Disaster preparedness: A concept analysis and its application to the intensive care unit

ObjectivesThe aim of the study is to understand the concept of disaster preparedness in relation to the intensive care unit through the review and critique of the peer-reviewed literature.Review method usedRodgers' method of evolutionary concept analysis was used in the study.Data sourcesHealthcare databases included in the review were Cumulative Index to Nursing and Allied Health Literature, Public MEDLINE, Scopus, and ProQuest.Review methodsElectronic data bases were searched using terms such as “intensive care unit” OR “critical care” AND prep1 OR readiness OR plan1 AND disaster1 OR “mass casualty incidents” OR “natural disaster” OR “disaster planning” NOT paed1 OR ped1 OR neonat1. Peer-reviewed articles published in English between January 2000 and April 2020 that focused on intensive care unit disaster preparedness or included intensive care unit disaster preparedness as part of a facility-wide strategy were included in the analysis.ResultsEighteen articles were included in the concept analysis. Fourteen different terms were used to describe disaster preparedness in intensive care. Space, physical resources, and human resources were attributes that relied on each other and were required in sufficient quantities to generate an adequate response to patient surges from disasters. When one attribute is extended beyond normal operational capacities, the effectiveness and capacity of the other attributes will likely be limited.ConclusionThis concept analysis has shown the varied language used when referring to disaster preparedness relating to the intensive care unit within the research literature. Attributes including space, physical resources, and human resources were all found to be integral to a disaster response. Future research into what is required of these attributes to generate an all-hazards approach in disaster preparedness in intensive care units will contribute to optimising standards of care.     

Clinical observation of vitrectomy combined with endolaser photocoagulation at the edge of posterior scleral staphyloma for macular hole retinal detachment in high myopia

AIM: To observe the clinical effect of pars plana vitrectomy (PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma (PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment (MHRD) with PS. METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS (62 eyes) were enrolled in the study. Patients were divided into 23G PPV combined with PS marginal retina intraoperative photocoagulation group (combined group) and conventional surgery group (conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane (ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity (BCVA) and average number of operations were observed and compared between the two groups. RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7% (29/31) and 67.7% (21/31), respectively (χ2=6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2% (23/31) and 67.7% (21/31), respectively (χ2=0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group (t=-41.962, P≤0.001). Postoperative logMAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the logMAR BCVA before surgery, each group was improved (t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the logMAR BCVA between the eyes of the two groups (t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average (t=-2.705, P=0.009). CONCLUSION: Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.     

Photopic pupil size change in myopic orthokeratology and its influence on axial length elongation

AIM: To explore the photopic pupil size behavior in myopic children undergoing overnight orthokeratology (ortho-k) over 1-year period and its effects on the axial elongation. METHODS: A total of 202 Chinese myopic children were enrolled in this prospective clinical trial. Ninety-five subjects in ortho-k group and eighty-eight subjects in spectacle group completed the 1-year study. Axial length (AL) was measured before enrollment and every 6mo after the start of ortho-k. The photopic pupil diameter (PPD) was determined using the Pentacam AXL and measured in an examination room with lighting of 300-310 Lx. Stepwise multiple linear regression analysis was used to identify variables contribution to axial elongation. RESULTS: Compared with spectacle group, the average 1-year axial elongation was significantly slower in the ortho-k group (0.25±0.27 vs 0.44±0.23 mm, P<0.0001). In ortho-k group, PPDs significantly decreased from 4.21±0.62 mm to 3.94±0.53 mm after 1mo of lens wear (P=0.001, Bonferroni correction) and the change lasts for 3-month visit. No significantly change during the other follow-up visits was found (P>0.05, Bonferroni correction). The 4.81 mm PPD may be a possible cutoff point in the ortho-k group. Subjects with PPD below or equal to 4.81 mm tended to have smaller axial elongation compared to subjects with PPD above 4.81 mm after 1-year period (t=-3.09, P=0.003). In ortho-k group, univariate analyses indicated that those with older age, greater degree of myopia, longer AL, smaller baseline PPD (PPDbaseline) experienced a smaller change in AL. In multivariate analyses, older age, greater AL and smaller PPDbaseline were associated with smaller increases in AL. In spectacle group, PPD tended to be stable (P>0.05, Bonferroni correction) and did not affect axial growth. CONCLUSION: PPDs experience significantly decreases at 1-month and 3-month ortho-k treatment. Children with smaller PPD tend to experience slower axial elongation and may benefit more from ortho-k.     

巩膜外黄斑外垫压术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离

目的　探讨巩膜外黄斑外垫压术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离（macular hole retinal detachment，MHRD） 的可行性及疗效。方法　回顾性分析 2016年6月至2018年1月玻璃体切割硅油填充术后的复发性超高度近视MHRD患者10例（10眼），所有患者均由同一术者行巩膜外黄斑外垫压术，将MEDPOR种植体+人造血管+环扎条带制成的“三明治加压块”固定垫压于黄斑区，术后行眼眶CT检查明确加压块位置。术后6~12个月取出硅油。术后随访18个月，观察并记录术后并发症、视网膜脱离复位、黄斑裂孔闭合情况、术后视力、眼轴长度等指标。结果　眼眶CT显示10眼加压块均位于黄斑区；末次随访 SD-OCT示10眼视网膜完全复位，7眼黄斑裂孔完全闭合，3眼黄斑裂孔部分闭合；9眼术后最佳矫正视力（best corrected visual acuity，BCVA）较术前提高，1眼提高不明显；术前患者 BCVA为（1.55±0.26）LogMAR，术后3个月BCVA为（0.99±0.05）LogMAR，与术前比较差异有统计学意义（P<0.001）；术前患者眼轴长度为（31.27±1.18）mm，术后3个月为（28.81±0.87）mm，与术前比较差异有统计学意义（P<0.001）。所有患眼均未发生眼底出血、眼内炎、涡静脉回流障碍、眼前部缺血综合征等并发症。结论　巩膜外黄斑外垫压术是治疗硅油填充术后复发性超高度近视MHRD安全有效的手术方法，能提高视网膜解剖复位率、黄斑裂孔闭合率和视力。     

形觉剥夺性高度近视豚鼠巩膜形态改变及缺氧诱导因子-1α和氧自由基在高度近视中的作用

目的　观察形觉剥夺性高度近视（form deprivation high myopia，FDHM）豚鼠巩膜形态变化，探讨缺氧诱导因子-1α（hypoxia-inducible factor-1α，HIF-1α）及氧自由基在高度近视中的作用。方法　将豚鼠适应性饲养1周后，随机分为空白对照组（25只）和模型组（25只）。模型组豚鼠右眼行眼睑缝合，所有模型组豚鼠均选择右眼作为FDHM组，对侧眼为自身对照组。空白对照组豚鼠不做任何处理。于造模前及造模后8周采用检影镜测量屈光度，A超进行生物测量。形觉剥夺8周以后处死豚鼠，观察巩膜形态和超微结构的变化，测定巩膜HIF-1α相对表达量，超氧化物歧化酶（superoxide dismutase，SOD）活力及丙二醛（malondialdehyde，MDA）的含量。结果　豚鼠形觉剥夺8周以后，FDHM组屈光度从（+3.59±0.33）D变为（-7.96±0.55）D，明显高于空白对照组（+0.89±0.32）D、自身对照组（-0.55±0.49）D（均为P<0.05）；玻璃体腔深度为（4.12±0.13）mm明显高于空白对照组（3.71±0.23）mm和自身对照组（3.93±0.04）mm（均为P<0.05）；眼轴长度为（8.93±0.22）mm明显长于空白对照组（7.95±0.37）mm和自身对照组（8.01±0.15）mm（均为P<0.05）。巩膜组织明显变薄，细胞外基质增多，成纤维细胞密度降低，胶原纤维平均直径减小。FDHM组巩膜中HIF-1α相对表达量、MDA含量明显高于空白对照组和自身对照组，SOD活力明显低于空白对照组和自身对照组（均为P<0.05）。结论　形觉剥夺8周后，豚鼠FDHM眼近视度数明显增加，玻璃体腔深度增加，眼轴延长，巩膜形态发生病理性变化；HIF-1α、SOD、MDA可能参与了FDHM的形成。     

Ocular dysfunctions and toxicities induced by antiepileptic medications: Types,pathogenic mechanisms,and treatment strategies

Introduction: Ocular dysfunctions and toxicities induced by antiepileptic drugs (AEDs) are rarely reviewed and not frequently received attention by treating physicians compared to other adverse effects (e.g. endocrinologic, cognitive and metabolic). However, some are frequent and progressive even in therapeutic concentrations or result in permanent blindness. Although some adverse effects are non-specific, others are related to the specific pharmacodynamics of the drug.

Areas covered: This review was written after detailed search in PubMed, EMBASE, ISI web, SciELO, Scopus, and Cochrane Central Register databases (from 1970 to 2019). It summarized the reported ophthalmologic adverse effects of the currently available AEDs; their risks and possible pathogenic mechanisms. They include ocular motility dysfunctions, retinopathy, maculopathy, glaucoma, myopia, optic neuropathy, and impaired retinal vascular autoregulation. In general, ophthalmo-neuro- or retino-toxic adverse effects of AEDs are classified as type A (dose-dependent), type B (host-dependent or idiosyncratic) or type C which is due to the cumulative effect from long-term use.

Expert opinion: Ocular adverse effects of AEDs are rarely reviewed although some are frequent or may result in permanent blindness. Increasing knowledge of their incidence and improving understanding of their risks and pathogenic mechanisms are crucial for monitoring, prevention, and management of patients’ at risk.     

青少年近视综合防控的基本原则与对策分析

目的 探讨青少年近视综合防控的基本原则与对策。方法 随机选取2017年6月～2019年6月我院健康体检青少年60例，随机分为综合防控组（n=30）和常规防控组（n=30）两组，常规防控组青少年接受常规防控，综合防控组青少年接受综合防控，然后统计分析两组青少年的近视情况。结果 综合防控组青少年防控前后的近视率分别为73.3%（22/30）、33.3%（10/30），常规防控组青少年防控前后的近视率分别为76.7%（23/30）、56.7%（17/30）。两组青少年防控后的近视率均显著低于防控前（P＜0.05）；防控前两组青少年的近视率比较，差异无统计学意义（P＞0.05），防控后综合防控组青少年的近视率显著低于常规防控组（P＜0.05）。综合防控组总满意度为93.3%（28/30），显著高于常规防控组的73.3%（22/30）（P＜0.05）。结论 青少年近视综合防控的效果较常规防控好，能有效降低青少年的近视率，值得推广。