A Case of Thoracic Spondylosis Deformans and Multilevel Instrumented Spinal Fusion in an 84-Year-Old Male.

Spondylosis deformans is a type of spinal claw osteophytosis which can be found on the anterolateral vertebral bodies of any region, and which consists of protrusions of intervertebral disc tissue covered by a bony shell. We report here a case of thoracic spondylosis deformans and multilevel instrumented fusion found during routine dissection of a cadaver. Theories of the etiology of this condition are reviewed in general, and with respect to this specific case and the potential interaction of the presenting comorbidities. The clinical implications of these osteophytes, including musculoskeletal and visceral sequelae, are also discussed.

Proximity of the Carotid Bifurcation to the Laryngeal Prominence: Results of a Cadaver Study and Recommendations for Safe Pulse Palpation.

BACKGROUND/PURPOSE: The carotid bifurcation (CB) is the location of the carotid sinus and the baroreceptors and is also a major site for atherosclerotic plaque formation. Health care providers have therefore been cautioned to avoid the CB during carotid pulse palpation (CPP) to prevent triggering the baroreflex, occluding an artery, or propagating a thrombus. Potential risks of adverse events during CPP may be greater for older adults due to age-related vascular changes and increased risk of baroreceptor hypersensitivity. The exact location of the CB relative to easily identifiable landmarks has, however, not been well-studied. The purpose of this descriptive study was to identify the location of the CB relative to key landmarks in a cadaver sample and to make recommendations allowing clinicians to avoid the CB during CPP. METHODS: The CB and other regional landmarks in 17 male and 20 female cadavers were exposed by dissection and pins were placed at all landmarks. Digital calipers were then used to measure the distance between the CB and all landmarks. RESULTS AND DISCUSSION: The mean vertical distance from the laryngeal prominence (LP) to the CB was 25.14 mm for females and 36.13 mm for males. No CBs were located below the LP. Ninety-four percent of female CBs and 100% of male CBs were located above the LP, and 74% of female subjects and 87% of male subjects had CBs greater than 20.00 mm superior to the LP. No clinically relevant relationships were found between the CB and any of the other measured landmarks. CONCLUSIONS: Based on this cadaver sample, CPP below the level of the LP in a supine individual would be unlikely to compress the CB and thus unlikely to trigger the baroreflex or occlude the region of greatest atherosclerotic buildup. If a pulse is not palpable below the LP, moving vertically up to 1 cm above the LP in a supine individual would be likely to compress the CB in only a small number of cases.

Consumers of Mental Health Services: Their Knowledge, Attitudes, and Practices About High Energy Drinks and Drugs.

To date, whether individuals with mental illness use high energy drinks (HED) to offset their symptoms, or whether their use began after diagnosis or psychoactive drugs were prescribed is unknown. Their degree of knowledge regarding their symptoms, diagnosis, or what strategies they have used to feel better is also undetermined. A search of the literature yielded no studies about these areas or domains. The current article provides background information on caffeine and HED, with or without alcohol, and the use patterns of consumers of mental health services, as well as their attitudes and knowledge. Participants in the Network for Psychiatric Nursing Researchers, who were consumers, influenced the current study group to expand their thinking about how to address the unknown areas. Their related work and publication are described. [Journal of Psychosocial Nursing and Mental Health Services, 55(4), 37-43.].

Women's strategies to achieve access to healthcare in Ontario, Canada: a meta-synthesis.

As part of a mixed methods study on women's access to the healthcare system in Ontario, Canada, we undertook a qualitative meta-synthesis to better understand the contextual conditions under which women access healthcare. An earlier phase of the synthesis demonstrated a series of factors that complicate women's access to healthcare in Ontario. Here, we consider women's agency in responding to these factors. We used meta-study methods to synthesise findings from qualitative studies published between January 2002 and December 2010. Studies were identified by searches of numerous databases, including CINAHL, MEDLINE, Scopus, Gender Studies Database and LGBT Life. Inclusion criteria included use of a qualitative research design; published in a peer-reviewed journal during the specified time period; included a sample at least partially recruited in Ontario; included distinct findings for women participants; and in English language. Studies were included in the final sample after appraisals using a qualitative research appraisal tool. We found that women utilised a spectrum of responses to forces limiting access to healthcare: mobilising financial, social and interpersonal resources; living out shortfalls by making do, doing without, and emotional self-management; and avoiding illness and maintaining health. Across the studies, women described their efforts to overcome challenges to accessing healthcare. However, there were evident limits to women's agency and many of their strategies represented temporary measures rather than viable long-term solutions. While women can be resourceful and resilient in overcoming access disparities, systemic problems still need to be addressed. Women need to be involved in designing and implementing interventions to improve access to healthcare, and to address the root problems of these issues.

Beyond barriers in studying disparities in women's access to health services in Ontario, Canada: a qualitative metasynthesis.

Women live within complex and differing social, economic, and environmental circumstances that influence options to seek health care. In this article we report on a metasynthesis of qualitative research concerning access disparities for women in the Canadian province of Ontario, where there is a publicly funded health care system. We took a metastudy approach to analysis of results from 35 relevant qualitative articles to understand the conditions and conceptualizations of women's inequitable access to health care. The articles' authors attributed access disparities to myriad barriers. We focused our analysis on these barriers to understand the contributing social and political forces. We found that four major, sometimes countervailing, forces shaped access to health care: (a) contextual conditions, (b) constraints, (c) barriers, and (d) deterrents. Complex convergences of these forces acted to push, pull, obstruct, and/or repel women as they sought health care, resulting in different patterns of inequitable access.

Thinking about "Think Again" in Canada: assessing a social marketing HIV/AIDS prevention campaign.

The Canadian "Think Again" social marketing HIV/AIDS prevention campaign, adapted from an American effort, encourages gay men to rethink their assumptions about their partners' HIV statuses and the risks of unsafe sex with them. To improve future efforts, existing HIV/AIDS prevention initiatives require critical reflection. While a formal evaluation of this campaign has been carried out elsewhere, here we use the campaign as a social marketing case study to illustrate its strengths and weaknesses, as a learning tool for other campaigns. After describing the campaign and its key results, we assess how it utilized central tenets of the social marketing process, such as formative research and the marketing mix. We then speak to the importance of theoretical influence in campaign design and the need to account for social-contextual factors in safer sex decision making. We conclude with a summary of the lessons learned from the assessment of this campaign.

Triptans and the incidence of epithelial defects during laser in situ keratomileusis.

PURPOSE: To investigate whether the incidence of epithelial defects during laser in situ keratomileusis (LASIK) was different in patients who were taking sumatriptan (Imitrex, Glaxo Smith Kline, Pittsburgh, Pa) for migraine headaches than in those who were not. METHODS: A retrospective chart review was performed on 54 eyes of 28 patients who had been identified as taking sumatriptan and had undergone LASIK at Minnesota Eye Consultants between 1999 and 2001. These patients were compared with 54 gender- and age-matched control eyes operated on with the same microkeratome at the same location during the same period of time. The incidence of epithelial defects during LASIK was compared between the two groups. RESULTS: In the sumatriptan group, 11.1% (6 of 54) of eyes developed epithelial defects as compared to 9.3% (5 of 54) of eyes in the non-triptan group (P=.75, chi square). More recent sumatriptan exposure did not increase the incidence of epithelial defect (P=.47). In patients in whom sumatriptan was stopped >1 month prior to LASIK, 6.3% (1 of 16 eyes) had epithelial defects; in patients in whom sumatriptan was stopped <1 month prior to LASIK, 14.3% (4 of 28 eyes) developed epithelial defects; and 9.3% (5 of 54 eyes) of patients in whom no triptans had ever been used had epithelial defects (P=.70). CONCLUSIONS: There is no correlation between the use of sumatriptan for relief of migraine headaches and the generation of epithelial defects during LASIK. There appears to be no reason to stop triptans before proceeding with LASIK.

Changes in contrast sensitivity after Artisan lens implantation for high myopia.

PURPOSE: To determine the effects of Artisan lens implantation on contrast sensitivity. DESIGN: Prospective consecutive interventional case series. PARTICIPANTS AND CONTROLS: Forty-nine eyes of 30 patients with myopia and myopia with astigmatism, who underwent implantation of the Artisan iris-fixated phakic intraocular lens. Preoperative testing served as the control. INTERVENTION: Implantation of the Artisan phakic intraocular lens to correct myopia. MAIN OUTCOME MEASURES: Refractive predictability and Snellen visual acuity were evaluated preoperatively and at least 4 months postoperatively. Additionally, photopic and mesopic contrast sensitivities were measured at 1.5, 3, 6, 12, and 18 cycles per degree, with and without glare testing. RESULTS: The mean preoperative spherical equivalent (SE) was -12.16 diopters (D) (range, -6.88 to -18.00). The mean postoperative SE was -0.46+/-0.58 D (range, +0.50 to -1.75). Ninety percent of eyes were within 1.00 D of the predicted result, and 39% gained > or =1 lines of best-corrected visual acuity (BCVA). When compared with preoperative measurements, postoperative contrast sensitivity was increased under photopic conditions and slightly decreased under mesopic conditions. Adverse events were one wound leak requiring resuturing in the immediate postoperative period and one subluxed lens after significant blunt trauma. No eyes lost > or =2 lines of BCVA. CONCLUSIONS: Artisan implantation for the correction of high myopia seems to be a predictable procedure. Increases in photopic contrast sensitivity values after implantation of this phakic intraocular lens stand in distinction to the decreases in photopic contrast sensitivity previously reported after LASIK correction of this degree of myopia.