Primary 360° Broad Buckling in Retinal Detachment

Background

Chronic rhegmatogenous retinal detachment behaves like proliferative vitreo-retinopathy (PVR) even without evidence of the same. Surgery could be done either with conventional buckling procedures where the extent of buckling is determined by the number and location of the breaks or by primary vitreous surgery. In this study these cases were managed with primary 360°encircling broad buckle without a vitreous procedure.

Methods

210 eyes, with rhegmatogenous retinal detachment of more than six months duration and with PVR up to C3 (CP3 focal) were subjected to buckling surgery. Trans-scleral cryopexy of the breaks, 360°encircling buckle with a 276 - 279 tire and subretinal fluid drainage was performed.

Result

Most (85.74%) of the eyes showed anatomical retinal re-attachment.

Conclusion

Primary broad encircling buckling can be conducted successfully in cases of long standing retinal detachment.Key Words: Rhegmatogenous retinal detachment, Proliferative vitreo-retinopathy, Scleral buckling, Vitreous replacement, Retinal re-attachment     

A practical guide for implementing and maintaining value-added clinical systems learning roles for medical students using a diffusion of innovations framework

After emphasizing biomedical and clinical sciences for over a century, US medical schools are expanding experiential roles that allow students to learn about health care delivery while also adding value to patient care. After developing a program where all 1st-year medical students are integrated into interprofessional care teams to contribute to patient care, authors use a diffusion of innovations framework to explore and identify barriers, facilitators, and best practices for implementing value-added clinical systems learning roles. In 2016, authors conducted 32 clinical-site observations, 29 1:1 interviews with mentors, and four student focus-group interviews. Data were transcribed verbatim, and a thematic analysis was used to identify themes. Authors discussed drafts of the categorization scheme, and agreed upon results and quotations. Of 36 sites implementing the program, 17 (47%) remained, 8 (22%) significantly modified, and 11 (31%) withdrew from the program. Identified strategies for implementing value-added roles included: student education, patient characteristics, patient selection methods, activities performed, and resources. Six themes influencing program implementation and maintenance included: (1) educational benefit, (2) value added to patient care from student work, (3) mentor time and site capacity, (4) student engagement, (5) working relationship between school, site, and students, and, (6) students’ continuity at the site. Health systems science is an emerging focus for medical schools, and educators are challenged to design practice-based roles that enhance education and add value to patient care. Health professions’ schools implementing value-added roles will need to invest resources and strategize about best-practice strategies to guide efforts.     

Spectrum of Head-Neck cancers at Allahabad

A retrospective study of Head-Neck malignancy was conducted at Allahabad over a period of twenty two years from 1975 to 1996. During this period, 5,386 new Head-Neck Cancer cases were reported. Peak presentation of males was in sixth decade and in females it was in fifth decade of life. The sex ratio in this series was 3∶6∶1 while reverse sex ratio was observed in malignancies of thyroid, alveolus-gingiva, nasal cavity and post-cricoid region. Oral cavity lesion was the predominant cancer followed by larynx and oropharyngeal malignancy. Histologically, majority (89.97%) were squamous cell carcinoma with varied differentiation. Factors responsible for the high incidence of Head-Neck Cancers are discussed. An argent need is felt for the prevention and cessation strategies to achieve the goal of smoke free society by the year 2000 as expressed by Dr. Knoop so as to revert back the present trend of preventable Head-Neck Cancers.     

Spectrum of Head-Neck cancers at Allahabad

A retrospective study of Head-Neck malignancy was conducted at Allahabad over a period of twenty two years from 1975 to 1996. During this period, 5,386 new Head-Neck Cancer cases were reported. Peak presentation of males was in sixth decade and in females it was in fifth decade of life. The sex ratio in this series was 3∶6∶1 while reverse sex ratio was observed in malignancies of thyroid, alveolus-gingiva, nasal cavity and post-cricoid region. Oral cavity lesion was the predominant cancer followed by larynx and oropharyngeal malignancy. Histologically, majority (89.97%) were squamous cell carcinoma with varied differentiation. Factors responsible for the high incidence of Head-Neck Cancers are discussed. An argent need is felt for the prevention and cessation strategies to achieve the goal of smoke free society by the year 2000 as expressed by Dr. Knoop so as to revert back the present trend of preventable Head-Neck Cancers.     

Outcome at 2 years for very low birthweight infants in a geographical population: risk factors, cost, and impact of congenital anomalies

AIM: To determine the type and rate of disability at 2 years of age in infants born in the geographically defined population of East Anglia with a birthweight less than 1500 g and to assess the risk factors for disability. STUDY DESIGN: A prospective cohort analysis from all eight neonatal units in East Anglia from 1993-1997 using a single database. METHODS: Local paediatricians assessed children at 2 years using the Health Status Questionnaire and data collection was centrally coordinated. RESULTS: Outcomes for 947 children, 99% of survivors, were available, 74 (7.8%) had severe disability and this was significantly associated with gestational age (p<0.0005), birthweight (p<0.0005) and sex (p=0.046). Major congenital abnormality contributed 27% of all severe disability. The overall cerebral palsy rate was 6.2%, nine children were blind and five had sensorineural hearing loss requiring aids. These children had a high level of use of community services with 19% of the cohort being referred to one or more community service. ELBW infants or those born <30 weeks gestation were 1.5 times and twice as likely to have moderate or severe disability and 2.3 and 5.4 times as likely to have cerebral palsy as those weighing 1000 to 1500 g or >30 weeks gestation. Boys were at higher risk of adverse outcome. CONCLUSIONS: The study was able to define the increased risk associated with being born at lower gestational age or lower birthweight and demonstrates successful ascertainment of outcomes for large local populations at a reasonable cost.     

Extraocular muscle enlargement as a paraneoplastic effect of breast carcinoma in a male patient

The authors report a rare case of a male patient who was diagnosed with breast cancer following investigations for proptosis secondary to extraocular muscle enlargement. A 65-year-old man presented with complaints of double vision and proptosis. CT scan of the orbits showed bilateral superior rectus muscle enlargement. On further investigation, the patient was detected to have a right breast mass. Biopsy of the mass showed an intermediate-grade carcinoma in situ. The patient underwent a right radical mastectomy following which his proptosis and symptoms of double vision resolved. Repeat MRI scans showed reduction in the size of the superior rectus muscle after mastectomy. Extraocular muscle enlargement has not been previously identified as a paraneoplastic effect of breast carcinoma in a male patient. Extraocular muscle enlargement can be a presenting feature of malignancies, and an appropriate systemic workup for the occult primary when all other preliminary tests are negative should be considered.     

An evaluation of compliance and performance following the introduction of the Inter-Facility Transport Triage Guideline

BACKGROUND: In Hong Kong, the reorganization of healthcare frame work for better utilization of resources has led to an increase in the frequency of inter-facility transport in recent years. An Inter-Facility Transport Triage Guideline (IFTTG) was introduced and evaluated on its compliance and performance. This study aimed to evaluate the compliance to the IFTTG and performance of inter-facility transport after the IFTTG was implemented.METHODS: The patients who required emergency IFT with accompanying personnel in two consecutive periods (pre-implementation period: January 1, 2006 to April 30, 2006; post-implementation period: May 1, 2006 to August 31, 2006) were included. The compliance to pre-transport triage and transport team configuration was evaluated by a review panel with eight performance indicators identified. The performance indicators were compared individually and as an overall score.RESULTS: Sixty-eight (26 in the pre-implementation period and 42 in the post-implementation period) IFTs were reviewed. There was demonstrable improvement on compliance to the IFTTG. The appropriateness of pre-transport triage increased from 34.6% to 54.8% whereas appropriateness of transport team configuration rose significantly from 73.1% to 92.9% (P<0.05). Staff performance on individual IFT performance indicator was satisfactory in both periods and the means of overall score on performance indicators were 7.12 and 7.29 respectively. The most improved performance indicator was the appropriateness of transport team configuration.CONCLUSIONS: The compliance and performance with the newly implemented IFTTG were satisfactory. However, staff comment and satisfaction with the use of the new guideline should be collected so as to achieve continuous quality improvement.