Peri-orbital surgical emphysema following endoscopic dacryocystorhinostomy.

BACKGROUND: Peri-orbital surgical emphysema is a rare complication that can occur after lacrimal surgery. It has only been described in isolated cases, following external dacryocystorhinostomy (n = 2) and Lester Jones tube insertion (n = 1). METHOD: A retrospective, non-comparative case series was conducted of patients who developed surgical emphysema following endoscopic dacryocystorhinostomy. RESULTS: A total of 356 endoscopic dacryocystorhinostomy cases (primary, n = 316; revision, n = 40) were performed over a six-year period. Seven cases of post-operative surgical emphysema were identified, all of which were preceded by uncontrolled sneezing, nose-blowing or coughing within the first week of surgery. The occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy in our centre was 7 in 356, or 2 per cent, over six years. CONCLUSION: This is the first study to report the occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy. Clinicians may wish to suggest patients stifle the aforementioned triggers within the first week to reduce the potential for surgical emphysema.

Acquired lacrimal sac fistula mimicking basal cell carcinoma.

BACKGROUND: Lacrimal sac fistulae can arise after an episode of dacryocystitis, usually forming below the medial canthus. Preceding symptoms of a watery eye with mucous discharge and a history or signs of inflammation are typical. OBJECTIVES: To highlight the features of lacrimal sac fistulae and encourage readers to consider this in the differential diagnosis of apparently ulcerative medial canthal skin lesions. METHODS: We describe three patients with inferior-medial canthal ulcerative skin lesions, all referred to ophthalmic plastic surgeons either by dermatologists or plastic surgeons, presumed clinically to have basal cell carcinoma (BCC). RESULTS: All three were in fact due to acquired lacrimal sac fistulae, and syringing of the nasolacrimal system confirmed the presence of a fistula. CONCLUSIONS: These cases illustrate the importance of questioning patients about their previous ocular symptoms when dealing with less familiar periocular lesions.

Measurement error in performance studies of health information technology: lessons from the management literature.

Just as researchers and clinicians struggle to pin down the benefits attendant to health information technology (IT), management scholars have long labored to identify the performance effects arising from new technologies and from other organizational innovations, namely the reorganization of work and the devolution of decision-making authority. This paper applies lessons from that literature to theorize the likely sources of measurement error that yield the weak statistical relationship between measures of health IT and various performance outcomes. In so doing, it complements the evaluation literature's more conceptual examination of health IT's limited performance impact. The paper focuses on seven issues, in particular, that likely bias downward the estimated performance effects of health IT. They are 1.) negative self-selection, 2.) omitted or unobserved variables, 3.) mis-measured contextual variables, 4.) mismeasured health IT variables, 5.) lack of attention to the specific stage of the adoption-to-use continuum being examined, 6.) too short of a time horizon, and 7.) inappropriate units-of-analysis. The authors offer ways to counter these challenges. Looking forward more broadly, they suggest that researchers take an organizationally-grounded approach that privileges internal validity over generalizability. This focus on statistical and empirical issues in health IT-performance studies should be complemented by a focus on theoretical issues, in particular, the ways that health IT creates value and apportions it to various stakeholders.

Drivers and barriers in health IT adoption: a proposed framework.

Despite near (and rare) consensus that the adoption and diffusion of health information technology (health IT) will bolster outcomes for organizations, individuals, and the healthcare system as a whole, there has been surprisingly little consideration of the structures and processes within organizations that might drive the adoption and effective use of the technology. Management research provides a useful lens through which to analyze both the determinants of investment and the benefits that can ultimately be derived from these investments. This paper provides a conceptual framework for understanding health IT adoption. In doing so, this paper highlights specific organizational barriers or enablers at different stages of the adoption process - investment, implementation, and use - and at different levels of organizational decision-making - strategic, operational, and frontline. This framework will aid both policymakers and organizational actors as they make sense of the transition from paper-based to electronic systems.

Rethinking work and family policy: the making and taking of parental leave in Australia.

Despite the continued increase in female participation rates, Australia remains one of only two developed nations in the world without a paid maternity leave scheme. While research interest and public policy debate about paid maternity leave entitlements continues, little is known about the actual utilization of the 52 weeks unpaid parental leave that is currently available to all employees. Moreover, research and policy debate on the availability and provision of paid paternity leave has only just begun. This paper argues that, given the gendered nature of employee entitlements, it is time to re-evaluate all aspects of parental leave policy in Australia. Using unique data from a national survey of Australian employees, the paper provides a statistical analysis of the use of unpaid parental leave and the availability of paid maternity leave. The paper models the availability of paid maternity leave to Australian employees as a function of demographic and organizational characteristics, including annual income, union status, and establishment size. A parallel analysis of the likelihood that an individual has used the unpaid parental leave provision is also provided. The results show that the existing unpaid parental leave provision is rarely used and that the current availability of paid maternity leave is inequitable. The paper discusses the conceptual and policy implications of these results and concludes that a re-thinking of parental leave policy in Australia is essential if gender inequities at work and in society are to be addressed.

Affluence is not related to delay in diagnosis of Type 2 diabetes as judged by the development of diabetic retinopathy.

AIM: To determine the relationship between affluence and the presence of diabetic retinopathy at time of diagnosis of Type 2 diabetes. METHODS: Records of patients held by Southampton Retinal Screening Programme were examined. Patients (n = 1844) newly diagnosed with Type 2 diabetes and subsequently receiving photographic retinal screening within 24 months were selected. Townsend scores for social deprivation were calculated and the patients with and without retinopathy at first screening were then compared. RESULTS: No significant difference was found in the median Townsend score of those people with (-0.2, interquartile range (IQR) -3.7 to 3.8) and those without (-0.5, IQR -3.3 to 3.6) diabetic retinopathy at first screening after diagnosis of Type 2 diabetes (P = 0.6). CONCLUSION: The relative affluence of the area in which a person lives, as judged by postcode, does not appear to predict likelihood of diabetic retinopathy at diagnosis of Type 2 diabetes.