Navigating the Healthcare Conundrum: Leadership Perspective from a Premier Healthcare Organization in Loma Linda's Blue Zone.

Navigating the healthcare conundrum in the Blue Zone of Loma Linda, California, requires understanding the unique factors that make this region stand out in terms of health and longevity. But more important is understanding the healthcare system sustaining the Blue Zone in Loma Linda, California. In an era marked by soaring healthcare costs and diminishing reimbursement rates, hospitals and physicians face an unprecedented challenge: providing excellent patient care while maintaining financial sustainability. This leadership perspective publication paper delves into the multifaceted struggles encountered by healthcare and hospital leaders, exploring the root causes, implications, and potential solutions for this complex issue. As we examine the evolving healthcare landscape, we aim to shed light on the critical need for innovative approaches to sustain the future of healthcare excellence in one of the five original Blue Zones.

Improvement in Glycemic and Lipid Profiles in Type 2 Diabetics with a 90-Day Ketogenic Diet.

Because low-carbohydrate diets are effective strategies to improve insulin resistance, the hallmark of type 2 diabetes, the purpose of reporting these clinical cases was to reveal the meaningful changes observed in 90 days of low-carbohydrate (LC) ketogenic dietary intervention in female type 2 diabetics aged 18-45. Eleven women (BMI 36.3 kg/m2) who were recently diagnosed with type 2 diabetes based on HbA1c over 6.5% (8.9%) volunteered to participate in an intensive dietary intervention to limit dietary carbohydrates to under 30 grams daily for 90 days. The main outcome was to determine the degree of change in HbA1c, while secondary outcomes included body weight, blood pressure, and blood lipids. The volunteers lost significant weight (85.7 ± 3.2 kg to 76.7 ± 2.8 kg) and lowered systolic (134.0 ± 1.6 to 123.3 ± 1.1 mmHg) and diastolic (89.9 ± 1.3 to 82.6 ± 1.0 mmHg) blood pressure. HbA1c dropped to 5.6%. Most blood lipids were significantly altered, including HDL cholesterol (43.1 ± 4.4 to 52.3 ± 3.3 mg/dl), triglycerides (177.0 ± 19.8 to 92.1 ± 8.7 mg/dl), and the TG : HDL ratio (4.7 ± 0.8 to 1.9 ± 0.2). LDL cholesterol was not significantly different. AST and ALT, plasma markers of liver health, were reported for eight patients and revealed no significant changes. These findings indicate that a short-term intervention emphasizing protein and fat at the expense of dietary carbohydrate functionally reversed the diabetes diagnosis, as defined by HbA1c. Furthermore, the intervention lowered body weight and blood pressure, while eliciting favorable changes in blood lipids.

Use of x-ray film implant for the repair of orbital fractures.

PURPOSE: To evaluate the experience with sterilized x-ray film in the repair of orbital blow-out fractures (BOFs). METHODS: A retrospective review of case notes from 56 patients with orbital BOF repaired using sterilized x-ray film onlay implants at 2 institutions between November 2004 and December 2010. Patient demographics, timing of surgery, surgical approach, postoperative complications, and length of follow up were recorded. RESULTS: Fifty-six patients (44 men, 12 women) received sterilized x-ray film implants during the 6-year study period. Mean age at the time of repair was 29 years (range 4-85 years). For 68% of patients, surgical repair was performed within 2 weeks of injury. Average length of postoperative follow up was 5.5 months (range 1-36 months), 48% had follow up >3 months. Following surgical repair, diplopia in primary or down gaze reduced from 98% to 4% and enophthalmos ≥2 mm reduced from 21% to 5% cases. One patient required a second operation for repositioning of an incompletely reduced fracture. A second patient presented 9 months postoperatively with recurrent episodes of proptosis, and the implant and its surrounding pseudocapsule were subsequently removed. There were no cases of visual loss, implant infection, or migration. CONCLUSIONS: This series has demonstrated that in selected orbital fractures sterilized x-ray film can provide a safe, effective, and low-cost onlay implant.

Renal cell carcinoma metastasis masquerading as recurrent orbital haematoma.

A 70 year old man developed orbital haemorrhage after retrobulbar anaesthesia for cataract surgery and biopsy of a persistent lateral rectus mass suggested organising haematoma. Subsequent progression of the mass was shown, on repeated biopsy, to be due to metastatic renal cell carcinoma--a tumour recognised for its angiogenic and haemorrhagic potential.

Early response to intravenous glucocorticoids for severe thyroid-associated ophthalmopathy predicts treatment outcome.

BACKGROUND/AIMS: The results for 18 consecutive patients with severe thyroid-associated ophthalmopathy (TAO) treated with high-dose, pulsed intravenous methylprednisolone (MP) are presented in this paper. METHODS: Eighteen (18) patients with severe TAO, defined as either optic neuropathy, progressive diplopia, or severe soft-tissue swelling accompanied by evidence of NOSPECS class 2b or more severe eye disease, were studied in a prospective, noncontrolled case series. Patients were treated with 1.5 g of intravenous MP, divided over 3 days, followed by a tapering course of oral prednisolone. All patients were examined before treatment, 1 week and 1 month after commencement of treatment and at 2-3 monthly intervals thereafter. Assessment of visual acuity, differential intraocular pressure (IOP), soft-tissue inflammation, diplopia, and exophthalmometry were used to calculate a modified ophthalmopathy index (OI) for each patient at each visit. Median duration of follow-up was 14 months. RESULTS: A statistically significant reduction in OI following treatment with high-dose MP was observed after 1 week of treatment from 10.8 +/- 3.9 standard deviation (SD) to 8.3 +/- 3.4 (SD) (P < 0.001) and between 1 week and the end of the treatment period (OI, 7.2 +/- 3.4 (SD); P < 0.05). A response occurred in 83% of patients within a week but only 66% maintained this response. There was a significant negative correlation between response to treatment (OI before treatment-OI after treatment) and duration of eye disease (P = 0.034, Spearman correlation). CONCLUSIONS: High-dose, pulsed intravenous MP is an effective medical treatment for severe TAO. Responders can be identified within the 1st week. Treatment response is inversely related to disease duration.

Secondary orbital implants after evisceration: a new conjunctiva-sparing technique.

PURPOSE: To describe a new conjunctiva-sparing technique for secondary orbital implantation after evisceration. METHODS: Two patients with conjunctival cicatrization and a volume-deficient anophthalmic socket had implantation of an intraconal biointegratable implant. This was placed through a lateral canthal approach, after temporary disinsertion of the lateral rectus, thereby avoiding further injury to the conjunctiva. RESULTS: A good surgical outcome was achieved in both patients. There were no intraoperative or postoperative complications, and both have remained stable for nearly 2 years. CONCLUSIONS: Secondary intraconal implantation through the lateral canthal approach is safe and effective and suitable for patients in whom it is desirable to avoid a conjunctival incision.

Arthur Thomas Paterson: the life and times of a New Zealand ophthalmologist.

Arthur Thomas Paterson was a pre-eminent New Zealand ophthalmologist who settled in the United Kingdom after the First World War and became a leading figure in the development of ophthalmic services in the north-east of England. This vignette explores his contributions to clinical education and the establishment of comprehensive ophthalmic services in Newcastle upon Tyne. It also highlights the Arthur Thomas Paterson scholarship bequest to enable New Zealand ophthalmologists to acquire additional specialist training in inter-national centres of excellence.

Loss of vision caused by expansion of intraocular perfluoropropane (C(3)F(8)) gas during nitrous oxide anesthesia.

PURPOSE: To report visual loss associated with nitrous oxide anesthesia in patients with intraocular perfluoropropane (C(3)F(8)) gas. DESIGN: Observational case series. METHODS: Three patients are described who lost vision in the eye with intraocular gas after subsequent nitrous oxide general anesthesia. RESULTS: Three patients, aged 75, 80, and 73 years, with intraocular C(3)F(8) gas in three eyes underwent nitrous oxide general anesthesia in three different medical centers for conditions unrelated to their ophthalmic surgery, ranging from 10 days to 1 month after their vitreoretinal procedure. All three patients suffered visual loss due to presumed central retinal artery occlusion caused by expansion of the intraocular gas by nitrous oxide during general anesthesia. In two patients, there was no recovery of light perception. In one patient, there was moderate recovery of vision. CONCLUSIONS: Identification of patients with intraocular gas is critical when planning nitrous oxide anesthesia. This may be achieved by the use of a simple intraocular gas identification bracelet issued to patients at the time of their vitreoretinal procedure.