McFarland Mathiesen (octaveowl6)

Introduction To analyze foveal displacement after macular surgery for idiopathic epiretinal membrane (iERM). Methods Twenty-eight patients who underwent macular surgery for symptomatic iERM in one eye by one physician were included in this retrospective study. Spectral domain optical coherence tomography (SD-OCT) volume scans were acquired with a Spectralis OCT device (Heidelberg Spectralis). Using the follow-up view mode, the displacement of the fovea was classified and measured according to its postoperative location in the horizontal and/or vertical plane. Results One day after surgery, 86% of eyes (24/28) showed foveal displacement. Vertical displacement occurred in a superior direction in 50% eyes, and in an inferior direction in 36% of the eyes. The postoperative mean foveal displacement on the vertical plane was 99 ± 82 μm (range, 0-300). Horizontal displacement occurred in a nasal direction in 21%, and temporally in 21%. The postoperative mean foveal displacement on the horizontal plane was 35 ± 45 μm (range, 0-123). One year after the macular surgery 69% of the eyes showed still a foveal dislocation. Discussion Most of the eyes with iERM showed a foveal dislocation after the macular surgery. Our findings emphasize the necessity to carefully study of the OCT images in such eyes after the surgery as the manually determined postoperative foveal position may be in a different vertical or horizontal plane than the machine-generated pre- and postoperative overlay for the foveal position. Our findings may thus be helpful for surgeons to avoid misinterpretation when evaluating OCT images pre- and postoperatively. This study introduces an empirical approach for studying the role of prudence in physician treatment of end-of-life (EOL) decision making. A mixed-methods analysis of transcripts from 88 simulated patient encounters in a multicenter study on EOL decision making. Physicians in internal medicine, emergency medicine, and critical care medicine were asked to evaluate a decompensating, end-stage cancer patient. Transcripts of the encounters were coded for actor, action, and content to capture the concept of Aristotelian prudence, and then quantitatively and qualitatively analyzed to identify actions associated with preference-concordant treatment. Focusing on codes that describe characteristics of physician-patient interaction, the code for physicians restating patient preferences was associated with avoiding intubation. Multiple codes were associated with secondary measures of preference-concordant treatment. Prudent actions can be identified empirically, and research focused on the virtue of prudence may provide a new avenue for assessment and training in EOL care. Prudent actions can be identified empirically, and research focused on the virtue of prudence may provide a new avenue for assessment and training in EOL care.In healthcare, it is not uncommon for neurodiagnostic technologists to provide care and testing for patients who are in restraints or in need of restraints. When properly used, restraints ensure patient safety and the safety of others while allowing the continuation of life saving tests and treatments. Oversight for restraint use is provided by outside agencies such as the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC). Improper use of restraints can lead to serious sanctions by both organizations and can negatively impact patients, leaving them with emotional and psychological trauma. The process of restraint management such as ordering, implementing, or monitoring restrained patients is not within the scope of practice for neurodiagnostic technologists. Restraints should only be utilized as a last resort for the safety of the patient to receive proper care. This paper seeks to inform Technologists on what does and does not constitute a restraint, and the factors that should be considered before making the decision to req