Relationship between corneal thickness and measured intraocular pressure in a general ophthalmology clinic

OBJECTIVE: To assess whether central corneal thickness (CCT) is a confounding factor in the classification of patients attending for glaucoma assessment in a district general hospital. DESIGN: Cross-sectional study by a single observer. PARTICIPANTS: Patients attending a general ophthalmic clinic: 235 clinically normal eyes, 52 eyes with normal-tension glaucoma (NTG), 335 eyes with primary open-angle glaucoma (POAG), 12 eyes with pseudoexfoliative glaucoma (PXE), 42 eyes with chronic angle closure glaucoma (CACG), and 232 glaucoma suspect (GS) eyes. INTERVENTION: Central corneal thickness was measured using ultrasonic pachymetry. MAIN OUTCOME MEASURE: Correlation of CCT and diagnosis. RESULTS: Mean CCT was 553.9 microm (95% confidence intervals [CI] for the mean, 549.0-558.8 microm) in the clinically normal eyes, 550.1 microm (95% CI, 546.6-553.7 microm) in the POAG eyes, 514.0 microm (95% CI, 504.8-523.3 microm) in the NTG eyes, 530.7 microm (95% CI, 511.2-550.1 microm) in the PXE eyes, 559.9 microm (95% CI, 546.8-573.0 microm) in the CACG eyes, and 579.5 microm (95% CI, 574.8-584.1 microm) in the GS eyes. The differences of mean CCT between the groups were highly significant (P< 0.001 analysis of variance). Eighty-five percent of eyes with NTG and only 36% of eyes with POAG had a mean CCT of 540 microm or less. Thirteen percent of eyes with POAG and 42% of GS eyes had a mean CCT greater than 585 microm. CONCLUSIONS: The CCT measurement is desirable in patients attending for glaucoma assessment in a district general hospital to avoid misclassification resulting from the relationship between CCT and tonometric pressure. Central corneal thickness alone is not an accurate predictor for the clinical diagnosis in this group of eyes. However, many eyes diagnosed as having NTG have thin corneas, which would tend to lower the tonometrically recorded intraocular pressure (IOP), so the finding of a less-than-normal thickness cornea introduces some doubt as to the diagnosis of NTG. For the GS eyes, most eyes had thick corneas, which would tend to increase the tonometrically recorded IOP. Thus, GS eyes with modest elevation of IOP and a thick cornea may be at low risk of progressing to POAG. Thus, many patients with "high IOPs" and a thick CCT do not necessarily have high IOPs and may not need to be followed as GS eyes.     

Nonmechanical excimer laser penetrating keratoplasty for perforated or predescemetal corneal ulcers

OBJECTIVE: To review the authors' results using nonmechanical excimer laser trephination in penetrating keratoplasty for perforated or predescemetal corneal ulcers. DESIGN: Noncomparative, consecutive, interventional case series. PARTICIPANTS: Thirty-two patients with perforated (17) or deep (15) corneal ulcers (9 bacterial, 5 acanthamoebal, 10 herpetic, 3 associated with rheumatoid arthritis, 5 other) necessitating immediate tectonic keratoplasty. INTERVENTION: Penetrating tectonic keratoplasty with excimer laser trephination was performed along metal aperture masks in donor and recipient corneas. MAIN OUTCOME MEASURES: Clinical results including intraoperative and postoperative complications were evaluated. RESULTS: Trephination was possible in all eyes without perforation of predescemetal ulcers or extrusion of intraocular contents. No eyes with bacterial or acanthamoebal ulcers showed persistence or recurrence of infection. One eye showed recurrent epithelial herpetic keratitis. Best-corrected postoperative visual acuity ranged from 20/700 to 20/20 (median, 20/58), with 30 of 32 eyes achieving improvement of best visual acuity during follow-up (mean, 22.4 months) and with 12 of 32 eyes reaching a visual acuity of 20/40 or greater. Eyes with bacterial or acanthamoebal ulcers showed best results. Episodes of graft rejection occurred in nine eyes and resulted in irreversible opacity of the graft in seven cases. None of the eyes lost all vision, developed endophthalmitis, or had to be enucleated. CONCLUSIONS: Nonmechanical trephination is a useful technical refinement of tectonic penetrating keratoplasty à chaud for perforated or deep progressive corneal ulcers. This technique greatly facilitates exact trephination under these difficult surgical conditions and might possibly improve the prognosis of this procedure.     

Visual-evoked potential evidence of chiasmal hypoplasia

PURPOSE: To show that chiasmal hypoplasia or aplasia need not be an isolated developmental anomaly and to examine the spectrum of associated clinical findings to explore the possibility that these patients may represent a phenotypic manifestation of a developmental gene anomaly. DESIGN: An observational case series. PARTICIPANTS: Five infants, between several weeks and 7 months of age, in whom the electrophysiologic characteristic of chiasmal hypoplasia had been noted were included. METHODS: Flash electroretinography and flash and pattern visual-evoked potentials (VEPs) were elicited from all patients. Clinical ophthalmologic examinations, including funduscopy, were performed, and all patients had magnetic resonance imaging (MRI) brain scans. MAIN OUTCOME MEASURES: The occipital distribution of monocular VEP response peaks was studied. The symmetry of lateral channel responses was compared for monocular stimulation. RESULTS: All five patients had a crossed asymmetry in the monocular VEP occipital distribution, which is consistent with a paucity of fibers crossing at the chiasm. The MRI findings supported this electrophysiologic observation, illustrating degrees of chiasmal hypoplasia and variable coincidence of other midline abnormalities of the brain. Optic disc appearances varied from normal to hypoplastic and colobomatous. CONCLUSIONS: The ophthalmologic and MRI findings of five patients who showed a crossed asymmetry in monocular flash VEPs are consistent with a paucity of axons crossing at the chiasm. The similarities between achiasmia in humans and mice due to a Pax2 gene anomaly are discussed.     

Retrograde intubation dacryocystorhinostomy for proximal and midcanalicular obstruction

Objective

Retrograde intubation of canaliculi during dacryocystorhinostomy can restore canalicular patency in cases otherwise managed with bypass tubes. The surgical technique and success for this procedure are discussed.

我国医院科技影响力评价指标体系研究

应用文献调研法形成指标体系框架,通过两轮Delphi专家咨询法确定适用于我国医院科技影响力评价的指标体系,具体包括3个1级指标、9个2级指标和21个3级指标。本研究所建立的较完备的中国医院科技影响力评价指标体系,可用于评价我国医院的科技影响力水平,为医院的科研管理和科研决策提供信息支持。     

基于OKR理念的医院核心工作指标体系建设及应用

以三级公立医院绩效考核及院长绩效考核为指导,结合医院实际情况,构建医院核心工作指标体系。运用目标与关键成果法管理理念,从医院的发展目标和核心问题出发,通过流程优化、任务分解、全员参与,聚焦有挑战性的目标,从而实现管理模式转变。认为核心工作指标体系可赋能医院绩效管理,充分发挥绩效考核在医院管理中的“指挥棒”作用。     

国内外医院预约诊疗服务系统现状及发展策略分析

对比分析目前国内外预约诊疗系统建设和投入应用的现状,剖析国内预约诊疗系统存在的问题,进而提出相应对策,包括加大社会宣传力度,建立患者预约就诊诚信约束体系,提高预约号源数量,规范医生出诊等,为卫生管理部门建设预约诊疗服务系统提供决策依据。     

我国三级公立医院护士薪酬满意度调查

目的调查我国三级公立医院护士薪酬满意度,分析其影响因素,为稳定护士队伍提供参考。 方法依托第5次“全国改善医疗服务行动第三方评估”项目,选取全国31个省（自治区、直辖市）及新疆生产建设兵团共136家三级公立医院护士进行调查。应用SPSS 23.0软件对数据进行统计学分析。结果护士薪酬满意度为43.6%。医院所在地区、医院类型、护士工作年限、职称、所在科室、聘用形式、行政职务和教学任务担任情况、工作负荷、休息室提供是否充足以及对子女从医态度等,是护士薪酬满意度的影响因素。结论三级公立医院护士薪酬总满意度较低。应从国家层面和医院层面完善绩效分配制度,切实体现护士劳动价值,从而稳定护理队伍。     

DRGs在医院重点学科管理中的应用

通过对2015年和2016年天津市某医院病案首页数据分组,分析主要诊断组（MDC）分组占比构成情况,采用CMI、总权重、平均住院日和参考平均住院日等指标进行统计学分析,能够较好反应重点科室—肝胆外科情况。DRGs能够为新形势下的医院管理工作提供准确、科学的数据支持。     

南京军区福州总医院网站建设实践

介绍了南京军区神州总医院网站建设的成功经验：一是以人为本，设置网站栏目和功能；二是突出医院文化的独特内涵；三是充分利用网络优势，实现互动交流；四是努力建成为医务人员继续教育的园地；五是建立有效的运作机制。