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Injury surveillance in public hospital emergency departments.

AIMS: To identify existing surveillance initiatives and to seek and reach consensus on a national minimum data set for injury surveillance in public hospital emergency departments in New Zealand. METHODS: Every public hospital emergency department was visited to obtain information on current surveillance initiatives. At the same time, guidelines for a national minimum data set for injury surveillance were considered. National organisations who might use the information were contacted and also asked to consider the guidelines. RESULTS: Of the 43 public hospital emergency departments visited, five had on-site computerised information systems, the majority collecting data manually. Basic demographic data and information in a narrative form were the only data recorded consistently by all hospitals. A national minimum data set for injury surveillance was adopted by general agreement at a consensus forum, held in Wellington, in March, 1992. Current developments indicate that the minimum data set for injury surveillance, as adopted at the forum will become a component of the National Minimum Data Set within the proposed Health Information Strategy for New Zealand. CONCLUSIONS: Injury data collection will, in time become mandatory. However, the promotion of the minimum data set for injury surveillance by health professionals, national organisations and community groups will be essential to ensure its implementation and utilisation for the prevention and control of injuries.

Data Collection↗

Towards a nursing minimum data set for Ireland: making Irish nursing visible.

AIM: The aim of this study was to identify patient problems, nursing interventions and nursing outcomes to be included in a nursing minimum data set for Ireland. BACKGROUND: In 2002, a research programme funded by the Irish Health Research Board, was established to develop and test a nursing minimum data set to capture the nursing contribution to patient care in Ireland. A nursing minimum data set is comprised of the smallest number of information items required to capture the range of patient problems, nursing interventions and nursing outcomes recorded by nurses on a regular basis. Nursing minimum data sets have been developed in several countries for a range of applications such as workforce planning, financing nursing care, examining patient profiles and forecasting trends in nursing diagnoses. METHOD: Eleven focus groups were conducted with 59 registered general nurses to explore their conceptualizations of patient problems, nursing interventions and nursing outcomes. In addition, data relating to nurses' recordings of patient problems, nursing interventions and nursing outcomes were collected from a sample of 45 sets nursing records. The research took place between January 2003 and April 2004. FINDINGS: A range of patient problems, nursing interventions and outcomes were identified that were similar to those found in existing nursing minimum data sets. However, several new items and categories of items were also identified, justifying the empirical approach taken to generate the initial list of items. Data from nursing records supported several points raised in focus groups and also highlighted some inconsistencies between nurses' perceptions and recordings of what they do. CONCLUSION: Our research identified several new types of indirect interventions and managing/organizing activities in addition to items found in existing nursing minimum data sets. The importance of these aspects of the nursing contribution to patient care will be tested further in the development of the Irish nursing minimum data set.

Adult↗

Trial telemedicine system for supporting medical students on elective in the developing world.

RATIONALE AND OBJECTIVES: The authors sought to create a simple, versatile, and effective store-and-forward telemedicine system to facilitate consultation between medical students pursuing elective study at remote locations in the developing world and specialists at the central institution. MATERIALS AND METHODS: A trial telemedicine system was established between Gizo Hospital (Gizo, Solomon Islands) and Emory University Hospital (Atlanta, Ga). At Gizo Hospital, the system consisted of a commercially available digital camera and a locally available personal computer with a modem providing low-bandwidth (dial-up) Internet access. A visiting British medical student at Gizo Hospital used this equipment to relay digital photographs of patients, as well as the results of relevant tests, such as electrocardiograms, radiographs, and ultrasound images, to Emory University Hospital via the Internet for review by a specialist. RESULTS: The medical student, who had received minimal training (approximately 1 hour) in the use of this telemedicine system, used it successfully to perform eight referrals during the elective course period. Following the student's return home, his local preceptors at Gizo Hospital and a physician at Helena Goldie Hospital on New Georgia Island used the same system for more than 60 additional referrals. CONCLUSION: The telemedicine system is a low-cost, robust, and sustainable means of providing expert support to medical students and other health care providers in remote locations.

Developing Countries↗

Poor reduction of HIV-1 RNA titres in nucleoside reverse transcriptase inhibitor experienced patients treated with indinavir combination therapy.

OBJECTIVES: The long term effectiveness of combination therapy at reducing viral loads in seminal fluid and blood plasma obtained from HIV-1 infected men who had undergone previous antiretroviral therapy was assessed. METHODS: Samples of semen and blood were obtained from a cohort of 12 nucleoside reverse transcriptase inhibitor experienced men before and during 25-68 weeks of combination therapy, which included the protease inhibitor indinavir. HIV-1 RNA titres present in the cell free blood and seminal plasma samples were determined using the nucleic acid sequence based amplification (NASBA)/Nuclisens assay system. RESULTS: Viral RNA was detected in 9/12 and 7/12 baseline blood plasma and seminal plasma samples, with median viral titres of 10(4.81) and 10(4.56) per ml, respectively. By the end of the study period the detection rates of HIV RNA in the blood and seminal plasma samples were 5/12 and 2/12, respectively, with the median viral titres below the assay cut off level for both sample types. Of the nine patients who had detectable viral RNA in the baseline sample, only three cleared virus from both compartments by the end of the study. CONCLUSIONS: These data show that stable reduction of blood and seminal fluid viral titres is not achievable in a significant proportion of nucleoside reverse transcriptase inhibitor experienced men.

Drug Therapy, Combination↗

Positron emission mammography: initial clinical results.

BACKGROUND: Evaluation of high-risk mammograms represents an enormous clinical challenge. Functional breast imaging coupled with mammography (positron emission mammography [PEM]) could improve imaging of such lesions. A prospective study was performed using PEM in women scheduled for stereotactic breast biopsy. METHODS: Patients were recruited from the surgical clinic. Patients were injected with 10 mCi of 2-[18F] fluorodeoxyglucose. One hour later, patients were positioned on the stereotactic biopsy table, imaged with a PEM scanner, and a stereotactic biopsy was performed. Imaging was reviewed and compared with pathologic results. RESULTS: There were 18 lesions in 16 patients. PEM images were analyzed by drawing a region of interest at the biopsy site and comparing the count density in the region of interest with the background. A lesion-to-background ratio >2.5 appeared to be a robust indicator of malignancy and yielded a sensitivity of 86%, specificity of 91%, and overall diagnostic accuracy of 89%. No adverse events were associated with the PEM imaging. CONCLUSIONS: The data show that PEM is safe, feasible, and has an encouraging accuracy rate in this initial experience. Lesion-to-background ratios >2.5 were found to be a useful threshold value for identifying positive (malignant) results. This study supports the further development of PEM.

Adult↗

Developing an educational reminder system for a handheld encounter log.

BACKGROUND AND OBJECTIVES: Medical students increasingly log patient encounters on handheld computers. Detailed patient records captured at the bedside would allow these log programs to complement medical education with automated reminders. We evaluated progress toward this goal. METHODS: A series of electronic student encounter logs (ESEL) were designed to quickly record common diagnoses in a family medicine clerkship. Common diagnoses were organized in a shallow, broad-tree structure that locates many concepts with one to four taps. Third-year clerks' ESEL records of patient problems were evaluated longitudinally and across two similar clerkships. Grading criteria were introduced to encourage attention to target problems, especially infrequently reported psychosocial issues. A pilot reminder system in ESEL-4, the latest version of the computer application program, included 17 high-specificity reminders. Students' viewing of reminders was monitored. RESULTS: Students recorded complex patients in ESEL-4 and entered 80% of patients during office hours. ESEL grading generated anxiety but was associated with significantly increased and plausible documentation of tobacco abuse, depression, and alcohol abuse. Students viewed titles of about 25% of generated reminders but reviewed less than 1% of reminders in detail. CONCLUSIONS: Students using ESEL-4 document plausibly complex patients, usually during office hours. Grading probably improves completeness and accuracy. Diagnosis-driven educational reminder systems are possible but do not yet capture students' attention.

Adult↗

Dengue virus infection: a major cause of acute hepatic failure in Thai children.

BACKGROUND: Acute hepatic failure (AHF) can be caused by a variety of viruses, drugs, toxins and metabolic disorders. AIMS: A prospective study was conducted to determine the aetiology and outcome of AHF in Thai children aged 1-15 years. METHODS: All serum samples were tested for anti-HAV IgM, HBsAg, anti-HBc IgM, anti-HCV, anti-HEV IgM and anti-dengue IgG and IgM. Further individual investigations were done according to the clinical impression. RESULTS: Forty subjects were enrolled from 14 centres during February 2000 to December 2001. Five cases were excluded owing to a lack of evidence of encephalopathy. The causes of AHF were dengue infection in 12 (34.3%), Wilson disease in 2 (5.7%), T-cell lymphoma in 2 (5.7%), ischaemic hepatitis in two (5.7%), haemophagocytic syndrome in one (2.8%), CMV in 2 (5.7%), Reye syndrome in one (2.8%) and unknown in 13 (37.1%) patients. The fatality rate was 68.6%. Eight of 24 (33.3%) deaths were caused by dengue infection. CONCLUSIONS: Improvements in sanitation and socio-economic status as well as the implementation of hepatitis B vaccine in the Extended Programme on Immunization (EPI) are likely to be the reasons for the observed absence of AHF caused by hepatitis A and B. The study showed that dengue infection, on the other hand, was a major cause of AHF in Thailand.

Acute Disease↗

Deconstructing schizophrenia: an overview of the use of endophenotypes in order to understand a complex disorder.

The genetics of schizophrenia has been approached utilizing a variety of methods. One emerging strategy is the use of endophenotypes in order to understand and identify the functional importance of genetically transmitted, brain-based deficits across schizophrenia kindreds. The endophenotype strategy is a topic of this issue of Schizophrenia Bulletin. Endophenotypes are quantitative, heritable, trait-related deficits typically assessed by laboratory-based methods rather than clinical observation. Endophenotypes are seen as closer to genetic variation than are clinical symptoms of schizophrenia, and are therefore closely linked to heritable risk factors. There has been a broad expansion of opportunities available to psychiatric neuroscientists who use the endophenotype strategy to understand the genetic basis of schizophrenia. In this context, genetic variation such as single nucleotide polymorphisms (SNPs) induces abnormalities in endophenotypic domains such as neurocognition, neurodevelopment, metabolism, and neurophysiology. This article discusses the challenges that abound in genetic research of schizophrenia, including issues in ascertainment, epistasis, ethnic diversity, and the potentially normalizing effects of second-generation antipsychotic medications on neurocognitive and neurophysiological measures. Robust strategies for meeting these challenges are discussed in this review and the subsequent articles in this issue. This article summarizes conceptual advances and progress in the measurement and use of endophenotypes in schizophrenia that form the basis of the multisite National Institute of Mental Health Consortium on the Genetics of Schizophrenia. The endophenotype strategy offers powerful and exciting opportunities to understand the genetically conferred neurobiological vulnerabilities and possible new strong inference and molecularly based treatments for schizophrenia.

Antipsychotic Agents↗

Beneficial effects of inhaled nitric oxide in adult cardiac surgical patients.

BACKGROUND: Pulmonary hypertension with associated right ventricular dysfunction may complicate the postoperative cardiac patient despite maximum pharmacologic and ventilatory support. The purpose of this study was to retrospectively review our experience with inhaled nitric oxide (INO) in adult postoperative cardiac patients with pulmonary hypertension. METHODS: We retrospectively reviewed the medical records of 17 adult cardiac patients treated with INO postoperatively between November 1998 and February 2000. The INO was used to manage pulmonary hypertension postoperatively in patients who had undergone coronary artery bypass graft (CABG) (n = 13), valve operation (n = 3), and combined CABG/aortic valve replacement (n = 1). Hemodynamic and respiratory measurements before INO and again 6 hours after administration were examined. Student's t test was used to analyze the data. RESULTS: Inhaled nitric oxide (20 ppm to 30 ppm) was administered for a median duration of 30.2 hours. The group, as a whole, demonstrated a significant decrease in both mean pulmonary artery pressure and right ventricular stroke work index. In addition, a significant increase in posttherapeutic cardiac index and Pao2/Fio2 ratio was observed. The vasodilatory effects of nitric oxide were specific to the pulmonary circulation as no significant change in mean arterial pressure was noted. Overall mortality was 6%. CONCLUSIONS: Inhaled nitric oxide effectively and selectively lowered right ventricular afterload and right ventricular work in critically ill adult cardiac patients with acute pulmonary hypertension.

Administration, Inhalation↗

Description and predictors of direct and indirect costs of pain reported by cancer patients.

The purpose of this study was to describe direct and indirect costs associated with pain in cancer patients and to examine potential predictors of these costs. The study surveyed cancer outpatients about direct costs resulting from pain-related hospitalizations, emergency department visits, physician office visits, and use of analgesic medications and indirect costs related to money spent on pain-related transportation, complementary methods to improve pain management, educational materials, over-the counter medication, domestic support, and childcare. Furthermore, the study examined age, marital status, race, income level, pain severity, pain interference, and presence of breakthrough pain as predictors of direct and indirect costs. Three hundred and seventy-three cancer outpatients were sampled. One hundred and forty-four cancer patients (39%) reported experiencing cancer-related pain and completed the study questionnaires. Seventy-six percent (76%) of the patients had experienced at least one pain-related cost, resulting in an average monthly direct cost of US$ 891/month per patient. Sixty-nine percent (69%) of patients had experienced some type of direct medical cost due to pain, resulting in an average total direct pain-related cost of US$ 825/month per patient. Fifty-seven percent (57%) of patients reported incurring at least one indirect pain-related expense for an average indirect cost of US$ 61/month per patient. Higher pain intensity, greater pain interference, and presence of breakthrough pain predicted higher direct and indirect medical expenses. Younger age and lower income level also predicted higher direct medical expenses.

Forecasting↗

High-throughput purification of combinatorial libraries I: a high-throughput purification system using an accelerated retention window approach.

We have developed a high-throughput purification system to purify combinatorial libraries at a 50-100-mg scale with a throughput of 250 samples/instrument/day. We applied an accelerated retention window method to shorten the purification time and targeted one fraction per injection to simplify data tracking, lower QC workload, and simplify the postpurification processing. First, we determined the accurate retention time and peak height for all compounds using an eight-channel parallel LC/UV/MS system, and calculated the specific preparative HPLC conditions for individual compounds. The preparative HPLC conditions include the compound-specific gradient segment for individual compounds with a fixed gradient slope and the compound-specific UV or ELSD threshold for triggering a fraction collection device. A unique solvent composition or solvent strength was programmed for each compound in the preparative HPLC in order to elute all compounds at the same target time. Considering the possible deviation of the predicted retention time, a 1-min window around the target time was set to collect peaks above a threshold based on UV or ELSD detection. Dual column preparative instruments were used to maximize throughput. We have purified more than 500 000 druglike compounds using this system in the past 3 years. We report various components of this high-throughput purification system and some of our purification results.

Journal Article↗

Successful management of aniridic ocular surface disease with long-term bandage contact lens wear.

PURPOSE: To present an aniridic patient with failed penetrating keratoplasties OU (PK) who underwent successful repeat PK OD, which has remained clear for 4 years with continuous bandage lens (BCL) wear. METHODS: A 73-year-old aniridic woman who had a failed PK complicated by ocular surface disease refused limbal stem cell transplantation and underwent repeat PK in her right eye. The immediate postoperative course was uneventful except for mild irregularity of the graft epithelium. Two months postoperatively, she presented with an epithelial defect along the inferotemporal graft margin adjacent to an exposed, loose interrupted suture. The suture was removed, and although the initial epithelial defect healed, she suffered recurrent episodes of epithelial breakdown and generalized whorl epitheliopathy. A BCL was inserted and rendered prompt healing of the graft epithelium, which has remained smooth and intact for 4 years. RESULTS: The graft remains thin and clear with a smooth and intact epithelial surface beneath the BCL and no signs of limbal stem-cell deficiency. CONCLUSION: Long-term BCL wear provided good corneal transplant surface protection in an aniridic patient with recurrent epithelial breakdown, thereby sparing the need for limbal stem cell transplantation and the use of potentially toxic systemic immunosuppressive therapy. Meticulous follow-up is required to monitor contact lens loss and epithelial breakdown as well as signs of secondary infectious keratitis.

Aged↗

The epidemiology of paediatric intussusception in Singapore: 1997 to 2004.

INTRODUCTION: The world's first rotavirus vaccine, Rotashield or RRV-TV, was registered in the US in 1998, but withdrawn within a year because of an observed association with intussusception (IS). Surveillance for IS has consequently become important in safety monitoring of new-generation rotavirus vaccines during development. Post-marketing surveillance is also important, and requires the availability of local baseline epidemiology data on IS. MATERIALS AND METHODS: An eight-year study of IS in children under 2 years of age in Singapore was performed by retrospective review of admissions to KK Women's and Children's Hospital, the main paediatric hospital, from 1997 to 2001, followed by prospective surveillance of all hospitals from 2001 to 2004, using the case definition of the Brighton Collaboration Intussusception Working Group. RESULTS: The average IS incidence was 60 per 100,000 in under-ones, and 32 per 100,000 in under-twos, with a downward trend between 1999 and 2004. Ninety-two per cent of subjects were aged below one year, with 51% aged 6 months to 11 months. The mean age at which IS occurred increased from 6.4 months to 12.5 months over the study period. The male-to-female ratio was 1.3:1. No trend in IS numbers was observed over different months of the year. CONCLUSION: IS in Singapore shows no seasonality, but has demonstrated a trend of decreasing incidence in recent years. While highest in the first year of life, the risk of IS is increasing in the second year of life. Males have a slightly higher risk.

Child, Preschool↗

Radiologic differentiation of intracranial epidermoids from arachnoid cysts.

OBJECTIVE: Intracranial epidermoids (cholesteatomas) mimic arachnoid cysts in their radiologic characteristics, especially in the cerebellopontine angle. It is essential to differentiate the two conditions because they warrant different therapeutic interventions. The objective of this study is to elucidate the different radiologic characteristics of the conditions. STUDY DESIGN AND SETTING: This was a retrospective study of 4 patients referred for a differential diagnosis and management of intracranial cystic lesions to the Departments of Neurotology/Neurosurgery and Neuroradiology in a tertiary referral university hospital. PATIENTS: Four patients of different age groups with cystic intracranial lesions, diagnosed epidermoid or arachnoid cysts, were chosen. A retrospective analysis of their case charts, radiologic and surgical interventions, and follow-up records was undertaken. METHODS: The imaging techniques used included computerized tomographic scans, magnetic resonance imaging (MRI) with T1, T2, proton-density, and gadolinium-enhanced T1 images. In addition, special MRI sequences were used that included fluid-attenuated inversion recovery and echo planar diffusion scanning. All the patients underwent an audiovestibular evaluation. RESULTS: Both lesions are characteristically well demarcated and have a homogeneous low density, similar to cerebrospinal fluid on computerized tomographic scan, showing no contrast enhancement. On MRI, epidermoids and arachnoid cysts usually appear hypointense on T1-weighted images and hyperintense on T2-weighted images. On fluid-attenuated inversion recovery, an arachnoid cyst tends to follow cerebrospinal fluid intensity, whereas an epidermoid becomes hyperintense. There are occasions when an epidermoid may appear as a low-intensity lesion on fluid-attenuated inversion recovery. This dilemma is resolved with the use of echo planar diffusion scanning, on which an epidermoid remains bright. CONCLUSION: The authors recommend the use of fluid-attenuated inversion recovery and diffusion sequence MRI when definitive radiologic diagnosis of cystic intracranial lesions becomes difficult with routine computerized tomographic scanning and MRI.

Adult↗

Trichomoniasis in men and HIV infection: data from 2 outpatient clinics at Lilongwe Central Hospital, Malawi.

BACKGROUND: Little is known about the epidemiologic profile of trichomoniasis in men and its relationship to human immunodeficiency virus (HIV) infection. Among men presenting for care for symptomatic sexually transmitted infections (STIs) in Malawi, trichomoniasis is not considered for first-line treatment. METHODS: We conducted a cross-sectional survey of 1187 men attending either a dermatology or STI outpatient clinic in the capital of Malawi. Men were interviewed, and the etiologies of the STIs were determined. RESULTS: At the STI clinic (n = 756 men), we identified 150 men (20%) with Trichomonas vaginalis infection, 358 men (47%) with HIV infection, and 335 men (44%) with Neisseria gonorrhoeae infection. At the dermatology clinic (n = 431 men), we identified 54 (13%), 118 (27%), and 2 (0.5%) men, respectively. At both clinics, a lower education level and reporting never having used a condom were predictive of T. vaginalis infection. Only at the dermatology clinic was older age associated with infection, and only at the STI clinic were marital, genital ulcer disease, and HIV-infection status associated with T. vaginalis infection. At the STI clinic, urethral symptoms attributable to trichomoniasis were more severe among HIV-positive men than among HIV-negative men. CONCLUSIONS: Given its high prevalence and the increased risk for HIV transmission, T. vaginalis infection should be reconsidered for inclusion in the Malawi STI-treatment regimen for men.

Adolescent↗

Depressive symptoms are associated with unhealthy lifestyles in hypertensive patients with the metabolic syndrome.

OBJECTIVE: Metabolic syndrome results from a complex interaction between lifestyle and genetic factors. Among this population, adhesion to healthy recommendations is a cornerstone of cardiovascular disease prevention. We examined the association between depression and multiple unhealthy behaviours in hypertensive patients with the metabolic syndrome. RESEARCH DESIGN AND METHODS: Eight hundred and forty consecutive hypertensive subjects with the metabolic syndrome were studied in our secondary-care centre. Separated scores reflecting unhealthy behaviours (physical inactivity, smoking and unhealthy diet) were combined to produce a global unhealthy lifestyle score. The Hospital Anxiety and Depression scale was used to assess and quantify depression. We performed a separate analysis for each sex. RESULTS: The prevalence of depression (13.0 versus 7.3%, P < 0.001) was greater in women than in men. Presence of depression was significantly associated in both men and women with unhealthy diet (in particular, excessive cholesterol and total caloric intake) but also with decreased physical activity in men and with smoking habits in women. In both sexes, the global unhealthy lifestyle score, reflecting a cluster of unhealthy behaviours, was positively correlated with the depression score. In multivariate analysis, the depression score appeared in both sexes as an independent determinant of unhealthy lifestyle. CONCLUSIONS: Among hypertensive subjects with the metabolic syndrome, depressive symptoms along a continuum of severity are independently associated with multiple unhealthy lifestyles. This suggests that even minor forms of depression may impact on adhesion to health behaviours beyond major depressive symptoms and/or psychiatric condition.

Adult↗

Dissociated vertical deviation: head and body orientation affect the amplitude and velocity of the vertical drift.

PURPOSE: Five subjects with dissociated vertical deviation (DVD) were studied to determine if the amplitude or velocity of the vertical components of the DVD were affected by head/body orientation with respect to gravity. METHODS: Deviations were measured in head upright, head supine, and supine positions, with head hanging postures using a binocular CCD video-based infrared eye tracker. Subjects were required to fixate a target presented in the primary position during alternate or cover/uncover tests. RESULTS: Amplitude and velocity of DVD both in onset and recovery were affected by head/body orientation with respect to gravity. In four of five subjects, the amplitude of the DVD was asymmetric between the two eyes when the head was upright. When the head/body was moved from an upright to a supine with head hanging backward condition, the amplitude of the DVD in the two eyes inverted. The eye with the larger DVD in the upright position had a smaller DVD in the head-hanging orientation. A similar relationship existed between velocity and head/body orientation. We found that DVD velocity increased with amplitude. CONCLUSIONS: Passive effects of gravity on the eye-inorbit do not influence DVD magnitude or frequency of occurrence. The data suggest, however, that otolithic and possibly neck afferent inputs play a role in DVD magnitude and may be a part of the etiology of the condition.

Adult↗

Effects of scleral search coil wear on visual function.

PURPOSE: The scleral search coil is widely regarded as the gold standard measurement technique for eye movements. The effect of wearing scleral search coils on human vision has not been systematically studied. However, there are anecdotal reports of degraded visual acuity, mild eye irritation, and an increase rise in intraocular pressure (IOP). The current study was conducted to investigate the effect of scleral search coil use on visual acuity and ocular integrity. METHODS: Six subjects were examined; all had previously worn search coils. Two drops of topical anesthetic were administered before insertion of the coils. Coils were inserted by hand and secured by applying mild pressure. The coils were removed after 45 minutes or on request of either the subject or the clinician. Before, during (at 15-minutes intervals), and after the coil was worn, the following measurements were taken for both eyes: tonometry (noncontact), corneal topography, biomicroscopic examination, visual acuity (monocular Snellen), and an eye-discomfort rating. RESULTS: Scleral coils produced a variety of effects, including ocular discomfort, hyperemia of the bulbar conjunctiva, increased IOP, buckling of the iris, grade 2 and 3 corneal staining, and reduction in visual acuity. Effects appeared as early as 15 minutes after insertion of the coils. All observed effects seemed to be transient and dissipated after coils were removed. CONCLUSIONS: Scleral coils may not be appropriate for all subjects. The findings suggest that there is a need for thorough subject prescreening and that clinicians should consider the risk/benefit ratio. Acute reduction in visual acuity may confound search coil findings. More research is needed to determine the maximum wearing time for properly screened subjects.

Adult↗