Financial Toxicity in Emergency General Surgery: Novel Propensity-Matched Outcome Comparison.

Background: Financial toxicity describes the harmful effect of individual treatment costs and fiscal burdens that have a compounding negative impact on outcomes in surgery. While this phenomenon has been widely studied in surgical oncology, the purpose of this study was to perform a novel exploration of the impact of financial toxicity in emergency general surgery (EGS) patients throughout the US.

Study Design: The Nationwide Readmissions Database for January and February 2018 was queried for all EGS patients aged 18 to 65 years.

Tissue plasminogen activator with prolonged dwell time effectively evacuates pleural effusions.

Objectives: Fibrinolytic therapy can be effective for management of complex pleural effusions. Tissue plasminogen activator (tPA, 10 mg) and deoxyribonuclease (DNAse) every 12 h with a dwell time of one hour is a common strategy based on published data. We used a simpler protocol of tPA (4 mg) without DNAse but with a longer dwell time of 12 h, repeated daily.

Improving outcomes for underserved adolescents with asthma.

Background And Objective: Asthma is the most common chronic disease of childhood. Treatment adherence by adolescents is often poor, and their outcomes are worse than those of younger patients. We conducted a quality improvement initiative to improve asthma control and outcomes for high-risk adolescents treated in a primary care setting.

The human milk project: a quality improvement initiative to increase human milk consumption in very low birth weight infants.

Objective: Human milk has well-established health benefits for preterm infants. We conducted a multidisciplinary quality improvement effort aimed at providing at least 500 mL of human milk/kg in the first 14 days of life to very low birth weight (VLBW) (< 1,500 g) infants in the neonatal intensive care unit.

Subjects And Methods: Improvement activities included antenatal consults with at-risk mothers, staff and parent education, a breast pump loaner program for uninsured/underinsured mothers, pump logs, establishment of a donor milk program, and twice-daily physician evaluation of infants' ability to tolerate feedings.

Utilising improvement science methods to optimise medication reconciliation.

Background: In 2005, The Joint Commission included medication reconciliation as a National Patient Safety Goal to reduce medication errors related to omissions, duplications and interactions. Hospitals continue to struggle to implement successful programmes that meet these objectives.

Methods: The authors used improvement methods and reliability principles to develop and implement a process for medication reconciliation completion at admission at a large, paediatric medical centre.

Erosion and intrusion of silicone rubber scleral buckle. Presentation and management.

Objective: To describe the clinical presentation and management of erosion and intrusion of silicone rubber implants that are used in scleral buckling procedures for the treatment of retinal detachment.

Methods: The authors identified four patients from their practices during the last 20 years (1978-1998) who had erosion or intrusion of silicone rubber scleral buckles that were used to manage retinal detachment. Approximately 4400 scleral buckling procedures were performed during this period.

Complications associated with posterior staphyloma.

Macular degeneration can result in legal blindness among those with progressive myopia and posterior staphyloma. Programmed photoreceptor death, apoptosis, is operative in some. Electrophysiologic and psychophysiologic techniques can permit detection of functional abnormalities before lesions become clinically apparent.

Macular complications associated with posterior staphyloma.

Purpose: To report macular abnormalities associated with posterior staphyloma in eyes with myopia.

Methods: In a retrospective study, we surveyed 116 eyes of 58 patients with myopic refractions. Myopic fundus abnormalities are related to clinically quantified posterior staphyloma formation.

Mutations in the tissue inhibitor of metalloproteinases-3 (TIMP3) in patients with Sorsby's fundus dystrophy.

The hereditary macular dystrophies are progressive degenerations of the central retina and contribute significantly to irreversible visual loss in developed countries. Among these disorders, Sorsby's fundus dystrophy (SFD), an autosomal dominant condition, provides an excellent mendelian model for the study of the genetically complex age-related macular degeneration (AMD), the most common maculopathy in the elderly. Recently, we mapped the SFD locus to 22q13-qter.

Retinal function in birdshot retinochoroidopathy.

The electroretinograms (ERGs) of 15 patients with birdshot retinochoroidopathy varied from super-normal to non-recordable, depending upon the severity and the stage of the disease. The abnormal ERGs were characterized by a disproportionate decrease of the b-wave amplitude compared with the a-wave amplitude, demonstrating the negative (-) type response. This distinct ERG pattern has not been observed in any other type of uveitis or chorioretinitis, and appears specific to birdshot retinochoroidopathy.

Hereditary hemorrhagic macular dystrophy.

We treated two brothers who had a hemorrhagic macular lesion in one eye; a similar problem affected the fellow eye of both patients within eight months. Generalized fine granularity of the retinal pigment epithelium and peripheral iris transillumination defects were observed in both siblings. A study of the family suggested that the disorder was dominantly inherited and probably was Sorsby's pseudoinflammatory macular dystrophy.

Prevalence of lattice degeneration and its relation to axial length in severe myopia.

We studied 436 eyes of 218 patients with myopia of -6.00 diopters or more in both eyes. Of 218 patients, 72 (33.

Distinctive cataract in the Stickler syndrome.

We determined the clinical characteristics of cataract in 133 patients with the Stickler syndrome. Cataracts of various types or aphakia were found in 115 of 231 eyes (49.8%) studied.

Refractive surgery: psychophysical considerations in progressive myopia.

There is a trend towards recommending refractive surgery for young patients with high degrees of progressive myopia. Although many can benefit from certain procedures, staphylomatous eyes present unique impediments to normal visual acuity, visual field, binocularity and stereopsis. They are also prone to premature cataract formation, glaucoma and retinal detachment.

Progressive myopia and intraocular pressure: what is the linkage? A literature review.

Progressive myopia may result from an inherited biomechanical weakness of the sclera that allows it to stretch (creep) in response to stress. Increased intraocular pressure could be the mediator of stress produced by the inclined head position and the accommodation/convergence aspects of near work. This paper reviews data that relate to this hypothesis including work on sclera, intraocular pressure, animal models of myopia, and attempts at human treatment.

Transient visual loss in ornithine transcarbamoylase deficiency.

We examined a 32-year-old, previously healthy man who developed episodic bilateral visual impairment and confusion. Coincident hyperammonemia led to the diagnosis of ornithine transcarbamoylase deficiency, which was established by enzymatic analysis of a liver biopsy specimen. The available data were insufficient to determine if the metabolic derangement impaired vision at the level of the optic nerves or at the cerebral level.

Choroidal neovascularization in degenerative myopia: role of laser photocoagulation.

Laser photocoagulation of extrafoveal choroidal new vessels was performed in 19 eyes with degenerative myopia. Sixteen eyes required only one treatment. Three eyes required more than one because of incomplete closure of the new vessels after the first treatment.

Ocular coloboma associated with a solitary maxillary central incisor and growth failure: manifestations of holoprosencephaly.

A one-year-old boy presented with findings of ocular colobomas and staphylomas in both eyes. He also had a single central incisor and growth failure. His mother had hyposmia.

Myopic cracks, angioid streaks, and traumatic tears in Bruch's membrane.

We studied the pattern of break formation in 60 eyes with myopic lacquer cracks, angioid streaks, or traumatic tears in Bruch's membrane, using a graphics composition technique and computer analysis of digitized images. Lacquer cracks were found in a reticular distribution within a posterior staphyloma; angioid streaks occurred in a spider-web configuration centered on the optic nerve; traumatic tears were characteristically curved, perineural, and eccentric temporally. The specific break patterns imply the operation of biomechanical forces.

Giant cysts of the conjunctiva following scleral buckling.

Four patients developed giant conjunctival cysts following scleral buckling for retinal detachment. Histologically these cysts showed a core of fibrous tissue lined by stratified, non-keratinizing epithelium and with goblet cells. They probably arose from inadvertent implantation of epithelium during surgery.

Transmission electron microscopic observations of vitreous abnormalities in retinitis pigmentosa.

Ultrastructural studies of six vitreous biopsy specimens obtained during cataract surgery on patients with retinitis pigmentosa showed four types of cells. These were ocular pigment epithelium, uveal melanocytes, retinal astrocytes, and macrophage-like cells. The fibrous astrocytes displayed plump cell bodies, large nuclei, and numerous intracytoplasmic filaments.