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1.
Retin Cases Brief Rep ; 16(3): 285-288, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32032289

RESUMO

PURPOSE: To report the first two observations of bilateral paracentral acute middle maculopathy in the early postoperative period after cardiopulmonary bypass procedures. METHODS: Comprehensive ophthalmic examinations were performed, including best-corrected visual acuity, Humphrey visual field testing, dilated fundus examination, and optical coherence tomography. RESULTS: Two patients complained of unilateral vision loss after cardiac surgery involving cardiopulmonary bypass. Unilateral optic disc edema consistent with ischemic optic neuropathy was observed in the symptomatic eye of each patient, whereas scattered cotton-wool spots were identified bilaterally. In addition, optical coherence tomography imaging revealed bilateral paracentral acute middle maculopathy, correlating with visual field defects detected on automated perimetry in the asymptomatic eyes. CONCLUSION: Although symptomatic postoperative vision loss is a rare complication of cardiac surgery, intraoperative retinal microvascular nonperfusion as a consequence of extracorporeal circulation of blood may be a more common and under-recognized occurrence.


Assuntos
Degeneração Macular , Papiledema , Doenças Retinianas , Ponte Cardiopulmonar/efeitos adversos , Angiofluoresceinografia/métodos , Fundo de Olho , Humanos , Papiledema/diagnóstico , Doenças Retinianas/diagnóstico , Doenças Retinianas/etiologia , Tomografia de Coerência Óptica/métodos , Transtornos da Visão/complicações
2.
Am J Ophthalmol ; 233: 48-56, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34303687

RESUMO

PURPOSE: Many clinicians treat unilateral amblyopia with glasses alone and initiate patching when needed; others start glasses and patching simultaneously. In this study, we reviewed the outcomes of the two approaches at our institution. DESIGN: Retrospective nonrandomized clinical trial. METHODS: Setting: Institutional practice. PATIENT POPULATION: All patients diagnosed with amblyopia at Boston Children's Hospital between 2010 and 2014. INCLUSION CRITERIA: Unilateral amblyopia (visual acuity (VA) 20/40 to 20/200 with interocular difference ≥3 lines,) age 3 to 12 years, with a 6-month follow-up visit. EXCLUSION CRITERIA: Deprivation amblyopia, prior amblyopia treatment, treatment other than patching, surgery. Patients were categorized as "simultaneous treatment" (concurrent glasses and patching therapy at their first visit) or "sequential treatment" (glasses alone at first visit, followed by patching therapy at second visit.) Observation procedures: Patient demographics, VA, and stereopsis were compared. OUTCOME MEASURES: VA and stereopsis at the last visit on treatment. RESULTS: We identified 98 patients who met inclusion criteria: 36 received simultaneous treatment and 62 sequential treatment. Median amblyopic eye VA improved similarly between the simultaneous (∆0.40; interquartile range [IQR], 0.56-0.30 logMAR) and sequential (∆0.40; IQR, 0.52-0.27 logMAR) groups. Patients without stereopsis at first visit had better stereopsis outcomes with sequential treatment (5.12 [IQR, 4.00-7.51] log stereopsis) compared with simultaneous treatment (8.01 [IQR, 5.65-9.21]) log stereopsis, P = 0.046). CONCLUSIONS: VA improved approximately 4 lines regardless of treatment type. For children without stereopsis at first presentation, sequential patching yielded better stereopsis outcomes. These findings require further validation and highlight the importance of evaluating stereopsis in future studies.


Assuntos
Ambliopia , Ambliopia/terapia , Criança , Pré-Escolar , Seguimentos , Humanos , Estudos Retrospectivos , Privação Sensorial , Resultado do Tratamento , Visão Binocular
3.
Indian J Ophthalmol ; 69(10): 2859-2861, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34571651

RESUMO

The force required for trocar insertion in hypotonous eyes can cause significant deformation of the globe and result in an iatrogenic injury to the lens, posterior capsule, or retina from the sharp trocar tip. We developed a device designed to stabilize the globe and provide counterpressure without significant globe deformation during trocar insertion. Our novel device was modeled using computer-aided design software, three-dimensional (3D) printed, and validated in an ex vivo porcine model. The risk of trocar-retinal touch was evaluated by comparing the distance between the trocar tip and opposing retina with either a cotton swab or our 3D printed device. We found an increased distance between the retina and trocar tip at the time of trocar insertion using our novel device: 3.3 ± 1.3 mm (P = 0.035), suggesting an improved safety margin. This device has the potential to improve the safety of trocar insertion in eyes at risk of trocar-associated injury, including hypotonous, previously vitrectomized, and nanophthalmic eyes.


Assuntos
Instrumentos Cirúrgicos , Animais , Suínos
4.
Br J Ophthalmol ; 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389548

RESUMO

BACKGROUND/AIMS: Neonatal insults from systemic diseases have been implicated in the pathway of impaired neurodevelopment in preterm infants. We aimed to investigate the associations between systemic health factors and retinal nerve fibre layer (RNFL) thickness in preterm infants. METHODS: We prospectively enrolled infants and imaged both eyes at 36±1 weeks postmenstrual age (PMA) using a hand-held optical coherence tomography system at the bedside in the Duke intensive care nurseries. We evaluated associations between RNFL thickness and 29 systemic health factors using univariable and multivariable regression models. RESULTS: 83 infants with RNFL thickness measures were included in this study. Based on the multivariable model, RNFL thickness was positively associated with infant weight at imaging and was negatively associated with sepsis/necrotising enterocolitis (NEC). RNFL thickness was 10.4 µm (95% CI -15.9 to -4.9) lower in infants with than without sepsis/NEC in the univariable analysis (p<0.001). This difference remained statistically significant after adjustment for confounding variables in various combinations (birth weight, birthweight percentile, gestational age, infant weight at imaging and growth velocity). A 250 g increase in infant weight at imaging was associated with a 3.1 µm (95% CI 2.1 to 4.2) increase in RNFL thickness in the univariable analysis (p<0.001). CONCLUSIONS: Low infant weight and sepsis/NEC were independently associated with thinner RNFL in preterm infants at 36 weeks PMA. To our knowledge, this study is the first to suggest that sepsis/NEC may affect retinal neurodevelopment. Future longitudinal studies are needed to investigate this relationship further.

5.
Am J Ophthalmol ; 230: 200-206, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33992614

RESUMO

PURPOSE: To identify demographic and disease-related characteristics predictive of Lost-to-Follow-Up (LTFU) status in amblyopia treatment and create a risk model for predicting LTFU status. DESIGN: Retrospective cohort study METHODS: Setting: Single-center, ophthalmology department at Boston Children's Hospital (BCH). PATIENTS: 2037 patients treated for amblyopia at BCH between 2010 and 2014. OBSERVATION PROCEDURE: LTFU was defined as patients who did not return after initial visit, excluding those who came for second opinion. Multiple variables were tested for association with LTFU status. OUTCOME MEASURE: Odds ratio of LTFU risk associated with each variable. Multivariate logistic regression was used to create a risk score for predicting LTFU status. RESULTS: A large proportion of patients (23%) were LTFU after first visit. Older age, nonwhite race, lack of insurance, previous glasses or atropine treatment, and longer requested follow-up intervals were independent predictors of LTFU status. A multivariable risk score was created to predict probability of LTFU (area under the curve 0.68). CONCLUSIONS: Our comprehensive amblyopia database allows us to predict which patients are more likely to be LTFU after baseline visit and develop strategies to mitigate these effects. These findings may help with practice efficiency and improve patient outcomes in the future by transitioning these analyses to an electronic medical record that could be programmed to provide continually updated decision support for individual patients based on large data sets.


Assuntos
Ambliopia , Idoso , Ambliopia/diagnóstico , Ambliopia/terapia , Criança , Seguimentos , Humanos , Modelos Logísticos , Perda de Seguimento , Estudos Retrospectivos
6.
J AAPOS ; 25(2): 128-131, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33737053

RESUMO

Fundus manifestations of primary hyperoxaluria include crystalline deposits, focal or diffuse macular hyperpigmentation, and subretinal fibrosis. Choroidal neovascularization has been hypothesized to underlie the pathogenesis of subretinal fibrosis, yet its manifestations are rarely observed. We report a case of infantile primary hyperoxaluria type 1 in a 17-month-old infant with macular subretinal fluid and subretinal hemorrhage that was associated with leakage on fluorescein angiography and responded to bevacizumab treatment, consistent with choroidal neovascularization. This case suggests that choroidal neovascularization may contribute to subretinal fibrosis and subsequent vision loss in infantile primary hyperoxaluria and may benefit from anti-vascular endothelial growth factor therapy.


Assuntos
Neovascularização de Coroide , Hiperoxalúria Primária , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/etiologia , Angiofluoresceinografia , Humanos , Hiperoxalúria Primária/tratamento farmacológico , Lactente , Injeções Intravítreas , Tomografia de Coerência Óptica , Acuidade Visual
7.
Ophthalmol Retina ; 5(4): 374-380, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32810681

RESUMO

PURPOSE: When the International Classification of Diseases 9th Revision (ICD-9) transitioned to the International Classification of Diseases 10th Revision (ICD-10), there was a marked increase in the complexity of International Classification of Diseases (ICD) codes with potential for improved specificity in clinical database research. The purpose of this study was to characterize the accuracy of coding for stage of diabetic retinopathy (DR) and DR-related complications (including vitreous hemorrhage, retinal detachment, and neovascular glaucoma) during this transition. DESIGN: Retrospective chart review of 3 time periods corresponding to the use of ICD-9: 2014-2015; "early" use of ICD-10, 2015-2016; and "late" use of ICD-10, 2018-2019. PARTICIPANTS: Patients aged 18 years or older with a diagnosis of DR at a multispecialty academic institution. METHODS: Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, and kappa (κ) statistics were generated for each diagnosis. Generalized estimating equation (GEE) models were used to assess the significance of the variables. MAIN OUTCOME MEASURE: The main outcome was the proportion of agreement between the ICD code and the documented chart standard for stage of DR and DR-related complications. RESULTS: A total of 600 patients were included in the study (average age, 61 years; range, 25-93 years). Overall, there was substantial agreement between the ICD codes for stage of DR and the documented standard (κ = 0.66). The proportion of ICD codes in agreement with the documented standard diagnosis increased with time: 66.5%, 78.5%, and 83.3% for ICD-9, "early" ICD-10, and "late" ICD-10, respectively. The odds of agreement were 2.67 (95% confidence interval [CI], 1.49-4.76, P < 0.001) and 3.96 (95% CI, 2.34-6.69, P < 0.0001) times greater for "early" and "late" ICD-10 codes compared with ICD-9 codes, respectively. For specific codes, the overall PPV, NPV, sensitivity, and specificity for nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) were excellent (>90%). The odds of agreement were 19.70 (95% CI, 11.54-33.64, P < 0.0001) times greater for PDR than NPDR. Compared with the stage of DR, DR-related diagnoses were overall less accurately coded (κ = 0.61, 0.48, and 0.52 for vitreous hemorrhage, retinal detachment, and neovascular glaucoma, respectively). CONCLUSIONS: Coding in ICD-10 is more accurate than in ICD-9, particularly for PDR compared with NPDR. The increased accuracy emphasizes the potential for ICD-10 coding to be used effectively in database research.


Assuntos
Retinopatia Diabética/classificação , Glaucoma Neovascular/etiologia , Descolamento Retiniano/etiologia , Hemorragia Vítrea/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Retinopatia Diabética/diagnóstico , Feminino , Seguimentos , Glaucoma Neovascular/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Descolamento Retiniano/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Hemorragia Vítrea/diagnóstico
8.
J AAPOS ; 24(5): 299-301, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32890735

RESUMO

Press Ganey patient satisfaction scores are increasingly being used as a physician quality metric. In this retrospective review of over 25,000 patient surveys for 61 ophthalmologists, pediatric ophthalmologists and neuro-ophthalmologists received significantly lower patient satisfaction scores than their peers, suggesting that the problem for which a patient seeks care may affect whether he or she is satisfied with the care received. These findings should be taken into account when considering the validity of Press Ganey scores as an equitable, modifiable measure of physician performance, especially when considering factoring these scores into physician evaluation and reimbursement.


Assuntos
Oftalmologia , Médicos , Criança , Demografia , Feminino , Humanos , Masculino , Satisfação do Paciente , Estudos Retrospectivos , Inquéritos e Questionários
11.
Am J Ophthalmol ; 211: 87-93, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31712066

RESUMO

PURPOSE: Many bilateral amblyopia patients have asymmetric visual acuity (VA). There is no standard treatment for these patients, and outcomes have not been well described. Our goal is to compare VA outcomes in this group based on timing of occlusion therapy. DESIGN: Retrospective interventional comparative case series. METHODS: Setting: Institutional practice. PatientPopulation: Patients diagnosed with amblyopia at Boston Children's Hospital between 2010 and 2014. InclusionCriteria: VA ≥ 0.3 logMAR bilaterally by objective optotype-based measures, interocular difference (IOD) ≥ 0.18 logMAR, age 2-12 years. ExclusionCriteria: Loss to follow-up, managed surgically, deprivation amblyopia. Patients had either primary or secondary occlusion (primary = initiated when VA ≥ 0.3 logMAR bilaterally; secondary = initiated to correct residual IOD once VA improved to ≤0.18 logMAR in the stronger eye). ObservationProcedure: Patient demographics, VA, IOD, and stereopsis were compared between groups. OutcomeMeasures: VA improvement at 12-18 months and at last visits. RESULTS: Of 2,200 patients reviewed, 167 (7.6%) had asymmetric, bilateral amblyopia; 98 met inclusion and exclusion criteria. Patients were equally divided between primary (n = 50) and secondary (n = 48) occlusion groups. There were no differences in demographics, baseline VA, or IOD between groups (P ≥ .22), although the primary occlusion group had a higher proportion of strabismic amblyopia (P = .007). VA in both eyes, IOD, and stereopsis improved similarly between groups, even after stratifying by amblyopia subtype (P ≥ .48). The secondary occlusion group was more likely to achieve 20/30 bilaterally and IOD ≤ 1 line at 12-18 months (P ≤ .4), although this equalized by the last visit. CONCLUSION: In patients with asymmetric, bilateral amblyopia, VA improved by 4 lines in the weaker eye and 2 lines in the stronger eye, while IOD improved by 2 lines, irrespective of occlusion status. Primary occlusion thus provided no further benefit over spectacle correction alone.


Assuntos
Ambliopia/terapia , Privação Sensorial , Oclusão Terapêutica , Acuidade Visual/fisiologia , Ambliopia/fisiopatologia , Criança , Pré-Escolar , Percepção de Profundidade/fisiologia , Óculos , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Visão Binocular/fisiologia
12.
Am J Ophthalmol ; 195: 171-175, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30098349

RESUMO

PURPOSE: To describe a phenomenon, depression in attempted abduction, not previously recognized as a feature of Duane syndrome (DS). DESIGN: Retrospective, observational case series. METHODS: Setting: Institutional practice. PATIENT POPULATION: Patients diagnosed with esotropic DS at Boston Children's Hospital from 2002 to 2015. Patients with clinical photographs documenting horizontal gaze were included. Patients with prior strabismus surgery were excluded. OBSERVATION PROCEDURES: Patients were classified into 3 groups according to their vertical eye position in attempted abduction: midline group, depression group, and elevation group. Group assignment was performed by 3 independent ophthalmologists. Baseline characteristics, eye movement, and ocular deviation were compared among the 3 groups. MAIN OUTCOME MEASURES: Horizontal and vertical deviation on attempted abduction in the DS eye. RESULTS: Depression in attempted abduction was present in 74 of 113 unilateral patients (66%) and 18 of 42 gradable eyes (43%) of bilateral patients. Abduction limitation was significantly less severe in the midline group (median: -3.0) than in the depression group (median: -4.0) (P = .01). Vertical deviation in attempted abduction was more severe in the elevation group than in the depression group (P = .003). CONCLUSIONS: Depression of the eye in attempted abduction has not been widely described, yet it is present in the majority of DS patients. It is more likely to occur with more severe abduction limitation. This phenomenon is likely another form of dysinnervation in DS, the result either of anomalous vertical rectus muscle activation or asymmetric lateral rectus muscle innervation during attempted abduction. Awareness of vertical deviation in attempted abduction may facilitate surgical planning in affected patients.


Assuntos
Síndrome da Retração Ocular/diagnóstico , Esotropia/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Técnicas de Diagnóstico Oftalmológico , Síndrome da Retração Ocular/cirurgia , Esotropia/cirurgia , Movimentos Oculares , Feminino , Humanos , Lactente , Masculino , Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Visão Binocular/fisiologia , Acuidade Visual
13.
Invest Ophthalmol Vis Sci ; 58(4): 2388-2396, 2017 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-28437527

RESUMO

Purpose: To spatially and temporally define ocular motor nerve development in the presence and absence of extraocular muscles (EOMs). Methods: Myf5cre mice, which in the homozygous state lack EOMs, were crossed to an IslMN:GFP reporter line to fluorescently label motor neuron cell bodies and axons. Embryonic day (E) 11.5 to E15.5 wild-type and Myf5cre/cre:IslMN:GFP whole mount embryos and dissected orbits were imaged by confocal microscopy to visualize the developing oculomotor, trochlear, and abducens nerves in the presence and absence of EOMs. E11.5 and E18.5 brainstems were serially sectioned and stained for Islet1 to determine the fate of ocular motor neurons. Results: At E11.5, all three ocular motor nerves in mutant embryos approached the orbit with a trajectory similar to that of wild-type. Subsequently, while wild-type nerves send terminal branches that contact target EOMs in a stereotypical pattern, the Myf5cre/cre ocular motor nerves failed to form terminal branches, regressed, and by E18.5 two-thirds of their corresponding motor neurons died. Comparisons between mutant and wild-type embryos revealed novel aspects of trochlear and oculomotor nerve development. Conclusions: We delineated mouse ocular motor nerve spatial and temporal development in unprecedented detail. Moreover, we found that EOMs are not necessary for initial outgrowth and guidance of ocular motor axons from the brainstem to the orbit but are required for their terminal branching and survival. These data suggest that intermediate targets in the mesenchyme provide cues necessary for appropriate targeting of ocular motor axons to the orbit, while EOM cues are responsible for terminal branching and motor neuron survival.


Assuntos
Movimentos Oculares/fisiologia , Músculos Oculomotores/embriologia , Nervo Oculomotor/embriologia , Animais , Axônios/fisiologia , Camundongos , Microscopia Confocal , Modelos Animais , Neurônios Motores/fisiologia , Músculos Oculomotores/inervação , Nervo Oculomotor/fisiologia
14.
Otol Neurotol ; 38(4): 572-576, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28114180

RESUMO

OBJECTIVE: Contemporary guidelines advise facial nerve (FN) decompression within 2 weeks of temporal bone trauma if a single electroneuronography (ENoG) demonstrates more than 90% degeneration of the FN. We report a case series demonstrating the potential of serial ENoG to guide FN management more than 2 weeks following injury. PATIENTS: Adults with traumatic temporal bone fractures and resultant ipsilateral FN paresis. INTERVENTION: Serial ENoG followed by observation or decompression of the FN. MAIN OUTCOME MEASURE: House-Brackmann (HB) graded FN function. RESULTS: Nine cases of blunt temporal bone trauma resulting in ispilateral FN paralysis were identified and reviewed. Two patients were women, and average age at the time of trauma was 30 years (range, 17-52). Immediate paralysis occurred in four cases, while five were delayed. A single ENoG was performed in seven patients and was predictive of final function in six, while one patient had an initially reassuring ENoG but did not obtain full recovery of FN function (HB 4). Two patients underwent serial ENoG on a weekly basis which, while initially reassuring, demonstrated declining FN function on subsequent testing. Decompression was performed in both patients with excellent recovery of FN function (HB1 and HB2). CONCLUSIONS: The majority of ENoGs performed within 2 weeks of temporal bone trauma provide sufficient prognostic data for treatment decisions; however, in selected cases, a single ENoG may not adequately predict long-term FN outcomes. For patients failing to improve with observation alone, serial ENoG may capture declining FN function, identifying patients that may benefit from late decompression.


Assuntos
Eletrofisiologia/métodos , Nervo Facial/patologia , Paralisia Facial/diagnóstico , Osso Temporal/lesões , Adolescente , Adulto , Descompressão Cirúrgica/métodos , Nervo Facial/cirurgia , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Osso Temporal/cirurgia , Adulto Jovem
15.
Neurosurgery ; 79(2): 182-93, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27171325

RESUMO

BACKGROUND: Cerebrovascular surgery offers potentially lifesaving treatments for intracranial vascular pathology yet bears substantial risks in the form of perioperative complications and mortality. OBJECTIVE: To better characterize the risks associated with cerebrovascular surgery by broadly investigating the incidence of complications, patient-level predictors of complications, and mortality using the National Surgical Quality Improvement Program database, a prospective, audited, national data set. METHODS: All cerebrovascular cases were extracted from the National Surgical Quality Improvement Program with the use of Current Procedural Terminology codes. Complication and mortality rates were analyzed with univariate and multivariate statistical analyses. RESULTS: A total of 1141 cases were analyzed. The rate of complications was nearly twice that of previous estimates: Almost one-third of patients (30.9%) experienced at least 1 complication, which was significantly associated with 30-day mortality (odds ratio, 7.76; 95% confidence interval, 4.27-14.10; P < .001). Emergency surgery was associated with higher mortality rates (15.1%) than nonemergency procedures (2.3%). Significant predictors of complications included preoperative ventilator dependence, emergency surgery, bleeding disorders, diabetes mellitus, and alcohol abuse. Significant predictors of mortality included postoperative coma >24 hours, preoperative or postoperative ventilator dependence, black or Asian race, and stroke. The most common complications were ventilator dependence (64.5% in patients ventilated preoperatively, 8.4% in patients not ventilated preoperatively), bleeding requiring transfusion (10.2%), reoperation within 30 days (9.6%), pneumonia (7.3%), and stroke (7.3%). CONCLUSION: Cerebrovascular surgery is associated with significant risks of morbidity and mortality. Mitigation of these risks requires broader, patient-centered understanding of risk factors and complications specific to cerebrovascular surgery, as presented in this article. These findings pave the way for improving patient safety and outcomes in cerebrovascular surgery. ABBREVIATIONS: AVM, arteriovenous malformationCI, confidence intervalNSQIP, National Surgical Quality Improvement ProjectOR, odds ratio.


Assuntos
Transtornos Cerebrovasculares/mortalidade , Transtornos Cerebrovasculares/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/mortalidade , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Bases de Dados Factuais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Melhoria de Qualidade , Fatores de Risco , Estados Unidos
16.
J Neurosurg ; 124(6): 1794-804, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26636377

RESUMO

OBJECT Surgery requires careful coordination of multiple team members, each playing a vital role in mitigating errors. Previous studies have focused on eliciting errors from only the attending surgeon, likely missing events observed by other team members. METHODS Surveys were administered to the attending surgeon, resident surgeon, anesthesiologist, and nursing staff immediately following each of 31 cerebrovascular surgeries; participants were instructed to record any deviation from optimal course (DOC). DOCs were categorized and sorted by reporter and perioperative timing, then correlated with delays and outcome measures. RESULTS Errors were recorded in 93.5% of the 31 cases surveyed. The number of errors recorded per case ranged from 0 to 8, with an average of 3.1 ± 2.1 errors (± SD). Overall, technical errors were most common (24.5%), followed by communication (22.4%), management/judgment (16.0%), and equipment (11.7%). The resident surgeon reported the most errors (52.1%), followed by the circulating nurse (31.9%), the attending surgeon (26.6%), and the anesthesiologist (14.9%). The attending and resident surgeons were most likely to report technical errors (52% and 30.6%, respectively), while anesthesiologists and circulating nurses mostly reported anesthesia errors (36%) and communication errors (50%), respectively. The overlap in reported errors was 20.3%. If this study had used only the surveys completed by the attending surgeon, as in prior studies, 72% of equipment errors, 90% of anesthesia and communication errors, and 100% of nursing errors would have been missed. In addition, it would have been concluded that errors occurred in only 45.2% of cases (rather than 93.5%) and that errors resulting in a delay occurred in 3.2% of cases instead of the 74.2% calculated using data from 4 team members. Compiled results from all team members yielded significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays (p = 0.001 and p = 0.028, respectively). CONCLUSIONS This study is the only of its kind to elicit error reporting from multiple members of the operating team, and it demonstrates error is truly in the eye of the beholder-the types and timing of perioperative errors vary based on whom you ask. The authors estimate that previous studies surveying only the attending physician missed up to 75% of perioperative errors. By finding significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays, this study shows that these surveys provide relevant and useful information for improving clinical practice. Overall, the results of this study emphasize that research on medical error must include input from all members of the operating team; it is only by understanding every perspective that surgical staff can begin to efficiently prevent errors, improve patient care and safety, and decrease delays.


Assuntos
Transtornos Cerebrovasculares/cirurgia , Erros Médicos/estatística & dados numéricos , Procedimentos Neurocirúrgicos , Salas Cirúrgicas , Equipe de Assistência ao Paciente , Falha de Equipamento/estatística & dados numéricos , Feminino , Escala de Coma de Glasgow , Humanos , Tempo de Internação , Masculino , Corpo Clínico Hospitalar , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
17.
J Exp Psychol Gen ; 143(1): 434-54, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23565670

RESUMO

The shape of an object restricts its movements and therefore its future location. The rules governing selective sampling of the environment likely incorporate any available data, including shape, that provide information about where important things are going to be in the near future so that the object can be located, tracked, and sampled for information. We asked people to assess in which direction several novel objects pointed or directed them. With independent groups of people, we investigated whether their attention and sense of motion were systematically biased in this direction. Our work shows that nearly any novel object has intrinsic directionality derived from its shape. This shape information is swiftly and automatically incorporated into the allocation of overt and covert visual orienting and the detection of motion, processes that themselves are inherently directional. The observed connection between form and space suggests that shape processing goes beyond recognition alone and may help explain why shape is a relevant dimension throughout the visual brain.


Assuntos
Atenção , Percepção de Forma , Percepção de Movimento , Reconhecimento Visual de Modelos , Adolescente , Adulto , Feminino , Humanos , Masculino , Orientação , Estimulação Luminosa , Adulto Jovem
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