Ectropion after blepharoplasty. Experimental and clinical observations.

Ectropion, or eversion of the lower lid, is the most common serious complication of blepharoplasty. Although many factors can be related to the production of this phenomenon, excess tension on the suture line has been implicated as a causal factor in the past. Because of the lack of instrumentation for measuring suture line tensions during the performance of blepharoplasty, and the relative difficulty in identifying suitable animal models, there has been little investigation of excess suture line tension as a cause of ectropion. This study was designed to establish a technique for measuring suture line tension during the performance of blepharoplasty and evaluating the effects of excessive suture line tension in the experimental production of ectropion in the stump-tailed monkey. In both monkey and human eyelid excisions, suture line tension is evaluated with the use of a fine-balance dynamometer. Suture line tension is shown to be a measurable parameter, and the technique of measurement is described. Excessive suture line tension has been demonstrated in monkeys and humans to be a causal factor in the production of ectropion following eyelid excisions.     

Effective Teaching Strategies and Methods of Delivery for Patient Education: A Systematic Review and Practice Guideline Recommendations

The objective of this study was to determine effective teaching strategies and methods of delivery for patient education (PE). A systematic review was conducted and reviews with or without meta-analyses, which examined teaching strategies and methods of delivery for PE, were included. Teaching strategies identified are traditional lectures, discussions, simulated games, computer technology, written material, audiovisual sources, verbal recall, demonstration, and role playing. Methods of delivery focused on how to deliver the teaching strategies. Teaching strategies that increased knowledge, decreased anxiety, and increased satisfaction included computer technology, audio and videotapes, written materials, and demonstrations. Various teaching strategies used in combination were similarly successful. Moreover, structured-, culturally appropriate- and patient-specific teachings were found to be better than ad hoc teaching or generalized teaching. Findings provide guidance for establishing provincial standards for the delivery of PE. Recommendations concerning the efficacy of the teaching strategies and delivery methods are provided.     

Physician credentials and practices associated with childhood immunization rates: Private practice pediatricians serving poor children in New York City

Private practice physicians in New York City’s poorest neighborhoods are typically foreign trained, have generally substandard clinical practices, and have been accused of rushing Medicaid patients through to turn a profit. However, they also represent a sizable share of physician capacity in medically underserved neighborhoods. This article documents the level of credentials, systems, and immunization-related procedures among these physicians. Furthermore, it assesses the relationship between such characteristics and childhood immunization rates. The analysis utilizes a cross-sectional comparison of immunization rates in 60 private practices that submitted 2,500 or more Medicaid claims for children. Immunization data were gathered from medical records for 2,948 randomly selected children under 3 years of age. Half of sampled physicians were board certified (55%), and half were accepted by the Medicaid P referred P hysicians and Children (P P AC) program (51.7%). Of physicians, 43% saw patients only on a walk-in basis, while only 17% scheduled the next appointment while the patient was still in the office. There were 75% of the physicians who reported usually immunizing at acute care visits. Immunization rates were higher among PPAC physicians compared to others (41% vs. 29% up to date for diphtheria and tetanus toxoids and pertussis [DTP]/Haemophilus influenzae type b [Hib], polio, and measles-mumps-rubella [MMR], P=.01), and board-certified physicians showed a trend tovard better immunization rates (39% vs. 30%, P=.07). Physicians who reported usually immunizing at acute care visits also had higher rates than those who did not (38% vs. 27%, P=.05). Scheduling a date and time for the next immunization showed a trend toward association with immunization coverage (37% vs. 28%, P=.10). Private practice physicians who provide high volumes of care reimbursed by Medicaid have improved their credentials and affiliations over time, thereby expanding reimbursement options. Credentials and affiliations were at least as effective in distinguishing relatively high- and low-performing physicians, as were immunization-related practices, suggesting that they are useful markers for higher quality care. The relative success of the P P AC programshould informefforts to inprove the capacity and quality of primary care for vulnerable children. Appointment and reminder systems that effectively manage the flow of children back into the office for immunizations and the vigilant use of acute care visits for immunizations go hand in hand. Opportunity exists for payers and plans to encourage and support these actions. This research was supported by the Centers for Disease Control and Prevention through contract 9775565 with the New York City Department of Health.