Despite the continuous advances in cancer treatment, many patients undergoing cancer treatment still suffer because of inability to find
meaning
in their treatment experiences. Nurses involved also suffer because they prioritize the implementation of treatment protocols rather than providing holistic care. Therefore, special care is needed in clinical settings. This report aimed to demonstrate helpfulness and possibility of “caring partnership” with patients in the treatment phase on the basis of Margaret Newman's theory of health as expanding consciousness.
Caring partnership
is a nursing intervention in a unitary and relational perspective that helps patients and nurses make a difference. For this intervention, patients need to recognize their own pattern in the relationship to exert their
own strengths
in finding
meaning
to their cancer treatment experience and so their lives, while nurses are encouraged to partner with them, trusting patients' own power and becoming a
rich environment
for them. Hence, dialog is necessary to facilitate patients'
pattern recognition
in process of
the patient-nurse partnership
. Three cases are presented for each treatment phase (perioperative, chemotherapy treatment, and prolonged postoperative self-care management). Through
caring partnership
with an oncology certified nurse, the patients found
meaning
in their treatment experiences and exerted their
own inner strength
to establish a new way of life, and the nurses reconfirmed what nursing was. From the theoretical viewpoint,
caring partnership
was helpful for patients in distress and was possible in clinical settings even with partial involvement during a treatment phase.
Objective : To evaluate the long-term maxillomandibular changes after maxillary distraction osteogenesis in growing children having cleft lip with or without cleft palate. Patients : Eight Japanese patients with cleft lip with or without cleft palate aged 9.3 to 13.1 years. Measures : The maxillary and mandibular positions before (T0), immediately after (T1), and 1, 3, and 5 years after distraction osteogenesis (T2, T3, and T4, respectively) measured on cephalograms superimposed at the sella turcica with the Frankfort horizontal plane as the horizontal reference. The anterior nasal spine (x, y), pogonion (x), and menton (y) were used for linear measurements, and sella turcica-nasion-point A, sella turcica-nasion-point B, and point A-nasion-point B angles were used for angular measurements. Results : The mean horizontal maxillary advancement (anterior nasal spine [x]) was 12.3 mm during T0 to T1, but -2.7, -1.1, and -0.1 mm of the posttreatment changes were observed during T1 to T2, T2 to T3, and T3 to T4, respectively. Anterior nasal spine (y) shifted 2.3 mm downward during T0 to T1, and further downward changes were observed during T1 to T2 and T2 to T3 (P < .05). Pogonion (x) did not show distinct changes due to individual variance, but menton (y) shifted downward from T1 to T4. Sella turcica-nasion-point A significantly decreased during T1 to T2 and T2 to T3 but not during T3-T4. Point A-nasion-point B significantly decreased only during T2 to T3, and sella turcica-nasion-point B did not show any distinct change. Conclusions : There was no further maxillary advancement after distraction osteogenesis in the growing children with cleft lip with or without cleft palate. Therefore, long-term observation and management of occlusion in case of the mandibular growth pattern are important.
Objective: Ultrasonographic (US) observation was carried out in order to investigate bone formation and remodeling after distraction osteogenesis (DOG) using the rigid external distraction (RED) system. Patients and method: The patients were seven cases of unilateral cleft lip and palate treated using the RED system: six males and one female with the mean age of 19 years. The amount of maxillary advancement by DOG ranged from 7.5 to 17.5mm and the timing of US observation was from 2.2 to 6.9 years post-DOG. B mode US examination of the distracted maxillary anterior wall was performed with a 14-MHz transducer. Bone formation and remodeling were assessed on both cleft
Noncontact optical surface scanners have been used to evaluate facial soft tissues. Appropriate evaluation of patients with cleft lip and palate requires comprehensible assessment of the changes in their pre-and post-orthodontic soft tissue and facial growth during chairside assistance. The authors developed a new scanning system that required a shorter measurement time than conventional modalities. The system was implemented on a mannequin and a 6-year-old patient. Seven midfacial landmarks were identified on their faces. The authors measured these landmarks 5 times daily. An experienced orthodontist evaluated and recorded the scores. The scores obtained from the mannequin had a variation of within 0.2 mm, while those obtained from the patient varied within 0.8 mm, except that of the inferior limit of the lips. The study findings suggest that the new laser scanning system can accurately measure facial soft tissue. Further studies should fix patients' head at a definite position for more accurate measurements. An appropriately angled laser sensor would eliminate distortions, thereby increasing the measurement validity.
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