[Clinical nursing--nurses should be able to mark the abdomen for stomas. Interview by Kjell Arne Bakke].
Explore the source record for details and available documents.
Enterostomy↗
Biomedical subjects
T Olsen
Publications and source records attributed to T Olsen.
Retinal detachment after cataract extraction in myopic eyes.
PURPOSE: To determine the incidence of retinal detachment (RD) after cataract extraction in people 40 years of age or older with axial myopia (i.e., axial length > or = 25.5 mm). SETTING: Fifteen Danish eye clinics. METHODS: Two hundred forty-five eyes had cataract extraction performed at 15 eye clinics; 237 eyes had extracapsular cataract extraction (ECCE) and 8 eyes, intracapsular cataract extraction (ICCE). Postoperative data were reported by the practicing ophthalmologists. Mean follow-up was 27 months (range 14 to 32 months). RESULTS: Five RDs occurred in the 245 eyes (2.0%). Excluding the ICCE cases and the two cases of combined cornea transplantation and ECCE, RD occurred in 4 of the 235 eyes that had ECCE (1.7%). The incidence after ECCE with posterior chamber lens implantation was 1.4%. Complete postoperative status was reported on 158 eyes. Forty-eight eyes (30.4%) had a neodymium:YAG capsulotomy and 3 (6.0%) developed an RD 1, 3.5, and 21 months after the capsulotomy. CONCLUSION: The RD incidence after ECCE with posterior chamber lens implantation was low but higher than that in unselected populations. The incidence increased after laser capsulotomy.
Adult↗
Anterior chamber fluorescein kinetics compared with vitreous kinetics in normal subjects.
PURPOSE: Describe and compare barrier properties in various parts of the eye. METHODS: Fluorophotometric measurements of the anterior chamber, vitreous and plasma fluorescein concentrations were performed and subjected to a kinetic two-compartment analysis. RESULTS: The overall barrier properties as revealed by a permeability-index was found to be 12.2% (anterior chamber) and 3.5% (vitreous). The apparent rate constant of permeation into the anterior chamber (Kin=1,59 h(-1)) was found to be significantly higher than into the vitreous (Kin=0,66 h(-1)) and into the apparent peripheral body compartment (Kin=0,23 h(-1)). The terminal rate constant of fluorescein disposition from the anterior chamber (Kout=0,21 h(-1)) was in agreement with the terminal disposition rate constant for plasma fluorescein (P=0,23 h(-1)), whereas elimination from the vitreous (Kout=0,072 h(-1)) was significantly slower. CONCLUSION: Compartment analysis of ocular fluorescein kinetics is suitable for the study of anterior and posterior barrier properties in the eye. In this study fluorescein elimination from the anterior chamber was restricted by terminal plasma fluorescein decay rather than by ocular tissue.
Adult↗
Factors contributing to seasonal increases in inoculative freezing resistance in overwintering fire-colored beetle larvae dendroides canadensis
The insects and microarthropods that vary seasonally in susceptibility to cross-cuticular inoculation by external ice (inoculative freezing) represent a phylogenetically diverse group; however, few studies have explored possible mechanisms experimentally. This study documents seasonally variable inoculative freezing resistance in Dendroides canadensis beetle larvae and combines immunofluorescence, in vivo removal of epicuticular lipids and in vitro chamber studies to explore the roles of seasonal modification in the cuticle and in epidermal and hemolymph antifreeze proteins (AFPs). Seasonal cuticular modifications contribute to the inhibition of inoculative freezing since more cold-hardy larvae froze inoculatively when epicuticular waxes were removed with hexane and, in in vitro chamber experiments, cuticle patches (with the underlying epidermis removed) from winter larvae provided greater protection from inoculative freezing than did cuticle patches from summer larvae. The results indicate that seasonal modifications in epidermal and hemolymph AFPs contribute most strongly to the inhibition of inoculative freezing. Subcuticular epidermal AFPs were present in immunocytochemically labeled transverse sections of winter larvae but were absent in summer ones. Winter integument patches (cuticle with epidermis) were more resistant to inoculative freezing than were summer integument patches. Integument patches resisted inoculative freezing as well as live winter-collected larvae only when hemolymph AFP was added. The results also suggest that some integumentary ice nucleators are removed in cold-hardy larvae and that AFP promotes supercooling by inhibiting the activity of these nucleators.
Journal Article↗
Cognitive-behavioral group therapy for panic disorder in the general clinical setting: a naturalistic study with 1-year follow-up.
BACKGROUND: Cognitive-behavioral therapy (CBT) is well documented in the treatment of panic disorder. As most investigators have studied selected patients without comorbid disorders, it is less clear how well the treatment will perform in the usual clinical setting for patients with comorbid disorders and with physicians who do not have training in CBT. During the last 6 years, we have offered CBT in outpatient groups for patients with panic disorder and agoraphobia. The purpose of this prospective study was to assess the outcome of group treatment and compare the results with those of studies that used individual treatment. We wanted to identify variables that might predict outcome at follow-up and to assess the number and characteristics of dropouts. METHOD: Eighty-three consecutive patients with DSM-III-R panic disorder (56 women and 27 men; mean age = 34.5 years) were studied. Mean duration of panic disorder was 7.5 years. There was a high degree of comorbid major depression, social phobia, and psychoactive substance abuse/dependence. Treatment consisted of 4-hour group sessions conducted once a week for 11 weeks. More than half of the patients used antidepressant drugs. Degree of phobic avoidance, bodily sensations, anxiety cognitions, and depression were assessed at pretreatment, baseline, and end of treatment and at follow-up after 3 and 12 months. RESULTS: There was a large decrease in scores from start to end on all assessments. Sixty-three (89%) of 73 completers responded (> or = 50% reduction in Phobic Avoidance Rating Scale scores). Gains were maintained and even improved upon at follow-up. The results are comparable with studies that used individual therapy. A high depression score at the end of treatment predicted poor outcome at 1-year follow-up. Twelve (14%) of 83 did not complete the program. The presence of severe personality disorders and ongoing alcohol or substance abuse or dependence was associated with poor outcome and high dropout rate. CONCLUSION: CBT appears to be effective in the usual clinical setting, even in the hands of therapists without formal competence. Group therapy is a feasible arrangement, and the results from group treatment are comparable to those of individual approaches. Precise diagnosis and treatment of comorbid depression are of utmost importance. Patients with additional substance abuse or dependence, as well as severe personality disorders, may find this treatment modality less helpful.
Adult↗
Contrast sensitivity with silicone and poly(methyl methacrylate) intraocular lenses.
PURPOSE: To compare the optical performance of silicone intraocular lenses (IOLs) with that of conventional poly(methyl methacrylate) (PMMA) IOLs. SETTING: University hospital outpatient cataract clinic. METHODS: Ninety-one patients were randomly assigned to receive a PMMA IOL (n = 48 eyes) or a silicone IOL (n = 43 eyes). Contrast sensitivity was evaluated 4 months after surgery using the Vistech sinusoidal-grating chart and the Pelli-Robson letter sensitivity chart. RESULTS: No between-group differences were found using the Vistech test. Using the Pelli-Robson test, mean uncorrected contrast sensitivity was 1.59 log units +/- 0.13 (SD) in the PMMA group and 1.53 +/- 0.15 log units in the silicone group. Mean best corrected contrast sensitivity was 1.67 +/- 0.11 and 1.63 +/- 0.16, respectively. The differences between groups using the Pelli-Robson test were statistically significant (P < .05). No correlation was found between reduced contrast sensitivity and brownish discoloration or thickness of silicone IOLs or posterior capsule fibrosis. CONCLUSION: Contrast sensitivity was lower in patients with silicone IOLs than in those with conventional PMMA lenses.
Adult↗
Corneal versus scleral tunnel incision in cataract surgery: a randomized study.
PURPOSE: To compare the induced regular and irregular astigmatism after scleral and corneal tunnel incision. SETTING: University hospital outpatient cataract clinic. METHODS: One hundred phacoemulsification patients with less than 1.0 diopter (D) of preoperative astigmatism were randomly assigned to have a clear corneal incision (50 patients) or a scleral tunnel incision (50 patients). All incisions were 3.5 to 4.0 mm wide and were made in the steepest axis of the corneal astigmatism. The surgically induced astigmatism was analyzed by vector analysis from keratometric data, as well as by Fourier harmonic series analysis of the topographic data. RESULTS: One day after surgery, the surgically induced astigmatism (vector analysis, keratometry) was 1.41 D +/- 0.66 (SD) and 0.55 +/- 0.31 D in the corneal incision group and the scleral incision group, respectively (P < .01). Six months after surgery, the induced astigmatism was 0.72 +/- 0.35 D and 0.36 +/- 0.21 D in the two groups, respectively (P < .01) The corneal topography data confirmed the regular astigmatism changes found by conventional keratometry. However, in addition, Fourier harmonic series analysis of the topography data showed significantly more irregular induced astigmatism with the corneal approach than with the scleral approach. CONCLUSION: The clear corneal incision induces significantly more regular as well as irregular astigmatism than the scleral tunnel incision.
Adult↗
Fluorometric evaluation of panretinal photocoagulation in diabetic subjects.
The effect of panretinal photocoagulation on the blood-retinal barrier was examined by long-term kinetic vitreous fluorophotometry in eight insulin treated diabetic subjects, before and one month after unilateral panretinal photocoagulation. The fluorophotometric investigations revealed an increased permeability-index following this treatment. A further analysis based upon a two-compartment fluorescein kinetic model revealed a decreased penetration rate constant together with increased zero-time concentration coefficients for fluorescein following panretinal photocoagulation. No alterations were observed in kinetic parameters in the group of untreated eyes. This points towards a delayed but increased fluorescein penetration to the vitreous following panretinal photocoagulation, probably indicating an increased net flux of fluorescein across the entire retina. In patients with unilateral proliferative retinopathy the permeability-index obtained from eyes with classified proliferative retinopathy was 18.1%, whereas the permeability-index from eyes without proliferative retinopathy was 15.4%. This relatively small difference seems to indicate that the main part of vitreous fluorescence comes from an increased penetration across the entire retina, whereas a direct leakage from the proliferations themselves is less in magnitude. This increased retinal penetration might possibly be caused by affected transport processes for fluorescein within the retina.
Adult↗
Induced astigmatism after 4 and 6 mm scleral tunnel incision. A randomized study.
PURPOSE: To study the surgically induced astigmatism after phacoemulsification through either a 4 or a 6 mm scleral tunnel incision by using multiple analyses of astigmatism. METHODS: 197 eyes from 186 patients scheduled for phacoemulsification between October 1992 and March 1994 were randomly assigned two different-sized incisions with follow-ups at 1 day, 1 week, 2 weeks, 1 month and 4 months after surgery. The surgically induced astigmatism was evaluated using at each follow-up: 1) The subtraction method, 2) vector analysis, 3) vector decomposition, 4) Cravy's vertical vector, 5) Naeser's polar values, and 6) the algebraic method. RESULTS: By subtraction, without regard to axis, the induced astigmatism 4 months after surgery was +0.04 D and +0.18 D in the 4 mm and the 6 mm incision group, respectively. By vector analysis, the numerical value of the induced cylinder was stable one month after surgery at 0.61 D and 0.77 D in the 4 mm and in the 6 mm group, respectively. However, cylinder orientation was not found stable until 4 months after surgery, where 94% and 96% of the surgically induced astigmatism (vector decomposition) was against-the-wound in the two groups, respectively. By Cravy's method, the mean induced astigmatism changed from -0.08 D to -0.32 D and from -0.42 D to -0.60 D between 1 and 4 months in the 4 mm and the 6 mm group, respectively. Similar values were found with Naeser's method and with the algebraic method. CONCLUSION: We conclude the mean cylinder of the surgically induced astigmatism (vector analysis) to be stable 1 month after phacoemulsification with both the 4 mm and 6 mm scleral tunnel incision. However, the direction of the induced axis (vector decomposition) was still drifting between 1 and 4 months in both groups. These astigmatic changes were adequately described using vector analysis and vector decomposition.
Adult↗
Biomechanical characteristics of the human anterior lens capsule in relation to age.
PURPOSE: The purpose of the study was to investigate the influence of age on the biomechanical properties of the human anterior lens capsule. METHODS: The material comprised 67 lens capsules obtained from human donors ranging in age from 7 months to 98 years. Test specimens were prepared from the anterior lens capsule as tissue rings by means of excimer laser technique using a metal ring (mask) to shape the laser output (outer diameter = 3.2 mm, width = 100 microns). Capsular thickness was measured under microscope as the difference in focus between microspherules placed on the outer and inner surfaces of the capsule. The rings were slipped over two pins connected to a motorized micropositioner and a force transducer, respectively, and stretched at constant speed until rupture, with continuous recording of load and elongation. RESULTS: Capsular thickness was associated significantly with age of the donors and increased gradually (1.2% per year) until age 75, after which a slight decrease was observed. The elastic response curves showed a high degree of nonlinearity and were influenced markedly by age. Ultimate strain decreased 0.5% per year (range, 108% to 40%). Ultimate tensile strength decreased 1% per year (range, 17.5 N/mm2 to 1.5 N/mm2), and ultimate elastic stiffness (tangent modulus) decreased 0.9% per year (range, 44.8 N/mm2 to 4.4 N/mm2), whereas elastic stiffness corresponding to a specific strain level (30%) increased until age 35, after which a slight decrease was observed. CONCLUSIONS: Aging of the human anterior lens capsule is associated with a progressive loss of mechanical strength. The young capsule is strong, tough, and highly extensible, whereas the older, thicker capsule is less extensible and much more brittle, and it has a markedly reduced breaking strength.
Adolescent↗
Predicting the refractive result after cataract surgery.
PURPOSE: To study the accuracy of predicting visual results after cataract surgery using a mathematical model of surgically induced refractive change and a previously published regression formula predicting uncorrected visual acuity as a function of the resulting spherocylinder. SETTING: Outpatient cataract clinic at a university hospital. METHODS: In this prospective study with a 4 month follow-up, 333 patients had phacoemulsification using a 6 or 4 mm scleral tunnel incision. Final refraction and uncorrected visual acuity were predicted based on preoperative and 1 day postoperative measurements, which were compared with the final visual results. RESULTS: A significant correlation was found between the observed and the predicted visual acuity in each eye (P < .01). CONCLUSION: The visual outcome of cataract extraction can be predicted from a theoretical model of the surgically induced refractive change.
Adult↗
Evaluating surgically induced astigmatism by Fourier analysis of corneal topography data.
PURPOSE: To evaluate surgically induced astigmatism using Fourier harmonic series analysis of corneal topography data. SETTING: Aarhus Kommunehospital, Aarhus University, Denmark. METHODS: We evaluated the results of 46 phacoemulsifications with a 4 or 6 mm scleral tunnel sutureless incision based on the axis of the steepest meridian. We performed conventional keratometry and corneal topography before and up to 1 month after surgery. Using Fourier analysis, the corneal topographic images were broken into spherical power, regular astigmatism, and nonregular astigmatism for individual or aggregate analysis of surgically induced astigmatism. The induced refractive change (average of the difference between preoperative and postoperative corneal topographies) was analyzed and normalized according to the surgical meridian and to right/left eye. RESULTS: Regular astigmatism calculated by Fourier analysis of mires from the keratometer zone correlated well with conventional keratometry readings. Surgery induced a localized flattening in the superior region and a with-the-rule regular astigmatism component in the central area. CONCLUSION: Surgically induced corneal topography changes can be analyzed by Fourier series harmonic analysis, allowing aggregate data to be broken into optically meaningful quantities.
Adult↗
Predictors of outcome for treatment of temporomandibular disorders.
Psychosocial factors have been frequently suggested as important risk factors that may delay recovery in patients with temporomandibular disorders. In this study, 94 subjects with chronic temporomandibular disorders were studied using IMPATH:TMJ prior to their entering an interdisciplinary treatment program to determine which factors were most predictive of outcome. Treatment outcome was determined based on significant decreases in the Craniomandibular Index and the Symptom Severity Index from pretreatment to posttreatment. The IMPATH:TMJ items were regressed on treatment outcome for a random sample of half of the subjects (n = 47) to isolate the psychosocial and demographic items most predictive of treatment response. Discriminant analysis was then employed to test the predictive utility of the identified items for these subjects (criterion group), followed by a cross-validation of the items on the remaining 47 subjects (cross-validation group). Low self-esteem, feeling worried, low energy, and sleep activity were identified as useful predictors of treatment outcome for the criterion group. Each are correlates of depression. The discriminant analysis employing these four items accounted for 49% of the variance in treatment response, was statistically significant (P < .0001), and correctly predicted treatment outcome for 41 of 47 subjects (87%) in the criterion group. The predictive utility of the identified items remained statistically significant when applied to the cross-validation group (P < .01). The discriminant function employing the items correctly predicted treatment outcome for 37 of 47 subjects (79%) and explained 28% of the variance in treatment response. Findings of this study suggest that pretreatment psychosocial information is important in predicting treatment outcome for chronic temporomandibular disorders, and that symptoms of depression mediate treatment response for chronic pain patients.
Adolescent↗
Efficiency and accuracy of disease monitoring systems: application of capture-recapture methods to injury monitoring.
Capture-recapture methods were employed to determine the most accurate and efficient approaches to monitor adolescent injuries. Multiple sources were used to ascertain cases of adolescent injuries that occurred between September 1 and December 31, 1991, in a single school district in metropolitan Pittsburgh, Pennsylvania. Eliminating the duplicate cases between the sources revealed 144 verified injuries; 127 (88.2%) were identified by student monthly recalls, 33 (22.9%) by daily attendance records, 58 (40.3%) by medical excuses, and 72 (50.0%) by a 4-month student recall. Capture-recapture analyses were undertaken to assess potential dependencies between the sources, to estimate the degree of underascertainment in the population, and to evaluate the efficiency of the individual sources and the combinations between them. It was estimated that 91% of the cases in the population were ascertained when all four methods of case finding were utilized. Furthermore, the analysis indicated that accurate injury estimates could be achieved using combinations of only two or three of the sources. An analysis of the efficiency of the methods of ascertainment revealed a trade-off between effort (the number of hours needed to identify cases) and the precision (coefficient of variation) of the injury estimates. Capture-recapture analysis not only provided an approach to evaluate and adjust for undercount but also offered a formal means to evaluate the most efficient combination of the sources to maximize completeness while minimizing effort. The use of these techniques has the potential to evaluate and improve injury surveillance as well as other disease monitoring systems.
Adolescent↗
Intraocular lens power calculation with an improved anterior chamber depth prediction algorithm.
The accuracy of intraocular lens (IOL) power calculation was evaluated in a multicenter study of 822 IOL implantations using the Binkhorst II, Sanders/Retzlaff/Kraff (SRK I, SRK II, SRK/T), Holladay, and Olsen formulas. All but the first of these were optimized in retrospect with calculation of the SRK A-constant, the Holladay surgeon factor, and the Olsen pseudophakic anterior chamber depth (ACD) for each lens style. The ACD prediction of the Olsen formula was based on a previously described regression formula incorporating preoperative ACD, corneal height, axial length, and lens thickness. Among the optical IOL power calculation formulas, the highest IOL power prediction error was found with Binkhorst's and the lowest with Olsen's, which was more accurate than the SRK/T and the Holladay formulas (P < .05). The SRK/T formula was significantly more accurate than the original SRK regression formulas (P < .001). When analyzed for axial length dependence, all formulas showed the least error in the normal range. Error of the Olsen formula was lower than that of the others in the axial length interval 20 mm to 26 mm. No differences in accuracy were found between the optical IOL calculation formulas in eyes with an axial length above 26 mm (P < .05). The accuracy of IOL power calculation can be improved with optical formulas using newer-generation ACD-prediction algorithms.
Adult↗
Video controlled M-mode biometry.
To increase the accuracy of intraocular lens power calculation, an interface between an ultrasonic A-scanning device and a personal computer was created, allowing for an on-line interpretation of the ultrasonogram in an M-mode fashion. On the same computer display, a video recording of the movements of the transducer probe relative to the eye was inserted to obtain simultaneous information on the external alignment of the transducer probe. The precision of the experimental set-up in the measurement of intraocular distances was compared with conventional A-scanning procedures run in automatic mode. The video controlled M-mode biometry was found easy to operate and to result in reproducible axial length determination: The median value of the standard deviation was found to be below 0.04 mm as compared to a value of about 0.10 mm with conventional equipment. We concluded that video controlled M-mode biometry has great potential in the endeavour to increase the accuracy of intraocular lens calculation.
Anterior Chamber↗
Outcome monitoring in cataract surgery.
The short-term surgical results are reported in a consecutive series of 1473 patients undergoing cataract surgery (60% planned extracapsular cataract extraction and 40% phacoemulsification) on an out-patient basis in a major university eye clinic. Preoperatively, 80% of all cases had a visual acuity of 0.3 (6/18) or lower. On the first day after surgery, 51% of all patients had a corrected visual acuity of 0.5 (6/18) or better and 9% had a visual acuity of 1.0 (20/20) or better. The unaided visual acuity was 0.5 (6/12) or better in 20% of all patients (78% of these after phaco-emulsification). The average postoperative refraction was -0.43 D (+/- 1.03 D SD, range -6.00 D to +5.00 D). A significant improvement in refractive error was achieved in many patients. The mean intraocular lens power prediction error was found to be +0.04D (+/- 0.84D). The surgically induced astigmatism (vector analysis) was found to be +4.91D (+/- 2.08) in the extracapsular cataract extraction cases and +1.37D (+/- 1.38) in the phacoemulsification cases (p < 0.001). Capsular or zonular rupture and/or vitreous loss occurred in 43 (2.9%) of which 26 (1.8%) received an anterior chamber lens rather than the intended posterior chamber lens. The results of this study document the favorable results of modern cataract surgery.
Adolescent↗
Psychosocial benefits of postmastectomy lymphedema therapy.
The effect of a comprehensive lymphedema management program was assessed in 25 patients in whom moderate to severe lymphedema had developed after surgery and/or radiotherapy for carcinoma of the breast. Intensive treatment (4 weeks) involved massage, compression bandaging, and sequential pneumatic compression, with an adjunct program of education to provide skills in exercise, massage, bandage, and containment garment use. The intensive treatment phase was followed by a self-management phase based on the skills that had been acquired. A significant reduction in limb circumference and volume, with continuing improvement over 12 months of self-management, was observed. There was a decrease in need for physical assistance. Quality of life generally remained high and stable throughout the 12 months. Quality of life specific to lymphedema, however, declined during the intensive phase of treatment, but recovered and surpassed pretreatment levels during the self-management phase of treatment. Perceived comfort and strength in the lymphedematous limb improved, and perceived size decreased. The study confirmed that the combination of multimodal physical therapy and education for self-management reduces lymphedema and its adverse subjective consequences and maintains the improvement thus achieved.
Adult↗