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At least 631 records · Page 35Linked to original sources

Vision-specific health-related quality of life: content areas for nursing home residents.

Nursing home residents have a high prevalence of remediable visual impairment and blindness. Future research on the effectiveness of providing eye care to nursing home residents will need to include a vision-targeted health-related quality of life (HRQOL) instrument appropriate for this population. The purpose of this study was to identify the core content areas for such an instrument. In-depth interviews on vision-related issues were conducted with 40 residents. Interviews were audio-taped, transcribed, and coded using a standardized protocol. Binocular distance and near visual acuity were assessed using the resident's 'walking around' correction to examine whether one vision-specific HRQOL measure could address the needs of residents with 'good' and 'poor' vision. Overall 1070 vision-related comments were identified. Residents mentioned 315 problem comments that were grouped into 13 categories, including ocular symptoms (18% of comments), reading (15%), general vision (13%), psychological distress (12%), and activities of daily living (ADLs) (7%). Compared to published data on vision-specific content areas most relevant to community based persons, nursing home residents focused more on ocular symptoms and basic ADLs, with no mention of issues related to driving, home care, and finances. The majority of categories mentioned did not differ on the proportion of comments made- by those with 'good' and 'poor' visual acuity, suggesting that one vision-specific HRQOL instrument would be appropriate for residents with varying levels of visual acuity. Future work will focus on developing a vision-specific HRQOL instrument for nursing home residents.

Activities of Daily Living↗

[Wound stability of the "no-stitch" technique in various incision sites and depths].

BACKGROUND: Supported by experiments on cadaver eyes the no-stitch technique seems to possess higher wound strength. Until now there have been no clinical trials addressing this subject. This prompted us to investigate the wound strength with varying incision depth and incision site in a prospective randomized and controlled clinical trial. METHODS: For this study 162 patients with a 7-mm tunnel incision were recruited. They were divided into the following subgroups: Primary incision depth of 300 microns versus 500 microns, limbal incision versus scleral incision, scleral incision in 12 h position versus temporal scleral incision, limbal incision in 12-h position versus temporal limbal incision. The wound strength was measured by an ophthalmodynamometer on the first postoperative day and after 1 week at the site with the least mechanical stability adjacent and posteriorly to the primary incision. RESULTS: On the first day after surgery the wound strength was best in the temporal scleral incision with an ophthalmodynamometer reading of 37.6 +/- 4.1 kPa and it was the least in the 12-h limbal incision with an ophthalmodynamometer reading of 21.8 +/- 5.4 kPa. After 1 week also the wound strength was best in the temporal scleral incision with 38.4 +/- 2.1 kPa and it was the least in 12-h limbal incision with 30.9 +/- 7.5 kPa. CONCLUSIONS: These findings demonstrate that the site of the primary incision is a very important factor in determining the mechanical wound strength concerning resistance against external pressure. The wound strength was best in the temporal scleral incision.

Aged↗

Evaluation of the use of anesthesia and analgesia in reptiles.

OBJECTIVE: To determine anesthetic techniques and the drugs used to provide anesthesia and analgesia to reptiles. DESIGN: Mail-out questionnaire. SAMPLE POPULATION: 367 members of the Association of Reptile and Amphibian Veterinarians. PROCEDURE: 1,091 members listed in the 2002 directory of the Association of Reptile and Amphibian Veterinarians were asked to complete a questionnaire regarding anesthesia and analgesia. RESULTS: 367 of 1,091 (33.6%) individuals completed the questionnaire; 88.8% used inhalants (particularly isoflurane) for anesthesia, and ketamine, propofol, and butorphanol were the most commonly used injectable agents. Intubation, fluids, and having a dedicated anesthetist were most commonly used for patient support, and pulse oximetry and Doppler ultrasonography were most commonly used for monitoring. Respiratory depression, difficulty monitoring anesthetic depth, prolonged recovery, and hypothermia were the most frequent complications. Nearly all respondents believed that reptiles feel pain, but analgesics were used infrequently for many reasons. CONCLUSIONS AND CLINICAL RELEVANCE: Providing anesthesia in reptiles is difficult, especially regarding anesthetic depth and vital parameters, and methods of support are used less frequently than in domestic species. Provision of analgesia is uncommon. Research regarding pain and its assessment, response to analgesics, and drug pharmacokinetics is needed. Dissemination of this information to practitioners needs to be improved for enhancement of the standard of care for reptiles.

Analgesia↗

The effectiveness of personal education plans in continuing professional development: an evaluation.

The aim of this study was to evaluate the use of personal education plans (PEPs) as a method of continuing professional development (CPD), by means of a questionnaire, analysis of completed PEP reports, and in-depth interviews. The setting was the Yorkshire Deanery, and the participants were general practitioners (GPs) who had completed a PEP. The main outcome measures were reported identification of learning needs, educational methods used, and support received. GPs' views were received on their experiences of undertaking PEPs, personal and professional development, and changes in patient care that resulted from their PEPs. Personal impression was the most frequently used method of deciding on learning needs. A variety of educational methods were used, the most frequent being personal reading, practical sessions, and taught courses. The majority of respondents felt that they were well supported by their GP tutors, and that the PEP had helped them to enhance their personal knowledge and skills, as well as to improve service to patients. There were gains in terms of increased confidence and self-awareness. Most were keen to use PEPs in future, and hoped to involve other members of the practice. Our results suggest that PEPs are an effective method of CPD in that they frequently lead to reported changes in patient care, and personal and professional development of the learner.

Adult↗

Intraocular pressure change after laser in situ keratomileusis (LASIK).

To analyze the relationship between change in intraocular pressure (IOP) after laser in situ keratomileusis (LASIK), and preoperative central-corneal thickness (CCT), and central-corneal ablation depth (CCAD), a prospective study was conducted of 30 patients (60 eyes) with myopia or myopic astigmatism who underwent LASIK and who were followed up for a mean of 6 months. The parameters evaluated included IOP 1 week preoperatively and 3 months postoperatively, pre- and postoperative CCT, and CCAD; in addition, the anterior ocular segment and the fundus were examined, as was the apparent and cycloplegic refraction. There were 11 male patients and 19 female patients (mean age, 28.3 years) involved in the study. Mean IOP readings were 14.9 mmHg 1 week preoperatively, and 8.3 mmHg 3 months postoperatively; thus, the mean decrease in IOP after LASIK was 6.6 mmHg. Mean values for preoperative CCT, postoperative CCT, and CCAD were 537.2+/-34.7 microm, 434.0+/-32.5 microm, and 101.6+/-23.90 microm, respectively. IOP correlated with CCT both pre- and postoperatively. The mean change in IOP after LASIK for myopia and myopic astigmatism was statistically significant, but did not correlate with CCAD or age. We postulate that CCAD is not a significant predictor of IOP after LASIK.

Adult↗

Implantation of a new accommodative posterior chamber intraocular lens.

PURPOSE: A new, potentially accommodative posterior chamber lens (PCIOL) was designed based on principles elaborated by Hanna using finite element computer simulation methods. We report 3-month postoperative results in patients. METHODS: In a prospective study, 12 eyes of 12 patients (age 45 to 87 yr) underwent phacoemulsification for cataracts and PCIOL implantation. The PCIOL, 1 CU, has haptics designed for anterior optic movement following ciliary muscle contraction. Patients were examined postoperatively after 1 and 2 days, 1, 2 and 6 weeks, and 3 months, and results were compared with a control group of 12 eyes that received standard PMMA or acrylic PCIOLs. RESULTS: Surgery was uncomplicated and all PCIOLs were well-tolerated and stable with good centration in the capsular bag. The results were (mean +/- SD [range] and median; 1 CU versus control PCIOL): near visual acuity (Birkhäuser reading chart at 35 cm) with best distance correction 0.34 +/- 0.17 (0.2 to 0.6), 0.3 (J10-J1, median J7) versus 0.15 +/- 0.07 (0.1 to 0.3), 0.15 (J16-J7, median J13), P=.001; subjective near point 59 +/- 10 cm (40 to 100 cm), 53.5 cm versus 93 +/- 20 cm (64 to 128 cm), 86 cm, P=.004; retinoscopic accommodative range 1.2 +/- 0.4 D (0.63 to 1.5 D), 1.2 D versus 0.2 +/- 0.19 D (-0.25 to 0.5 D), 0.25 D, P < .001; decrease of anterior chamber depth after 2% pilocarpine 0.63 +/- 0.16 mm (0.40 to 0.91 mm), 0.63 mm versus 0.15 +/- 0.05 mm (0.08 to 0.20 mm), 0.17 mm, P < .001. CONCLUSIONS: The new PCIOL appears to be safe at short to medium term. Our results indicate pseudophakic accommodation secondary to focus shift with this PCIOL. Additional larger and long-term studies are necessary for exact evaluation of safety and accommodative power of this new PCIOL.

Accommodation, Ocular↗

Predisposition to colonic dysplasia is unaffected by continuous administration of insulin-like growth factor-I for twenty weeks in a rat model of chronic inflammatory bowel disease.

BACKGROUND: Insulin-like growth factor-I (IGF-I) is currently under evaluation for the treatment of a variety of chronic disease conditions. We investigated the safety of long-term IGF-I administration in a rat model of inflammatory bowel disease which predisposes to the development of dysplasia. METHODS: Chronic consumption of dextran sulphate sodium (DSS) by rats manifests a colitis with dysplastic features. Rats consumed 2% DSS for 4 weeks when pumps were implanted to deliver either vehicle or IGF-I for 15 or 20 weeks while rats continued to consume DSS. Features of colitis and dysplasia were assessed at kill. RESULTS: Compared to vehicle, 20 weeks IGF-I significantly increased body weight by 19% and total gut weight by 43%. Colonic crypt depth, proliferative compartment, labelling index, dysplasia, neoplasia and other indices of colitis were not significantly affected. CONCLUSIONS: Twenty weeks administration of IGF-I to rats induced growth of the intestine but did not affect the severity of experimentally-induced colitis or the incidence or progression of colonic dysplasia.

Adenoma↗

Psychosocial disadvantages in the lives of persons with long-term mental illness living in a Swedish community.

The aim of this study was to gain in-depth knowledge of how persons with long-term mental illness experience their everyday situation, in order to identify potential psychosocial obstacles to a meaningful existence. The focus was on psychosocial aspects, such as contact with others and the quality of these contacts. An ethnographic design was used, in order to provide an inside perspective. Four persons with long-term mental illness participated in the study. Three open-ended interviews, at 1-week intervals, were conducted with each informant. Analysis of transcribed material consisted of naive reading and content analysis guided by the investigators' understanding of the psychiatric context. Three themes were generated: feeling lonely but being unable to establish friendships; knowledge of what to do but lacking initiative; and awareness of the need for support but not wanting to be subject to control. These themes reflect contradictions between thoughts, feelings and actions, which seem to contribute to a psychosocial disadvantage in the life of persons with long-term mental illness.

Humans↗

An accurate method for localization of the boost volume in breast radiotherapy.

Patients with early stage breast cancer who are treated with adjuvant radiotherapy post-lumpectomy often receive a tumor bed boost with electrons. The tissue considered at high risk of local recurrence is defined from the surgical scar to the deepest portion of the tumor bed, which is ideally marked with radiopaque surgical clips. To adequately treat this tissue, one must superimpose the scar, surgical path and clips within the beam and choose an appropriate electron energy based on the deepest clip depth, while sparing low risk and cosmetically important tissues. Clip localization is therefore emphasized in the literature; however, published procedures do not adequately address how to meet all of the above goals. Additionally, CT planning alone cannot assess optimal coverage of tissue outside of the transverse plane, nor guarantee visualization of all clips. We have devised a method of boost planning based on localization of the surgical clips which may be accomplished in a single simulation session, utilizing two sets of orthogonal films, radiopaque skin surface markers, and FSD readings. Our procedure meets all of the above goals, is applicable to any field orientation that can be simulated, and can provide useful information for alternative techniques.

Breast Neoplasms↗

A pilot trial of BIS monitoring for procedural sedation in the emergency department.

OBJECTIVE: Procedural sedation is common in the ED. However, there is no objective physiologic parameter available to monitor a patient's conscious state. The Bispectral Index (BIS) monitor has been validated as an objective measure of depth of anaesthesia. We studied the BIS monitor for this role in procedural sedation. METHODS: A prospective, observational study with convenience sampling of adult patients in ED who underwent procedural sedation. Patients were treated according to standard practice and sedated as determined by the treating physician. Treating physicians were blinded to the BIS value. BIS values were recorded and compared to the Observer's Assessment of Alertness/Sedation Scale (OAAS). Upon recovery, patients were asked about recall of events while they were sedated. RESULTS: Twelve patients were enrolled and 110 paired readings from 11 patients (7 male) were obtained. It was not possible to obtain readings from one patient. The mean age was 58 years (range 20-94). The Spearman correlation between BIS and OAAS was 0.027 (95% CI -0.582-0.617). For the three patients who received propofol, the correlation was 1.0. There were no episodes of explicit recall of events during the period of sedation. CONCLUSIONS: BIS monitoring is feasible in the ED. Our small study suggests that there is a poor correlation between BIS values and the OAAS scale. Larger studies are required to further explore this relationship. Further developments in brain monitoring technology are also needed before this form of monitoring becomes clinically useful for procedural sedation.

Adult↗

Energy correction factors of LiF powder TLDs irradiated in high-energy electron beams and applied to mailed dosimetry for quality assurance networks.

Absorbed dose determination with thermoluminescent dosimeters (TLDs) generally relies on calibration in 60Co gamma-ray reference beams. The energy correction factor fCo(E) for electron beams takes into account the difference between the response of the TLD in the beam of energy E and in the 60Co gamma-ray beam. In this work, fCo(E) was evaluated for an LiF powder irradiated in electron beams of 6 to 20 MeV (Varian 2300C/D) and 10 to 50 MeV (Racetrack MM50), and its variation with electron energy, TLD size and nature of the surrounding medium was also studied for LiF powder. The results have been applied to the ESTRO-EQUAL mailed dosimetry quality assurance network. Monte Carlo calculations (EGS4, PENELOPE) and experiments have been performed for the LiF powder (rho = 1.4 g cm3) (DTL937, Philitech, France), read on a home made reader and a PCL3 automatic reader (Fimel, France). The TLDs were calibrated using Fricke dosimetry and compared with three ionization chambers (NE2571, NACP02, ROOS). The combined uncertainties in the experimental fCo(E) factors determined in this work are less than about 0.4% (1 SD), which is appreciably smaller than the uncertainties up to 1.4% (1 SD) reported for other calculated values in the literature. Concerning the Varian 2300C/D beams, the measured fCo(E) values decrease from 1.065 to 1.049 +/- 0.004 (1 SD) when the energy at depth in water increases from 2.6 to 14.1 MeV; the agreement with Monte Carlo calculations is better than 0.5%. For the Racetrack MM50 pulsed-scanned beams, the average experimental value of fCo(E) is 1.071 +/- 0.005 (1 SD) for a mean electron energy at depth Ez ranging from 4.3 to 36.3 MeV: fCo(E) is up to 2% higher for the MM50 beams than for the 2300C/D beams in the range of the tested energies. The energy correction factor for LiF powder (3 mm diameter and 15 mm length) varies with beam quality and type (pulsed or pulsed-scanning), cavity size and nature of the surrounding medium. The fCo(E) values obtained for the LiF powder (3 mm diameter and 15 mm length) irradiated in water, have been applied to the EQUAL external audit network, leading to a good agreement between stated and measured doses, with a mean value of 1.002 +/- 0.022 (1 SD), for 170 beam outputs checked (36 electron beam energies) in 13 'reference' radiotherapy centres in Europe. Such fCo(E) data improve the accuracy of the absorbed dose TLD determination in electron beams, justifying their use for quality control in radiotherapy.

Calibration↗

Three-dimensional finite element analysis of current density and temperature distributions during radio-frequency ablation.

This study analyzed the influence of electrode geometry, tissue-electrode angle, and blood flow on current density and temperature distribution, lesion size, and power requirements during radio-frequency ablation. We used validated three-dimensional finite element models to perform these analyses. We found that the use of an electrically insulating layer over the junction between electrode and catheter body reduced the chances of charring and coagulation. The use of a thermistor at the tip of the ablation electrodes did not affect the current density decreased more slowly with distance from the electrode surface. We analyzed the effects of three tissue-electrode angles: 0, 45, and 90 degrees. More power was needed to reach a maximal tissue temperature of 95 degrees C after 120 s when the electrode-tissue angle was 45 degrees. Consequently, the lesions were larger and deeper for a tissue-electrode angle of 45 degrees than for 0 and 90 degrees. The lesion depth, volume, and required power increased with blood flow rate regardless of the tissue-electrode angle. The significant changes in power with the tissue-electrode angle suggest that it is safer and more efficient to ablate using temperature-controlled RF generators. The maximal temperature was reached at locations within the tissue, a fraction of a millimeter away from the electrode surface. These locations did not always coincide with the local current density maxima. The locations of these hottest spots and the difference between their temperature and the temperature read by a sensor placed at the electrode tip changed with blood flow rate and tissue-electrode angle.

Animals↗

Corneal diameter in Greenland Eskimos. Anthropometric and genetic studies with special reference to primary angle-closure glaucoma.

In a population survey the corneal diameter (DC) was measured in 1,211 adult Greenland Eskimos from six districts. Using a Wessely keratometer, trnasversal and vertical readings were performed, and the CD value taken as the average. The unimodal distributions obtained were found to differ from normality. The results suggested a small decrease of CD with age whereas the sex difference (0.2 mm) was highly significant. Geographical variation was found, a West Greenland group (Umanaq) being below the others, while the purest Eskimos (from Angmagssalik) showed higher mean values. A Danish control sample had significantly larger corneae, about 0.5 mm above the Eskimos, and agreed with other reports on Europeans. The CD values and the anterior chamber depth (ACD) were positively correlated. The Eskimo primary angle-closure glaucoma patients showed a slight deviation towards the lower CD classes. The familial CD distributions suggested a mainly genetic determination of corneal size.

Adolescent↗

Can the bispectral index monitor the sedation adequacy of intubated ED adults?

The Bispectral Index Monitor (BIS) is validated as a measure of sedation depth during general anesthesia, but its value otherwise remains unclear. We hypothesized that BIS scores would correlate with standard subjective measures of assessing sedation in intubated adult ED patients and that BIS would predict inadequate sedation. Sedation was assessed by recording clinical features and by having treating physicians complete a visual analog scale (VAS; rated "not sedated" to "completely sedated") at 10, 30, and 60 minutes after intubation. Measurements of BIS were later paired with sedation assessments. Despite being statistically significant (p=.002), the correlation between BIS and VAS in our 147 paired readings was fair (Pearson's rho=-0.37) and displayed wide variability. Receiver operating characteristic curve analysis of BIS demonstrated no discriminatory power in predicting sedation adequacy (area under curve 0.53). BIS is not associated with and did not predict standard measures of sedation adequacy in intubated adults.

Adult↗

The estimation of bladder volume by sonocystography.

Real-time ultrasonography was used to measure bladder volumes. Volumes were calculated as the product of 3 internal bladder diameters (height, width and depth). The true bladder volume was obtained from the voided volume or by catheterization. There was a good correlation between calculated and true volumes provided a correction factor of 0.6 was applied. It also was found that a simpler method using only 2 diameters and a correction factor of 0.15 was nearly as reliable. The accuracy of this quantitative method was shown to be limited to an average error of plus or minus 25 per cent for bladder volumes between 100 and 500 ml. Smaller volumes could be assessed only qualitatively. False negative readings were common for bladder volumes less than 50 ml.

Humans↗

Insulin-like growth factor-I (IGF-I) stimulates regrowth of the damaged intestine in rats, when administered following, but not concurrent with, methotrexate.

BACKGROUND: We tested the ability of insulin-like growth factor-I (IGF-I) to reduce damage to the intestinal mucosa (mucositis) in rats injected with methotrexate. IGF-I was infused concurrent with methotrexate administration and compared to IGF-I administered following the withdrawal of methotrexate. METHODS: Rats were injected with methotrexate at the start of days 1, 2 and 3. IGF-I was infused for 5 days, commencing at the start of day 1 [concurrent administration] or at the start of day 4 [post-methotrexate administration]. RESULTS: IGF-I administered coincident with methotrexate failed to restore mucosal integrity to the damaged small intestine. IGF-I administered post methotrexate stimulated regrowth of the damaged intestine, particularly the ileum, with 22%, 32% and 29% increases in small intestinal weight, ileal villus height and ileal crypt depth respectively. CONCLUSIONS: Following intestinal damage of methotrexate, IGF-I primarily induced growth of the distal small intestine. The ineffectiveness of concurrently administered IGF-I may have represented an IGF-I induced recruitment of proliferating epithelial cells to the anti-proliferative effects of methotrexate.

Animals↗

Intracerebral potentials to rare target and distractor auditory and visual stimuli. I. Superior temporal plane and parietal lobe.

Event-related potentials were recorded from 537 sites in the superior temporal plane and parietal lobe of 41 patients. Depth electrodes were implanted to localize seizure origin prior to surgical treatment. Subjects received an auditory discrimination task with target and non-target rare stimuli ("standard oddball paradigm"). In some cases, the target, distracting and frequent tones were completely balanced across blocks for pitch and volume. Variants included an analogous visual discrimination task, or auditory tasks where the rare target event was the omission of a tone, or the repetition of a tone within a series of alternating tones. In some subjects, the same auditory stimuli were delivered but the patient ignored them while reading. Three general response patterns could be distinguished on the basis of their wave forms, latencies and task correlates. First, potentials apparently related to rarity per se, as opposed to differences in sensory characteristics, or in habituation, were observed in the posterior superior temporal plane, beginning with a large positivity superimposed on early components. This positivity peaked at 150 msec after stimulus onset and inverted in sites superior to the Sylvian fissure. Subsequent components could be large, focal and/or inverting in polarity, and usually included a positivity at 230 msec and a negativity at 330 msec. All components in this area were specific to the auditory modality. Second, in the posterior cingulate and supramarginal gyri, a sharp triphasic negative-positive-negative wave form with peaks at about 210-300-400 msec was observed. This wave form was of relatively small amplitude and diffuse, and seldom inverted in polarity. It was multimodal but most prominent to auditory stimuli, appeared to remain when the stimuli were ignored, and was not apparent to repeated words and faces. Third, a broad, often monophasic, wave form peaking at about 380 msec was observed in the superior parietal lobe, similar to that which has been recorded in the hippocampus. This wave form could be of large amplitude, often highly focal, and could invert over short distances. It was equal to visual and auditory stimuli and was also evoked by repeating words and faces. The early endogenous activity in auditory cortex may embody activity that is antecedent to the other patterns in multimodal association cortex. The "triphasic" pattern may embody a diffuse non-specific orienting response that is also reflected in the scalp P3a. The later broad pattern may embody the cognitive closure that is also reflected in the scalp P3b or late positive component.

Acoustic Stimulation↗

Performance comparison of rapid and native barcoding methods for Oxford Nanopore sequencing of Poliovirus Viral Protein 1 (VP1) amplicons.

Accurate and timely sequencing of poliovirus is critical for global eradication efforts, particularly for molecular epidemiology based on the typing region of the genome, viral protein 1 (VP1). While Oxford Nanopore Technologies (ONT) sequencing has expanded capabilities for poliovirus surveillance, the relative performance of different ONT library preparation methods, including ligation-based (Native Barcoding) and transposase-based (Rapid Barcoding) approaches, has not been systematically evaluated. In this study, we compared rapid barcoding and native barcoding workflows for sequencing VP1 amplicons from 17 type 2 poliovirus-positive samples, each processed in triplicate. Native barcoding generated significantly more sequencing output, producing approximately 2.3-fold greater total read yield than rapid barcoding, and demonstrated higher run-to-run reproducibility (R2 = 0.979-0.998 vs. 0.847-0.929, respectively; p&#x202f;<&#x202f;0.001). In addition, native barcoding generated 80% of the total yield achieved by rapid barcoding within approximately 7&#x202f;h, whereas rapid barcoding required approximately 40&#x202f;h to reach the same output. Despite these differences, both methods produced identical VP1 consensus sequences across all samples, with comparable read quality (median per-base Q-scores of approximately Q17-Q18). Rapid barcoding provided substantial practical advantages, reducing hands-on library preparation time (55 vs. 200&#x202f;min) and per-sample cost ($12.82 vs. $16.54), while simplifying workflow and reducing technical complexity. These findings indicate that sequencing yield may not be a determinant of downstream analytical outcomes for poliovirus VP1 ONT sequencing. Rapid barcoding therefore represents a cost-effective and efficient approach for routine poliovirus surveillance, whereas native barcoding remains advantageous in applications requiring rapid data generation or maximal sequencing depth.

Poliovirus↗