bluuebunny/crossref_metadata_2025 huggingface dataset:
Horizontal Versus Vertical Orientation of the Loop for Tension Band Wiring of Transverse Patella Fractures
Authors: Lee Sang Ki , Hwang Yoon Sub , Choy Won Sik
Published: August 2014

Conventional operative treatments of patella fractures are frequently associated with implant failure or displacement. Recent biomechanical studies showed that the orientation of the wire loop and the site of the wire twist can affect the fixation strength. The purpose of this study was to compare the clinical outcome of the tension band technique with loops in different orientations and different knot positions. For this retrospective study, 72 patella fractures (71 patients) were fixed with figure-of-eight configurations in combination with 2 K-wires. Patients were divided into 3 groups according to the orientation of tension band construct. A total of 40 patella fractures were placed with figure-of-eight configurations in a vertical orientation either with 1 wire twist (group 1; 16 patella fractures) or with 2 wire twists at the adjacent corners (group 2; 24 patella fractures). Thirty-two patella fractures were placed with figure-of-eight configurations in a horizontal orientation with 2 wire twists at the adjacent corners (group 3). Range of motion, complication rates, and knee scoring scales (Hospital for Special Surgery and Lysholm) were assessed during serial follow-up. Satisfactory reductions were achieved in all groups, but functional results in the early stage were different. Group 3 had better Hospital for Special Surgery and Lysholm scores at 3 months postoperatively; however, at 6 months and 1 year postoperatively, all groups had similar scores. At the 1-year follow-up, all groups achieved acceptable flexion and range of motion. The overall complication rate was lower in the horizontal group (12.5%). Placing the figure-of-eight tension band construct in a horizontal orientation can provide functional benefits in the early stage after patella fractures.
Allergy/Hypersensitivity Reactions as a Predisposing Factor to Complex Regional Pain Syndrome I in Orthopedic Patients
Authors: Li Xinning , Kenter Keith , Newman Ashley , O’Brien Stephen
Published: August 2014

Several predisposing conditions have been associated with complex regional pain syndrome I (CRPS I). The purpose of this study was to determine the relationship between a history of allergy/hypersensitivity reactions and CRPS I in orthopedic patients. Orthopedic patients with CRPS I (n=115) who experienced pain relief after a successful sympathetic nerve blockade were identified for study inclusion; a control group (n=115) matched to the CRPS I group by age, sex, and location of injury was also included. All patients in the study had an average age of 42 years. In the CRPS I group, all participants were Caucasian and the majority (80.8%) were women. The skin of patients with CRPS I was described as fair (57.7%), mottled (57.7%), or sensitive (80.8%). Of the patients with CRPS I, 78 (67.8%) reported a statistically significant history of allergies compared with the 39 (33.9%) patients in the control group (
P
<.0001). Patients with CRPS I who experienced complete pain relief for at least 1 month following a single sympathetic nerve block were asked to answer a questionnaire (n=35), and some then underwent immediate hypersensitivity testing using a skin puncture technique (n=26). Skin hypersensitivity testing yielded an 83.3% positive predictive value with an accuracy of 76.9%. Based on these results, a positive history for allergy/hypersensitivity reactions is a predisposing condition for CRPS I in this subset of orthopedic patients. These hypersensitivity reactions may prove important in gaining a better understanding in the pathophysiology of CRPS I as a regional pain syndrome.
Understanding Acute Apophyseal Spinous Process Avulsion Injuries
Authors: Koehler Steven M. , Rosario-Quinones Frances , Mayer Jillian , McAnany Steven , Schiller Alan L. , Qureshi Sheeraz , Hecht Andrew C.
Published: August 2014

Apophyseal spinous process avulsion injury was first described in 1941. Since then, there have been sparse additional reports in the literature. The authors report their second case, involving an elite adolescent tennis player. The patient underwent surgical excision of the avulsed spinous process 12 weeks after initial presentation and experienced complete resolution of back pain. The authors provide the first reported histopathological analysis of the avulsion fracture site in the literature for both of their cases. The avulsion injury of the interspinous ligament was characterized by hypercellular fibrocartilage tissue, similar to that seen in severe Osgood-Schlatter’s disease. The key physical examination finding in patients with avulsion spinous process fractures is acute tenderness directly over the fracture site that worsens with flexion rather than extension (unlike in spondylolysis). Patients should have routine radiographs, including dynamic flexion-extension views, magnetic resonance imaging, and computed tomography. The authors conclude that after 6 months of nonsurgical management for an athlete, surgical excision should be offered as an alternative. In both of their cases, nonsurgical management failed. Surgical excision offers definitive and simple treatment, as well as early return to athletic activities. Both patients were allowed to return to their competitive level of performance 6 weeks after surgery.
Infection After Primary Total Hip Arthroplasty
Authors: Lindeque Bennie , Hartman Zach , Noshchenko Andriy , Cruse Margaret
Published: August 2014

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Understand contemporary postoperative infection rates for primary total hip arthroplasty (THA).

2.

Understand the epidemiology of bacterial species responsible for postoperative primary THA infections.

3.

Review current interventions to decrease the primary THA infection rate.

4.

Assess the volume and quality of data in the current orthopedics literature regarding primary THA infections.

The number of primary total hip arthroplasties (THAs) performed in the United States each year continues to climb, as does the incidence of infectious complications. The changing profile of antibiotic-resistant bacteria has made preventing and treating primary THA infections increasingly complex. The goal of this review was to summarize (1) the published data concerning the risk of surgical site infection (SSI) after primary THA by type of bacteria and (2) the effect of potentially modifying factors.

The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, EMBASE, Web of Science, and PubMed were searched. Studies dated between 2001 and 2011 examining primary THA in adults were included. Meta-analysis of the collected data was performed. The pooled SSI rate was 2.5% (95% confidence interval [Cl], 1.4%–4.4%;
P
<.001; n=28,883). The pooled deep prosthetic joint infection (PJI) rate was 0.9% (95% Cl, 0.4%–2.2%;
P
<.001; n=28,883). The pooled rate of methicillin-resistant
Staphylococcus aureus
SSI was 0.5% (95% Cl, 0.2%–1.5%;
P
<.001; n=26,703). This is approximately 20% of all SSI cases. The pooled rate of intraoperative bacterial wound contamination was 16.9% (95% Cl, 6.6%–36.8%;
P
=.003; n=2180). All these results had significant heterogeneity. The postoperative risk of SSI was significantly associated with intraoperative bacterial surgical wound contamination (pooled rate ratio, 2.5; 95% Cl, 1.4%–4.6%;
P
=.001; n=19,049). [
Orthopedics.
2013; 37(4):257–265.]
Early Intraprosthetic Dislocation in a Revision Dual-mobility Hip Prosthesis
Authors: Banka Trevor R. , Ast Michael P. , Parks Michael L.
Published: August 2014

This article presents a case of early intraprosthetic dislocation of a dual-mobility hip prosthesis after revision total hip arthroplasty for instability. A 70-year-old woman was revised to a dual-mobility cup for multiple hip dislocations. She dislocated the dual-mobility construct twice, which was closed reduced. Postreduction radiographs after the second closed reduction showed that the femoral head was eccentrically positioned within the acetabular shell, raising suspicion for intraprosthetic dislocation or disassociation between the femoral head and the mobile polyethylene liner. After closed reduction, the patient reported a mobile, golf ball-size mass deep to the posterior lateral incision and new onset of crepitus. Magnetic resonance imaging verified complete intraprosthetic dissociation between the femoral head and mobile polyethylene liner, which was located between the gluteus medius and minimus. The dual-mobility cup was revised to a constrained socket with retention of the femoral stem. The patient recovered uneventfully without further instability.
Finite Element Analysis of 3 Posterior Fixation Techniques in the Lumbar Spine
Authors: Gong Zhiqiang , Chen Zixian , Feng Zhenzhou , Cao Yuanwu , Jiang Chun , Jiang Xiaoxing
Published: August 2014

This study compared the biomechanics of 3 fixation techniques: bilateral pedicle screw (BPS) fixation, unilateral pedicle screw (UPS) fixation, and UPS supplemented with translaminar facet screw (UPS+TLFS) fixation. The study was conducted in an L3–L5 finite element model. Three different finite element models were created by adopting different fixation techniques after removal of the left L3–L4 and L4–L5 facet joints. A 500-N compressive preload combined with 8-NM moment were applied in 3 finite element models with 3 fixation techniques during different movements. Angular displacement and stress distribution were recorded. As described in this article, the UPS model had the most variation in angular displacement, the BPS model was intermediate, and the UPS+TLFS model had the least mobility. Most of the stress accumulated on the body and tail of the pedicle screws and the connecting rods in the UPS and BPS models, but stress accumulated on the rods and the part of the facet joint pierced by the TLFS in the UPS+TLFS model. The middle part of the pedicle screw endured little stress compared with the upper and lower parts. The maximum stress on the fixation devices was highest in the UPS model. The maximum stress in the UPS+TLFS model was the lowest among the 3 models. Biomechanically, UPS+TLFS fixation is superior to either UPS fixation or BPS fixation in improving stability and reducing stress. Bilateral pedicle screw fixation is intermediate, and UPS fixation is inferior.
Relationship Among Radiographic Ankle Medial Clear Space, Sex, and Height
Authors: Murphy Joshua M. , Kadakia Anish R. , Schilling Peter L. , Irwin Todd A.
Published: August 2014

The ankle medial clear space (MCS) is frequently measured to evaluate ankle stability after an injury. However, controversy exists regarding a threshold size that distinguishes a normal MCS from an abnormal MCS. A retrospective radiographic review of mortise ankle radiographs in the uninjured ankle was performed, with the goal of defining the relationship among patient height, sex, and radiographic ankle MCS. Forty-nine patients with normal mortise radiographs and with information on patient height available in the electronic medical chart were identified for inclusion. For men, mean±standard deviation (in millimeters) was 3.3±0.8 for MCS perpendicular (MCSp), 3.8±0.7 for MCS oblique (MCSo), and 3.8±0.5 for superior clear space (SCS). For women, mean±standard deviation was 2.3±0.6 for MCSp, 2.9±0.5 for MCSo, and 3±0.4 for SCS. Univariate analysis showed that all 3 variables (MCSp, MCSo, and SCS) were statistically different when men were compared with women (
P
<.0001). Bivariate regression models showed statistically significant (
P
<.001) positive relationships between each of the measures of clear space and height. In multivariate analysis, female sex alone was associated with a decrease in clear space. When evaluating isolated lateral malleolus fractures, clinicians should consider the patient’s height and sex when measuring MCS and SCS to determine deltoid ligament competence. These data suggest that men and people of tall stature are at risk for a false-positive diagnosis of deltoid ligament rupture when previously published threshold MCS and SCS values, such as 4 mm or 5 mm, are used for diagnosis and operative indication.
Three Intraoperative Methods to Determine Limb-length Discrepancy in THA
Authors: Rice Ian S. , Stowell R. Lee , Viswanath Purab C. , Cortina Gary J.
Published: August 2014

Limb-length discrepancy (LLD) is a common concern for both surgeon and patient in the setting of elective total hip arthroplasty (THA). There is a paucity of evidence guiding surgeons to an optimal method for measuring intraoperative LLD and minimizing postoperative LLD. The primary objective of this prospective, randomized, double-blinded study was to determine which of 3 intraoperative methods used at the authors’ institution was best correlated to postoperative radiographic LLD. From 2011 to 2012, 81 patients undergoing either primary (75) or revision (6) THA with an anterolateral (Watson-Jones) approach were prospectively randomized and received intraoperative measurement of LLD via 1 of 3 methods: abductor shuck (AS), tranosseous pins with calibrated caliper (TP), or patella electrocardiogram (EKG) leads (PL). Intraoperative measurements of LLD were compared to clinical and radiographic postoperative measurements of LLD, and absolute differences and correlation coefficients were calculated for each method. Overall, the mean LLD preoperatively was 8.09 mm, and mean radiographic LLD postoperatively was 4.20 mm. The AS method was associated with the highest correlation to postoperative radiographic LLD (
R
=0.360;
P
<.05), whereas the other methods had mildly positive but statistically insignificant correlations (TP
R
=0.275;
P
>.05; PL
R
=0.301;
P
>.05). The AS method best correlates to postoperative radiographic LLD among the 3 techniques, although all methods were positively correlated. Clinical measurements of LLD correlate poorly with radiographic measurements and may be of limited utility.
Unilateral Adrenal Hemorrhage After Total Knee Arthroplasty
Authors: Chronopoulos Efstathios , Nikolaou Vassilios S. , Masgala Aikaterini , Kaspiris Angelos , Babis Georgios C.
Published: August 2014

Adrenal hemorrhage (AH) is a rare but serious condition that is often diagnosed at autopsy. Unilateral adrenal hemorrhage (UAH) in adults is extremely rare and is often due to trauma or anticoagulation or is associated with systemic illness. The case of a 73-year-old man who was diagnosed with UAH several days after an elective total knee replacement is presented. The patient had an uncomplicated procedure and he was treated postoperatively with a prophylactic dose of subcutaneous low-molecular– weight heparin and compression sleeves. On postoperative day 8, he reported sustained epigastric and midback pain at the lower thoracic level. He had a temperature of 38.5°C. On clinical examination, the patient expressed only mild tenderness at the lumbar area. Abdominal ultrasound and computed tomography (CT) scan were inconclusive. On postoperative day 13, the patient experienced no pain but remained febrile. An abdominal CT scan revealed a high-density mass on the left adrenal gland suggestive of hemorrhage. The subcutaneous heparin as well as the antimicrobial therapy was discontinued and a serum cortisol examination was done. Serum levels were within normal values in the evening and the morning. On postoperative day 16, all laboratory values returned to normal and the patient was discharged in excellent condition. Patients who have abdominal pain, hypotension, or both soon after initiation of anticoagulation or patients who experience abdominal pain, fever, nausea, or confusion postoperatively should be screened for AH.
Fibrosarcoma Development 15 Years After Curettage and Bone Grafting of Giant Cell Tumor of Bone
Authors: Li JuMing , Zhu Yan , Wei YongZhong
Published: August 2014

Malignant transformation of conventional giant cell tumor of bone is rare and usually occurs with irradiation. This article describes a case of malignant transformation of a giant cell tumor 15 years after initial curettage and bone graft. A 35-year-old man was admitted to the hospital with a recurrent giant cell tumor of the distal femur. On presentation, the patient reported the insidious onset of a dull aching pain in the distal part of the left thigh 4 months prior to admission. Radiographs revealed a destructive lesion in the left distal femur. Needle biopsy revealed recurrence of giant cell tumor with suspected malignant transformation. The patient underwent en bloc resection of the distal femur with adequately wide margins and reconstruction of the knee joint with a prosthesis. Pathological findings showed malignant transformation of a giant cell tumor to high-grade spindle cell sarcoma. Immunohistochemistry showed diffuse and strong p53 expression. A diagnosis of secondary fibrosarcoma was made after discussion. Unfortunately, the tumor proved to be highly resistant to the chemotherapy, and the patient died of multiple lung metastases 14 months after the diagnosis of malignant transformation. What has to be stressed in this case is that any late recurrence must be approached considering the possibility of a secondary induced primary tumor. Because of the rarity of this disease, the effective therapeutic strategy for fibrosarcoma secondary to giant cell tumor is lacking. In addition, identification of the p53 mutation may help in diagnosing cases of potential malignant transformation of giant cell tumor.
Guidelines for Assessment and Instruction in Statistics Education(GAISE): ExtendingGAISEInto Nursing Education
Authors: Hayat Matthew J.
Published: August 2014

Statistics coursework is usually a core curriculum requirement for nursing students at all degree levels. The American Association of Colleges of Nursing (AACN) establishes curriculum standards for academic nursing programs. However, the AACN provides little guidance on statistics education and does not offer standardized competency guidelines or recommendations about course content or learning objectives. Published standards may be used in the course development process to clarify course content and learning objectives. This article includes suggestions for implementing and integrating recommendations given in theGuidelines for Assessment and Instruction in Statistics Education(GAISE) report into statistics education for nursing students. [J Nurs Educ. 2014;53(4):192–198.]
Flipping the Statistics Classroom in Nursing Education
Authors: Schwartz Todd A.
Published: August 2014

Flipped classrooms are so named because they substitute the traditional lecture that commonly encompasses the entire class period with active learning techniques, such as small-group work. The lectures are delivered instead by using an alternative mode—video recordings—that are made available for viewing online outside the class period. Due to this inverted approach, students are engaged with the course material during the class period, rather than participating only passively. This flipped approach is gaining popularity in many areas of education due to its enhancement of student learning and represents an opportunity for utilization by instructors of statistics courses in nursing education. This article presents the author’s recent experiences with flipping a statistics course for nursing students in a PhD program, including practical considerations and student outcomes and reaction. This transformative experience deepened the level of student learning in a way that may not have occurred using a traditional format. [
J Nurs Educ.
2014;53(4):199–206.]
Countering the Influence of Cultural Hegemony on Choosing a Nursing Career: A Group-Mentoring Approach for Student Recruitment
Authors: Kneipp Shawn M. , Rowsey Pamela J. , Giscombe Cheryl , Hodges Eric A. , Fowler Tamryn , Alexander Rumay
Published: August 2014

Extensive literature exists that demonstrates the influence of social cues and interpersonal interactions with influential others on student career choices. This article applies Gramsci’s political views of hegemony and counterhegemony to situate student descriptions of their experiences and the goals of a group-mentoring session designed to address the culturally hegemonic symbolic cues and interpersonal interactions that can negatively influence a student’s desire to select a career in nursing. Specifics around the development, implementation, and evaluation of the group-mentoring session, as part of a broader school-wide culture to promote diversity and as a larger program to increase the diversity of the nursing workforce, are described. [
J Nurs Educ
. 2014;53(5):296–299.]
Clinical Instructors’ Perceptions of Structural and Psychological Empowerment in Academic Nursing Environments
Authors: Wiens Sandra , Babenko-Mould Yolanda , Iwasiw Carroll
Published: August 2014

The study purpose was to explore clinical instructors’ (CIs’) perceptions of empowerment in academic nursing environments. Clinical instructors, often part-time faculty, facilitate learning in professional practice environments. However, they also need to function within the academic environment to learn about the curriculum and how students are to be evaluated. The qualitative description method was used to obtain an understanding of CIs’ empowerment experiences and to interpret their perceptions within the frameworks of Kanter’s structural empowerment and Spreitzer’s psychological empowerment theories. Eight CIs from two nursing programs were interviewed for this study. The empowerment components of support and confidence were important, yet insufficient, in CIs’ perceptions of their role effectiveness. An implication for CIs was slow development of confidence in their ability to facilitate student learning that was consistent with curriculum goals. Recommendations for CIs and academic faculty are offered to support and retain clinical faculty. [
J Nurs Educ.
2014;53(5):265–270.]
Centering the Concept of Transitional Care: A Teaching–Learning Innovation
Authors: Mood Laura C. , Neunzert Caroline , Tadesse Ruth
Published: August 2014

Coordination of care, including the provision of safe and effective transitions, is a core professional standard for nurses. However, as currently designed, prelicensure nursing education prepares nurses to function in discrete settings rather than across settings. A teaching–learning innovation focusing on transitional care was implemented as an educational pilot project with 20 senior-level baccalaureate students in their leadership course. Students in the educational pilot immersed in the subject of transitional care via concept-based learning activities and performance improvement projects. During the course, students were assigned to designated clinical sites representative of a continuum of care. An integrated clinical postconference offered students the opportunity to discover the role of the nurse in transitional care from a systems perspective and facilitated a deeper understanding of the subject that extended beyond the walls of students’ discrete clinical sites. [
J Nurs Educ.
2014;53(5):287–290.]
Psychogenic Non-Epileptic Seizures in the Older Adult
Authors: Yates Erica
Published: August 2014

Psychogenic non-epileptic seizures (PNES) are classified in the
Diagnostic and Statistical Manual of Mental Disorders
, 5th edition, as a functional neurological symptom disorder. This disorder is often misdiagnosed as epilepsy, with the consequence that older adults may have been treated for years for epilepsy before they learn their seizures are non-epileptic. Video electroencephalography monitoring, which is the standardized approach for ruling out epilepsy, is often performed in a specialized epilepsy monitoring unit where the patient lies in bed 24 hours per day waiting for a seizure to be recorded. The immobility, loss of independence, and anxiety that occurs during the monitoring process can be difficult for older adults. It is important for all nurses to be aware of PNES and to be sensitive to the unique needs of older adults who are experiencing these seizures. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(5), 17–20.]
Delirium and Its Prevention with Melatonergic Drugs
Authors: Howland Robert H.
Published: August 2014

Delirium is a complex neurobehavioral syndrome caused by dysregulation of brain activity, characterized by an alteration in the level of attention and awareness, which develops over a short period of time and is seen as a change from the patient’s baseline. Dysregulation of 24-hour circadian cycles, including melatonin secretion or activity, has suggested the potential therapeutic use of melatonergic drugs for delirium. Melatonin and the melatonin analog drug ramelteon have been shown to be effective in the prevention of delirium in three controlled studies. Additional studies using these drugs are warranted. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(5), 13–16.]
Clinical and Optical Intraocular Performance of Rotationally Asymmetric Multifocal IOL Plate-Haptic Design Versus C-Loop Haptic Design
Authors: Alió Jorge L. , Plaza-Puche Ana B. , Javaloy Jaime , Ayala María José , Vega-Estrada Alfredo
Published: August 2014

PURPOSE:

To compare the visual and intraocular optical quality outcomes with different designs of the refractive rotationally asymmetric multifocal intraocular lens (MFIOL) (Lentis Mplus; Oculentis GmbH, Berlin, Germany) with or without capsular tension ring (CTR) implantation.

METHODS:

One hundred thirty-five consecutive eyes of 78 patients with cataract (ages 36 to 82 years) were divided into three groups: 43 eyes implanted with the C-Loop haptic design without CTR (C-Loop haptic only group); 47 eyes implanted with the C-Loop haptic design with CTR (C-Loop haptic with CTR group); and 45 eyes implanted with the plate-haptic design (plate-haptic group). Visual acuity, contrast sensitivity, defocus curve, and ocular and intraocular optical quality were evaluated at 3 months postoperatively.

RESULTS:

Significant differences in the postoperative sphere were found (
P
= .01), with a more myopic postoperative refraction for the C-Loop haptic only group. No significant differences were detected in photopic and scotopic contrast sensitivity among groups (
P
⩾ .05). Significantly better visual acuities were present in the C-Loop haptic with CTR group for the defocus levels of −2.0, −1.5, −1.0, and −0.50 D (
P
⩽.03). Statistically significant differences among groups were found in total intraocular root mean square (RMS), high-order intraocular RMS, and intraocular coma-like RMS aberrations (
P
⩽.04), with lower values from the plate-haptic group.

CONCLUSIONS:

The plate-haptic design and the C-Loop haptic design with CTR implantation both allow good visual rehabilitation. However, better refractive predictability and intraocular optical quality was obtained with the plate-haptic design without CTR implantation. The plate-haptic design seems to be a better design to support rotational asymmetric MFIOL optics.

[
J Refract Surg.
2013;29(4):252–259.]
Inferior Intrastromal Corneal Ring Segments in Paracentral Keratoconus With No Coincident Topographic and Coma Axis
Authors: Alfonso José F. , Fernández-Vega Cueto Luis , Baamonde Begoña , Merayo-Lloves Jesus , Madrid-Costa David , Montés-Micó Robert
Published: August 2014

PURPOSE:

To assess the visual and refractive outcomes of implantation of intrastromal corneal ring segments (ICRS) in keratoconic eyes with no coincident topographic and comatic axes.

METHODS:

Forty-one keratoconic eyes of 39 patients with no coincident topographic and comatic axes were implanted inferiorly with a Ferrara-type ICRS (Keraring SI6; Mediphacos Inc., Belo Horizonte, Brazil) of 150° of arc with a thickness of 150, 200, and 250
μ
m. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal coma-like root mean square, and residual refractive errors analyzed using vector analysis were recorded before and 6 months after the ICRS implantation.

RESULTS:

Mean UDVA was 0.76 ± 0.41 logMAR before and 0.53 ± 0.46 logMAR after surgery (
P
= .0006). CDVA was 0.13 ± 0.14 logMAR before and 0.07 ± 0.09 logMAR after surgery (
P
= .0007). Two eyes (4.9%) lost two lines or more of CDVA, 3 eyes (7.32%) lost one line, 16 eyes (39.02%) had no change in CDVA, 9 eyes (21.95%) gained one line, and 11 eyes (26.83%) gained two lines or more of CDVA. The safety index was 1.10. Spherical equivalent was significantly reduced after ICRS implantation (
P
< .001). Corneal coma-like root mean square changed from 0.80 ± 0.53
μ
m before surgery to 0.61 ± 0.59
μ
m after surgery (
P
= .02) for 4.5 mm of pupil size.

CONCLUSIONS:

One Ferrara-type ICRS of 150° of arc with a thickness of 150, 200, or 250
μ
m implanted inferiorly may reduce both astigmatism and corneal coma-like aberrations in keratoconic eyes with no coincident topographic and comatic axes, providing an improvement of UDVA and CDVA values.

[
J Refract Surg.
2013;29(4):266–272.]
Improved Effectiveness of Transepithelial PTK Versus Topography-Guided Ablation for Stromal Irregularities Masked by Epithelial Compensation
Authors: Reinstein Dan Z. , Archer Timothy J. , Gobbe Marine
Published: August 2014

PURPOSE:

To demonstrate improved effectiveness of transepithelial phototherapeutic keratectomy (PTK) where topography-guided ablation is degraded by epithelial compensation for localized irregularities.

METHODS:

Artemis very high-frequency digital ultrasound (ArcScan Inc., Morrison, CO) scanning was performed on five eyes (four patients) after LASIK in which a truncated nasal flap was created but the ablation was still performed, resulting in irregular astigmatism and double vision. The stromal ablation pattern of a transepithelial PTK ablation was modeled and compared to topography-guided ablation simulations. Artemis-assisted transepithelial PTK procedures were performed in three eyes (two patients).

RESULTS:

In all cases, Artemis very high-frequency digital ultrasound demonstrated a crevice on the stromal surface caused by ablation on the underside of the flap nasally, which had been compensated for by epithelial thickening, thus masking a significant proportion of the stromal surface irregularity from corneal surface topography. The transepithelial PTK ablation pattern appeared logically to reduce the ridge nasal to the crevice, whereas topography-guided ablation patterns demonstrated poor targeting of the stromal ridge. Artemis-assisted transepithelial PTK greatly reduced the stromal irregularity, resulting in smoother epithelium and topography. In one eye, the epithelium had compensated fully for the irregularity and the patient reported 95% subjective improvement. One patient (two eyes) reported little change in visual symptoms despite significant anatomical regularization due to the partial nature of epithelial compensation, demonstrating that multiple procedures may often be required.

CONCLUSION:

Compensatory epithelial remodeling masks stromal irregularities from the corneal surface, meaning that topography-guided (or wavefront-guided) ablations may not provide an adequate treatment option and may potentially worsen the irregularity. The effectiveness of transepithelial PTK will depend on the proportion of epithelial masking due to remodeling, related to the rate of change of curvature of the stromal surface.

[
J Refract Surg.
2013;29(8):526–533.]
Coaxially Sighted Corneal Light Reflex Versus Entrance Pupil Center Centration of Moderate to High Hyperopic Corneal Ablations in Eyes With Small and Large Angle Kappa
Authors: Reinstein Dan Z. , Gobbe Marine , Archer Timothy J.
Published: August 2014

PURPOSE:

To determine whether centering ablations on the coaxially sighted corneal light reflex (CSCLR) in eyes with large angle kappa leads to poor visual outcomes when compared to patients with eyes with negligible angle kappa that by default would be centered on the entrance pupil. In eyes with no angle kappa, the CSCLR coincides with the entrance pupil center, whereas eyes with large angle kappa possess an offset between the CSCLR and the entrance pupil center.

METHODS:

This study was a retrospective case series of consecutive patients treated by hyperopic LASIK using the MEL80 excimer laser (Carl Zeiss Meditec, Jena, Germany). All ablations were centered on the CSCLR using the standard non-wavefront–guided ablation profile. Angle kappa was classified according to pupil offset defined as the distance in the corneal plane between the entrance pupil center and the corneal vertex. Eyes were divided into two discrete groups according to the pupil offset: small angle kappa for pupil offset of 0.25 mm or less (n = 30) and large angle kappa for pupil offset of 0.55 mm or greater (n = 30). Safety, accuracy, cylinder vector analysis, contrast sensitivity, vertex centered corneal aberrations, entrance pupil centered whole eye aberrometry, and night vision disturbances were compared between the two groups.

RESULTS:

There were no statistically significant differences in safety, accuracy, induced astigmatism, contrast sensitivity, or night vision disturbances between the two groups. There was also no statistically significant difference between groups for vertex centered corneal aberrations; however, as expected, coma was higher in the large angle kappa group for entrance pupil centered aberrometry because the treatment had been centered on the CSCLR rather than the entrance pupil center.

CONCLUSION:

Refractive outcomes of high hyperopic LASIK were not found to be worse for eyes where ablation was centered more than 0.55 mm from the entrance pupil as determined by CSCLR in eyes with large angle kappa. The absence of poor quality visual outcomes in cases, which by entrance pupil centration are considered significantly “decentered,” supports the notion that centration relative to the CSCLR may be preferable. This provides evidence that refractive corneal ablation should not be systematically aligned with the entrance pupil center.

[
J Refract Surg.
2013;29(8):518–525.]
Femtosecond Laser Cataract Incision Morphology and Corneal Higher-Order Aberration Analysis
Authors: Alió Jorge L. , Abdou Ahmed A. , Soria Felipe , Javaloy Jaime , Fernández-Buenaga Roberto , Nagy Zoltán Z. , Filkorn Tamás
Published: August 2014

PURPOSE:

Analysis of the femtosecond laser refractive lens surgery corneal incision configuration and corneal higher-order aberration (HOA) effect from the first postoperative day.

METHODS:

High-resolution anterior segment optical coherence tomography was used to assess 20 eyes undergoing femtosecond laser refractive lens surgery with 2.2-mm minimal incision. The primary incision (tri-planar) actual length, cord length, surface angle, surface irregularity, and regional pachymetry values and the secondary incision (uni-planar) length, angle, surface irregularity, and pachymetry values were analyzed. Hartmann-Shack aberrometer was used to assess corneal HOAs to correlate the effect. Assessment was done preoperatively and 1 month postoperatively.

RESULTS:

The actual length, cord length, and surface angle means for the primary incision in the first postoperative day and month were 1.50 ± 0.1 and 1.47 ± 0.2 mm (P= .5), 1.41 ± 0.1 and 1.42 ± 0.2 mm (P= .8), and 27° ± 4° and 23° ± 5° (P= .07), respectively. The length and surface angle for the secondary incision in the first postoperative day and month were 1.17 ± 0.01 and 1.04 ± 0.1 mm (P= .05) and 52° ± 3° and 42° ± 5° (P= .007). The regional pachymetry values for the primary and secondary incisions were significantly increased in the first postoperative day and then significantly decreased after 1 month. All irregularities occurred in the posterior surface (endothelium): 2 cases of posterior gap (first day) and 1 case of posterior retraction (first month). The HOAs had not significantly changed preoperatively and after 1 month.

CONCLUSIONS:

The femtosecond laser refractive lens surgery incision is stable and does not significantly change the HOA.

[J Refract Surg.2013;29(9):590–595.]
Influence of Corneal Cross-linking for Keratoconus on Several Objective Parameters of Dry Eye
Authors: Taneri Suphi , Oehler Saskia , Asimellis George , Kanellopoulos A. John
Published: August 2014

PURPOSE:

To evaluate the potential influence of corneal cross-linking (CXL) with ultraviolet-A light and riboflavin in keratoconic eyes on several objective parameters of dry eye syndrome.

METHODS:

This prospective single center study included 30 consecutive eyes of 16 patients that underwent CXL with riboflavin and ultraviolet-A treatment (epithelial removal, 30 minutes soaking with riboflavin, 30 minutes of illumination with 365 nm, 3 mW/cm
2
, 5 cm distance). Several dry eye syndrome parameters were evaluated preoperatively and 3 and 6 months after the procedure: intra-individual comparison of fluorescein and Rose bengal staining, height of tear film meniscus, and tear film break-up time.

RESULTS:

Pathologic staining (more than 10 point-shaped areas or diffuse staining) with fluorescein was evident before CXL in 1 eye, 3 months after CXL in 1 eye, and 6 months after CXL in 1 eye. Rose bengal staining 3 and 6 months postoperatively was comparable to preoperative staining. Tear film height was reduced in 2 eyes before CXL and in 4 eyes 3 months postoperatively, and was normal in all eyes after 6 months. The number of eyes with reduced tear film break-up time was not significantly changed.

CONCLUSIONS:

CXL had no significant impact on several parameters of dry eye syndrome 3 and 6 months postoperatively.

[
J Refract Surg.
2013;29(9):612–616.]
Development of the Activity Card Sort—United Kingdom Version (ACS-UK)
Authors: Laver-Fawcett Alison J. , Mallinson Sarah H.
Published: August 2014

The Activity Card Sort (ACS) is a valid and reliable measure of older adults' participation; however, cultural sensitivity issues are a limitation to its application in the United Kingdom. A content validity study was undertaken to identify culturally relevant activity items to be included in a United Kingdom version of the ACS (ACS-UK). For item generation, United Kingdom time-use studies, research related to other ACS versions, and expert opinions were used. A two-round survey of community-living United Kingdom older adults (aged 65 years and older; round 1, n = 177; round 2, n = 21) was used for item selection, clarifying the wording of activity labels, and agreeing activity domain classification. Ninety-one activities were identified for the ACS-UK and these were compared with items from other ACS versions. The ACS-UK is a culturally relevant measure that can provide useful insight into the participation of older adults for clinical practice and research.
Life Balance and Perceived Stress: Predictors and Demographic Profile
Authors: Matuska Kathleen , Bass Julie , Schmitt John S.
Published: August 2014

This article explored differences in life balance scores between demographic groups and whether life balance predicted perceived stress. This research used secondary analysis of 1,048 subjects from a database for the Life Balance Inventory (LBI). Analysis of variance showed that the profile of people with the highest total life balance scores was: white, 61 years or older, earned a master's degree, had incomes between $81,000 and $100,000, lived in the suburbs, had two children (but the children were not at home), were not working (if working, they were self-employed), owned a home, and lived in the United States. Other demographic groups differed in their LBI subscale scores. Regression analysis showed that life balance scores predicted lower perceived stress scores. This research provides additional construct validity evidence for the LBI and its associated Life Balance Model.
Relationship of Global Self-Evaluations of Activity to Psychosocial and Health-Related Aging Outcomes
Authors: Carlson Mike , Kuo Ann , Chou Chih-Ping , Clark Florence
Published: August 2014

The authors obtained older adults' self-rated judgments about the quality of their activity engagement considered as a whole (global activity evaluation) and, using cross-sectional survey data, tested the ability of such judgments to predict well-being. Participants were 460 community-dwelling older adults who responded to (1) global activity evaluations, (2) activity participation frequency scales, and (3) indices of life satisfaction, depression, and physical and mental health-related quality of life. Regression analyses indicated that global activity evaluations had a stronger relationship to psychosocial outcome indices than did participation frequency ratings, although both measurement approaches were associated with statistically significant predictions. However, global evaluations and participation frequency ratings were approximately equal in their ability to predict physical health-related quality of life. These relationships were fairly consistent across ethnic groups. Overall, the results suggest that ideally the two strategies for assessing activity should be incorporated in future research on activity and occupational therapy practice.
Well-Being and Engagement in Valued Activities: Experiences of Young People with Psychosis
Authors: Lal Shalini , Ungar Michael , Leggo Carl , Malla Ashok , Frankish James , Suto Melinda J.
Published: August 2014

The purpose of this study was to understand how engagement in valued activities contributes to the well-being of young people diagnosed as having psychosis within the past 3 years. Using a qualitative approach, the authors conducted semi-structured interviews and photography-elicited focus groups with 17 participants between the ages of 18 and 24 years who were recruited from an early intervention program for psychoses and a psychiatric service specializing in providing care to street youth. Analysis combined the methods of constructivist grounded theory and narrative inquiry. Participants derived six well-being enhancing experiences from engaging in highly valued activities: making meaning; expressing thoughts and emotions; changing physical, emotional, and cognitive states; cultivating skills, strengths, and virtues; connecting and belonging; and making a contribution. These findings highlight the importance of identifying activities that young people perceive as being valuable to their well-being, the meanings and experiences derived from these activities, and how best to support engagement in them.
Occupational Health Nursing in Hungary
Authors: Hirdi Henriett Éva , Hong OiSaeng
Published: August 2014

This article is the first about occupational health nursing in Hungary. The authors describe the Hungarian health care and occupational health care systems, including nursing education and professional organizations for occupational health nurses. The Fundamental Law of Hungary guarantees the right of every employee to healthy and safe working conditions, daily and weekly rest times and annual paid leave, and physical and mental health. Hungary promotes the exercise of these rights by managing industrial safety and health care, providing access to healthy food, supporting sports and regular physical exercise, and ensuring environmental protection. According to the law, the responsibility for regulation of the occupational health service lies with the Ministry of Human Resources. Safety regulations are under the aegis of the Ministry of National Economy.
Fixation Stability and Location in Patients With Unilateral Idiopathic Epiretinal Membrane
Authors: Tarita-Nistor Luminita , Mandelcorn Mark S. , Steinbach Martin J. , Mandelcorn Efrem D. , González Esther G.
Published: August 2014

BACKGROUND AND OBJECTIVE:

To explore fixation stability of patients with decreased vision due to idiopathic epiretinal membrane.

PATIENTS AND METHODS:

Fourteen consecutive patients with unilateral idiopathic epiretinal membrane participated. Visual acuity was measured with ETDRS, and fixation stability was recorded with the MP-1 microperimeter (Nidek Technologies Srl., Vigonza, Italy) for both eyes. Informed consent was obtained from all participants.

RESULTS:

Visual acuity of the affected eye (mean = .45 ± .23 LogMAR) was significantly worse than that of the contralateral eye (mean = .11 ± .16 Log-MAR),
P
< .0001. Fixation stability of the affected eye was not significantly different from that of the contralateral eye. There was a high correlation between fixation stability of the affected and contralateral eyes,
r
(12) = .67,
P
= .0087. Moreover, fixation was central or within 3 degrees from the fovea.

CONCLUSION:

Despite lower visual acuity, untreated eyes with idiopathic epiretinal membrane have unimpaired central fixation.
Ocriplasmin Is a Useful Clinical Tool; Careful Case Selection Will Improve Treatment Results
Authors: Puliafito Carmen A.
Published: August 2014

This editorial discusses the significance of the first reported case series of real-world use of ocriplasmin for treating symptomatic vitreomacular adhesion and addresses the importance of case selection in improving treatment results.
Fundus Autofluorescence in Ampiginous Choroiditis
Authors: Patel Mrinali , Vavvas Demetrios G.
Published: August 2014

Fundus autofluorescence (FAF) is being increasingly employed in the evaluation of retinal diseases. We report the first description of FAF findings during the natural history of ampiginous choroiditis and correlate these findings to fundus photography, infrared imaging, and cross-sectional optical coherence tomography. In a patient with a 12-month recurring, relapsing course of ampiginous choroiditis, there was a predictable pattern of FAF findings. At the time of presentation with a whitish-yellow, creamy clinical lesion, FAF reveals a diffuse, subtle hyperautofluorescence at the site of activity. As the clinical lesion fades, the FAF takes on a more intense, discrete, coalesced hyperautofluorescence, which decreases and becomes stippled over time, eventually giving way to a patch of hypoautofluorescence at the site of inactivity. Examination over the patient’s long course suggests that FAF evolves predictably during exacerbations and remissions, and the FAF findings reveal activity well after the clinical lesion resolves. FAF is a simple, noninvasive, and effective modality for following the evolution of ampiginous choroiditis.

[
Ophthalmic Surg Lasers Imaging Retina.
2013;44:393–397.]
Association Between Systemic Anticoagulation and Rate of Intraocular Hemorrhage Following Intravitreal Anti-VEGF Therapy for Age-Related Macular Degeneration
Authors: Olson Joanna M. , Scott Ingrid U. , Kerchner Denise L. , Kunselman Allen R.
Published: August 2014

BACKGROUND AND OBJECTIVE:

To investigate the association between systemic anticoagulant medication usage at the time of intravitreal anti–vascular endothelial growth factor (anti-VEGF) injection with post-injection intraocular hemorrhage among patients with age-related macular degeneration (AMD).

PATIENTS AND METHODS:

Retrospective, consecutive case series of all patients treated with anti-VEGF injection for neovascular AMD at the Penn State Hershey Eye Center between 2004 and 2010: 1,710 anti-VEGF injections performed in 228 eyes of 191 patients. Each injection was analyzed according to whether the patient was taking systemic anticoagulant medication at the time of injection.

RESULTS:

Intraocular hemorrhage occurred after intravitreal anti-VEGF injection in four eyes (0.25%). Vitreous hemorrhage occurred in three patients taking systemic anticoagulation. Subretinal hemorrhage occurred in one patient not on anticoagulant therapy. In a bivariate analysis, the odds of intraocular hemorrhage are 1.9 times higher for injections performed in patients on systemic anticoagulation versus those not on systemic anticoagulation; this difference is not statistically significant.

CONCLUSION:

The rate of intraocular hemorrhage after intravitreal injection of anti-VEGF therapy among patients with AMD is low, and there is no significant difference between patients taking systemic anticoagulant medications at the time of injection and patients not on anticoagulation.

[
Ophthalmic Surg Lasers Imaging Retina
. 2013;44:455–459.]