Sensitivity and specificity of the Humphrey Matrix to detect homonymous hemianopias

PURPOSE: To compare the sensitivity and specificity of the Humphrey Matrix frequency-doubling perimeter (Carl Zeiss Meditec, Inc., Dublin, CA) to that of standard automated perimetry (SAP) in detecting homonymous hemianopic visual field defects. METHODS: Thirty-three patients with homonymous hemianopias and 50 normal subjects were tested with SAP with the Humphrey Visual Field Analyzer (SITA standard program 24-2) and Humphrey Matrix frequency-doubling perimetry, program 24-2 (Matrix) on the same day. Patients with hemianopias had lesions of the retrochiasmal visual system that were documented by magnetic resonance imaging or by computed tomography. To be classified as a hemianopic visual field defect, the abnormal test location had to be homonymous, respect the vertical meridian, and have no additional scattered abnormal points that obscured the hemianopic pattern. The sensitivity and specificity of SAP and Matrix in detecting hemianopic defects were calculated. The chi(2) test was used to test for differences between groups. RESULTS: The sensitivity for hemianopic defects by total deviation probability plots was 75% for SAP and 59% for Matrix (not statistically significant, P = 0.29). The sensitivity of hemianopic defects by pattern deviation probability plots was 88% for SAP and 69% for Matrix (not statistically significant, P = 0.13). The specificity of total deviation probability plots was 84% for SAP and 86% for Matrix. The specificity of the pattern deviation probability plots was 68% for SAP and 74% for Matrix. CONCLUSIONS: Although there was no statistically significant difference between the Matrix and SAP in the detection of hemianopias, the sensitivity of SAP was higher, probably because of the obscuration of defects by scattered abnormal test locations with the Matrix.     

Effects of Breast Self-Examination Consultation Based on the Health Belief Model on Knowledge and Performance of Iranian Women Aged Over 40 Years

Background Breast cancer is the most prevalent malignancy in women worldwide; lack of awareness of symptoms and delay on diagnosis of breast cancer are the main causes of mortality among women. This study was conducted with the purpose of assessing the effect of educational consulting for breast self-examination (BSE) based on the health belief model (HBM) on the knowledge and performance of women over 40 years attending health care centers in Hamadan, Iran. Materials and Methods In this quasi-experimental study, eligible women admitted to health centers in Hamadan city in 2015 were randomly assigned to intervention and control groups (n75 in each group). The intervention group received 4 weekly sessions of breast cancer screening consulting based on the HBM. Control group received only routine care. Knowledge, HBM constructs, and BSE practice were compared between the groups before, immediately after and three months after the consultation. Results Before the intervention, no significant differences were observed in knowledge, health belief and practice between two groups. However, after the intervention a significant difference was observed between two groups in mean scores of perceived benefits, perceived barriers, self-efficacy and the health motivations (<0.05). Significant differences were also observed in terms of knowledge and BSE practice (<.01). Conclusions The results indicate the importance of consultation on knowledge and beliefs to improve BSE performance and prevention of breast cancer in Iranian women.     

The financial impact and drivers of hospital charges in contralateral prophylactic mastectomy and reconstruction: a Nationwide Inpatient Sample hospital analysis

Purpose

Rates of contralateral prophylactic mastectomy (CPM) have increased over the last decade; it is important for surgeons and hospital systems to understand the economic drivers of increased costs in these patients. This study aims to identify factors affecting charges in those undergoing CPM and reconstruction.

Methods

Analysis of the Healthcare Cost and Utilization Project National Inpatient Sample was undertaken (2009–2012), identifying women aged ≥18 with unilateral breast cancer undergoing unilateral mastectomy with CPM and immediate breast reconstruction (IBR) (CPM group), in addition to unilateral mastectomy and IBR alone (UM group). Generalized linear modeling with gamma regression and a log-link function provided mean marginal hospital charge (MMHC) estimates associated with the presence or absence of patient, hospital and operative characteristics, postoperative complications, and length of stay (LOS).

Results

Overall, 70,695 women underwent mastectomy and reconstruction for unilateral breast cancer; 36,691 (51.9%) in the CPM group, incurring additional MMHCs of $20,775 compared to those in the UM group (p < 0.001). In the CPM group, MMHCs were reduced in those aged >60 years (p < 0.001), while African American or Hispanic origin increased MMHCs (p < 0.001). Diabetes, depression, and obesity increased MMHCs (p < 0.001). MMHCs increased with larger (p < 0.001) hospitals, Western location (p < 0.001), greater household income (p < 0.001), complications (p < 0.001), and increasing LOS (p < 0.001). MMHCs decreased in urban teaching hospitals and Midwest or Southern regions (p < 0.001).

Conclusion

There are many patient and hospital factors affecting charges; this study provides surgeons and hospital systems with transparent, quantitative charge data in patients undergoing contralateral prophylactic mastectomy and immediate breast reconstruction.

     

Localized forms of steatocystoma multiplex: case report and review of the literature

A 70-year-old man presents with multiple asymptomatic, yellow to skin-colored firm papules scattered on the scalp; the lesions had been present for about 30 years. Histological findings are consistent with the diagnosis of steatocystoma. We review the English-language literature of the published cases of localized forms of steatocystoma multiplex.     

Preparation and ex vivo evaluation of TEC as an absorption enhancer for poorly absorbable compounds in colon specific drug delivery

In previous studies, it was established that chitosan and its quaternized derivatives are potent enhancers of hydrophilic compounds absorption across intestinal epithelia. The aim of this study was to evaluate the application of a new quaternized chitosan, triethyl chitosan (TEC), in pharmaceutical approaches. TEC was synthesized by a one step process via a 2(2) factorial design to optimize the preparation conditions. In ex vivo experiments, everted rat colon sac was used to determine the effect of TEC on the penetration of hydrophilic compounds of different molecular masses (e.g., sodium fluorescein and brilliant blue) through colonic epithelia in comparison with chitosan at pH 7.4. These studies indicated a significant increase in absorption of sodium fluorescein and brilliant blue in the presence of TEC compared to chitosan. TEC bearing positive charge is able to interact with the tight junctions of colon epithelia and hence increase the permeation of sodium fluorescein and brilliant blue through the tight junctions. This investigation has shown that triethyl chitosan could be used as a penetration enhancer for poorly absorbable compounds in the colon drug delivery system.     

Attitudes of Finnish community pharmacists toward concordance

BACKGROUND: Concordance is a new model of interaction between healthcare professionals and patients. The work of pharmacists and patients in the consultation is a negotiation between equals, and the aim is therapeutic alliance between them. OBJECTIVE: To assess Finnish community pharmacists' attitudes toward concordance and its perceived impact on pharmacist-patient consultations during a 4-year Finnish project (TIPPA Project 2000-2003) aimed at promoting patient counseling. METHODS: A survey of a random sample of 734 community pharmacists in Finland was conducted in 2002. The questionnaire included an attitudinal scale and 2 open-ended questions on the impact of the TIPPA Project on patient counseling. Attitudes toward concordance were measured using a modified version of the LATCon scale. The construct validity and internal consistency of the scale were evaluated using factor analysis and Cronbach's alpha. Mean summative factor scores (MSS) and 95% confidence intervals were calculated for each factor. The responses to the open-ended questions were content analyzed. RESULTS: A response rate of 51% (n = 376) was obtained. Almost 80% of the respondents strongly agreed that the highest priority in patient counseling was to establish a therapeutic alliance between the pharmacist and patient. Factor analysis of the attitudinal scale yielded 3 primary factors explaining 37.6% of the variance, interpreted as respecting patients' beliefs (alpha = 0.60; MSS = 1.90; 95% CI 2.25 to 2.40), establishing a therapeutic alliance (alpha = 0.65; MSS = 1.36; 95% CI 1.31 to 1.40), and sensitivity to patients' reactions (alpha = 0.66; MSS = 2.33; 95% CI 1.83 to 1.96). Results of the open-ended questions indicated that the TIPPA Project had a positive impact on pharmacists' attitudes toward concordance. CONCLUSIONS: Respondents to our survey were supportive of concordance. The TIPPA Project elicited a positive impact on pharmacists' attitudes toward counseling. Pharmacist education through programs such as TIPPA can aid in the implementation of a concordance-based counseling practice.     

Pigment epithelial growth factor suppresses inflammation by modulating macrophage activation

PURPOSE: To study the contribution of murine retinal pigment epithelial (RPE) cells to the innate immune-privilege status of the subretinal space as determined by the ability of pigment epithelial-derived factor (PEDF) and somatostatin (SOM), produced by RPE, to regulate macrophage-mediated inflammation. METHODS: Serum-free medium was added to RPE eyecups (a healthy monolayer of RPE resting on choroid and sclera) and the supernatants were removed after 24 hours (RPE SN). The RPE SN was assayed for the presence of PEDF and SOM and for its ability to regulate interleukin (IL)-12, IL-10, and nitric oxide (NO) production by resting and activated macrophages. A group of mice received intradermal injection of lipopolysaccharide (LPS) and PEDF in one ear and LPS alone in the other ear. Ear thickness was measured before- and 24 hours after ear injections. RESULTS: Soluble factors present in the RPE SN inhibited IL-12 production and substantially increased IL-10 while having minimal effects on NO production by activated macrophages. The message for PEDF, SOM, and IL-10 was detected in RPE cells, and the protein for these factors was found in the RPE SN. The stimulation of IL-10 and suppression of IL-12 production by RPE-SN-treated macrophages was neutralized by anti-PEDF antibodies. Neutralization of SOM in the RPE SN, suppressed NO production by activated macrophages. Intradermal injection of PEDF substantially inhibited LPS-induced inflammatory response. CONCLUSIONS: PEDF inhibits LPS-driven macrophage activation in vitro and in vivo. By producing PEDF, the RPE contributes to innate immune privilege of the eye.     

Comparison of 5-, 10-, and 15-Point Laparoscopic Ovarian Electrocauterization in Patients With Polycystic Ovarian Disease: a Prospective, Randomized Study

Objective:

We compared 12-month pregnancy and live birth rates in patients with polycystic ovarian disease undergoing 5-, 10-, and 15-point laparoscopic ovarian electrocauterization.

Methods:

This was a prospective, randomized study performed at the Dabirashrafi Fertility and Endoscopy Research Center, Tehran, Iran. The study included 187 patients with polycystic ovarian disease who were randomly assigned to 3 groups. Group I comprised 67 patients whose ovaries received 5-point electrocauterization. Group II comprised 57 patients whose ovaries received 10-point electrocauterization. Group III comprised 63 patients whose ovaries received 15-point electocauterization.Laparoscopic ovarian electrocauterization with a unipolar current was used. The main outcome measures were 12-month pregnancy and live birth rates.

Results:

Patients were homogeneous for age, body mass index, and type and duration of infertility. Twenty pregnancies resulted in Group I, with a pregnancy rate of 29.9% (20/67) and a live birth rate of 20.9% (14/57). Eighteen pregnancies resulted in Group II, with a pregnancy rate of 31.6% (18/57), and a live birth rate of 28.1% (16/57).Thirty-three pregnancies resulted in group III, with a pregnancy rate of 52.4% (33/63), and a live birth rate of 47.6% (30/63). Comparison of Group III with Groups I and II revealed a statistically significant increase in pregnancies (P=0.016) and live birth rates (P=0.004).

Conclusion:

We recommend 15-point electrocauterization of ovaries in patients with polycystic ovarian disease.