30) and our self-designed questionnaire clearly demonstrate that patients with an orthotopic neobladder better adapt to the new situation than patients with an ileal conduit. In addition, neobladder to the urethra improves quality of life due to a better self-confidence, better rehabilitation as well as restoration of leisure, professional, traveling, and social activities, and reduced risk of inadvertent loss of urine. For example, 74.6% of neobladder patients felt absolutely safe with the urinary diversion in contrast to 33.3% in the ileal conduit group. Only 1.5% of neobladder patients had wet clothes caused by urine leakage during day versus 48.5% of ileal conduit patients; 92.8% of neobladder patients felt not handicapped at all; and 87% felt not sickly or ill in contrast to 51.5% and 66.7% of ileal conduit patients, respectively. Moreover, 97% of our neobladder patients would recommend the same urinary diversion to a friend suffering from the same disease in contrast to only 36% of ileal conduit patients. The results obtained by this study demonstrate that quality of life is preserved in a higher degree after orthotopic neobladder than after ileal conduit urinary diversion.

Body image and psychopathology in male bodybuilders

BACKGROUND

To compare male bodybuilders to men with eating disorders and control men regarding body image, psychopathology and sexual history.

METHOD

We compared 28 male bodybuilders, 30 men with eating disorders (anorexia nervosa, bulimia or binge eating disorder defined by DSM-IV), and 30 controls, using a battery of questionnaires covering weight history, eating behavior, body image, lifetime history of psychiatric disorders, and sexuality. Eating-disordered and control men were recruited from a college student population and studied during the course of an earlier investigation.

RESULTS

Bodybuilders exhibited a pattern of eating and exercising as obsessive as that of subjects with eating disorders, but with a 'reverse' focus of gaining muscle as opposed to losing fat. Bodybuilders displayed rates of psychiatric disorders intermediate between men with eating disorders and control men. In measures of body image, the bodybuilders closely resembled the men with eating disorders, but significantly differed from the control men, with the former two groups consistently displaying greater dissatisfaction than the latter. Sexual functioning did not distinguish the three groups except for the item 'lack of sexual desire' which was reported significantly more often by both bodybuilders and men with eating disorders.

CONCLUSION

On measures of body image and eating behavior, bodybuilders share many features of individuals with eating disorders.

[Quality of life of patients with eating disorders. A catamnestic study]

OBJECTIVE

To assess the eating behaviour, quality of life and changes in life style in 46 female patients with eating disorders, discharged from our psychosomatic unit at least six month ago.

METHODS

Patients meeting the criteria for DSM-IV anorexia nervosa or bulimia nervosa completed the "Lancashire Quality of Life Profile" [16] and a questionnaire covering demographic aspects, eating behaviour and changes in life style.

RESULTS

Positive changes in eating behaviour correlated with higher quality of life scores in many of the domains assessed, including leisure, financial situation and perceived mental health. These changes also correlated with positive changes in life style in several domains, in particular family situation and leisure activities.

CONCLUSIONS

Results show that various connections between eating behaviour and quality of life as well as life style exist, suggesting a treatment concept that emphasizes both clinical symptoms and psycho-social conflicts.

Quality of life after cystectomy and orthotopic neobladder versus ileal conduit urinary diversion

The impact of bladder removal and urinary diversion for patients' everyday life is largely unknown. The aims of this study were to compare subjective morbidity of ileal neobladder to the urethra versus ileal conduit urinary diversion and to elucidate its influence on quality of life. A total of 102 patients who underwent cystectomy due to a bladder malignancy were included in the study. In 69 patients (67.6%) an orthotopic neobladder and in 33 patients (32.4%) an ileal conduit was performed as urinary diversion. The compliance was 99% and mean follow-up was 37 months. All patients completed two retrospective quality of life questionnaires, namely the QLQ-C30 and a questionnaire developed at our institution to ask for urinary diversion specific items. The questioning and assessment was performed by non-urologists. The results obtained from the validated (QLQ-C30) and our own specially compiled questionnaire clearly demonstrate that patients with an orthotopic neobladder are more able to adapt to the new situation than patients with an ileal conduit. In addition, neobladder to the urethra improves the quality of life because it improves self-confidence, causes better rehabilitation as well as the restoration of leisure, professional, travelling, and social activities, and reduced risk of inadvertent loss of urine. For example, 92.8% of neobladder patients did not feel handicapped at all, and 87% did not feel sick or ill, in contrast to 51.5% and 66.7% of ileal conduit patients, respectively. Of the neobladder patients, 74.6% felt absolutely safe with the urinary diversion in contrast to 33.3% in the ileal conduit group. Only 1.5% of neobladder patients had wet clothes caused by urine leakage during the day, versus 48.5% of ileal conduit patients. Moreover, 97% of our neobladder patients would recommend the same urinary diversion to a friend suffering from the same disease, but only 36% of ileal conduit patients would do so. These results demonstrate that the quality of life is preserved to a higher degree after orthotopic neobladder than after ileal conduit urinary diversion.

Knowledge of calories and its effect on eating behavior in overweight, normal weight, and underweight individuals

BACKGROUND

To assess changes in the eating behavior of overweight, normal weight, and underweight individuals in response to knowledge about the caloric content of their food.

METHODS

Anonymous self-report questionnaires were completed by 1041 staff members attending the Innsbruck University Hospital cafeteria shortly after it started to display the caloric content of all meals. The questions covered the subjects' weight history, body image, eating behavior, and response to knowledge of caloric content.

RESULTS

Among the respondents, 141 were classified as overweight, 728 as normal weight, and 118 as underweight. Overweight individuals reported a significantly more frequent change in eating behavior in response to the information, and were also significantly more distressed about weight and eating and dissatisfied with their bodies and their weight than normal and underweight individuals.

CONCLUSIONS

Overweight individuals were more likely to report that they had modified their eating in response to information about calories. Whether this reflects an actual change in eating behavior, or merely a wish to give socially desirable responses, remains uncertain.

The weeping behavior in anorexic and bulimic females

BACKGROUND

The aim of the study was to examine the proneness, the functions and triggering situations of weeping in anorexic and bulimic women.

METHODS

Participants were 36 anorexic and 31 bulimic female patients and 56 age-matched female controls. All women completed the Questionnaire on Adult Crying. We limited our study to results on 'crying proneness', 'functions of crying' and 'determining factors of crying'.

RESULTS

Bulimic patients reported to have cried significantly more often in the last 4 weeks, to be more likely to cry in situations of distress and to have used weeping significantly more often as a manipulative behavior than control women. Anorexic patients rated their tendency to cry significantly lower and experienced weeping as significantly more negative than controls.

CONCLUSIONS

Compared to control women, anorexic patients associated weeping with negative feelings as opposed to bulimic patients who appeared to use weeping on an intentional basis. These deviations from control women seem to mirror the introvert character of anorexic patients and the extrovert impulsive personality of patients with bulimia nervosa, respectively.

Drug use and lifestyle among college students in Austria and the United States

Using an anonymous questionnaire, we assessed the prevalence of alcohol use and illicit drug use among 545 college students in Innsbruck, Austria in 1995. The questionnaire also assessed various aspects of students' lifestyles, including academic performance, college activities, career plans, visits to a psychiatrist, and sexual activity. We compared these results with those obtained using the same questionnaire at a similar American college in 1989. We found that the prevalence of virtually all forms of illicit substance use was much higher among the American students. In both Austria and the United States, however, we found few differences between drug users and nonusers on most measures of lifestyle, with the exception of hetero-sexual activity.

Denial of pregnancy: obstetrical aspects

Between 1987 and 1990 27 women were observed who professed they did not know they were pregnant until term or until premature contractions set in. The aim of this study was to evaluate obstetric history and pregnancy outcomes and assess defence mechanisms and coping strategies which contribute to negation of pregnancy. In 11 women pregnancy was denied until delivery, five of these had breech presentations. In nine women denial ended between 27 and 36 weeks and in seven women between 21 and 26 weeks of gestation. Three of the four fetal deaths that occurred and two of the three cases of prematurity occurred in the last group. There was no infanticide but one woman delivered her infant alone and concealed. Most women reported irregular, sometimes menstruation-like bleedings during pregnancy, three women had taken oral contraceptives during pregnancy. Few women reported actual symptoms of pregnancy, such as nausea and weight gain. Denial of pregnancy is a heterogeneous condition with different meanings and different psychiatric diagnoses in different women. Stressors (e.g. separation from partner, interpersonal problems etc.) do play an important role as precipitating factors for the development of an adjustment disorder with maladaptive denial of pregnancy. There is a fluid transition between conscious coping strategies and unconscious defence mechanisms.

Significance of vomiting for hyperamylasemia and sialadenosis in patients with eating disorders

The authors investigated the significance of vomiting for hyperamylasemia and sialadenosis in patients with bulimia nervosa. Hyperamylasemia was found in 61% of the bulimics and in 20% of the restrictor anorectics but in no patients with binge-eating syndrome. In more than three fourths of the bulimics there was a close positive correlation between the frequency of vomiting and total serum amylase levels. Both frequency and type of vomiting seem to be relevant to the extent of salivary gland enlargement. The significance of vomiting for the etiopathology of hyperamylasemia and for the diagnosis of eating disorders will be discussed.

[The significance of incest experience for the development of psychiatric and psychosomatic diseases]

A history intrafamilial sexual child abuse was dicited from 33 patients (20%), admitted to the Psychiatric Department (Psychosomatic Unit) of the University Clinics of Innsbruck in 1989. They exhibited quite different psychopathologies, with no typical incest syndrome, however, self-destructive behaviours of different kinds appeared to be characteristic of sexually abused patients. Experiences of separation and loss could be seen as the most frequent trigger for mental and psychosomatic disorders. The importance of child sexual abuse as a vulnerability factor, the necessity to consider the possibility of sexual abuse during childhood in all cases of mental disorder and the importance of the therapist's empathy as a precondition for the patient's ability to speak about the traumatic experience are discussed.

Sexual abuse of girls: aspects of the genesis of mental disorders and therapeutic implications

We studied the mental disorders of 33 women with a history of intrafamilial sexual abuse as a child and found a wide range of psychopathological symptoms, but no typical incest syndrome. Several psychosocial factors are presented and the psychodynamics of and the causative circumstances initiating the mental disorders are discussed. These circumstances were mainly situations of separation, which led to ego instability and gave rise to a feeling of helplessness and impotence. The necessity to take into consideration the possibility of sexual abuse during childhood in all cases of mental disorders as well as therapeutic guidelines are discussed.

Functional aphonia. A conversion symptom as defensive mechanism against anxiety

Aphonia is the extreme form of a functional voice disorder. 22 female patients with aphonia underwent laryngoscopic and phonic examinations, psychiatric evaluation, psychological testing and biographical history-taking. Results demonstrate a homogeneous clinical picture, but heterogeneous personality structures and conflict situations. All patients are overtaxed by their situation; the conversion reaction is used as a means to express anxiety and maintain self-assertion at the same time.

[Thromboembolism prevention in surgical medicine: heparin or heparin-dihydroergotamine?]

This review summarizes clinical studies on prevention of venous thromboembolism by heparin or heparin and dihydroergotamine. Advantages and disadvantages of both drugs are described. The value of low-dose-heparin can no longer be seriously disputed. Up to now, however, there is no clear evidence that heparin-dihydroergotamine improves the efficacy and reduces the frequency of complications. The later drug is a new approach still under investigation.