Nevin Manimala

Klin Monbl Augenheilkd. 2021 Apr 14. doi: 10.1055/a-1403-2218. Online ahead of print.

ABSTRACT

BACKGROUND: The SpeedWheel (SW) test is an objective test of visual acuity (VA) using suppression of the optokinetic nystagmus (OKN). Here, we established prediction intervals of the SW measures compared to Snellen acuity in adults and children.

SUBJECTS AND METHODS: In this prospective, single center study, subjects aged at least 4 years underwent testing of VA with SW, Landolt-C, and Tumbling-E symbols (Freiburg acuity test: FrACT-C, FrACT-E). Prediction intervals were established for SW compared to FrACT-C or -E and for FrACT-E compared to FrACT-C. Mixed linear effect models were applied for statistical analysis.

RESULTS: From 241 subjects, 471 eyes were included: median age 36 years, range 4 – 88 years, 43.6% male, 56.4% female. Eyes included were either healthy or had various underlying ophthalmic conditions. Prediction intervals for SW to estimate FrACT-C or -E acuity showed a similar range compared to the prediction interval of FrACT-C for the estimation of FrACT-E acuity. For each acuity step, there was no influence of age. Up to an SW acuity of 0.7 logMAR, 80% of the subjects had a FrACT-C acuity that was at most 1.6 logMAR lines below, and for an SW acuity of 1.0 logMAR, FrACT-C acuity was not worse than 4 logMAR lines. Prediction intervals for eyes with refractive error, cataract, visual field loss and retinal disease did not differ significantly from healthy eyes in contrast to eyes with amblyopia or multiple ophthalmic disorders. SW correlated well to FrACT tests and results of a previous study fell within our prediction estimates.

CONCLUSION: Our prediction intervals for SW acuity may be used to estimate Snellen acuity (FrACT-C and -E) in the clinic in adults and children unable to cooperate in other acuity testing.

PMID:33853189 | DOI:10.1055/a-1403-2218

Klin Monbl Augenheilkd. 2021 Apr 14. doi: 10.1055/a-1340-0066. Online ahead of print.

ABSTRACT

PURPOSE: To analyze the central macular thickness (CMT), retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), and choroidal thickness (ChT) measurements in patients with coronavirus disease 2019 (COVID-19).

METHODS: The study was conducted cross-sectionally 4 weeks after the completed treatment of COVID-19. The diagnosis of COVID-19 was based on the polymerase chain reaction test and/or clinical and radiological findings. The patients with treated COVID-19 were enrolled in the COVID-19 group; age- and sex-matched healthy participants served as the control group. All patients in the COVID-19 group were hospitalized and treated with favipiravir, moxifloxacin, and heparin without the requirement for intubation. The measurements of CMT, RNFLT (in four quadrants), GCLT (in six sectors of two different boundaries), and ChT (in five locations) were performed by swept-source optical coherence tomography (SS-OCT).

RESULTS: Similar visual acuity (p = 0.582) and intraocular pressure (p = 0.766) values were observed between the COVID-19 and control groups. Regarding SS-OCT measurements, all mean CMT, RNFLT (in four quadrants), GCLT (in six sectors of two different boundaries), and ChT (in five locations) values were similar in the COVID-19 and control groups (p > 0.05 for all). In the COVID-19 group, a statistically significant negative correlation was noted between the mean ferritin level and temporal RNFLT (r = – 0.378, p = 0.014) and a positive correlation was observed between the mean ferritin level and nasal RNFLT (r = + 0.371, p = 0.016).

CONCLUSION: SS-OCT measurements showed no retinal neurodegenerative and choroidal thickness alterations in COVID-19 patients. Nonsignificant results might be due to the examination of the patients in the early period of the COVID-19 after the treatment. Therefore, late period OCT measurements should be reviewed with new studies in the future.

PMID:33853186 | DOI:10.1055/a-1340-0066

J Knee Surg. 2021 Apr 14. doi: 10.1055/s-0041-1727112. Online ahead of print.

ABSTRACT

Accurately measuring the length and diameter of the hamstring tendon autograft preoperatively is important for planning anterior cruciate ligament (ACL) reconstructive surgery. The purpose of this study was to assess the reliability of three-dimensional computed tomography (3D CT) scanning technique to produce the actual measurement of the gracilis and semitendinosus (GT and ST, respectively) tendon grafts’ length and diameter for surgery. Ninety patients were scheduled for ACL reconstruction with hamstring autograft. Before the surgery, patients were examined under the multidetector row CT scanner and the ST and GT tendons were qualitatively measured by a volume-rendering technique. The length of ST and GT was measured with 3D CT compared with the length of the harvested ST and GT. The cross-sectional area (CSA) of ST and GT measured with 3D CT compared with the ST and GT graft diameter. Tendon size measured preoperatively and during surgery were statistically compared and correlated. The GT tendons length and cross-sectional area measured during surgery was both shorter and smaller compared with the ST tendon. GT and ST tendon length were correlated to patients’ body index such as the height and weight (p < 0.05). However, the correlation levels were low to medium (r = 0.23-0.49). There was strong correlation between the lengths of GT (r = 0.76; p < 0.001) and ST (r = 0.87; p < 0.001) measured with the 3D CT and tendon length at surgery. There was a moderate correlation between graft diameter measured at surgery and 3D CT cross-sectional area (r = 0.31; p < 0.05). A multidetector row CT scanner can determine the ST and GT tendons’ length and diameter. These measurements can be used for preoperative planning to help determine the surgical method and counsel patients on appropriate graft choices prior to surgery.

PMID:33853156 | DOI:10.1055/s-0041-1727112

J Knee Surg. 2021 Apr 14. doi: 10.1055/s-0041-1726419. Online ahead of print.

ABSTRACT

Presence of hardware in juxta-articular location poses challenge during total knee arthroplasty (TKA). When present in distal femur, it precludes the use of an intramedullary femoral jig during TKA often necessitating removal of hardware leading to prolonged surgery, higher risk of complications, and inferior results. We conducted a case-control study to assess the outcome of TKA among patients with post-traumatic arthritis using a handheld navigation system to perform bone cuts allowing retention of hardware in situ. In 15 patients with post-traumatic arthritis and hardware around the knee (Group A), none or part(s) of hardware were removed while performing TKA. These patients were matched to 15 patients who underwent TKA with handheld navigation for primary OA knee (Group B). The perioperative outcomes assessed were operative time, intraoperative blood loss, length of hospital stay, complications, and 30 days reoperation rate. Clinical outcomes were assessed by using Knee Society Score (KSS) and radiological outcomes using mechanical axis and coronal and sagittal component angles. Mean age of patients at surgery were 65.67 years (Group A) and 66.73 years (Group B). Mean operative time and blood loss were significantly higher in Group A as compared with Group B. At the mean follow-up of 34 months, KSS significantly improved in both the groups. However, there was no statistically significant difference in the clinical and radiological outcomes between the two groups. One patient in Group A developed wound dehiscence and had to undergo debridement and flap coverage within 30 days. The use of navigation helps surgeons in gaining proper limb alignment and implant positioning without complete removal of hardware.

PMID:33853153 | DOI:10.1055/s-0041-1726419

Appl Clin Inform. 2021 Mar;12(2):310-319. doi: 10.1055/s-0041-1727198. Epub 2021 Apr 14.

ABSTRACT

OBJECTIVE: The study aimed to evaluate an integrated electronic questionnaire system implementation in outpatient community pediatric practices on workflow, completion rates, and recorded scores.

METHODS: We evaluated the implementation and outcomes of an integrated electronic questionnaire system at 45 community pediatric practices that used standardized questionnaires to screen for autism, depression, and substance use and to measure asthma control. Electronic health record (EHR) data for all well child visits were extracted for the 3 months before and after implementation. We used statistical process control charts to evaluate questionnaire completion rates and Chi-square tests to evaluate screening completion and positive screening rates. The collection and entry of questionnaire information was observed and timed.

RESULTS: EHR data included 107,120 encounters across 45 practices that showed significant and sustained improvement in completion rates for all questionnaires. The rate of recorded concerning questionnaires decreased for asthma control (19.3 vs. 12.8%, p < 0.001), stayed the same for autism (96.6 vs. 96.2%, p = 0.38), decreased for depression (9.5 vs. 6.7%, p ≤ 0.001), and increased for any substance use (9.8 vs. 12.8%, p < 0.001). Twelve practices were observed, and patient time and staff time managing questionnaires were decreased after implementation.

DISCUSSION: Electronic questionnaire administration saved staff time and patient time. We report overall improvement in questionnaire completion rates, with notable variation in improvement in completion across practices and in change in concerning recorded result rates across measures.

CONCLUSION: Conversion of four standard paper questionnaires to an integrated electronic system reduces patient and staff time while increasing completion rates when well integrated into routine care.

PMID:33853141 | DOI:10.1055/s-0041-1727198

Facial Plast Surg. 2021 Apr 14. doi: 10.1055/s-0041-1726464. Online ahead of print.

ABSTRACT

The aim of the study is to report outcomes after treatment of nasal valve collapse with a bioabsorbable nasal implant. It involves two prospective, multicenter, post-market studies evaluating long-term effectiveness of the LATERA implant for severe to extreme nasal obstruction. Participants underwent implant alone or with concomitant inferior turbinate reduction (ITR) and/or septoplasty. Outcome measures included the change from baseline Nasal Obstruction Symptom Evaluation (NOSE) scores, NOSE responder rates, visual analog scale (VAS) scores, and adverse events. A total cohort of 277 participants (109 implants only, 67 implants + ITR, 101 implants + septoplasty + ITR) enrolled at 19 U.S. centers was available for analysis with 177 participants (69 implants only, 39 implants + ITR, 69 implants + septoplasty + ITR) available at 2 years. The mean changes from baseline in NOSE scores and VAS scores were statistically significant (p < 0.001) at all follow-up periods. The baseline NOSE score of 77.8 ± 13.6 was improved to 24.2 ± 23.6 at 24 months. Greater than 90% of participants were NOSE responders across all follow-up periods, 6.1% withdrew for lack of treatment effect. The baseline VAS score of 66.7 ± 18.8 was improved to 21.1 ± 23.9 at 24 months. There were no serious adverse events related to the device or implant procedure. Implant retrieval rate was 4.0% (22/543 implants). Nonserious adverse events were mild to moderate in severity, typically occurred within 6 months of implant, and resolved or were stable. Significant reductions in NOSE and VAS scores and high responder rates from our large population of patients with nasal obstruction who had nasal valve implants confirm sustained effectiveness at 24 months after treatment. The studies are registered on www.clinicaltrials.gov (NCT02952313 and NCT02964312).

PMID:33853139 | DOI:10.1055/s-0041-1726464

Facial Plast Surg. 2021 Apr 14. doi: 10.1055/s-0041-1726024. Online ahead of print.

ABSTRACT

The nose is highly vulnerable to skin cancers due to the unavoidable sun exposure. The most common localization of skin cancers on the face is nose. Although the nose appears to be a single structure, it comprises many aesthetic units with different histological and anatomical properties. Our aim was to determine the relationship between the prevalence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), histologically and anatomically distinct nasal subunits. The study included patients who underwent excision and repair due to BCC or SCC of the nose. The lesions were classified according to their location in the following topographic subunits: tip, alar lobule, dorsum, sidewall, and medial canthal region. Patients were analyzed according to age, sex, topographic subunit, tumor type, and repair technique. There was no statistically significant difference in tumor location according to etiology (p > 0.05). The alar subunit was the most common location of BCC, while the dorsum was the most common location for SCC. There is no statistical relationship between the two most common skin cancers, BCC and SCC, and the aesthetic subunits of the nose. The only factor associated with the reconstruction method used was the subunit in which the tumor was located.

PMID:33853137 | DOI:10.1055/s-0041-1726024

J Reconstr Microsurg. 2021 Apr 14. doi: 10.1055/s-0041-1727188. Online ahead of print.

ABSTRACT

BACKGROUND: Free flaps have become the preferred reconstructive approach to restore form and function for patients presenting with complex head and neck defects. For composite, complex defects for which a regular free flap might not meet all reconstructive demands, adequate coverage can be achieved with either a single chimeric free flap or a double free flap.

METHODS: We performed a single-center retrospective chart review of patients who underwent either single chimeric free flap or double free flap reconstruction. Indications for reconstruction included defects resultant from head and neck tumor or osteoradionecrosis resections. We extracted the following variables: tumor location, defect, flap(s) performed, and postoperative complications. Unpaired t-tests were performed to evaluate for statistically significant differences in complications encountered between the single chimeric versus the double free flap patient groups.

RESULTS: In our series of 44 patients, a total of 55 single chimeric and double free flaps were performed. We found no significant difference in overall complications (p = 0.41) or flap/skin paddle loss (p = 0.45) between the groups. There were three total flap losses; two patients underwent successful salvage procedures and one patient died. The anterolateral thigh (ALT) was the most common free flap (70%) used in our series, and 98% of our patients completed successful reconstruction.

CONCLUSION: As the initial reconstructive effort is critical for achieving favorable long-term outcomes in complex head and neck cases, effective and safe techniques should be employed to ensure optimal delivery of care. We believe that single chimeric and double free flap techniques should be appropriately utilized as part of the armamentarium of head and neck reconstructive microsurgeons.

PMID:33853130 | DOI:10.1055/s-0041-1727188

Horm Metab Res. 2021 Apr;53(4):272-279. doi: 10.1055/a-1402-0290. Epub 2021 Apr 14.

ABSTRACT

Thyroid hormone reference intervals are crucial for diagnosing and monitoring thyroid dysfunction during early pregnancy, and the dynamic change trend of thyroid hormones during pregnancy can assist clinicians to assess the thyroid function of pregnant women. This study aims to establish early pregnancy related thyroid hormones models and reference intervals for pregnant women. We established two derived databases: derived database* and derived database#. Reference individuals in database* were used to establish gestational age-specific reference intervals for thyroid hormones and early pregnancy related thyroid hormones models for pregnant women. Individuals in database# were apparently healthy non-pregnant women. The thyroid hormones levels of individuals in database# were compared with that of individuals in database* using nonparametric methods and the comparative confidence interval method. The differences in thyroid stimulating hormone and free thyroxine between early pregnant and non-pregnant women were statistically significant (p<0.0001). The reference intervals of thyroid stimulating hormone, free thyroxine and free triiodothyronine for early pregnant women were 0.052-3.393 μIU/ml, 1.01-1.54 ng/dl, and 2.51-3.66 pg/ml, respectively. Results concerning thyroid stimulating hormone and free thyroxine reference intervals of early pregnancy are comparable with those from other studies using the same detection platform. Early pregnancy related thyroid hormones models showed various change patterns with gestational age for thyroid hormones. Early pregnancy related thyroid hormones models and reference intervals for pregnant women were established, so as to provide accurate and reliable reference basis for the diagnosing and monitoring of maternal thyroid disfunction in early pregnancy.

PMID:33853119 | DOI:10.1055/a-1402-0290

Holist Nurs Pract. 2021 May-Jun 01;35(3):158-166. doi: 10.1097/HNP.0000000000000443.

ABSTRACT

Long hours, inadequate staff, and increasingly complicated patients make nurses more vulnerable to increased levels of stress and burnout. Nurses skilled in exercising self-care practices are better equipped to manage complex clinical situations. The purpose of this pilot study was to evaluate the feasibility of short mindfulness sessions (Mindful Moment) practiced prior to a shift, available in person and online, on nurse burnout and perceived levels of stress. The 8-week Mindful Moment study consisted of 20-minute sessions delivered either in person or online that included yoga, self-reflection, and meditation. Nurse burnout was assessed using the Maslach Burnout Inventory at weeks 0, 4, and 8. Perceived stress was assessed using a visual analog scale before and after each Mindful Moment session. Descriptive statistics, pre/postintervention differences, and percent change calculations were used to evaluate study outcomes. Forty-seven nurses agreed to participate, with 20 nurses completing the study (43%). Participants were all female, aged 36.8 ± 9.8 years, with 12 ± 8.6 years of nursing experience. With respect to nurse burnout, there was a -31% change in emotional exhaustion (P = .079), a -31% change in depersonalization (P = .057), and a +10% change in personal accomplishment (P = .331). There were consistent reductions in nurses’ perceived stress pre/post-Mindful Moment session, with percent changes ranging from -35% to 40%. Findings from this study suggest that practicing a brief Mindful Moment prior to the start of a shift is feasible and self-care interventions provide lower levels of burnout and perceived stress among this sample of nurses.

PMID:33853100 | DOI:10.1097/HNP.0000000000000443