bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgeon Bias in the Medical Record
Authors: Calfee Ryan , Fynn-Thompson Eric , Stern Peter
Published: October 2009

The medical chart is presumed to be an impartial record of a patient's history, examination, and treatment. This study was designed to determine if hand surgeons introduce selective bias into the medical record. Fifty consecutive new patients were referred to a hand surgery practice for presumed carpal tunnel syndrome. Forty-four patients were diagnosed with carpal tunnel syndrome and were eligible for study inclusion. Prior to evaluation, all patients wrote in free-response fashion and diagrammed their symptom quality and location. Surgeon dictations from these visits were then evaluated against the patients' self-reported symptomatology. Statistical analysis was performed to determine if specific symptom types and locations were preferentially omitted from medical records.

The surgeons' records most closely replicated patients' self-reported diminished sensibility in the thumb, index, and middle fingers (100% inclusion rate). When patients described presenting with pain, it was recorded significantly less frequently (
P
<.001) in the surgeon's note (16 of 27; 59%). Surgeon documentation of patient symptoms in the median nerve distribution (98% inclusion) was more likely than documentation of symptoms in the small finger (50% inclusion;
P
<.001), forearm (45% inclusion;
P
<.001), and arm (50% inclusion;
P
<.001).

Because symptoms less readily attributed to median nerve compression at the wrist were more likely to be omitted, it is possible that surgeons introduce bias into the medical record. Although the cause of this discrepancy is likely multifactorial, the medical records often failed to document patients' pain as well as symptoms outside of the median nerve distribution.
Rigid Stepped Plate for Internal Fixation for High Tibial Osteotomy
Authors: Yoo Jae Ho , Seong Sang Cheol , Lee Sahnghoon , Choi Kuiwon , Lee Moon Kyu , Lee Changyang , Lee Myung Chul
Published: October 2009

High tibial osteotomy is regarded as an effective treatment for unicompartmental arthrosis of the knee, but the optimal fixation method has not yet been devised. The purpose of this study was to confirm the superior strength of a rigid stepped plate as compared to a 4-hole L-plate device.

Lateral closing-wedge high tibial osteotomy was performed on 30 ten-month-old porcine tibiae. Fifteen tibiae were fixed using a rigid stepped plate and 15 were fixed with a 4-hole L-plate. Three types of deforming force—compression, valgus bending, and varus bending—were each applied to 5 pair of tibiae fitted with either the rigid stepped plate or the L-plate using a mechanical testing apparatus. Values of load, displacement, and stiffness were analyzed to compare the fixation powers. Mean stiffness in the rigid stepped plate and L-plate groups were 977.8 (SD 230.3) and 836.2 (SD 248.4) N/mm for compression testing (
P
=.465), 38.7 (SD 12.9) and 21.6 (SD 9.6) N/mm for valgus bending (
P
=.047), and 62.3 (SD 18.1) and 29.8 (SD 9.7) N/mm for varus bending (
P
=.009), respectively.

The rigid stepped plate has greater fixation strength than the conventional 4-hole L-plate. Given this improved level of fixation with the rigid stepped plate, immobilization duration after high tibial osteotomy could be shortened and complications reduced.
Comparison of Operative Times Between Pressure and Flow-Control Pump Versus Pressure-Control Pump for ACL Reconstruction
Authors: Sieg Ryan , Bear Russell , Machen M. Shaun , Owens Brett D.
Published: October 2009

Evidence suggests that a pressure and flow-control pump provides better visualization than a pressure-control pump alone. Increased visualization may lead to decreased operative time. We sought to perform a direct comparison in terms of operative times in anterior cruciate ligament (ACL) reconstructive surgery using these 2 automated pump systems.

We retrospectively studied all ACL reconstruction procedures performed at our institution over an 8-month period. During the first 4-month period, a pressure-driven pump was used (HydroFlex Multipurpose Irrigation Pump; Davol, Warwick, Rhode Island). During the second 4-month period, a pressure and flow-control pump was used (FMS Duo+; DePuy Mitek, Raynham, Massachusetts). Procedures that involved multiligament reconstruction or meniscal repair were excluded. Surgical time was defined as the time from incision to skin closure. The data were analyzed with the Student
t
test with significance set at
P
<.05. Forty-four procedures met our inclusion criteria, with 21 surgeries performed using the pressure-control pump and 23 surgeries performed using the pressure and flow system. Mean operative time using the pressure-control pump was 126 minutes (95% CI 118.9, 133.3), while mean operative time using the pressure and flow-control system was 111 minutes (95% CI 104.1, 117.9). This difference was significant (
P
=.004).

These results indicate that the use of pressure and flow-control pump system results in time savings compared with the pressure-control pump.
Patients' Perceptions of Hip Resurfacing Arthroplasty
Authors: Murphy Todd P. , Trousdale Robert T. , Pagnano Mark W. , Mabry Tad M. , Sierra Rafael J.
Published: October 2009

The purpose of this study was to understand patients' perceptions regarding hip resurfacing arthroplasty relative to conventional total hip arthroplasty (THA). A consecutive group of 139 patients being evaluated for hip symptoms were asked to complete a survey regarding hip resurfacing arthroplasty. Forty-one percent were aware of hip resurfacing arthroplasty, and 82% felt hip resurfacing arthroplasty was a safer procedure than THA. Seventy-nine percent felt there was less soft tissue damage associated with hip resurfacing arthroplasty, and 80% felt they would return to their activities more quickly. Eighty percent felt that their overall range of motion would be better following hip resurfacing arthroplasty.

Patients' perceptions of hip resurfacing arthroplasty are inconsistent with the known published advantages and disadvantages of the procedure when compared to conventional THA. Most of the patients received their information from sources other than an orthopedic surgeon.
Occipitocervical Fusion Using Contoured Rods and Medial Offset Connectors: Description of a New Technique
Authors: Garrido Ben J. , Puschak Thomas J. , Anderson Paul A. , Sasso Rick C.
Published: October 2009

Stabilization of the occipitocervical junction and fixation of the occiput is challenging. Rigid fixation with plates and screws has reduced dependence on external immobilization and improved fusion rates. The strength of the occipital fixation can be compromised as plates constrain the ability to place occipital screws along the midline. Bilateral contoured rods with medial offset connectors allow placement of 6 occipital screws in the thickest and strongest bone along the midline, while easily connecting to screws in the cervical spine. The purpose of this study is to review complications and fusion rates in a patient series using this new technique to stabilize the occipitocervical junction.

A retrospective review was performed at 2 years of 20 patients who underwent occipitocervical fusion for instability using bilateral contoured rods with medial offset connectors. Six occipital screws were successfully placed in 17 patients. The caudal screw on one side was abandoned in 3 patients due to insufficient occipital thickness. Sixteen patients fused. Four patients died in the perioperative period secondary to polytrauma complications. There were no hardware-related complications nor failure of occipital fixation.

Bilateral rods with medial offset connectors allow parasagittal placement of 6 bicortical screws in the thickest and strongest bone along the occipital midline. The use of 6 occipital screws has been shown to be biomechanically advantageous. Using this technique, 6 occipital screws were easily placed in each of 17 patients, while 5 strong points of fixation were obtained in the other 3 patients. We experienced no failure of occipital fixation, and all surviving patients went on to fusion.
Pectoralis Major Insertional Ratio in Proximal Humerus Fractures: A Method to Reconstruct Humeral Head Height in Arthroplasty
Authors: Hasan S. Ashfaq , Rauls Russell B. , Cordell Cari L. , Heinzelmann Andrew D. , Siegel Eric R.
Published: October 2009

A key factor for a successful outcome after hemiarthroplasty for a 4-part proximal humerus fracture is accurately restoring humeral length. Our hypothesis was that the pectoralis major insertion is not at a constant distance on the humerus, as has been previously suggested, but varies depending on the length of the humerus, and our goal was to determine if a consistent ratio exists for the insertion as it relates to total humeral length.

Thirty-eight cadaver arms were dissected to expose the pectoralis major insertion. Using a digital caliper, measurements were made from the top of the humeral head to the superior aspect of the pectoralis major insertion (HP), and from the pectoralis insertion to the lateral epicondyle (PL). The predictive ability of PL for HP was examined via regression, and the average prediction error was computed. The final predictive regression model had the following formula: pHP=0.2323×PL, where pHP is predicted HP. This equation had an average prediction error of 4.11 mm.

The PL can be measured intraoperatively during hemiarthroplasty for proximal humerus fractures. The proportionality relationship can then be used to predict HP with an average prediction error <5 mm. This relationship may facilitate accurate intraoperative reconstruction of prosthetic head height and enhance existing techniques for assessment of implant positioning.
Peripheral Neuropathy of the Upper Extremity: Medical Comorbidity That Confounds Common Orthopedic Pathology
Authors: Bales Joshua G. , Meals Roy
Published: October 2009

Educational Objectives

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

1.

Describe how medical comorbidities may mimic or confound common compression neuropathies.

2.

List and describe the common causes of peripheral neuropathy in the upper extremity.

3.

Discuss peripheral nerve pathophysiology and proper techniques to evaluate this pathology.

4.

Explain the treatment algorithms of compression neuropathies in the setting of medical comorbidity.
Unilateral Carpal Tunnel Syndrome Caused by an Occult Palmar Lipoma
Authors: Bagatur A. Erdem , Yalcinkaya Merter
Published: October 2009

Carpal tunnel syndrome usually presents bilaterally and space-occupying lesions should be suspected in patients with unilateral symptoms, especially with a long history and when the symptomatic hand shows severe neurophysiologic impairment, while the contralateral hand is neurophysiologically intact. Approximately half of patients with unilateral symptoms have positive electrodiagnostic test results in the asymptomatic, contralateral hand. Space-occupying lesions are known to cause carpal tunnel syndrome and the incidence of space-occupying lesions in unilateral carpal tunnel syndrome is higher than that of bilateral carpal tunnel syndrome. It is easy to detect a mass when it is palpable, but occult lesions may be overlooked easily.

Whenever a patient presents with unilateral symptoms and unilateral neurophysiologic impairment, the possibility of a space-occupying lesion compressing the median nerve should be kept in mind in the differential diagnosis. This article presents 2 cases of patients with occult deep palmar lipomas compressing the median nerve and causing unilateral symptoms of carpal tunnel syndrome. We stress the importance of imaging studies in patients with unilateral symptoms that are usually not used in carpal tunnel syndrome. While both patients' symptomatic hands showed severe neurophysiologic impairment, the contralateral hands were totally intact, which is contradictory with a long history. The reported patients were evaluated and magnetic resonance images revealed intra-tunnel lesions. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the hand are lipomas. Since the thick palmar fascia is strong, a deep lipoma may not be recognized although nerve compression symptoms may be gross.
Combined Posteroanterior Surgery for Osteoporotic Delayed Vertebral Fracture and Neural Deficit in Patients With Parkinson's Disease
Authors: Nakashima Hiroaki , Yukawa Yasutsugu , Ito Keigo , Horie Yumiko , Machino Masaaki , Kato Fumihiko
Published: October 2009

Osteoporotic thoracolumbar compression fracture occasionally occurs in patients with Parkinson's disease and can lead to neural compromise due to delayed vertebral body collapse, requiring surgical treatment. Surgical treatment and postoperative care are difficult because of poor bone quality, involuntary exercise, and postural imbalance. Due to such difficulties in treatment, few reports exist about surgery for osteoporotic thoracolumbar compression fracture in patients with Parkinson's disease. Anterior decompression and posteroanterior reconstructive stabilization were performed for 3 patients with Parkinson's disease and osteoporotic vertebral body collapse. To prevent instrument-related complications, it is important to achieve initial rigid stability. Regarding the stabilization of the posterior elements, laminar hooks were used. Two pedicle screws and 1 hook were placed at 1 level above and 1 level below the injured vertebra. As for the stabilization of the anterior part, a titanium cage was used. All patients resumed their activities of daily living postoperatively. Two of 3 patients experienced sinking of the rib cage after commencement of ambulation with a hard brace postoperatively. After these patients wore a body cast for 2 months, they were able to resume activities of daily living under careful treatment. In all patients, junctional kyphosis improved postoperatively and progressed postoperatively. None experienced recurrent neural deterioration or backache related to the fracture through >3 years of postoperative follow-up. Combined posteroanterior reconstruction surgery was useful for osteoporotic thoracolumbar compression fracture with Parkinson's disease. However, maintenance of postoperative alignment was difficult to achieve. Careful postoperative management was important for good clinical results.
Total Knee Arthroplasty in a Patient With Neglected Congenital Patellar Dislocation
Authors: Tunay Servet , Ozkan Huseyin , Köse Özkan , Atik Aziz , Basbozkurt Mustafa
Published: October 2009

Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of 56-year-old woman with advanced osteoarthritis due to right neglected congenital patellar dislocation treated with total knee arthroplasty (TKA) with release of the lateral retinaculum and proximal extensor mechanism realignment. One year later, the patient had improvement of her Knee Society scores and painless function, stability, and better extensor strength. A literature search revealed a limited number of similar cases in which congenital patellar dislocation was treated with TKA. Total knee arthroplasty provides a valid treatment option for adults with congenital patellar dislocation who have absence of the femoral sulcus and associated osteoarthritis. Total knee arthroplasty has the ability to correct the pathologies seen with congenital patellar dislocation, eg, external tibial rotation, absence of femoral groove, and patellar hypoplasia. Realignment of extensor mechanism restores quadriceps strength, normal knee biomechanics, and may prevent complications such as dislocation.
Inferior Scapular Notching Following Encore Reverse Shoulder Prosthesis
Authors: Levy Jonathan , Blum Sara
Published: October 2009

Inferior scapular notching following reverse shoulder arthroplasty has been described using devices with a center of rotation located at the glenoid. Notching is typically seen within the first few months. To date, the only prosthesis without a reported case of scapular notching is the Encore Reverse Shoulder Prosthesis (RSP) (DJO Surgical, Austin, Texas). We present the first reported case of inferior scapular notching with the Encore RSP seen in a patient treated using an alternative glenosphere (36 minus 4) with a center of rotation 2 mm lateral to the glenoid. The glenosphere was implanted using previously described techniques to avoid scapular notching: inferior tilt and inferior translation with overhang of the glenosphere. Inferior scapular notching was not observed at 1-year follow-up. However, at 2-year follow-up, radiographs revealed Sirveaux Grade 2 scapular notching. This case illustrates that using a glenosphere with a center of rotation at or near the glenoid places the shoulder at risk for scapular notching. When choosing this type of design, the treating surgeon must maintain a high index of suspicion for scapular notching as intermediate and long-term follow-up radiographs are reviewed. Scapular notching for these devices may develop later than devices with a center of rotation at the glenoid.
Vertical Dislocation of the Patella: Report of 2 Cases
Authors: Shetty Sanathkumar , Ramesh Balasundaram , Gul Arif , Madhusudan Thayur Raghavendra , Altayeb Talal
Published: October 2009

Vertical dislocation of the patella is rare and usually occurs as a result of blunt trauma. The patella rotates around a vertical axis. It can be diagnosed by its typical clinical features. This article presents a case of 2 patients with vertical dislocation who presented with high-impact injuries and had classic signs of a vertically dislocated patella. Unlike lateral patella dislocation, reduction under sedation is usually not possible. This is mainly due to increased tension within the quadriceps mechanism, which makes reduction difficult. The other factor that makes reduction difficult is that the patella could be wedged in the femoral condyles. Both patients underwent multiple unsuccessful attempts at reduction in the emergency department. These were later successfully reduced under general anesthesia and both patients went on to make an uneventful recovery. Multiple attempts without adequate relaxation could not only cause chondral damage but could also could endanger the extensor mechanism.
Osteosarcoma of the Patella: Biologic Reconstruction With Allograft
Authors: Cho Yool , Kim Jae-Do , Chung So-Hak
Published: October 2009

Osteosarcoma rarely occurs in the patella. The majority of lesions located in the patella are usually benign. According to the literature, osteosarcoma of the patella has been reported in 32 cases. Surgical treatment (patellectomy, resection and arthrodesis with allograft, and total joint replacement) was attempted in several cases, but neither function of the knee joint nor prognosis of the patients were good. A 53-year-old woman reported pain and swelling in the left knee. Based on plain radiographs and magnetic resonance imaging (MRI), a bone tumor was suspected, and an open bone biopsy of the patella was performed. The pathologic diagnosis was osteoblastic osteosarcoma. A total patellectomy was performed because MRI showed a lesion that did not spread into the joint. A reconstruction was subsequently performed by allograft patella. The graft consisted of a quadriceps tendon, a patella with a patellar tendon, and the medial and lateral retinacula. Twenty-six months postoperatively, the function of the knee joint was almost similar to that before the procedure, and there was no evidence of recurrence or metastasis. After the procedure, the patient could walk without pain and the knee joint could flex to 140° with extension lag of 10°. To our knowledge, this is the first report of a biologic reconstruction with allograft patella after total patellectomy in osteosarcoma involving the patella.
Decompression, Correction, and Interbody Fusion for Lumbar Burst Fractures Using a Single Posterior Approach
Authors: Sasagawa Takeshi , Kawahara Norio , Murakami Hideki , Demura Satoru , Tomita Katsuro
Published: October 2009

Burst fractures of the lumbar spine with instability or severe kyphosis are best served by surgical treatment. The question as to how these fractures should be approached and stabilized (anteriorly, posteriorly, or combined anteroposteriorly) is controversial. We performed decompression, correction, and interbody fusion using a single posterior approach for Denis type B or C lumbar burst fractures with severe kyphosis. The operative technique is as follows: after partial laminectomy, the bone fragment, which had migrated into the spinal canal, is impacted into the posterior wall of the vertebral body. After curetting the injured disk, bone chips and adapted lamina are inserted into the disk space for anterior support. Five Denis type B or C burst fractures demanding >20° kyphosis correction were treated by this procedure. Mean follow-up was 41 months. We evaluated neurologic assessment and localized kyphotic angle.

The neurologic function of all 5 patients improved by at least 1 grade, as measured by the Frankel grading scale. Mean values of localized kyphosis improved from a mean 23.0° before surgery to −3.0° after surgery. At follow-up examination, average regional kyphosis was −2.4°. No implant failure was observed at follow-up. Bony fusion was achieved in all patients.

The advantages of this operative procedure are it is safe for the neural structures and complete spinal canal decompression and kyphosis correction are achieved, while providing anterior support and posterior stabilization.
Botulinum Toxin Type a in the Treatment of Painful Adductor Muscle Contracture After Total Hip Arthroplasty
Authors: Santamato Andrea , Ranieri Maurizio , Panza Francesco , Solfrizzi Vincenzo , Frisardi Vincenza , Lapenna Luisa Maria , Moretti Biagio , Fiore Pietro
Published: October 2009

Painful adductor muscle contracture is an important cause of failure during rehabilitation following total hip arthroplasty (THA). Adductor muscle contracture may be caused by postoperative muscle retractions, adhesive capsulitis, postoperative leg-length inequalities caused by implant failure, or preexisting hip pathologies. A 34-year-old woman experienced a persistent painful contracture into the left adductor magnus muscle after THA. She had no leg-length inequalities and, according to the Medical Research Council scale (grades 0–5), muscle strength of the quadriceps was 5/5 for the right side and 3/5 for the left. The degree of functionality according to the Harris hip score (HHS) was 16/100 in the left hip. The pain level, measured with the visual analog scale (VAS), was 7/10. The patient was unable to fully adhere to the rehabilitation program and walked with a limp during the stance phase of gait. After 7 days of treatment with injections of botulinum toxin type A into the left adductor magnus muscle (dose, 150 UM) and subsequent rehabilitation, a great reduction of painful contracture was observed (VAS score, 2/10). The procedure was well tolerated and no adverse effects were noted. After 20 days, hip articular range of motion and gait had improved (HHS score, 75/100). The clinical effects of botulinum toxin type A were present at 2-month follow-up. This treatment may be a viable alternative for the management of painful adductor muscle contracture after THA, without significant side effects.
Osseous Sarcoidosis
Authors: Micah Watts , Sundaram Murali
Published: October 2009

The case:
A 36-year-old man presented with a chronic rash on his face and soft tissue nodules on his hands.
Reflections on the Use of Seclusion: In an Acute Mental Health Facility
Authors: Roberts Damien , Crompton David , Milligan Eleanor , Groves Aaron
Published: October 2009

This pilot study provides a snapshot of the use of seclusion within an acute care mental health unit in Queensland, Australia. The study collected baseline data against which practice reform aimed at reducing its use could be gauged. A mixed methodology was adopted, undertaking retrospective chart reviews, collecting qualitative survey data from individual nursing staff (
n
= 71) and patients (
n
= 4), and conducting focus groups to identify factors contributing to seclusion use. The study revealed a local facility seclusion rate of 12% compared with a national average of 10%. The re-seclusion rate of 76% was significantly higher than the national average of 31%. Eighty-seven percent of seclusion episodes were longer than 4 hours, compared with a national average of 41%. In approximately one third of cases, the required documentation was incomplete. Consumers mostly perceived seclusion as punishing and nontherapeutic, in contrast to staff, who generally viewed it as appropriate and potentially therapeutic.
Mental Health and Medical Challenges: Management of a Depressed Patient with a Left Ventricular Assist System in an Inpatient Psychiatric Setting
Authors: Tylus-Earl Nancy , Chillcott Suzanne
Published: October 2009

A depressed patient with a left ventricular assist device (LVAD) due to heart failure presented a unique challenge for staff in an inpatient psychiatric facility. Although depression in this patient population has been recognized and treated on an outpatient basis, the example described in this article may be the first known case to be treated in an acute inpatient psychiatric hospital setting. A variety of steps had to be taken to ensure the highest standards of care, as well as an optimal outcome for this patient. In addition to the individualized plan of care for depression, a more medically oriented and technologically advanced plan of care was also instituted. The inpatient psychiatric setting provides the necessary care and treatment to help the patient move beyond severe depression to engage in activities essential for health and the proper care and function of the LVAD. This article highlights an unusual psychiatric-mental health nursing situation to help others who may face this challenge in the future.
Addressing Nursing Students' Stigmatizing Beliefs Toward Mental Illness
Authors: Webster Debra A.
Published: October 2009

Implementing teaching methods that address nursing students' stigmatizing beliefs toward people with mental illness is important for nurse educators. The purpose of this article is to describe how a creative reflective learning project was used to encourage nursing students to express feelings about working with clients with mental illness, address stigma, and facilitate development of empathy. While working with a client with mental illness over a 4-week period, students maintained a reflective journal exploring their assumptions about mental illness. In addition, students created an individual project to depict their understanding of what it was like for their client to live with a mental illness. Examples of students' reflections and descriptions of their projects are presented to demonstrate how this experience affected students' views of mental illness.
Effects of Aging on Pharmacokinetic and Pharmacodynamic Drug Processes
Authors: Howland Robert H.
Published: October 2009

Aging affects the pharmacokinetics and pharmacodynamics of drugs, which has potentially important implications for the use of psychotropic medication in older adults. The absorption of orally administered drugs may be impaired or delayed, the volume of distribution of most drugs is decreased, and over time, the distribution shifts toward greater drug accumulation in fat stores. De crease in renal function with age is especially important regarding the use of lithium but is also relevant for most drugs because they are eventually cleared through the kidneys after metabolism in the liver. Because pharmacodynamic changes associated with aging will make elderly patients more sensitive to the pharmacological effects of medication—especially adverse effects—nurses should be appropriately trained in pharmacology and therapeutics in older adults.
Femtosecond Laser Lamellar Keratoplasty to Aid Visualization for Cataract Surgery
Authors: Lee Doh , Kim Jin-Hyoung , Oh Sae-Hoon , Choi Suk-Kyue , Kim Jung Kweon
Published: October 2009

Purpose:

To describe a new surgical technique for a patient with cataract combined with corneal opacity.

Methods:

This technique, femtosecond laser–assisted cataract surgery, was performed on a patient with a history of corneal opacity in both eyes from childhood. Because the patient had deep stromal corneal opacity, a corneal button 400-µm thick was made for lamellar keratoplasty while cataract surgery was performed simultaneously.

Results:

Lifting of the flap and removal of the corneal button before cataract surgery was successful without any intraoperative complications.

Conclusions:

Femtosecond laser–assisted cataract surgery is a promising surgical procedure for a cataract patient with stromal corneal opacity. [
J Refract Surg
. 2009;25:902–904.]
Comparison of Clinical and Patient-Reported Outcomes With Bilateral AcrySof Toric or Spherical Control Intraocular Lenses
Authors: Lane Stephen S. , Ernest Paul , Miller Kevin M. , Hileman Kendra S. , Harris Blake , Waycaster Curtis R.
Published: October 2009

Purpose:

To compare clinical and patient-reported outcomes with bilateral implantation of AcrySof toric or spherical control (Alcon Laboratories Inc) intraocular lenses (IOLs).

Methods:

Patients with cataract and corneal astigmatism who previously received either an AcrySof toric IOL or an AcrySof spherical control IOL were offered implantation of the same IOL in the fellow eye. Six-month assessments included visual acuity, refractive cylinder, spectacle use, and patient satisfaction.

Results:

The study included 62 patients (toric, n=40; control, n=22). All corneal incisions were temporal, with final mean incision sizes of 3.0 mm for the toric IOL and 3.1 mm for the spherical control IOL. A significantly greater proportion of patients with toric IOLs achieved spectacle independence for distance vision and did not require prescription glasses for near or distance vision (
P
=.0190). Patients with toric IOLs had significantly less residual refractive cylinder (
P
<.0001) and better binocular distance uncorrected visual acuity (UCVA) (
P
=.0014) than those with spherical control IOLs.

Conclusions:

Patients with bilateral AcrySof toric IOLs achieved superior spectacle freedom, residual refractive cylinder, and distance UCVA compared to patients with bilateral spherical control IOLs. [
J Refract Surg
. 2009;25:899–901.]
Intrastromal Correction of Presbyopia Using a Femtosecond Laser System
Authors: Ruiz Luis Antonio , Cepeda Liliana Marcela , Fuentes Vanessa Carolina
Published: October 2009

Purpose:

To introduce a new, minimally invasive intrastromal correction for presbyopia (INTRACOR procedure) using the TECHNOLAS femtosecond laser system (Technolas Perfect Vision GmbH).

Methods:

The INTRACOR procedure was performed in 83 eyes of 45 patients aged 44 to 67 years. Followup was 6 to 12 months. Data recorded included age; pre- and postoperative refraction; uncorrected distance (UDVA), intermediate, and near visual acuity (UNVA); corrected distance visual acuity (CDVA); distance corrected near visual acuity; corneal hysteresis (CH), corneal resistance factor (CRF), and asphericity; pachymetry; endothelial cell density; contrast sensitivity; and ocular aberrations.

Results:

At 6 months postoperatively, all 83 (100%) eyes had improved UNVA, with minimal or no change in UDVA. Twenty-two eyes were available at 12 months; UNVA improved to J1 in these eyes with continued improvement in mean UDVA. At last follow-up, a mild myopic shift in refraction was noted with only 3 (3.6%) eyes showing a 2- or 3-line decrease of UDVA, and 74 (89.2%) eyes achieved both J2 and 20/25 or better. Mean CDVA and distance corrected near visual acuity continued to improve with time. Two (2.4%) eyes lost 2 lines of CDVA at 6 months, but this did not occur in the 22 eyes seen at 1 year. Overall stability was noted in CH, CRF, pachymetry, endothelial cell density, and contrast sensitivity. Primary spherical aberrations shifted toward negative values and secondary spherical aberration shifted toward positive values. No corneal structural complications were observed.

Conclusions:

The INTRACOR intrastromal procedure using the TECHNOLAS femtosecond laser is a promising procedure for presbyopia correction. It preserves the corneal epithelium and anterior stromal fibers. [J Refract Surg. 2009;25:847–854.]
Effect of Femtosecond Laser Energy Level on Corneal Stromal Cell Death and Inflammation
Authors: de Medeiros Fabricio Witzel , Kaur Harmeet , Agrawal Vandana , Chaurasia Shyam S. , Hammel Jefferey , Dupps William J. , Wilson Steven E.
Published: October 2009

Purpose:

To analyze the effects of variations in femtosecond laser energy level on corneal stromal cell death and inflammatory cell influx following flap creation in a rabbit model.

Methods:

Eighteen rabbits were stratified in three different groups according to level of energy applied for flap creation (six animals per group). Three different energy levels were chosen for both the lamellar and side cut: 2.7
µ
J (high energy), 1.6
µ
J (intermediate energy), and 0.5
µ
J (low energy) with a 60 kHz, model II, femtosecond laser (IntraLase). The opposite eye of each rabbit served as a control. At the 24-hour time point after surgery, all rabbits were euthanized and the corneoscleral rims were analyzed for the levels of cell death and inflammatory cell influx with the terminal uridine deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay and immunocytochemistry for monocyte marker CD11b, respectively.

Results:

The high energy group (31.9±7.1 [standard error of mean (SEM) 2.9]) had significantly more TUNEL-positive cells in the central flap compared to the intermediate (22.2±1.9 [SEM 0.8],
P
=.004), low (17.9±4.0 [SEM 1.6],
P
⩽.001), and control eye (0.06±0.02 [SEM 0.009],
P
⩽.001) groups. The intermediate and low energy groups also had significantly more TUNEL-positive cells than the control groups (
P
⩽.001). The difference between the intermediate and low energy levels was not significant (
P
=.56). The mean for CD11b-positive cells/400× field at the flap edge was 26.1±29.3 (SEM 11.9), 5.8±4.1 (SEM 1.6), 1.6±4.1 (SEM 1.6), and 0.005±0.01 (SEM 0.005) for high energy, intermediate energy, low energy, and control groups, respectively. Only the intermediate energy group showed statistically more inflammatory cells than control eyes (
P
=.015), most likely due to variability between eyes.

Conclusions:

Higher energy levels trigger greater cell death when the femtosecond laser is used to create corneal flaps. Greater corneal inflammatory cell infiltration is observed with higher femtosecond laser energy levels. [
J Refract Surg
. 2009;25:869–874.]
Effects of Altered Corneal Stiffness on Native and Postoperative LASIK Corneal Biomechanical Behavior: A Whole-eye Finite Element Analysis
Authors: Roy Abhijit Sinha , Dupps William J.
Published: October 2009

Purpose:

To investigate the impact of corneal elasticity on corneal shape changes before and after simulated LASIK with and without consideration of whole-eye biomechanics.

Methods:

A finite element whole-eye model of a human eye was constructed. The cornea was modeled as hyper-elastic and incompressible using experimental data representing a range of corneal stiffness. The corneal response to intraocular pressure loading and LASIK for 2.00, 4.00, and 6.00 diopters of spherical myopia was analyzed as a function of corneal stiffness and limbal boundary conditions.

Results:

Myopic LASIK produced different degrees of central flattening and postoperative ametropia in low-stiffness and high-stiffness corneas. Although a cornea-only model demonstrated maximum stresses and displacements in the central cornea and predicted residual myopia, a whole-eye model with equivalent corneal stiffness predicted greater paracentral displacements and less myopic undercorrection. In a whole-eye model with a stiffer cornea, maximum displacements shifted further toward the limbus, favoring additional mechanically mediated central flattening and refractive overcorrection (hyperopia). In postoperative LASIK models thinned by high myopic corrections, corneal stiffening caused central cornea flattening.

Conclusions:

Differences in the corneoscleral stiffness relationship affect simulated refractive outcomes after LASIK and may be a source of individual variation in refractive surgery outcomes. A whole-eye model allowing limbal motion illustrates a stiffness-dependent biomechanical balance between central corneal flattening and pre-ectatic weakening of the corneal apex not demonstrated in previous computational models and provides insight into under- and overcorrection in myopic LASIK and the previously unexplained phenomenon of corneal flattening after therapeutic collagen cross-linking for keratoconus. [
J Refract Surg
. 2009;25:875–887.]
Factores involucrados en el proceso de toma de decisiones en bibliotecas de tamaño medio y pequeño. Resultados del Proyecto Decimal
Authors: Bosch M. , Espeit C.
Published: October 2009

Se presentan los resultados de la investigación realizada en el marco del proyecto europeo DECIMAL, que tiene como objetivo el desarrollo de un módulo integrado de soporte de la toma de decisiones para sistemas automatizados usados en bibliotecas pequeñas y medianas. La investigación cuantitativa y cualitativa llevada a cabo en el Reino Unido, Italia y España se ha basado en una combinación de diversos métodos: revisión de la literatura, entrevistas semiestructuradas, cuestionarios y grupos de discusión en ocasión de los dos seminarios de presentación realizados. Se distinguen dos líneas básicas de investigación: la primera en torno a la utilización real de indicadores y medidas para la gestión y evaluación de la actividad del centro, así como su interés potencial en el caso que no se hayan aplicado por el momento, y la segunda en torno al tipo de decisiones más habituales en los centros y los factores que inciden en este proceso (fuentes de información utilizadas, cultura institucional, formación, nivel de satisfacción). El artículo está centrado en los resultados obtenidos en las bibliotecas españolas, aunque se mencionan también los resultados globales a modo de comparación. Las conclusiones del estudio han dado como resultado la especificación de las necesidades de los usuarios, sobre cuya base se ha diseñado el módulo de soporte a la toma de decisiones. El proyecto ha concluido con una fase de evaluación del prototipo que ha implicado el desarrollo de cuatro versiones sucesivas del módulo con la finalidad de resolver los problemas presentados durante el proceso de evaluación.
Prolegomenos sobre publicaciones electrónicas de Poesía en lengua española
Authors: Vila-Belda Reyes
Published: October 2009

Este trabajo pretende informar sobre algunas de las publicaciones electrónicas de poesía en español así como resaltar ciertas innovaciones o cambios que estos nuevos soportes aportan al proceso de comunicación poética. No se trata de un estudio exhaustivo ni siquiera representativo de las fuentes existentes ya que sólo escogemos aquéllas que sirven a nuestros objetivos. Por tanto se trata de una selección intencional o "purposive sample" ya que sirve para ilustrar nuestras observaciones.
Algoritmo de filtrado multi-termino para la obtención de relaciones jerárquicas en la construcción automática de un tesauro de descriptores
Authors: Velasco M. , Díaz I. , Lloréns J. , De Amescua A. , Martínez V.
Published: October 2009

Las nuevas técnicas de análisis de dominios (temáticos, etc.) proporcionan métodos para la construcción de repositorios o conjuntos de información estructurada. Existe una metodología específica para generar automáticamente dominios (temáticos, etc.) que utiliza como repositorio una estructura basada en los tesauros documentales. Una de las fases indicadas en esta metodología para la generación del tesauro es la adquisición de conceptos, que utiliza técnicas de filtrado de información estadísticas. En este trabajo se presentan modificaciones a estas técnicas de filtrado para proporcionar términos compuestos.
La investigación cualitativa y sus aplicaciones en Biblioteconomía y Documentación
Authors: Borrego Huerta Ángel
Published: October 2009

Se intenta determinar cuáles son las técnicas cualitativas concretas que pueden ser útiles en el desarrollo de investigaciones en Biblioteconomía y Documentación, qué temas son más susceptibles de ser abordados desde una óptica cualitativa, y si existe una correlación entre la técnica empleada y el tema tratado. Se analiza la temática y técnicas empleadas en los artículos de investigación publicados en Journal of the American Society for Information Science entre 1995 y 1997, y en los aparecidos en Journal of Documentation y Library and Information Science Research desde 1993 hasta 1997. La mayor parte de los artículos que emplean técnicas cualitativas estudian el comportamiento del usuario en la recuperación de la información, bien sea explorando su conducta al utilizar un sistema automatizado, o bien centrándose en las tácticas que diversos grupos de usuarios emplean al resolver sus necesidades informativas. Finalmente se exponen las principales características que definen este tipo de investigaciones.
Aplicación de un modelo de evaluación a las revistas científicas españolas de economía: una aproximación metodológica
Authors: Giménez Toledo Elea , Román Román Adelaida , Sánchez Nistal José María
Published: October 2009

Se describe un modelo de evaluación de revistas científicas, basado en el análisis de parámetros múltiples: cumplimiento de la periodicidad, pervivencia, normalización, consejos de redacción, sistema de evaluación de originales, apertura institucional, difusión internacional y valoración de los pares. Se comentan los aspectos metodológicos más destacables, así como los resultados globales obtenidos al aplicar este modelo a una gran muestra de las revistas españolas de Economía.
Evaluación de la información contenida en seis sedes web de las Escuelas Universitarias y Facultades de Biblioteconomía y Documentación Españolas
Authors: Castillo Blasco Lourdes , Martínez de Pablo M. J. , Server Gloria
Published: October 2009

Se evalúa la información contenida en las sedes web de seis Escuelas Universitarias y Facultades de Documentación españolas. Se destaca la dificultad que entraña cualquier análisis de este tipo debido a la continua actualización de estos recursos, que dejan la sede temporalmente fuera de servicio.
Identificación y estudio de Grupos de Investigación a través de indicadores bibliométricos
Authors: Zulueta M. Angeles , Cabrero Aurelio , Bordons María
Published: October 2009

Se presenta un método para la identificación de los grupos de investigación activos en una determinada área o centro de investigación, a través de un análisis de co-autoría en las publicaciones científicas del área o centro objeto de estudio. La metodología expuesta se basa en programas de elaboración propia aplicados a una descarga de documentos del Science Citation Index. El proceso incluye tres etapas básicas: recuperación, descarga y normalización de los datos bibliográficos a estudiar; construcción del fichero de productividad de los autores; y delimitación de grupos a través de las frecuencias de co-autoría. La última etapa del proceso consiste en la caracterización de los grupos mediante indicadores bibliométricos: tamaño de grupo, producción, productividad, tasas de colaboración y especialización temática. Se ilustra el funcionamiento de la metodología mediante su aplicación a la producción española de una disciplina y de un centro de investigación en el período 1990-93.
Autores citados en los trabajos españoles de cirugía digestiva (1991-1995)
Authors: Sáez Gómez José Miguel , Gómez Terradillos Diana , Ramírez Romero Pablo , Valera Candel Manuel
Published: October 2009

Para identificar las influencias científicas ejercidas sobre los autores españoles en cirugía digestiva, se analizaron las referencias contenidas en los 483 artículos de cirugía publicados en Revista Española de Enfermedades Digestivas entre 1991 y 1995. Los autores citados fueron distribuidos en orden decreciente del número de citas recibidas y esta distribución fue comparada con la teórica de Lotka y con la obtenida cuando se considera exclusivamente al primer firmante del artículo citado. Hemos obtenido 23.326 citas a 15.886 autores distintos, procedentes de 8.125 referencias. La distribución de autores y citas por autor se ajusta a la expresión Ac = 13931c-2,9, y las citas a primeros firmantes a la expresión Ac = 6515,8c-3,23 ; ambas indican una alta dispersión de citas entre autores escasamente influyentes. Se confirma la elevada influencia de los autores españoles, ya que son de esta nacionalidad el más citado, tres de los cinco autores más citados y seis de los 20 más citados. De estos 20 autores, siete (uno español) no colaboran con el resto, y los otros 13 se organizan en cinco equipos de trabajo, dos de ellos españoles.
Producción científica española en el campo de los transplantes: 1990-1996
Authors: Prieto Castro Elisa , Catalán Vega Marcos Antonio
Published: October 2009

Este estudio bibliométrico intenta dar a conocer la situación que recientemente ha atravesado la investigación española en el campo de los transplantes tanto a nivel nacional como internacional, particularmente en este último. Para determinar esta situación, se han estudiado los documentos publicados por los científicos españoles entre 1990 y 1996 recogidos por las bases de datos IME, SCI y Medline. Además, se ha estudiado el índice de ganancia en competitividad y el índice de actividad de la producción española, comparándolos con la producción internacional y con la de otros países determinados. Por otro lado, se ha realizado un estudio de la bibliografía utilizada por los científicos españoles. mediante diversos indicadores como la vida media de las publicaciones y el índice de Price de referencias y citas. Los resultados obtenidos indican que la producción española está en un momento de auge, aunque tiene una tendencia excesivamente irregular, y aunque se han observado muchas diferencias respecto a los países más importantes, los puntos a favor encontrados matizan esta opinión desfavorable.
Evaluación de recursos digitales en línea: conceptos, indicadores y métodos.
Authors: Codina Lluís
Published: October 2009

Discusión de las propiedades principales de los recursos digitales. Se propone una metodología de evaluación de recursos digitales en la que se identifican los parámetros esenciales que pueden ser objeto de evaluación y se facilitan indicadores para realizar estimaciones sobre los mismos.
Una visión bibliométrica de la investigación en bibliotecología y ciencias de la informacion de América Latina y el Caribe.
Authors: Licea de Arenas Judith , Valles Javier , Arévalo Gerardo , Cervantes Carlos
Published: October 2009

Las discusiones en torno a la necesidad de hacer investigación, aún en áreas tales como la Bibliotecología y la Ciencia de la Información (BCI) han sido frecuentes. En virtud de lo anterior, se intentó identificar, a través de las tres bases de datos Library and Information Science Abstracts, Library Literature e Information Science Abstracts, los productos intelectuales generados en América Latina y el Caribe. Se obtuvieron 1.911 registros únicos. Brasil fue el país mejor representado en el estudio. Asimismo, las revistas brasileñas fueron las que publicaron el mayor número de artículos. El inglés y el portugués fueron los dos idiomas que captaron gran parte de los manuscritos.Los resultados aproximan a una realidad, basados en una revisión de bases de datos, que si bien indizan selectivamente las publicaciones generadas en la región, aseguran que se trabajó con información que ha sido controlada por servicios disponibles universalmente. Por lo tanto, los mencionados resultados podrían servir para que las instituciones de educación superior, entre otras, analicen su papel como formadoras de recursos humanos que, a través de comunidades científicas, tendrán que resolver problemas relacionados con el desarrollo de la investigación en BCI y la adaptación o adopción de conocimiento generado fuera de la región.