Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.
Objective The objective of this study is to investigate the prevalence and disparity of chronic opioid usage in surgical patients and the potential risk factors associated with chronic opioid usage. Background Chronic opioid usage is common in surgical patients; however, the characteristics of opioid usage in surgical patients is unclear. In this study, we hypothesize that the prevalence of chronic opioid usage in surgical patients is high, and that significant disparities may exist among different surgical populations. Methods Data of opioid usage in outpatients among different surgical services were extracted from the electronic medical record database. Patient demographics, clinical characteristics of sex, age, race, body mass index (BMI), specialty visited, duration of opioid use, and opioid type were collected. Chronic opioid users were defined as patients who had been recorded as taking opioids for at least 90 days determined by the first and last visit dates under opioid usage during the investigation. Results There were 79,123 patients included in this study. The average prevalence is 9.2%, ranging from 4.4% to 23.8% among various specialties. The prevalence in orthopedics (23.8%), neurosurgery (18.7%), and gastrointestinal surgery (14.4%) ranked in the top three subspecialties. Major factors influencing chronic opioid use include age, Ethnicitiy, Subspecialtiy, and multiple specialty visits. Approximately 75% of chronic users took opioids that belong to the category II Drug Enforcement Administration classification. Conclusions Overall prevalence of chronic opioid usage in surgical patients is high with widespread disparity among different sex, age, ethnicity, BMI, and subspecialty groups. Information obtained from this study provides clues to reduce chronic opioid usage in surgical patients.
Purpose: To evaluate ophthalmology trainees' perception of their gonioscopy learning experience in the Ophthalmology Specialty Training programme. Materials and methods: A cross-sectional electronic survey was conducted amongst ophthalmology trainees across London Deaneries. The 10 questions survey collected parameters including training grade, previous level of gonioscopy training, confidence in performing the procedure, level of satisfaction with the training formats received, potential barriers and improvements to the training programme. The respondents were also invited to express any additional comments. Results: Fifty-seven complete responses were analysed. Respondents included 25 junior trainees (ST1-3) and 32 senior trainees (ST4-7 and fellow). One fifth of the respondents (11/57) were unconfident in performing gonioscopy, majority being junior trainees (9/11). Over a quarter of the respondents were dissatisfied with the quantity of the gonioscopy training received. Teaching formats such as consultant teaching (mean 8.0), self-directed learning (mean 8.0) and small-group tutorials (mean 7.6) were all well received. Overall, lack of clinical time was considered as the major barrier to gonioscopy training; however lack of training was considered as the major barrier in the low confidence group. Conclusion: This study highlighted ophthalmology trainees' dissatisfaction in the current gonioscopy training curriculum and a lack of confidence in performing the procedure. Appropriate modifications to the Ophthalmology Specialty Training programme could enhance trainees' gonioscopy learning experience.
in some of the subgroups. However, this finding is not surprising, as for a factor, such as race or center, to confound the relations between severe ROP and the predictive variables in the CHOP ROP model (birth weight, gestational age, and postnatal weight gain), the factor must be related not only to severe ROP but also to the predictive variables, which is not clearly the case.We found the following sensitivities for type 1 ROP among racial subgroups: white, 240 of 244 (98.4%); Asian, 14 of 14 (100%); black, 95 of 95 (100%); Native American, 4 of 4 (100%); Native Hawaiian, 3 of 3 (100%); other 38 of 40 (95%); and unknown, 58 of 59 (98.3%) (unpublished data, 2017). Race is a challenging factor to incorporate practically into the prediction of ROP, as many parents and infants are of a multiracial background.With regards to center, among the 19 hospitals that had 5 or more cases of type 1 ROP (range, 5-62 cases per center), the sensitivity for type 1 ROP ranged from 92% to 100%. The similar performance of the model across centers was possibly because of similar neonatal care practices. Generally, the reductions in sensitivity of the postnatal weight gain-based ROP prediction models published to date are likely due to smallmodel development study cohorts that resulted in overfitted models rather than single-center vs multicenter study designs. To avoid this problem, model development should be based on a much larger cohort, such as the G-ROP study data set.We agree that it is paramount to identify infants who are at high risk for severe ROP in advance of the development of type 1 ROP to ensure that these infants are treated in time. Birth weight and gestational age are weighed heavily in the CHOP ROP model, so most infants developing type 1 ROP are correctly predicted at the time of birth. Three hundred thirty-nine of the 452 infants (75%) who developed type 1 ROP in the G-ROP study were identified as high-risk by the CHOP ROP model at least 46 days before developing type 1 ROP, and 90% of such infants were identified at least 20 days before developing type 1 ROP. The median time between prediction and type 1 ROP was 59 days, with a range of 1 day (2 infants) to 117 days (unpublished data, 2017).Finally, we agree that a consensus among ophthalmologists and neonatologists will need to be reached regarding the minimum performance standards for ROP screening before postnatal weight gain measurements can be incorporated into ROP screening guidelines and the number of infants undergoing examinations is reduced.
PurposeTo report a unique case of atypical Coats' Syndrome in an 80 year old female with facioscapulohumeral dystrophy.ObservationsAn 80 years old female was diagnosed clinically of retinal telangiectasia with exudation threatening the fovia. She received a successful macular laser photocoagulation with subsequent cessation of leakage.Conclusions and importanceThis case is in keeping with Coats' syndrome in fascioscapulohumeral dystrophy, which classically affects young male subjects - making this patient an obvious outlier. This once again reflects the variation in phenotypic manifestations of inherited disorders.
Pharmaceuticals, Regeneron, Regenxbio, Scifluor, Shire, Stealth Biotherapeutics, Thrombogenics, TLC, and Tyrogenex outside the submitted work. Dr Shah reports receiving speaker fees from Ellex. No other disclosures were reported. 1. Shah CP, Heier JS. YAG laser vitreolysis vs. sham YAG vitreolysis for symptomatic vitreous floaters-a randomized clinical trial.
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