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Cynthia Matossian,1 John D Stephens,2 Michelle K Rhee,3 Stephen E Smith,4 Parag A Majmudar,5 Subba Rao Gollamudi,6 Ravi H Patel,7 Maria E Rosselson,5 Aditi Bauskar,8 Alyssa Montieth,8 Fabiana Q Silva,8 Srilatha Vantipalli,8 Andrea Gibson,8 Jamie Lynne Metzinger,8 Michael H Goldstein8 1CM Associates, LLC, New Hope, PA, USA; 2Tyson Eye, Fort Myers, FL, USA; 3Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Eye Associates, Fort Myers, FL, USA; 5Chicago Cornea Consultants, Ltd., Chicago, IL, USA; 6Eye Specialty Group, Memphis, TN, USA; 7Eye Associates of Central Texas, Round Rock, TX, USA; 8Ocular Therapeutix, Inc., Bedford, MA, USACorrespondence: Srilatha Vantipalli, Ocular Therapeutix, Inc, 24 Crosby Drive, Bedford, MA, 01730, USA, Tel +1 413-230-7242, Email SVantipalli@ocutx.comPurpose: To describe the early real-world experience of physicians with an intracanalicular dexamethasone insert (DEX) in patients undergoing cataract surgery and to capture the clinical impact of adopting this therapy.Patients and Methods: 23 United States sites including Ambulatory Surgical Center Setting (ASC) and Outpatient Clinical settings. Respondents were physicians who had early experience with DEX in cataract surgery patients. This was a Phase 4 experiential cross-sectional survey study comprised of 3 sequential online physician surveys. Descriptive statistics summarized the surveys’ responses to determine the early impressions of the respondents.Results: Forty-two physicians completed surveys. On average, physicians reported feeling comfortable administering DEX after placing 3 inserts (mean 2.7; standard deviation 1.9). Most physicians (92%) were satisfied with DEX, and all physicians (100%) reported that DEX improved patient compliance. Most physicians (62.5%) indicated they would highly prefer DEX over traditional steroid eyedrops for the management of post-surgical inflammation and pain.Conclusion: The surveys exploring the early use of DEX suggest that DEX is a clinically effective treatment with a rapid initial learning curve and integrates well into clinical use. Physicians had a very positive early experience with DEX, including comfort with insertion and satisfaction. DEX shows promise as a primary treatment choice of physicians for ocular inflammation and pain following cataract surgery by offering patients a hands-free innovative therapy that delivers a preservative-free steroid to the ocular surface over approximately 30 days.Keywords: intracanalicular dexamethasone insert, phacoemulsification, hands-free therapy, ocular pain, ocular inflammation, sustained-release drug delivery

ObjectiveLarge studies of knee osteoarthritis (KOA) require well-characterized efficient methods to assess progression. We previously developed the local-area cartilage segmentation (LACS) software method, to measure cartilage volume on magnetic resonance imaging (MRI) scans. The present study further validates this method in a larger patient cohort and assesses predictive validity in a case-control study.MethodThe OA Biomarkers Consortium FNIH Project, a case-control study of KOA progression nested within the Osteoarthritis Initiative (OAI), includes 600 subjects in four subgroups based on radiographic and pain progression. Our software tool measured change in medial femoral cartilage volume in a central weight-bearing region. Different sized regions of cartilage were assessed to explore their sensitivity to change. The readings were performed on MRI scans at the baseline and 24-month visits. We used standardized response means (SRMs) for responsiveness and logistic regression for predictive validity.ResultsCartilage volume change was associated strongly with radiographic progression (odds ratios (OR) = 4.66; 95% confidence intervals (CI) = 2.85-7.62). OR were significant but of lesser magnitude for the combined radiographic and pain progression outcome (OR = 1.70; 95% CI = 1.40-2.07). For the full 600 subjects, theSRM was -0.51 for the largest segmented area. Smaller areas of cartilage segmentation were also able to predict the case-control status. The average reader time for the largest area was less than 20 min per scan. Smaller areas could be assessed with less reader time.ConclusionWe demonstrated that the LACS method is fast, responsive, and associated with radiographic and pain progression, and is appropriate for existing and future large studies of KOA.

Intracranial hemorrhage is a primary concern for patients with blunt head trauma. Any patient who has been struck on the head with a baseball bat should undergo a CT scan.A return-to-play decision for an athlete who has sustained a skull fracture should be based on fracture type, symptoms, clinical examination results, and a follow-up CT scan.Neuropsychologic testing may be a useful adjunct for the determination of readiness for return to play after head injury. [ABSTRACT FROM AUTHOR]

Purpose of study Previous research demonstrates that graduating medical students often feel unprepared for practice and that their perceptions of preparedness correlate only partially with those of their supervising consultants. This study explores the components of preparedness for practice from the perspectives of both newly qualified doctors and their educational supervisors. Study design A questionnaire study was undertaken at the University of Edinburgh, involving feedback on preparedness for practice over three consecutive years from 2007 to 2009, against 13 major programme outcomes, from graduates and their educational supervisors. In addition, free text responses were sought and thematically analysed. Results Graduates consistently felt well prepared in consultation and communication skills but less prepared in acute care and prescribing. Educational supervisors consistently felt that graduates were well prepared in information technology and communication skills but less prepared in acute care and practical procedures. Free text analysis identified four main themes: knowledge; skills; personal attributes; and familiarity with the ward environment. Conclusions Preparedness for practice data can be enriched by repeated collection over several years, comparison of different perspectives, and incorporation of free text responses. The non-technical skills of decision-making, initiative, prioritisation, and coping with stress are important components of preparing new doctors for practice. Education for Foundation trainees should focus on the areas in which graduates are perceived to be less prepared, such as acute care, prescribing, and procedural skills. [ABSTRACT FROM AUTHOR]

Arthrodesis for primary osteoarthrosis of the second metatarsocuneiform joint has received little attention in the literature when compared to salvage of posttraumatic osteoarthrosis after Lisfranc fracture dislocation. The use of screw or plate fixation is commonly advocated for such in situ arthrodesis, and the use of trephine/dowel plugs has also been described. The authors present an alternate approach for addressing primary osteoarthrosis of the second metatarsocuneiform joint with the use of Kirschner wires fashioned into staples with cancellous bone graft interposition. [ABSTRACT FROM AUTHOR]

Peroneal tendon subluxation or dislocation denotes intermittent or chronic anterior displacement of the peroneus longus and brevis tendons out of their fibro-osseous tunnel at the distal and posterior aspect of the fibula. Numerous surgical techniques have been described to address peroneal tendon subluxation, including isolated or combined soft tissue and osseous reconstructive procedures. The authors present an efficient and simplified approach for addressing this pathology using multiple, nonabsorbable retention sutures without the need for extensive dissection or osteotomy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine relationships of work and individual protective factors to health outcomes. METHODS: Participants from 2 corporate samples completed measures of supervisor support, hardiness, coping, global stress, and symptoms of illness. RESULTS: Regression analyses indicated that higher scores on hardiness and approach coping and being male predicted lower scores on stress and symptoms of illness. Additionally, supervisor support predicted fewer symptoms of illness but did not have a spillover effect onto stress. CONCLUSIONS: Interventions that enhance individual protective factors primarily and work protective factors secondarily may be most effective in reducing stress and illness among employees. [ABSTRACT FROM AUTHOR]

In 1996, Lehigh University merged its libraries, computing, and telecommunications services into a single organization called Information Resources. As part of the merger, the frontline services-the computing support desk and the library reference desk-were combined into a single help desk designed to offer a single point of service, with backup by a second tier of computing, instructional technology, enterprise information, and library consultants. The author reviews the literature on the service implications of merging libraries and computing and provides an overview of the new organizational structure of Lehigh's Information Resources. The rest of the paper traces the development of the LTS (Library and Technology Services) integrated help desk over ten years and describes management issues such as training, staffing, referral, work flow, assessment, and other topics. [ABSTRACT FROM AUTHOR]

This research involved interviewing three people who had experienced self-injury. They were accessed from the voluntary sector as I felt that if I had accessed them from the National Health Service their views might not be honest, due to their possible perceptions of threats to their care. It was not intended that the views of these people would be representative, my aim was that their views, as well as areas highlighted in the literature, would inform me of areas pertinent to the topic, when seeking staff views. The views of staff, of which there were 15 self-selecting clinicians, formed the main focus of the study. The aims of the research were designed to highlight potentially contrasting perceptions of self-injury as a means of illuminating a current clinical problem. The results showed that staff on the whole agreed with the perceptions of people who have experienced self-injury; that they are often viewed negatively, though this is changing. It was recognized that care was dependent on where the person entered the service. Staff recognized that the service is under pressure and provision may not be available in the voluntary sector for these clients. [ABSTRACT FROM AUTHOR]

Important lessons in policy implementation are available to welfare reformers who closely examine the case of the child welfare system. Similarities exist between the Personal Responsibility and Work Opportunity Act of 1996 and the Adoption Assistance and Child Welfare Act of 1980. While substantively the two pieces are very different, current welfare reform efforts are likely to repeat mistakes made by those implementing child welfare system reforms in the 1980s and 1990s. Four factors threaten the success of reforms: The vagueness of language; the search for one single solution for all families; insistence on defining the complexity of family problems in extremely narrow terms; and the excessive bureaucratization of service delivery. Policymakers are cautioned to look toward recent innovations in child welfare for guidance instead of inadvertently repeating missteps. [ABSTRACT FROM AUTHOR]

Darkness pupil diameters, light reflexes, and redilatation times have been recorded with infrared TV pupillometry in 12 consecutive patients with systemic amyloidosis associated with sensory motor and autonomic neuropathy. Nine of the patients had AL amyloidosis, two had familial amyloidosis associated with a transthyretin abnormality, and one was untyped. The pupils were abnormal in all 12 patients. On the basis of redilatation lag without pupillotonia, six patients had bilateral Horner's syndrome and in one of them amyloid deposits were found in a sympathetic ganglion and in the attached sympathetic chain obtained at necropsy. Four patients had bilateral tonic pupils with light-near dissociation and two had abnormally small pupils with reduced light reactions which could not be characterised. It seems that in patients with systemic amyloidosis generalised autonomic neuropathy is strongly associated with pupil abnormality as shown by tonic reactions with light-near dissociation, by redilatation lag, or by reduced size in darkness. [ABSTRACT FROM AUTHOR]

1. The cardiovascular effects of the proprietary cold remedies, Mu-cron and Boots Cold Relief tablets were compared with 'placebo' Boots Pain Relief tablets in a double-blind study involving 16 healthy volunteers. Measurements (impedance cardiography, forearm plethysmography) were made over 4 h after oral drug administration. 2. Two Mu-cron tablets (containing phenylpropanolamine [(1R,2S)- plus (1S,2R)-norephedrine] 50 mg) increased blood pressure (maximal effect 18 +/- 1/8 +/- 1 mm Hg (mean +/- s.e. mean), P less than 0.001), stroke volume (4.9 +/- 0.8 ml m-2, P less than 0.05), total peripheral resistance (243 +/- 27 dyn s cm-5 m2, P less than 0.001) and forearm vascular resistance (1.3 +/- 0.3 mm Hg ml-1 min, P less than 0.01) and reduced the ratio of pre- ejection period to ventricular ejection time (-0.031 +/- 0.003, P less than 0.05) and forearm blood flow (-2.6 +/- 0.5 ml min-1, P less than 0.05) but did not affect heart rate or cardiac index. 3. Two Boots Cold Relief tablets (containing phenylephrine 10 mg and caffeine 60 mg) caused a small and short-lived increase in total peripheral resistance but did not have consistent effects on other measurements. Two Boots Pain Relief tablets (containing caffeine 60 mg) did not have important cardiovascular effects. 4. The cardiovascular effects of phenylpropanolamine, including vasoconstriction and an increase in cardiac performance, are consistent with its alpha- and beta 1- adrenoceptor agonist action. While it may help the symptoms of rhinitis, its use in patients with heart disease or hypertension is hazardous.(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

McMaster-Aga Khan-CIDA Project personnel at McMaster University School of Nursing over a period of four years designed and conducted eight one-day introductory workshops for nurses, faculty, staff, host families, and others involved with Pakistani nurses and Lady Health Visitors studying in Canada. The workshops (entitled Increasing Intercultural Awareness) assisted the Canadian and international participants to improve their awareness and knowledge of transcultural communication in preparation for working and socializing together. Using a participatory and active-learning approach, the workshop method introduced participants to transcultural communication; emphasized appreciation of cultural values, similarities and differences; and provided country-specific information on Pakistan. This article outlines the workshop design and rationale and describes specific examples of the transcultural nursing principles, practices, and teaching activities included in the one-day event. [ABSTRACT FROM AUTHOR]