Effect of subconjunctival bevacizumab on primary pterygium [Case Report]
PURPOSE: To investigate the effect of subconjunctival bevacizumab on primary pterygium. METHODS: A patient with an inflamed nasal primary pterygium, refractory to artificial tears and naphazoline, was enrolled in this study. After pretreatment with topical proparacaine and moxifloxacin, 0.05 mL of bevacizumab (1.25 mg/0.05 mL) was injected subconjunctivally at the limbus. Clinical signs of irritation, redness, and vascularization were monitored over 7 weeks. RESULTS: At 1 week postinjection, irritation and hyperemia showed near-total regression. At week 2, the pterygium maintained this appearance. By week 7, the degree of vascularity and symptoms of irritation had regressed to its preinjection state. CONCLUSIONS: Treatment of primary pterygium with subconjunctival bevacizumab results in a short-term decrease in vascularization and irritation. Further long-term studies should investigate the efficacy of bevacizumab as an adjunct to surgical excision or combined topical treatment targeting other growth factors involved in pterygium pathogenesis
Safety and efficacy of the technique of complete tenon's membrane excision and mitomycin C in pterygium surgery
PURPOSE: Despite the established efficacy of mitomycin C (MMC) in preventing recurrence after pterygium surgery, there is no consensus on the optimal operative technique or dose of MMC. METHODS: The authors retrospectively evaluated 90 single-headed pterygium resections performed with excision of the entire pterygium to the plica and removal of all Tenon's membrane from the scleral bed and rectus muscle. Bare sclera was exposed to 0.4 mg/mL MMC for 5 minutes for primary pterygia and 6 minutes for recurrent pterygia. These procedures were compared to a previous series of 58 procedures using bare sclera technique with MMC, but without extensive Tenon's membrane removal. RESULTS: Extensive Tenon's membrane removal was associated with significantly fewer recurrences (6.7% vs. 21%; P< or =0.025) and significantly less pyogenic granuloma formation (24.4% vs. 40%; P< or =0.05). In addition, there were no vision-threatening complications, such as scleral melting or persistent corneal epithelial defects, in any of the patients. CONCLUSIONS: These findings suggest that complete removal of all Tenon's membrane in the affected quadrant combined with topical MMC in the aforementioned dose is a safe method of pterygium excision with a low rate of recurrence and pyogenic granuloma formation
Laser-assisted photodynamic therapy of actinic keratoses: Long-term follow-up [Meeting Abstract]
Post-operative results with implantation of the acrysof SA-60 intraocular lens into the ciliary sulcus [Meeting Abstract]
A comparative study of pterygium excision with intraoperative Mitomycin C with and without a rotational conjunctival graft [Meeting Abstract]
Prehospital triage in the injured pediatric patient
BACKGROUND/PURPOSE: Identifying major trauma patients in the prehospital setting is essential in determining management, destination, and best utilization of emergency department resources. Few methods of trauma triage have been accepted unanimously. This study prospectively evaluates the efficacy of comprehensive field triage using 12 criteria (simplified version of the American College of Surgeon's guidelines) in 1,285 pediatric trauma patients. METHODS: Major trauma was defined as occurring in those who died in the emergency room, had major surgery (penetrating injury involving surgery of the head, neck, chest, abdomen, or groin), or were admitted directly to the intensive care unit. The correlation between trauma triage criteria, hospital disposition, and triage accuracy were determined prospectively and compared in the pediatric patients (36 months) with an adult cohort of patients (12 months). RESULTS: A total of 1,285 pediatric trauma patients were evaluated and compared with 1,326 adult trauma patients. The most accurate trauma triage criterion for major injury was a blood pressure < or = 90 mmHg (systolic) with an accuracy of 86%. This was followed by burn greater than 15% total body surface area (79%), Glasgow Coma Scale score < or = 12 (78%), respiratory rate less than 10/min or greater than 29/min (73%), and paralysis (50%). Less accurate criteria included a fall from greater than 20 feet (33%); penetrating injury to head, neck, chest, abdomen, or groin (29%); ejection from vehicle (24%); pedestrian struck at greater than 20 mph (16%); paramedic judgement (12%); rollover (3%); and extrication (0%). The Glasgow Coma Scale score was a more accurate indicator of major injury in children than adults, and paramedic judgement was less accurate in children when compared with adults. Of the 379 major pediatric trauma victims, the Revised Trauma Score and Pediatric Trauma Score missed 36% and 45% of these major trauma victims, respectively. The overtriage rate for children was 71% with a sensitivity of 100% (no missed major trauma patients). CONCLUSIONS: Physiological variables, anatomic site, and mechanism of injury provide a sensitive and safe system of triage. Continued education of prehospital personnel regarding pediatric trauma and stratification of the current triage tools are necessary to minimize overtriage in an era of shrinking resources.
Comparison of combined cataract and glaucoma surgery using planned extracapsular and phacoemulsification techniques
BACKGROUND AND OBJECTIVE: The surgical management of coexisting cataract and glaucoma is a common problem for the ophthalmologist. PATIENTS AND METHODS: We evaluated intraocular pressure (IOP) reduction and bleb formation in combined cataract and filtration surgery, comparing planned extracapsular cataract extraction (ECCE) and phacoemulsification approaches coupled with similar trabeculectomy techniques. Seventy-two eyes with primary open-angle or pseudoexfoliation glaucoma underwent combined cataract and filtration surgery. Thirty-five eyes underwent planned ECCE, intraocular lens (IOL) implantation, and trabeculectomy, and 37 eyes underwent phacoemulsification, IOL implantation and trabeculectomy. Minimum follow-up for both groups was 1 year with a mean of 16 months. RESULTS: The mean IOP reduction for phacoemulsification/trabeculectomy eyes (5.0 +/- 4.3 mm Hg) was significantly lower than the mean IOP reduction for ECCE/trabeculectomy eyes (2.9 +/- 4.1 mm Hg; P < 0.03). There was no significant difference between the groups in terms of visual acuity improvement or glaucoma medication reduction. CONCLUSION: Combined cataract and filtration surgery using phacoemulsification is associated with greater IOP reduction than combined surgery using ECCE
Survey of nursing research in New York state: XV
Bridging the nursing research-practice gap through research utilization
This article explores the gap that currently exists between nursing research and nursing practice. The aim is to promote the conversion of new knowledge into practical innovations. Barriers to research utilization in practice settings come from both the academic and clinical arenas. Innovative models and strategies are needed to overcome these barriers. The purposes and value of research utilization and the clinical and academic strategies that facilitate research are discussed. Supporting clinical studies are provided as exemplars.
What is nursing research: evolving approaches to methods and content
In addressing what constitutes nursing research in the 1990s, approaches to conducting nursing research and examples of studies are discussed in the context of historical forces. The early studies were characteristically educational in focus and quantitative by design. Nursing research has come a long way in regard to foci of the questions asked, diversity of approaches to knowledge development, and sophistication of research methods. Three approaches are described to illustrate the diversity in nursing research: quantitative, qualitative, and triangulation.