bluuebunny/crossref_metadata_2025 huggingface dataset:
Narcissistic Pathology: Empirical Approaches
Authors: Levy Kenneth N. , Chauhan Preeti , Clarkin John F. , Wasserman Rachel H. , Reynoso Joseph S.
Published: June 2009

CME Educational Objectives

1.

Describe the historical context for development of theDiagnostic and Statistical Manual of Mental Disorders-based narcissistic personality disorder diagnosis.

2.

Identify the empirical literature on the prevalence, comorbidity, subtypes, gender differences, and assessment procedures for narcissistic personality disorder.

3.

Identify the treatment literature regarding narcissistic personality disorder.
Narcissistic and Borderline Personality Disorders in a Sample of Treatment Refractory Patients
Authors: Clemence A. Jill , Perry J. Christopher , Plakun Eric M.
Published: June 2009

CME Educational Objectives

1.

Discuss the similarities and differences between patients with treatment resistant narcissistic personality disorder (NPD) and borderline personality disorder (BPD) in a residential setting.

2.

Display factors that might contribute to treatment resistance for patients with NPD in a residential setting.

3.

Define ways that these patients may differ from those in less intensive settings.
Narcissism and Criminality
Authors: Stone Michael H.
Published: June 2009

CME Educational Objectives

1.

Identify the connection between narcissistic personality traits and the tendency of criminal behavior.

2.

Explain the manner in which certain psychiatric disorders magnify the tendency of narcissistic traits and antisocial behaviors.

3.

Discuss the variety of prenatal and post-natal (environmental) factors that contribute to the evolution of violent criminality in certain narcissistic persons.
Large-group Narcissism and Political Leaders with Narcissistic Personality Organization
Authors: Volkan Vamık D. , Fowler J. Christopher
Published: June 2009

CME Educational Objectives

1.

Describe large-group narcissism and how to detect it.

2.

Outline the role of “chosen traumas” in sustaining and fomenting large-group narcissism.

3.

Describe the interplay between narcissistic leaders and the need for a savior in large groups.
North American Zoonoses
Authors: Lieberman Jay M.
Published: June 2009

CME Educational Objectives

1.

Identify infectious diseases that children develop after contact with animals.

2.

Assess the clinical manifestations of different zoonotic infections.

3.

Describe the appropriate diagnostic evaluation and therapy for select zoonoses in children.
Evaluation Tool for Clinical Nursing Textbooks: Bridging Content Analysis with Evidence
Authors: Cassata Linda C. , Cox Tina M.
Published: June 2009

One of the challenges nurse educators face is choosing a textbook that ensures congruency within the discipline of nursing, national and global health priorities, and the mission of the university. This article discusses the development of a tool that evaluates course content concurrently with evidence. The need to critically link content analysis and evidence within clinical nursing textbooks is deemed important given the discipline's imperative to prepare nurses to use the best evidence available for practice. The history and concept of evidence-based nursing practice is explored to develop an operational definition for the tool, which was designed to guide a realistic and expeditious process for this important faculty responsibility.
Examining Patterns of Change in the Critical Thinking Skills of Graduate Nursing Students
Authors: McMullen Maureen A. , McMullen William F.
Published: June 2009

Although critical thinking in undergraduate nursing education has been explored in depth, little is known about the critical thinking skills of graduate nursing students. Prior research on change in critical thinking scores is based primarily on pretest and posttest assessments that provide minimal information about change. This study used individual growth modeling to investigate how critical thinking skills change during a 2-year graduate nurse program. Scores from the evaluation, inference, and analysis subscales of the California Critical Thinking Skills Test comprised the empirical growth record. Change in the three critical thinking skills was more dynamic than that reported in previous studies. Patterns of change differed by critical thinking skill and in relation to students' initial critical thinking skill levels at program entry.
Spiraling Evidence-Based Practice and Outcomes Management Concepts in an Undergraduate Curriculum: A Systematic Approach
Authors: Ross Amy Miner , Noone Joanne , Luce Linda L. , Sideras Stephanie A.
Published: June 2009

Preparing undergraduate nursing students to practice nursing in the 21st century requires a focus on the development of evidence-based practice and outcomes management knowledge and skills throughout the nursing curriculum. To this end, seven learning activities were created that spiral and increase in complexity while building on previously acquired skills. Working in teams and practicing team-building techniques, students learned how to develop a clinical question, search the literature, synthesize the current knowledge, identify the significance of the issue in an ecological model, decipher existing quality data and compare that data to national benchmarks, investigate a health care quality issue using quality improvement methods, and draft a proposal for implementation of a continuous quality improvement initiative. Work was presented in both written and oral presentation formats, with emphasis on engaging various audiences in a compelling health care issue.
Using New Resources to Teach Evidence-Based Practice
Authors: Heye Mary L. , Stevens Kathleen R.
Published: June 2009

This article describes an innovative strategy used to teach evidence-based practice (EBP) concepts in an undergraduate research course and explains the underlying framework used to design the strategy. The strategy for the Evidence-Based Practice Project was based on new resources: undergraduate nursing student competencies for EBP, national health care improvement priorities, evidence rating systems, and a model of knowledge transformation for EBP. Groups of students selected a priority area, categorized and critically appraised the evidence supporting the recommendation for change in health care practice, and compared the recommendation to actual practice. An oral and poster presentation of the project provided the opportunity to discuss the significance, influence, and strength of the evidence supporting the recommendation to change health care practice. Student presentations and faculty perceptions of the project indicated beginning competencies in EBP were achieved.
Collaborative Strategies for Teaching Evidence-Based Practice in Accelerated Second-Degree Programs
Authors: Kruszewski Ann , Brough Elizabeth , Killeen Mary B.
Published: June 2009

An important challenge for teaching in accelerated second-degree programs is how to manage essential content within a compressed curriculum format. This article describes a project that used a collaborative model for teaching evidence-based practice (EBP) in a redesigned second-degree nursing program. Instructors in two courses shared responsibility for teaching basic concepts and guiding students' implementation of EBP in a clinical setting in partnership with clinical nurses. This approach resulted in a high degree of satisfaction for students, instructors, and nursing staff in clinical agencies. The project demonstrated collaborative teaching strategies can help students achieve basic knowledge in EBP and translate that knowledge into their clinical practice. Collaboration also can achieve more efficient learning experiences, a critical element in accelerated nursing programs.
Student Articulation of a Nursing Philosophical Statement: An Assignment to Enhance Critical Thinking Skills and Promote Learning
Authors: Hernandez Cheri Ann
Published: June 2009

The development of a personal philosophical statement about nursing is a useful assignment for both undergraduate and graduate nursing students. Students are asked to write a paper describing their philosophical views about nursing related to the metaparadigm concepts and include in-depth examples from their clinical practice to illustrate these views. This article includes information regarding important preparatory activities and handouts to facilitate the writing and evaluation of this assignment. There are many potential benefits of this complex assignment. It promotes students' reflection on their personal clinical practice experiences and engages students in mental and verbal dialogue that elicits their philosophical ideas about the metaparadigm concepts. These activities promote critical thinking and reflective clinical practice, act as a foundation for building theoretical understanding, and promote confidence in learning about nursing and other theories.
Clinical Instruction: Using the Strengths-Based Approach with Nursing Students
Authors: Cederbaum Julie , Klusaritz Heather A.
Published: June 2009

Clinical instruction experience can vary significantly based on the needs of the organization and the individual characteristics of instructors and students. Clinical instructors may encounter difficulties in their relationships with students, such as personality conflicts, differences in style and values, and limited skill levels or a lack of interest on the part of students. To reduce obstacles when working with challenging students, a strengths perspective approach is recommended. This framework emphasizes discovering, affirming, and enhancing the capabilities, interests, knowledge, resources, goals, and objectives of individuals. The strengths perspective can provide an innovative framework for working with nursing students, one that emphasizes student empowerment, collaborative learning, and mutual growth. Strength-based strategies for supervision of students in clinical placements are shared, highlighting the practical application of the framework's tenets.
Cultivating Authentic Concern: Exploring How Norwegian Students Learn This Key Nursing Skill
Authors: Christiansen Bjørg
Published: June 2009

The importance of interpersonal and expressive qualities has long been recognized in nursing. Drawing on data from a qualitative study among nursing students in Norway, this article discusses how nursing students cultivate authentic concern with patients. Because the nursing role has become more ambiguous, it must be created and formed in a personal way. Nursing students need to learn how to use their subjectivity in a way that promotes caring and compassionate conduct.
The Influence of Concept-Based Learning Activities on Students' Clinical Judgment Development
Authors: Lasater Kathie , Nielsen Ann
Published: June 2009

The traditional nursing clinical education model of total patient care is becoming inadequate. New models are needed to foster deeper clinical thinking, thereby affecting students' development of clinical judgment. Concept-based learning activities, first introduced in 1990, offer a focus on a specific concept. This study evaluated the effect of concept-based learning activities on the development of clinical judgment in baccalaureate nursing students. The clinical judgment of students who were and were not exposed to concept-based learning activities was compared. Quantitative data were analyzed using a univariate analysis. In addition, a focus group consisting of members of the treatment group provided qualitative data. Results suggest concept-based learning activities are a clinical learning strategy that should be considered by faculty to deepen clinical thinking in preparation for reaching sound clinical judgments.
Teaching to the Three Apprenticeships: Designing Learning Activities for Professional Practice in an Undergraduate Curriculum
Authors: Noone Joanne
Published: June 2009

The Carnegie Foundation for the Advancement of Teaching recently completed a series of comparative studies that examined components and best practices in professional education and practice across five professions (clergy, law, medicine, nursing, and engineering). Across these disciplines, three apprenticeships were identified as necessary components of education for professional practice: an intellectual or cognitive apprenticeship, a skill-based apprenticeship related to clinical judgment and practice, and an apprenticeship to the ethical comportment or behavior of the profession. Although nursing education has a strong theory and clinical practice base historically, the comparative study of nursing education by the Carnegie Foundation found limited integration of the apprenticeships. Using an exemplar, this article discusses intentional design of learning objectives and activities to integrate learning across the three apprenticeships with an emphasis on key elements for professional practice in nursing.
What’s Your Diagnosis?
Authors: Yeung Helen H.
Published: June 2009

A 14-month-old girl presented for further evaluation for glaucoma with a history of esotropia and concern for corneal clouding first seen by her mother at 9 months of age without associated epiphora or photophobia. At 11 months of age, an examination under anesthesia recorded the presence of suspected epithelial edema with bilateral borderline elevated intraocular pressures. After removal of the temporal corneal epithelium, strikingly clear visualization of the filtration angle was present. Bilateral goniotomies were then performed. One month postoperatively, the examination under anesthesia was repeated and moderately improved intraocular pressures were measured and persistent epithelial opacification was present. She had just begun standing and her pediatrician had noted mild global developmental delay. Her parents are both of Ashkenazim ancestry. On examination, she possessed mild coarse facial features and generalized hypotonia without hepatosplenomegaly or skin abnormalities. She fixed and followed well without nystagmus. Her corneas were diffusely cloudy and thickened bilaterally (Figure). Corneal diameter measurements, intraocular pressures, gonioscopic findings, and lenses were normal. The fundi were normal, without evidence of retinal vessel attenuation or optic atrophy. Conjunctival and corneal epithelial biopsies were performed. Electron microscopic analysis revealed lysosomal membrane-bound intracytoplasmic lamellar inclusion bodies that confirmed the suspected diagnosis.
The Spontaneous Resolution of Primary Congenital Glaucoma
Authors: Nagao Karina , Noël Léon-Paul , Noël Marie-Éve , Walton David S.
Published: June 2009

Purpose:
To describe the ocular findings in a series of children with spontaneous resolution of primary congenital glaucoma (PCG).

Methods:
The medical records of 356 patients with PCG were reviewed. Nine patients with spontaneous resolution of PCG were studied. Fourteen of 18 eyes possessed evidence of early glaucoma, were found to have normal intraocular pressures, and were clinically classified as having spontaneous resolution of PCG. None of the eyes with spontaneous resolution received surgery or any glaucoma medication.

Results:
Spontaneous resolution of PCG in all nine patients was recognized after 4 months of age. At the time of diagnosis, large corneas were observed in all affected eyes and Haab’s striae in 10 of 14 eyes. Intraocular pressures were normal in 14 eyes. In all 14 eyes, the anterior chambers were deep, the lenses were clear, and the angles were abnormal with the typical appearance of PCG. Theeyes with spontaneous resolution of PCG possessed angle abnormalities that were less severe compared to three fellow eyes that required glaucoma treatments.

Conclusion:
The occurrence of spontaneous resolution of PCG in these patients is supported by objective clinical evidence. The explanation for this spontaneous resolution is unknown. Its mechanism could be related to continued postnatal development of the angle structures in eyes possessing milder angle abnormalities. The anterior segment findings in patients with spontaneous resolution of PCG are similar to those of patients with treated PCG, the intraocular pressures are normal, the optic nerve damage is stable, and the filtration angles possess mild or moderate abnormalities.
Clinical Characteristics and Surgical Outcomes of Pediatric Retinal Detachments with Lens Disorders
Authors: Wang Nan-Kai , Chen Tun-Lu , Lai Chi-Chun , Kuo Ya-Hui , Chao An-Ning , Wu Wei-Chi , Chen Kuan-Jen , Hwang Yih-Shiou , Chen Yen-Po , Liu Laura
Published: June 2009

Purpose:
To describe the clinical characteristics and outcomes of eyes with retinal detachments with lens disorders and compare them to eyes with retinal detachments without lens disorders.

Methods:
A retrospective chart review of 42 eyes of 37 children who had retinal detachments with lens disorders was performed. Eyes were compared based on epidemiological data, characteristics of retinal detachment, and anatomical and functional surgical outcomes and were then compared to 254 eyes with retinal detachment without lens disorders.

Results:
In eyes with lens disorders, the retina was reattached after the first operation in 13 (31%) eyes and at the end of the intervention in 22 (52%) eyes. Surgical and visual outcomes appeared to be slightly better in the subluxation and dislocation group compared with cataract and aphakia or pseudophakia groups. In eyes without lens disorders, the retina was reattached in 202 (80%) eyes after the first intervention and in 228 (90%) eyes at the end of the intervention.

Conclusion:
Pediatric retinal detachment with a lens disorder is associated with unsatisfactory surgical and visual outcomes compared to those without lens disorders. Primary internal and external approaches are suggested in children with complicated retinal detachment with lens disorders.
Congenital Symblephara, Progressive Corneal Pannus, and Skin Defects
Authors: Haddad Christiane Al , Maybodi Monira , Butrus Salim , Epps Roselyn , Przygodzki Ronald , Miller Marijean
Published: June 2009

The authors describe a girl with congenital symblephara, progressive corneal pannus, and skin defects caused by focal dermal hypoplasia. Her corneal neovascularization progressed to full pannus and blindness.
Brown Syndrome with Bifid Scleral Insertion of the Superior Oblique
Authors: Park Sang Woo , Heo Hwan , Park Yeoung Geol
Published: June 2009

The authors describe a patient with bilateral congenital Brown syndrome who had bifid scleral insertion of the superior oblique muscle of both eyes. They considered bifid scleral insertion of the superior oblique muscle as a possible cause of congenital Brown syndrome.
Phthiriasis Palpebrarum in an Infant
Authors: Keklikci Ugur , Cakmak Alpay , Akpolat Nezahat , Unlu Kaan , Ozkul Sedat
Published: June 2009

The authors describe a case of phthiriasis palpebrarum embedded in the right upper eyelid of a 9-month-old male infant. The patient was successfully treated with mechanical removal of all lice and nits from the eyelashes. In children, phthiriasis palpebrarum should be considered in the differential diagnosis of blepharoconjunctivitis that is resistant to treatment.
Spontaneous Subperiosteal Hematoma of the Orbit
Authors: Sáenz-Madrazo Nerea , Arribas-Garcia Ignacio , Tejada-Palacios Pilar , Romance-Garcia Ana
Published: June 2009

Orbital subperiosteal hemorrhage is rare, with most cases occurring in young males as a result of direct facial or orbital trauma. The authors present a case of a spontaneous subperiosteal hematoma of the orbit in a 4-year-old girl.
Spontaneous Resolution of Stage 4B Retinopathy of Prematurity
Authors: Nayak Harish , Lim May Kim , Watts Patrick
Published: June 2009

An unfavorable outcome occurs in 31% of cases of treated severe threshold retinopathy of prematurity (ROP) and includes a retinal detachment of the posterior pole. Early treatment with laser of high risk prethreshold or type 1 ROP has significantly reduced this complication. However, despite prompt laser treatment, retinal detachments continue to be seen. Treatment of tractional partial retinal detachments involving the posterior pole (stage 4B ROP) is surgical. Successful reattachment of stage 4B ROP with a lens-sparing vitrectomy is high. The authors describe an infant who had spontaneous reattachment after stage 4B ROP.
Marsupialization of Orbital Conjunctival Inclusion Cysts Related to Strabismus Surgery
Authors: Pereira Luciano S. , Hwang Thomas N. , McCulley Timothy J.
Published: June 2009

A 52-year-old woman presented with a giant conjunctival cyst related to strabismus surgery that was adjacent to the medial rectus muscle. Management consisted of excision of the anterior cyst wall with suturing of the remaining cyst lining to overlying conjunctiva. Following marsupialization, the cyst did not recur with persistence of the conjunctival drainage site.
Anisometropic Amblyopia and Nasolacrimal Duct Obstruction
Authors: Simon John W. , Ngo Yen , Ahn Eric , Khachikian Steven
Published: June 2009

The authors describe five children with nasolacrimal duct obstruction who developed anisometropic amblyopia in the same eye. Because three children had no indication of vision loss at their initial presentation, cycloplegic refraction and periodic visual acuity screenings for such patients is recommended.
Blepharokeratoconjunctivitis in Cockayne Syndrome
Authors: Bhojwani Rajan , Lloyd I. Chris , Alam Suemyaa , Ashworth Jane
Published: June 2009

Cockayne syndrome is a multisystemic, autosomal recessive disease resulting from abnormalities of DNA repair. Ocular manifestations are common, particularly congenital cataract and retinal dystrophy. This study describes a previously unreported association of blepharokeratoconjunctivitis (BKC) in Cockayne syndrome. The authors conducted a retrospective case review of patients with Cockayne syndrome between 1997 and 2006. The ocular manifestations were documented. All cases were bilaterally aphakic from congenital cataract surgery. Four cases of BKC with resultant corneal changes were identified. Two other cases of BKC without corneal changes were also noted. There were no cases of corneal ulceration or visually significant scarring. These findings are clinically important because many patients with Cockayne syndrome wear contact lenses for the refractive correction of aphakia with a resultant risk of corneal ulceration.
Challenges Associated with Being an Off-Site Depression Care Manager
Authors: Ackerman Betty (Sunny) , Pyne Jeffrey M. , Fortney John C.
Published: June 2009

Within the context of depression care, the U.S. Department of Veterans Affairs (VA) has an ongoing depression care manager (DCM) training program. The VA has already trained approximately 50 DCMs and plans to continue DCM training to facilitate the integration of primary care and mental health care. This article provides an overview of the role of a DCM, challenges encountered by an off-site DCM, and strategies to address those challenges. Specifically, this article addresses the following challenges from the perspective of the DCM: suicidal patients, different agendas between patients and DCMs, feeling isolated, maintaining boundaries, building trust, learning to read between the lines, and dealing with hard-to-contact patients. Care management in the context of a distributed care team is becoming increasingly popular in health care systems.
Risky Behavior of Adolescent College Students
Authors: Ahern Nancy R.
Published: June 2009

Nurses who provide care to adolescent college students are challenged to meet their diverse health care needs. Recent national survey data on American college students indicate that many participate in risky behaviors, which can have detrimental effects on their physical and psychosocial health. These data also reveal that college students rank health educators and health center medical staff as the most believable sources of health-related information. Thus, nurses are in key positions to screen for and educate about stress, coping styles, and mental health issues. In addition to decreasing barriers to access, nurses can inform students on the kinds of resources available and their locations. This article also describes interventions that may be effective on college campuses for the reduction of risks and the promotion of positive coping and health outcomes in this population.
Addressing Recovery from Severe Mental Illness in Clinical Supervision of Advanced Students
Authors: Lysaker Paul H. , Buck Kelly D. , Lintner Jill I.
Published: June 2009

Although it is widely recognized that curricula should incorporate emerging knowledge about recovery as an attainable outcome for individuals with severe mental illness, little has been written about the clinical supervision of advanced students within a recovery model. For example, are there systematic issues a supervisor should anticipate and be prepared to address? How should a clinical supervisor assist students as they begin to try and apply their knowledge in a clinical context? To begin a dialogue about these issues, this article will propose that clinical supervision from a recovery model is faced with at least four semi-distinct challenges: the detection and avoidance of stigma, the setting of consensually valid and personally relevant goals, the development of a therapeutic relationship, and the assessment of barriers to recovery and outcomes.
Clinical Practice Guideline: 1-Hour Face-to-Face Assessment of a Patient in a Mechanical Restraint
Authors: Nadler-Moodie Marlene
Published: June 2009

Face-to-face assessment within 1 hour after placing a patient in a restraint has been the standard of care following regulatory requirements set forth by the federal government in 1999. This rule, although widely followed and applauded as optimum patient care, has little evidence of a standardized format for what constitutes the examination. Health care providers agree that a face-to-face assessment is warranted; however, no set parameters exist for what constitutes the key elements of such an assessment. This clinical practice guideline offers a specific outline to follow that emphasizes the safety of the patient being placed in a mechanical restraint for a behavioral health emergency.
Caregivers of Victimized Children: Differences Between Biological Parents and Foster Caregivers
Authors: Dowdell Elizabeth B. , Cavanaugh Deborah J.
Published: June 2009

Caregivers of children who have been sexually abused often find the experience challenging, especially when the child begins to act out in the home. Many children who have engaged in sexually aggressive, sexually inappropriate, or coercive behaviors with other children are placed in foster care. The purpose of this article is to describe the characteristics of biological parents and their significant others and foster caregivers of sexually aggressive and abusive children. A descriptive, exploratory study was conducted involving 3,149 caregivers (1,764 of them foster caregivers) of more than 800 youth ages 3 to 20. Findings suggest that while the foster caregivers were a more stable group than the biological parents and their significant others, the children experienced significantly high levels of instability in foster care placement. Provision of emotional and psychosocial support, coupled with education and periodic health evaluations, for the foster caregivers may be focal points of interventions. Nurses are in an ideal position to provide positive health promotion strategies and lifestyle choices for both foster caregivers and the children.
Youth in the Mental Health Void: Wraparound Is One Solution
Authors: McGuinness Teena M.
Published: June 2009

Mental health treatment works—if you can gain access to it. For many U.S. children with mental disorders, treatment is so inaccessible that parents must terminate their custodial rights so their children can receive psychiatric care. Use of Safe Haven laws, originally intended to prevent abandonment of newborns, are now being used to provide basic mental health care to youth. The closing of psychiatric services during the past decade has contributed to this crisis. Yet, one solution, wraparound systems of care, holds tremendous promise for providing community-based, comprehensive, and cost-effective care. Psychiatric nurses should support wraparound services as the standard of care for children and their families as health care reform is initiated.
The Antidepressant Effects of Anticholinergic Drugs
Authors: Howland Robert H.
Published: June 2009

Acetylcholine is a neurotransmitter that is important for communication between neurons and muscle, is involved in direct neurotransmission in the autonomic parasympathetic nervous system, and has been implicated in cognitive processing, arousal, and attention in the brain. The cholinergic-adrenergic hypothesis of mood disorders states that a given affective state might represent a balance between central cholinergic and adrenergic neurotransmitter activity in those areas of the brain regulating moods. According to this hypothesis, depression would be the clinical manifestation of a state of cholinergic dominance, whereas mania would reflect adrenergic dominance. On the basis of this hypothesis, anticholinergic drugs have been investigated as potential treatments for depression, but study results have not shown consistent antidepressant effects. However, the dosage dependency of scopolamine's effect across different studies and the lack of antidepressant effects with other anticholinergic drugs suggest that a specific muscarinic receptor subtype might be most relevant to the potential antidepressant mechanism of action of anticholinergic drugs.
Topical Cyclosporin A and Mitomycin C Injection as Adjunctive Therapy for Prevention of Primary Pterygium Recurrence
Authors: Ibáñez Miguel A. , Eugarrios Marcela F. , Calderón Delmy I.
Published: June 2009

Background and Objective:

The authors evaluated the results of topical cyclosporin A 1% and injected mitomycin C 0.01% use as adjunctive therapy for prevention of primary pterygium recurrence.

Patients and Methods:

Eighty eyes of 76 consecutive patients who had pterygium excision surgery in a prospective, interventional clinical trial received conjunctival autografting combined with an immediate postoperative 0.1-cc injection of 0.01% mitomycin C in caruncula were randomized into two groups: those who received postoperative topical application of cyclosporin A and those who did not.

Results:

The recurrence rate in patients who received topical application of postoperative cyclosporin A was 7.5% (3 of 40) compared with 17.5% (7 of 40) for patients who did not receive topical application of postoperative cyclosporin A (P= .31). An unexpected and significant finding in women was that those who received cyclosporin A had no recurrences (0 of 26), whereas those who did not receive cyclosporin A did (6 of 25; 24%) (P= .03).

Conclusion:

Intracaruncular mitomycin C 0.01% and topical cyclosporin A 1% combined with conjunctival autograft is useful in reducing pterygium recurrence.

[Ophthalmic Surg Lasers Imaging 2009;40:239–244.]
Fresh-Tissue Corneolimbal Covering Graft for Large Corneal Perforation Following Childhood Trachoma
Authors: Kremer Israel , Ehrenberg Miriam , Weinberger Dov
Published: June 2009

Background and Objective:

When corneal perforation develops in patients with severe ocular surface disease and limbal stem cell deficiency following childhood trachoma infection, penetrating keratoplasty is doomed to fail. To overcome this problem, the use of a fresh-tissue corneolimbal covering graft is described.

Patients and Methods:

Retrospective interventional case series of four patients who presented to a tertiary center from 2003 to 2005 with a large corneal perforation due to ocular surface disease. Emergency surgery consisted of suturing a fresh-tissue corneolimbal covering graft to the patients' peripheral sclera.

Results:

The corneolimbal graft became partially incorporated into the perforated cornea, which healed by scar tissue, after a few months. The ocular epithelial surface improved considerably. There was no recurrence of corneal perforation during the follow-up period of 1 to 3 years.

Conclusion:

Fresh-tissue corneolimbal covering graft was found to be a useful technique for saving the integrity of the eye in cases of a large corneal perforation in patients with severe ocular surface disease, such as in childhood trachoma.

[Ophthalmic Surg Lasers Imaging 2009;40:245–250.]
Immediate Evaluation of the Flaps Created by Femtosecond Laser Using Anterior Segment Optical Coherence Tomography
Authors: Kucumen Raciha Beril , Dinc Umut Asli , Yenerel Nursal Melda , Gorgun Ebru , Alimgil Murat Levent
Published: June 2009

Background and Objective:

To demonstrate the practical and functional evaluation of flaps created intraoperatively by femtosecond laser using anterior segment optical coherence tomography (AS-OCT).

Patients and Methods:

The study prospectively examined 11 eyes of 6 patients who underwent uneventful LASIK surgery with the aid of the Intra-Lase femtosecond laser (IntraLase Corp., Irvine, CA). During the waiting period between femtosecond laser and excimer laser, all eyes were evaluated by AS-OCT to image each flap immediately before flap lifting and laser ablation. Flap thickness and residual stromal bed thickness were calculated automatically using the software's flap tool.

Results:

A uniform flap was created by femtosecond laser not only in the central cornea, but also in all quadrants.

Conclusion:

The qualitative and quantitative evaluation of the corneal flap created by a femtosecond laser using AS-OCT before lifting the flap confirms that the femtosecond laser is a practical intraoperative approach that offers a safer surgery.

[Ophthalmic Surg Lasers Imaging 2009;40:251–254.]
Titanium:Sapphire Laser Trabeculoplasty Versus Argon Laser Trabeculoplasty in Patients With Open-Angle Glaucoma
Authors: Goldenfeld Modi , Melamed Shlomo , Simon Gabriel , Ben Simon Guy J.
Published: June 2009

Background and Objective:

To compare the medium-term outcome of titanium:sapphire laser trabeculoplasty (TLT) (SOLX, Inc., Waltham, MA) to argon laser trabeculoplasty (ALT) in patients with uncontrolled open-angle glaucoma.

Patients and Methods:

Thirty-seven patients with open-angle glaucoma who had uncontrolled intraocular pressure and no previous filtration surgery participated. Eighteen patients were treated with TLT and 19 patients were treated with ALT. All patients underwent comprehensive eye and visual field examinations.

Results:

The 18 patients in the TLT group had an average (± standard deviation) reduction of 8.3 (± 2.7) mm Hg, or 32%, from preoperative intraocular pressure (
P
< .001). The 19 patients in the ALT group had an average reduction of 6.5 (± 4.3) mm Hg, or 25%, from preoperative intraocular pressure (
P
< .001). Patients in both groups achieved a similar decrease in intraocular pressure (
P
> .05). Two patients (1 in each group) underwent trabeculectomy and were considered failures. Mean follow-up time was 15 months.

Conclusion:

TLT provides similar efficacy to ALT in intraocular pressure reduction in patients with open-angle glaucoma. If confirmed in additional studies, TLT may be used as an alternative to ALT in patients with open-angle glaucoma.

[Ophthalmic Surg Lasers Imaging 2009;40:264–269.]
Photodynamic Therapy for Age-Related Macular Degeneration Treatment: Epidemiological and Clinical Analysis of a Long-Term Study
Authors: Mataix Jorge , Desco M. Carmen , Palacios Elena , Garcia-Pous Maria , Navea Amparo
Published: June 2009

Background and Objective:

The aim of this article was to analyze the long-term results of patients with exudative age-related macular degeneration treated with photodynamic therapy (PDT).

Patients and Methods:

This prospective nonrandomized clinical trial included 262 patients with exudative age-related macular degeneration who were treated with PDT in accordance with the Protocol of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study. The follow-up lasted 48 months.

Results:

There was a significant loss of visual acuity 3 months after the first PDT treatment, a slow, progressive decrease of vision until month 12, and then visual acuity remained stable from months 24 to 48. The choroidal neovascularization size increased noticeably during the first 12 months, particularly the first 3 months after PDT. The higher the classic component of choroidal neovascularization, the better it responded to PDT. The evolution of juxtafoveal choroidal neovascularization was worse than that of subfoveal choroidal neovascularization after PDT because it grew quickly toward the fovea and visual acuity loss was greater.

Conclusion:

PDT is a safe, long-term treatment for exudative age-related macular degeneration, but it is not definitive because this treatment cannot stop the initial growth of the choroidal neovascularization lesion.

[Ophthalmic Surg Lasers Imaging 2009;40:277–284.]
Sustained Elevation in Intraocular Pressure Associated With Intravitreal Bevacizumab Injections
Authors: Kahook Malik Y. , Kimura Alan E. , Wong Lisa J. , Ammar David A. , Maycotte Marco A. , Mandava Naresh
Published: June 2009

This retrospective case series reports sustained elevation of intraocular pressure (IOP) after single or repeated intravitreal injections of bevacizumab (Avastin; Genentech, San Francisco, CA) for wet age-related macular degeneration (AMD). All six cases experienced significant and sustained elevation in IOP after single or repeated intravitreal injections of bevacizumab. Initiation or advancement of IOP-lowering therapy was required in all cases. The results support the need for further studies investigating the incidence of this potential side effect and the need for close long-term surveillance of IOP after injection of bevacizumab, particularly in patients with glaucoma or suspected glaucoma. Future in vitro and in vivo studies are needed to better understand the reasons for this observed phenomenon.
[Ophthalmic Surg Lasers Imaging 2009;40:293–295.]
An Unusual Case of Retinoblastoma
Authors: Lawrence Scott D. , Hoehn Mary Ellen , Karcioglu Zeynel A. , Haik Barrett G.
Published: June 2009

The authors describe the treatment and complications of a case of retinoblastoma with an atypical presentation. A 20-month-old girl was diagnosed as having unilateral retinoblastoma by cytopathology during pars plana vitrectomy and the right eye was enucleated. Following the enucleation, computed tomography detected a questionable focus of retinoblastoma in the residual optic nerve. Exploration of the orbit and sampling of the optic nerve stump had to be performed because the enucleated globe was lost. Histopathology of the optic nerve stump showed granulation tissue and fibrosis but no evidence of retinoblastoma. Histopathology of the enucleated globe and transected optic nerve is the gold standard for staging retinoblastoma and formulating a treatment plan. Treatment of the patient with retinoblastoma becomes more complex when histopathologic findings are not available.
[Ophthalmic Surg Lasers Imaging 2009;40:296–299.]
Retinal Pigment Epithelial Tear After Half Fluence PDT for Serous Pigment Epithelial Detachment in Central Serous Chorioretinopathy
Authors: Kim Seong-Woo , Oh Jaeryung , Oh In kyung , Huh Kuhl
Published: June 2009

Retinal pigment epithelial tears may occur after photodynamic therapy (PDT) in various diseases. The authors report a case of a retinal pigment epithelial tear after half light intensity (300 mW/cm
2
) PDT in a large serous pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy. A 52-year-old woman with a large serous pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy in the left eye received her first PDT treatment using verteporfin with a spot size of 6,640 µm, a duration of 83 seconds, and half (300 mW/cm
2
) of the standard 600 mW/cm
2
light intensity, where the delivered PDT light dose was only 25 J/cm
2
. Two weeks later, visual acuity improved to 20/30. However, a large crescent-shaped retinal pigment epithelial tear was found during fundus examination. Even 50% reduced light fluence PDT can produce a retinal pigment epithelial tear in pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy.
[Ophthalmic Surg Lasers Imaging 2009;40:300–303.]
Three-Dimensional Visualization of Vitreoretinal Abnormalities in High Myopia
Authors: Forte Raimondo , Manzi Gianluigi , Gallo Otello , de Crecchio Giuseppe
Published: June 2009

The authors have evaluated with three-dimensional (3D) spectral domain optical coherence tomography (SD-OCT) four highly myopic eyes (2 patients) presenting with peripapillary detachment of the pigment epithelium (PDPM), vitreoretinal tractions, and myopic retinoschisis. Three-dimensional SD-OCT analysis of PDPM revealed an optically empty space localized beneath the retinal pigment epithelium (RPE). A peripapillary separation of the retina-RPE complex from the choroid could explain the presence of this space. The 3D imaging of vitreomacular tractions could help physicians plan the appropriate surgical approach in patients with myopic posterior detachment due to macular hole.
[Ophthalmic Surg Lasers Imaging 2009;40:304–307.]
Submacular Combination Treatment for Management of Acute, Massive Submacular Hemorrhage in Age-Related Macular Degeneration
Authors: Shah Sumit P. , Hubschman Jean Pierre , Gonzales Christine R. , Schwartz Steven D.
Published: June 2009

A surgical technique is described combining submacular anti-vascular endothelial growth factor (anti-VEGF) and recombinant tissue plasminogen activator (r-TPA) with pneumatic displacement of massive submacular hemorrhage in age-related macular degeneration. An 84-year-old man with a large, acute submacular hemorrhage secondary to age-related macular degeneration underwent combination vitrectomy, submacular anti-VEGF and r-TPA injection with pneumatic displacement of the hemorrhage. At the last follow-up visit, 7 months after surgery, visual acuity was 20/80 with a small fibrovascular pigment epithelial detachment and atrophic retinal pigment epithelial changes. A 77-year-old woman with known age-related macular degeneration underwent a similar surgical procedure for a similar acute, large submacular hemorrhage related to age-related macular degeneration. Nine months after surgery, the visual acuity was 20/70
−1
. Combination submacular anti-VEGF therapy delivered at the time of pars plana vitrectomy and submacular tissue plasminogen activator assisted hemorrhage displacement may be a viable treatment strategy for the management massive submacular hemorrhage.
[Ophthalmic Surg Lasers Imaging 2009;40:308–315.]
Selected Clinical Comparisons of Spectral Domain and Time Domain Optical Coherence Tomography
Authors: Luviano Damien M. , Benz Matthew S. , Kim Rosa Y. , Fish Richard H. , Wong Tien P. , Kegley Eric N. , Brown David M.
Published: June 2009

The authors report four cases where spectral domain optical coherence tomography (SD-OCT) imaged pathology not captured by time domain optical coherence tomography (TD-OCT). These cases include one of angioid streaks, two of juxtafoveal telangiectasia, and one of age-related macular degeneration. In each case, the improved images provided by SD-OCT changed either the management of the patient or the counseling of their disease process.
[Ophthalmic Surg Lasers Imaging 2009;40:325–328.]
Anatomical Correlate of a Persistent Paracentral Scotoma After an Airbag Injury
Authors: Carrim Zia I. , Khan Ashraf A. , Wykes William N.
Published: June 2009

Ocular injuries caused by deploying airbags are well-described in the literature and can be either mechanical or chemical in nature. To the authors' knowledge, this is the first report describing an isolated paracentral scotoma noted immediately after an airbag injury. The use of optical coherence tomography revealed an anatomical correlate of the scotoma. The authors discuss a likely mechanism for focal damage to the retina based on these findings.
[Ophthalmic Surg Lasers Imaging 2009;40:329–330.]
Spectral Domain Optical Coherence Tomography Imaging of Retinal Diseases in Singapore
Authors: Singh Mandeep , Chee Caroline K. L.
Published: June 2009

In this retrospective case series, the authors reviewed cases of patients with macular disorders whose eyes had been imaged using spectral domain optical coherence tomography (SD-OCT) (Cirrus HD-OCT; Carl Zeiss Meditec, Inc., Dublin, CA). SD-OCT images were obtained from patients with a variety of ocular conditions attending a tertiary retinal clinic in Singapore from August 2007 to December 2007, according to standardized protocols. Images of 428 eyes from 301 patients were reviewed. Ocular diagnoses included diabetic macular edema, exudative age-related macular degeneration, central serous chorioretinopathy, cystoid macular edema, retinal vein and artery occlusions, infective chorioretinitis, and others. The authors present four cases of particular interest to illustrate how SD-OCT was useful in complementing the clinician's assessment of macular disease.
[Ophthalmic Surg Lasers Imaging 2009;40:336–341.]
Ethical Considerations Regarding the Use of Technology for Older Adults: The Case of Telehealth
Authors: Demiris George , Doorenbos Ardith Z. , Towle Cara
Published: June 2009

Life expectancy increases and ongoing growth of the population older than 65 have led to new models of aging research aimed at promoting independence and empowerment of older adults. Advances in information technology have introduced numerous ways to enhance or expand health care and support service research and development. The purpose of this article is to discuss ethical considerations associated with the use of technology with older adults in research and practice and to present a framework for such ethical parameters. Specifically, we focus on the case of telehealth and discuss examples from the Native People for Cancer Control Telehealth Network to exemplify the framework. The proposed framework includes the concepts of privacy, informed consent, equity of access, patient-provider communication, and usability. These issues constitute a roadmap for researchers, practitioners, system designers, policy makers, and administrators who aim to conduct ethical research that results in improved care and support services to older adults and increase health care access for rural and underserved populations.
Considerations of Informed Consent and Decision-Making Competence in Older Adults with Cognitive Impairment
Authors: Mayo Ann M. , Wallhagen Margaret I.
Published: June 2009

Including older adults with cognitive impairment in research studies is necessary to ensure that interventions designed to improve care are effective for all older adults. However, issues related to capacity to consent raise many difficult questions that nurse researchers must address. Protecting vulnerable participants while simultaneously maintaining autonomy and moving important research forward can be challenging. Assessing the decision-making abilities of understanding, appreciation, reasoning, and expressing a choice is an important aspect of determining decision-making capacity. Yet although this is the prominent rational method for judging decision-making competence, it does not take into consideration the importance of culture, values, and emotions. This article focuses on the assessment of decision-making capacity to consent, recommendations for obtaining informed consent in older adults with cognitive impairment, the use of surrogate decision makers, strategies to maximize research participation, and directions for future research.