Dolan Park Hospital

Human papillomavirus (HPV) vaccination remains a cornerstone of cervical cancer prevention and the control of other HPV-related malignancies. Healthcare workers are critical to the success of vaccination programmes, as their knowledge, attitudes, and recommendations strongly influence public acceptance. This study assessed the level of knowledge, willingness, and factors influencing hesitancy toward HPV vaccination among healthcare workers in Anambra State, Nigeria. A cross-sectional study was conducted among 430 healthcare workers selected using a multistage stratified random sampling technique across public and private health facilities. Data were collected using a structured, self-administered questionnaire and analysed with IBM SPSS version 26. Descriptive statistics were used to summarise key variables, while inferential analyses—including chi-square tests, independent t-tests, analysis of variance, and correlation analysis—were employed to examine associations between knowledge, willingness, and selected sociodemographic characteristics. Statistical significance was set at p < 0.05. Overall, knowledge of HPV and its vaccine was high, with 91.6% of respondents demonstrating adequate knowledge. Awareness of the association between HPV and cervical cancer was high; however, knowledge that HPV affects both males and females was comparatively lower. Willingness to accept and recommend HPV vaccination was also high, with 81.4% of respondents exhibiting high willingness. Vaccine safety concerns and fears of long-term side effects were the most commonly reported factors influencing hesitancy. Knowledge scores differed significantly by age, profession, and practice location, while willingness varied by marital status, religion, level of healthcare, and practice location. A weak but statistically significant positive correlation was observed between knowledge and willingness to accept HPV vaccination (r = 0.152, p = 0.002). In conclusion, healthcare workers in Anambra State demonstrated high levels of knowledge and strong willingness to support HPV vaccination, despite residual concerns and misconceptions. Strengthening targeted continuing professional education, ensuring sustained institutional support, and improving vaccine availability may further enhance healthcare worker advocacy and HPV vaccine uptake.

Background:Infective endocarditis (IE) continues to present significant diagnostic and therapeutic challenges, despite advances in healthcare. The epidemiology of IE has shifted globally, but regional data, especially from Türkiye, remains limited. Objective:This study aims to examine the clinical and demographic changes in IE over three decades at a tertiary referral center in Türkiye. Methods:We conducted a retrospective analysis of 56 patients diagnosed with definite or probable IE between 2001 and 2010, comparing these with previous cohorts from 1978–1992 (n = 88) and 1992–2001 (n = 66). Diagnosis was based on the modified Duke criteria. Clinical, microbiological, echocardiographic, and treatment outcomes were compared, and logistic regression analysis was used to identify predictors of in-hospital mortality. Results:The mean age of patients increased significantly over time, from 32.3 years in 1978–1992 to 51.7 years in 2001–2010 (p<0.001). The incidence of rheumatic heart disease declined, while prosthetic valve endocarditis and degenerative valve disease increased. Culture-negative cases decreased, while infections with enterococci and coagulase-negative staphylococci rose. Surgery was required in 46.4% of recent cases. Female gender, presence of S3 or rales on auscultation, and mobile vegetations were significant predictors of higher mortality. Early surgical intervention was associated with improved survival. Conclusion:Over the last three decades, IE in Türkiye has shifted from being predominantly associated with rheumatic heart disease to being more related to prosthetic valves and device-associated infections, aligning with trends observed in developed countries. While diagnostic and surgical advances have improved management, mortality remains high, underscoring the importance of early intervention and standardized treatment protocols.

Health care inequities persist, and it is difficult to teach health professions students effectively about implicit bias, structural inequities, and caring for patients from underrepresented or minoritized backgrounds. Improvisational theater (improv), where performers create everything in a spontaneous and unplanned manner, may help teach health professions trainees about advancing health equity. Core improv skills, discussion, and self-reflection can help improve communication; build trustworthy relationships with patients; and address bias, racism, oppressive systems, and structural inequities. Authors integrated a 90-minute virtual improv workshop using basic exercises into a required course for first-year medical students at University of Chicago in 2020. Sixty randomly chosen students took the workshop and 37 (62%) responded to Likert-scale and open-ended questions about strengths, impact, and areas for improvement. Eleven students participated in structured interviews about their experience. Twenty-eight (76%) of 37 students rated the workshop as very good or excellent, and 31 (84%) would recommend it to others. Over 80% of students perceived their listening and observation skills improved, and that the workshop would help them take better care of patients with experiences different than their own. Six (16%) students experienced stress during the workshop but 36 (97%) felt safe. Eleven (30%) students agreed there were meaningful discussions about systemic inequities. Qualitative interview analysis showed that students thought the workshop helped develop interpersonal skills (communication, relationship building, empathy); helped personal growth (insights into perception of self and others, ability to adapt to unexpected situations); and felt safe. Students noted the workshop helped them to be in the moment with patients and respond to the unexpected in ways more traditional communication curricula have not. The authors developed a conceptual model relating improv skills and equity teaching methods to advancing health equity. Improv theater exercises can complement traditional communication curricula to advance health equity.

Plastic surgery as a specialty is afflicted with one of the highest incidence rates of thromboembolic events, with abdominoplasty procedures known to assimilate the greatest rates of deep vein thrombosis (DVT). The aim of this study was to develop a prophylactic protocol to reduce the rate of DVT occurrence postabdominoplasty. Over a 7-year period 1078 abdominoplasty patients were enrolled onto a holistic 8-point prophylaxis protocol. For a 4-week period before the operation all patients were required to stop smoking, and to cease hormone replacement therapy and combined oral contraception. All patients were required to have a preoperative BMI of less than 40 kg/m2. Participants were supplied with compression stockings, external pumping devices, and enoxaparin. Individuals with a history of DVT were also required to be 1-year treatment free prior to surgery. Furthermore, the protocol required postoperative ambulation of fit patients within 4 hours. Between 2008 and 2013, no incidence of DVT was recorded in all 1078 abdominoplasty surgery patients, indicating the potential for this protocol to lead to a significantly lower incidence than any previously published methodology. Previous studies of DVT incidence were reviewd to identify rates statistically significantly similar to our sample, thereby providing conservative incidence rate estimates. This 8-point DVT prophylaxis protocol is the first noncriteria-based inclusive protocol aimed at preventing abdominoplasty-associated DVT. A holistic and procedure-specific approach to prophylaxis can drastically reduce the occurrence of DVT in abdominoplasty surgery.With over 116,000 procedures performed annually in the United States, abdominoplasty has become one of the most popular and sought-after surgeries in the plastic and cosmetic field.1 Despite its ever-increasing popularity and the advancement of techniques, abdominoplasty-as with any other surgery-has its complications, including infection, seroma, hematoma, thrombosis, embolism, scarring, and even death. Complication rates as high as 37% have been reported, with some studies reporting a 16% major complication rate.2 One of the most serious and troubling complications for both surgeon and patient is deep vein thrombosis (DVT). With over 1 million patients tested, an estimated 250,000 cases of DVT are diagnosed per year in the United States alone.

It is often assumed that seroma formation trails closely behind with incidence rates reported at 1 to 2%. Seroma is highly problematic for both the surgeon and patient and results in both patient anxiety and discomfort, succeeded by frequent outpatient visits, follow-up treatment, increased costs, and potentially hampered aesthetic outcomes. Consequently, it is now more important than ever to study seroma and to assess its pathophysiology and mechanisms of prevention. The aim of this study was to isolate and identify risk factors that may be associated with early seroma formation. The authors reviewed 539 female patients who had undergone bilateral breast augmentation with silicone cohesive gel implants in a period of 12 months. Five possible risk factors were isolated for analysis: patient’s age, body mass index (BMI), smoking habit, implant pocket position, and implant size. A total of 15 patients developed early seromas within the one-year postoperative period. Using exact logistic regression with the independent variables treated as binary variables, we found that smoking, BMI, and pocket are associated with increased risk of seroma while we cannot reject the hypothesis that pocket size and age do not affect the development of seroma at 5% significance level. A high BMI, large implant size, submammary pocket, and smoking are factors significantly associated with seroma development whilst age is not. Smoking however was found to be the most detrimental factor as it significantly amplified the effects of other variables. 2

We report herein the case of a 42-year-old woman who presented to the Burns Unit with 81% of her body surface severely burned following sun bathing, after applying fig leaf tea as a tanning agent. The patient was hospitalized for 13 days in a Burns Intensive Care Unit, and was discharged for an ambulatory follow-up. The treatment of such burns does not differ from any conventional treatment for heat- induced second-degree burns. The physiopathology of the phytophotodermatitis induced by such homemade tanning solutions rich in psoralen is discussed in detail.

We prospectively followed patients who underwent esthetic abdominoplasty and flank liposuction to determine the influence of the amount of fat removed on the occurrence of pulmonary embolism. We recruited patients undergoing abdominoplasties and flank liposuction and composed 2 groups according to the amount of fat removed, one of small resections (<1500 g) and the other of great resections (>1500 g). All patients received deep vein thrombosis prophylaxis. Since January 2005, we enrolled 103 patients and registered 3 embolisms (2.9%). All occurred in nonsmokers, had no risk factor for deep vein thrombosis, and a resection weight greater than 1500 g (21.4%; 3/14). The calculated relative risk conferred by the amount of fat greater than 1500 g was 7.4. An association was also found with duration of surgery: all embolisms occurred in patients that underwent long operation (>140 minutes; 8.8%; 3/34) with a relative risk of 3.0. The amount of fat removed during plastic surgery is a factor influencing the occurrence of pulmonary embolism in patients undergoing abdominoplasty/flank liposuction, and the duration of surgery is a concomitant factor. Should this data be confirmed, specific measures for prevention of this serious complication could be developed.

Sir: Dr. Keramidas recently wrote a letter regarding his experience with subfascial breast augmentations.1 This letter was followed by a reply from Dr. Parsa.2 We have performed subfascial breast augmentations since 2004, and so far we have performed more than 500 operations. With regard to this controversial issue, we would like to describe our experience. The literature includes many relevant publications regarding this technique, many of them with contradictory results and theories, and some authors are still concerned about the positive role of the fascia.3–6 The technique we have adopted is a modification of Dr. Graf's original method.7 The initial incision is located in the inframammary folds. Periareolar incisions alter the integrity of the breast tissue, leave scars that can interfere with radiologic investigations, and produce damage to the sensitivity of the nipple-areola complex, with subsequent impaired breast-feeding ability. We perform the dissection using a monopolar diathermocoagulator with a very thin tip (Colorado Microdissection Needle; Colorado Biomedical, Inc., Evergreen, Colo.) set in the cut mode only. We stopped using the coagulation mode after 12 operations, when we realized that it could damage the fascia (higher temperatures) and render more difficult the individuation of fascia/muscular borders. Although the coagulation mode gives the theoretic advantage of producing more hemostasis, the surgeon's technique and experience can supply this difference. Actually, our operation lasts 30 minutes (range, 24 to 42 minutes), and the fascia is easily dissected as a continuous layer from the muscle and is raised within the breast gland. We do not agree with Dr. Keramidas1 when he states that "the ease of dissection has to do mostly with the quality of the breast tissue." Since we have been using the thin tip set on the cut mode, we have obtained a thin, strong layer of pectoralis major fascia. Furthermore, vigorous traction upward with a long light retractor is necessary in this passage to cut the muscle fibers closely and eventually visualize small blood vessels before the cut. This results in a slower but precise dissection. We do not agree completely with Dr. Parsa when he states that extensive vascular connections exist between the fascia and the lower, caudal portion of the pectoralis major, rendering more arduous and bloody the disconnection.2 We honestly did not find any significant difference of connections among the upper and lower portions of the muscular fibers/fascia. On the contrary, we have the impression that it is easier to disconnect the lower part than the upper part, probably because the operative view is better and the traction can be more vigorous. When the pocket is complete, we wash it with an antibiotic solution and leave a compressive swab containing 40 ml of saline and 2 ml of peroxide inside for 10 minutes, the time required to prepare the opposite pocket. The swab produces a soft compression for small capillaries, and the small amount of peroxide washes out the blood (for a better visualization of small bleedings) and has a mild antimicrobial effect. We never actually use drains, as we have demonstrated that they increase the occurrence of infections.8,9 Patients who bled consistently (n = 16 in our experience) received an additional 10-minute swab compression. In our 511 patients, we recorded only one postoperative hematoma, in the thirtieth operation (during the learning curve). Subfascial pockets undoubtedly produce good coverage (about 60 to 70 percent of the implant area). Coverage of the implant's superior part is of fundamental importance to reduce the risk of rippling, and coverage of the superior and central parts avoids the direct contact with the fat tissue, which is more reactive to prostheses, to reduce the amount of inflammation and (maybe) capsular contraction. We have never recorded any capsular contraction in our patients, but this could be due to the short follow-up period.9,10 Antonino Araco, M.D. Dolan Park Hospital Birmingham, United Kingdom Gianpiero Gravante, M.D. Department of General Surgery University of Tor Vergata Rome, Italy Francesco Araco, M.D. Dolan Park Hospital Birmingham, United Kingdom Daniela Delogu University "La Sapienza" of Rome Rome, Italy Valerio Cervelli, M.D. Department of Plastic Surgery University of Tor Vergata Rome, Italy

Medical Journal of AustraliaVolume 1, Issue 4 p. 129-131 Report of Case L.S.D. PSYCHOSIS C. M. Rosenberg M.D., M.A.N.Z.C.P., D.P.M., C. M. Rosenberg M.D., M.A.N.Z.C.P., D.P.M. Callan Park Hospital, Rozelle, N.S.W.Psychiatric Research Unit.Search for more papers by this authorB. Eldred M.B., B.S., M.A.N.Z.C.P., D.P.M., D.C.H., B. Eldred M.B., B.S., M.A.N.Z.C.P., D.P.M., D.C.H. Callan Park Hospital, Rozelle, N.S.W.Search for more papers by this author C. M. Rosenberg M.D., M.A.N.Z.C.P., D.P.M., C. M. Rosenberg M.D., M.A.N.Z.C.P., D.P.M. Callan Park Hospital, Rozelle, N.S.W.Psychiatric Research Unit.Search for more papers by this authorB. Eldred M.B., B.S., M.A.N.Z.C.P., D.P.M., D.C.H., B. Eldred M.B., B.S., M.A.N.Z.C.P., D.P.M., D.C.H. Callan Park Hospital, Rozelle, N.S.W.Search for more papers by this author First published: 01 January 1968 https://doi.org/10.5694/j.1326-5377.1968.tb27521.xCitations: 1 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume1, Issue4January 1968Pages 129-131 RelatedInformation

1Psychologist, Psychiatric Research Unit, Callan Park Hospital, Sydney, Australia. 2Neurosurgeon, Psychiatric Research Unit, Callan Park Hospital, Sydney, Australia.