Biomedical subjects

D Birkmire-Peters

Publications and source records attributed to D Birkmire-Peters.

3 recordsLinked to original sources

PubMed2001

Stereo nonmydriatic digital-video color retinal imaging compared with Early Treatment Diabetic Retinopathy Study seven standard field 35-mm stereo color photos for determining level of diabetic retinopathy.

OBJECTIVE: To evaluate the ability to determine clinical levels of diabetic retinopathy, timing of next appropriate retinal evaluation, and necessity of referral to ophthalmology specialists using stereoscopic nonmydriatic digital-video color retinal images as compared with Early Treatment Diabetic Retinopathy Study (ETDRS) seven standard field 35-mm stereoscopic color fundus photographs. DESIGN: Prospective, clinic-based, comparative instrument validation study. PARTICIPANTS: Fifty-four patients (108 eyes) with type 1 or type 2 diabetes mellitus selected after chart review from a single center to include the full spectrum of diabetic retinopathy. METHODS: Nonsimultaneous 45 degrees -field stereoscopic digital-video color images (JVN images) were obtained from three fields with the Joslin Vision Network (JVN) system before pupil dilation. Following pupil dilation, ETDRS seven standard field 35-mm stereoscopic color 30 degrees fundus photographs (ETDRS photos) were obtained. Joslin Vision Network images and ETDRS photos were graded on a lesion-by-lesion basis by two independent, masked readers to assess ETDRS clinical level of diabetic retinopathy. An independent ophthalmology retina specialist adjudicated interreader disagreements in a masked fashion. MAIN OUTCOME MEASURES: Determination of ETDRS clinical level of diabetic retinopathy, timing of next ophthalmic evaluation of diabetic retinopathy, and need for prompt referral to ophthalmology specialist. RESULTS: There was substantial agreement (kappa = 0.65) between the clinical level of diabetic retinopathy assessed from the undilated JVN images and the dilated ETDRS photos. Agreement was excellent (kappa = 0.87) for suggested referral to ophthalmology specialists for eye examinations. Comparison of individual lesions between the JVN images and the ETDRS photos and for interreader comparisons were comparable to the prior ETDRS study. CONCLUSIONS: Undilated digital-video images using the JVN system were comparable photographs for the determination of diabetic retinopathy level. The results validate the agreement between nonmydriatic JVN images and dilated ETDRS photographs and suggest that this digital technique may be an effective telemedicine tool for remotely determining the level of diabetic retinopathy, suggesting timing of next retinal evaluation and identifying the need for prompt referral to ophthalmology specialists. Thus, the JVN system would be an appropriate tool for facilitating increased access of diabetic patients into recommended eye evaluations, but should not be construed as a paradigm that would replace the need for comprehensive eye examinations.

Adult↗

PubMed2000

Saline irrigation in the prevention of otorrhea after tympanostomy tube placement.

OBJECTIVES: Comparison of intraoperative saline irrigation to otic drops in the prevention of postoperative otorrhea in children with middle ear effusion undergoing bilateral myringotomy with ventilation tubes. STUDY DESIGN: This study was designed as a blinded, controlled, prospectively randomized trial. METHODS: Study children were randomly assigned to receive either otic drops for 3 days postoperatively or saline irrigation of the middle ear space at the time of myringotomy. Only children with effusion present at the time of surgery were included. All children were evaluated for drainage 7 to 14 days postoperatively, and the degree of drainage was graded from 0 to 4. RESULTS: Of the 84 patients entered into the study, 62 patients were eligible for data analysis (16 failed follow-up, 6 records were lost). Of the patients who completed the study, not all had bilateral effusions, resulting in 111 ears for inclusion in the study. Fifty-two ears underwent irrigation, and 10 were noted to have otorrhea (19.2%). Fifty-nine ears received otic drops, resulting in 21 ears with otorrhea (35.6%). Evaluating the degree of otorrhea with a five-point Leichert scale, the average score per ear was 0.42 for the saline irrigation group and 1.07 for the control group. The rate and degree of drainage were both statistically reduced in the saline irrigation group (P < .05). CONCLUSIONS: Using middle ear irrigation at the time of tympanostomy may be more effective than antibiotic drops in preventing postoperative otorrhea.

Anti-Bacterial Agents↗

PubMed2000

Telementored laparoscopic cholecystectomy: a pilot study.

Few laparoscopic surgical experts exist relative to the number of surgeons needing training in laparoscopic surgical techniques. This study tested application of telemedicine technology in the mentoring of surgeons during laparoscopic cholecystectomy. Our Surgical Telementoring Suite provided real-time audio and video telecommunication to the operating room. Data points for telementored laparoscopic cholecystectomy (TLC, n = 6) were compared to age and sex-matched controls having standard laparoscopic cholecystectomy (SLC, n = 6) with mentors physically present in the operating room. TLC data were also compared between cases performed with a staff surgeon and resident as mentorees (SRM, n = 3), versus two residents as mentorees (RRM, n = 3). Data were analyzed with chi-square testing. The level of statistical significance was set at p < 0.05. No major operative complications occurred in either group (p > 0.05). Total operative times were similar (92.2 +/- 18.4 minutes SLC vs. 94.7 +/- 25.3 minutes TLC, p > 0.05). Additional data compared between SRM and RRM groups included time to establishment of a pneumoperitoneum of 12-15 mm Hg (7.0 +/- 6.1 minutes SRM vs. 6.7 +/- 2.9 minutes RRM), time to placement of all four trocars (13.0 +/- 3.6 minutes SRM vs. 10.3 +/- 3.1 minutes RRM, time to isolation and proximal clipping of the cystic duct (38.0 +/- 12.1 minutes SRM vs. 55.7 +/- 29.0 minutes RRM), and time to removal of the gallbladder (77.3 +/- 25.4 minutes vs. 77.7 +/- 27.5 minutes RRM). For all data points, p > 0.05. We conclude that telementoring is a safe, effective method for teaching the techniques of LC. This is true for operating teams composed of surgical residents, with or without staff surgeons present.

Adolescent↗