Recurrent lacrimal gland pleomorphic adenoma.

Pleomorphic adenoma is the most common tumour of the lacrimal gland. Correct preoperative diagnosis is essential as the tumour should be removed en bloc. Incisional biopsy is contraindicated due to risk of recurrence and subsequent risk of malignancy. We identified 13 patients who were diagnosed with lacrimal gland pleomorphic adenoma in our institution over a 31-year period from 1990 to 2021. Of these, we describe four patients, three males and one female, who underwent incisional biopsy. One of these patients had a number of recurrences and required an orbital exenteration. The other two were treated with radiation to the orbit and experienced severe dry eye post-radiotherapy. All three patients are currently disease-free. The fourth patient underwent an incisional biopsy of his lacrimal gland pleomorphic adenoma (LGPA) within the last 6 months and has been referred for radiotherapy. The reasons for a lack of preoperative diagnosis of LGPA included clinical uncertainty and broad radiologic differential. None of the patients who had an en bloc resection experienced recurrence. We recommend that a fine needle aspirate (FNA) biopsy in lieu of a tissue biopsy should be performed where LGPA is included in the clinical and radiological differential diagnosis. If incisional biopsy is required, the suture track should be marked so that the entire biopsy track is removed with the specimen.

Modelling the Relationship Between Resilience to Depression and Recent Stressful Life Events in University Students.

Resilience, or successful coping with the experience of stressful life events (SLEs), protects against depression, but its operational mechanisms are unclear. Views diverge whether resilience intervenes as a trait or as a process of dynamic interactions of protective factors, such as self-esteem, social support and family cohesion. We evaluated five theoretically-based models of how resilience, defined as either a trait or a process, interacts with recent SLEs, to explain depressive symptomatology in 2434 university students. The moderating effect of problematic, age-inappropriate parenting (i.e., helicopter parenting) was also assessed. SLEs moderated both the effects of trait and process resilience on depression, but models conceptualising resilience as a dynamic process of interacting components showed better explanatory power than models conceptualising resilience solely as a trait. Trait resilience was protective through self-esteem at all levels of SLEs exposure (low, mild, moderate or high), and significantly, but less so through hope or social support. Experiencing helicopter parenting weakened the protective influence of process resilience, through decreasing family cohesion in the presence of SLEs. The overall assessment of the five models supports a process conceptualisation of resilience to depression in the face of adversity. However, the results also suggest that not all protective factors are equally important, with self-esteem appearing a significant and strong mediator of resilience to depression in all models including it as a variable. Building process resilience is proposed as a key intervention target for depressive symptoms. Clinical assessments and interventions following SLEs should routinely consider both trait resilience and self-esteem, as the interaction of these two factors protects against depression even at the highest levels of adversity exposure. Depression prevention approaches should address the individual's experience of overparenting, given the deleterious influence of helicopter parenting on resilience.

Subepidermal Moisture and Pressure Injury in a Pediatric Population: A Prospective Observational Study.

PURPOSE: To describe relationships between subepidermal moisture (SEM) and visual skin assessment of pressure injury (PI) in children. DESIGN: Prospective descriptive study. SUBJECTS AND SETTING: Twenty-four participants aged 8 to 16 years recruited from a pediatric orthopedic unit in a children's hospital in Ireland. METHODS: Subepidermal moisture measured with the SEM scanner (Bruin Biometrics, Los Angeles, California) ranged from 0 to 7 picoFarads [pF], and visual observation of trunk and heels occurred daily for 3 days after admission to the unit and/or after surgery. Skin was assessed for discoloration categorized as blanchable erythema, stage 1 PI, or deep tissue injury (DTI). Any open wound PI was classified as stage 2, 3, 4, or unstageable. Demographic, medical, and pain data were collected. Chi-square test, t tests, analysis of variance, and regression were used to describe data and examine relationships. RESULTS: Participants were pediatric patients; 100% (n = 24) were white, 62% (n = 15) were female, 8 to 16 years of age (mean = 12.5 ± 2.5 years), and 29% (n = 7) had fractures and 71% (n = 17) surgery diagnoses. Blanchable erythema incidence was 21% (n = 5) and stage 1 PI incidence was 42% (n = 10); nearly all at heels. Deep tissue injury incidence was 4% (one sacral DTI). Stage 2 or greater PI incidence was 4% (one heel stage 2 PI). For skin that was assessed as normal in this pediatric population, SEM for trunk was 2.65 to 2.76 pF and for heels 2.37 to 2.41 pF. Subepidermal moisture for blanchable erythema and stage 1 PI was higher (range, 3.2-3.7 pF) and significant at trochanters and heels (left trochanter: P = .003; right trochanter: P = .02; right and left heels: P = .000). Nominal regression, controlling for participant and assessment day, showed SEM a predictor of erythema and stage 1 PI at heels. We also found that SEM was higher with pain (significant at sacrum and heels). CONCLUSIONS: In this pediatric population, SEM values over skin assessed as normal are lower than SEM values reported for normal skin in adults, 2.37 to 2.76 pF. Subepidermal moisture was significantly higher for blanchable erythema and stage 1 PI at trochanters and heels, and with the presence of pain at sacrum and heels. We recommend that SEM should be examined for detecting PIs in pediatric populations; SEM and pain should be explored in larger pediatric and adult populations.

Decision making on clinical care choices including end-of-life decision making for older adults in an acute care setting.

BACKGROUND: The Scottish Government's vision for older people is that 'Older people are valued as an asset; their voices are heard and they are supported to enjoy full and positive lives.' In the health and social care setting in Scotland it is increasingly recognised that there is a need for careful planning of care for older patients with complex comorbidities, and that this should involve the patient where possible via a process of shared decision making (SDM). AIM: To establish what future planning for healthcare decision making and end-of-life care was undertaken in the care of the older patients in a secondary care facility, and how much they participate in this process. METHOD: An audit was conducted across four wards in the care of the older patient setting in a hospital for older patients in Scotland. Over a 2-week period, all patients' charts (n = 82) were reviewed, and evidence was examined on whether the following documents were in place: a do not resuscitate order; an escalation of medical care plan; and an assessment of capacity/incapacity. RESULTS: The majority of patients (55%) had a resuscitation plan in place. An Incapacity Statement was also in place for the majority of patients who required it (90%). The escalation of medical care plan was only completed for a minority of patients, mainly those on the palliative care ward. CONCLUSION: Plans for decision making around resuscitation were reasonably well developed. However, planning for other, more complex, future medical care needs was less well defined or explored with older patients.

Can Resistance Training Improve Upper Limb Postural Tremor, Force Steadiness and Dexterity in Older Adults? A Systematic Review.

BACKGROUND: The ageing process and several health conditions may increase tremor and reduce force steadiness and dexterity, which can severely impact on function and quality of life. Resistance training can evoke a range of neuromuscular adaptions that may significantly reduce tremor and/or increase force steadiness and/or dexterity in older adults, irrespective of their health condition. OBJECTIVES: The objective of this study was to systematically review the literature to determine if a minimum of 4 weeks' resistance training can reduce postural tremor and improve force steadiness and/or dexterity in older adults, defined as aged 65 years and over. METHODS: An electronic search using Ovid, CINAHL, SPORTDiscus and EMBASE was performed. Risk of bias was assessed using the Cochrane Risk of Bias Tool. RESULTS: Fourteen studies met the eligibility criteria, including six randomised controlled trials and two quasi-randomised controlled trials. All eight studies that recruited healthy older adults reported significant reductions in postural tremor and/or improvements in force steadiness and dexterity. Five out of seven studies that examined older adults with a particular health condition reported some improvements in force steadiness and/or dexterity. Specifically, significant benefits were observed for older adults with chronic obstructive pulmonary disease and essential tremor; however, small or no changes were observed for individuals with osteoarthritis or stroke. CONCLUSIONS: Resistance training is a non-pharmacological treatment that can reduce tremor and improve force steadiness and dexterity in a variety of older adult populations. Future research should employ randomised controlled trials with larger sample sizes, better describe training programme methods, and align exercise prescription to current recommendations for older adults.