Reasons for Distress Among Burn Survivors at 6, 12, and 24 Months Postdischarge: A Burn Injury Model System Investigation

Objective

To identify important sources of distress among burn survivors at discharge and 6, 12, and 24 months postinjury, and to examine if the distress related to these sources changed over time.

Feasibility of a Kinect®-based rehabilitation strategy after burn injury

Introduction

The advent of consoles that deliver both interactive games and therapy may augment rehabilitation options in burn patients. The Jintronix software combines therapy-specific software and interactive gaming as a form of coaching and records patient performance on the Kinect^® platform. Our objective was to determine the feasibility of a set of Jintronix games and therapy modules in hospitalized adult burn patients.

Analyses of odontometric sexual dimorphism and sex assessment accuracy on a large sample

Correct sex assessment of skeletonized human remains allows investigators to undertake a more focused search of missing persons' files to establish identity. Univariate and multivariate odontometric sex assessment has been explored in recent years on small sample sizes and have not used a test sample. Consequently, inconsistent results have been produced in terms of accuracy of sex allocation. This paper has derived data from a large sample of males and females, and applied logistic regression formulae on a test sample. Using a digital caliper, buccolingual and mesiodistal dimensions of all permanent teeth (except third molars) were measured on 600 dental casts (306 females, 294 males) of young adults (18–32 years), and the data subjected to univariate (independent samples' t-test) and multivariate statistics (stepwise logistic regression analysis, or LRA). The analyses revealed that canines were the most sexually dimorphic teeth followed by molars. All tooth variables were larger in males, with 51/56 (91.1%) being statistically larger (p < 0.05). When the stepwise LRA formulae were applied to a test sample of 69 subjects (40 females, 29 males) of the same age range, allocation accuracy of 68.1% for the maxillary teeth, 73.9% for the mandibular teeth, and 71% for teeth of both jaws combined, were obtained. The high univariate sexual dimorphism observed herein contrasts with some reports of low, and sometimes reverse, sexual dimorphism (the phenomenon of female tooth dimensions being larger than males'); the LRA results, too, are in contradiction to a previous report of virtually 100% sex allocation for a small heterogeneous sample. These reflect the importance of using a large sample to quantify sexual dimorphism in tooth dimensions and the application of the derived formulae on a test dataset to ascertain accuracy which, at best, is moderate in nature.     

Perfluorocarbon liquid assisted large retinal epithelium patching in sub-macular hemorrhage secondary to age related macular degeneration

Background  We investigate the safety and feasibility of large retinal pigmentary epithelium (RPE)-Choroid-free graft after surgical drainage of massive sub-macular hemorrhage (SMH) due to age-related macular degeneration (ARMD). Methods  Four previously untreated patients (three females and one male) underwent to three port pars plana vitrectomy, induction of retinal detachment and peripheral temporal 180° retinotomy. The retina was then folded nasally, to allow access for removal of sub-macular Hg and CNV complex. A full-thickness-large autologus Chorio-RPE patch was grafted. Silicone oil was used as endotemponade for approximately 12 weeks. After removal of silicone oil, the patients were followed-up for 6 months. Results  SMH was completely removed in all cases. It was possible to graft a large RPE patch safely that is sufficiently large to cover the entire defect of macular RPE. At last follow-up, improvement in visual acuity (from 3 ± 0.9 to 55 ± 9 ETDRS letters) and recovery of central fixation was observed in all patients. Conclusions  Our surgical technique for large elevated SMH seems to be feasible and efficacious approach to harvest and relocate large RPE patch and to save limited vision in selected patients. No research funding was provided for this research.     

The effect of changes in Medicare reimbursement on the practice of office and hospital‐based endoscopic surgery for bladder cancer

BACKGROUND:

Procedures performed in the office offer potential cost savings. Recent analyses suggest, however, that a fee‐for‐service system may incentivize subscale operations and, thus, contribute to excessive spending. The authors of this report sought to characterize changes in the practice of office‐based and hospital‐based endoscopic bladder surgery after 2005 increases in Medicare reimbursement.

METHODS:

All office and hospital‐based endoscopic surgeries that were performed in a faculty practice from 2002 through 2007 were identified using billing codes for procedures, diagnoses, and procedure locations and then analyzed using the chi‐square test and logistic regression. Costs were estimated based on published Medicare reimbursements for office and hospital‐based surgeries.

RESULTS:

In total, 1341 endoscopic bladder surgeries were performed, including 764 in the office and 577 in the hospital. After 2005, the odds ratio (OR) for office surgery occurring among all cystoscopies and for surgery occurring in the office versus the hospital was 2.01 (95% confidence interval [CI], 1.71‐2.37) and 2.29 (95% CI, 1.83‐2.87), respectively. Among all treated lesions that were associated with a diagnosis of bladder cancer and nonbladder cancer, the OR for a procedure occurring in the office versus the hospital was 1.36 (95% CI, 1.07‐1.73) and 1.99 (95% CI, 1.52‐2.60), respectively. The likelihood of repeat surgery on the same lesion increased after 2005 (OR, 2.86; 95% CI, 1.46‐5.62), and the likelihood of an office surgery leading to a bladder cancer diagnosis at the next visit declined (OR, 0.29; 95% CI, 0.16‐0.51). The overall estimated expenditure increased by 50%.

CONCLUSIONS:

After 2005, more bladder lesions were identified and treated in the office. In a single group practice, office treatment of bladder cancer did not fully explain this new practice pattern, suggesting a lowered threshold for office intervention. Cancer 2010. © 2010 American Cancer Society.     

Trans‐vitreal endoresection for vasoproliferative retinal tumours

We present an interventional consecutive case series to describe our experience of transvitreal endoresection (TVE) for vasoproliferative retinal tumours (VPRTs). Three patients with VPRTs refractory to conventional treatment modalities of cryotherapy, plaque radiotherapy and anti‐VEGF presented with macular exudative changes and were offered TVE. Complete ophthalmic examination with colour fundal photographs was performed before and during the follow‐up period. All patients were followed up for 6 months following silicone oil removal. At the last follow up, resolution of macular and retinal exudative changes with parallel improvement in vision was observed. No recurrences were detected during the follow‐up period. Two of three patients had simultaneous cataract surgery and developed fibrinous uveitis, requiring management with intensive topical steroids. After 3 months, these patients had a fibrotic pupillary membrane enveloping the intraocular lens (IOL) with posterior synechiae. These two patients underwent SO removal, IOL explantation and artisan IOL (iris clipped) insertion, resulting in visual improvement. We did not observe any PVR complications in our cases. TVE represents an effective and safe option for the treatment of VPRTs refractory to other treatment modalities. Further studies with a larger sample size and long‐term follow up are indicated to evaluate the role of TVE in the management of VPRTs.