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Purpose@#This descriptive study aimed to identify the effects of purposeful and timely nursing rounds on patients' perception of the quality of nursing services and nurses' perception of nursing rounds. @*Methods@#Intentional nursing rounds were conducted by communicating patients’ questions on pain, position, pump, potty, and possessions. A total of 144 nurses and 149 patients participated, and data were collected using self-report questionnaires. The independent t-test, x 2 test, and Wilcoxon’s rank-sum test were used to analyze the data with SPSS version 24.0. @*Results@#Although intentional nursing rounds improved the nurses’ perception of nursing rounds, there was no significant difference. The nurses’ benefit had the lowest score (3.36), and the benefit of communication with patients had the highest score (3.79).Intentional nursing rounds significantly improved the patients’ perception of the quality of nursing services in the intervention group. Among the factors of empathy (Z=4.98, p<.001) related to the quality of nursing services as perceived by the patient, assurance (Z=5.50, p<.001), reliability (Z=4.43, p<.001), and responsiveness (Z=5.02, p<.001) significantly increased. @*Conclusion@#Intentional nursing rounds positively affected patients’ perception of the quality of nursing service. It is important to improve intentional nursing rounds to enhance nurses’ perceptions of them.
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Purpose@#To report a case of traumatic optic neuropathy aggravated by orbital emphysema after an orbital fracture.Case summary: A 19-year-old man with no specific medical history was referred for a right orbital fracture caused by blunt trauma to the supraorbital rim of the right eye. Computed tomography (CT) showed a right orbital fracture involving the inferomedial wall and inferomedial strut. The corrected visual acuity was 0.4 in the right eye (RE) and 1.0 in the left and the intraocular pressure was 15 and 18 mmHg, respectively. Restriction on downgaze, abduction, and an indefinite relative afferent pupillary defect (RAPD) were observed in the RE. Fundus exam was non-specific other than commotio retinae on the temporal side of the macula in the RE. After 12 hours post trauma, the visual acuity of the RE had decreased to light perception. Definite RAPD was observed with optic disc swelling on the fundus photo and optical coherence tomography. Orbital CT showed air shadows, which were not seen on the initial evaluation, adjacent to the optic disc. We diagnosed traumatic optic neuropathy aggravated by orbital emphysema. High-dose intravenous steroid was given for 3 days. Despite a lateral canthotomy and cantholysis to decompress the right orbit, visual acuity did not improve above counting fingers. @*Conclusions@#Increased intraorbital pressure and congestion caused by orbital emphysema may exacerbate traumatic optic neuropathy. Therefore, close observation is required.
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Purpose@#To demonstrate the efficacy of subcutaneous tocilizumab (TCZ-SC) treatment for recalcitrant thyroid eye disease (TED) refractory to intravenous methylprednisolone (MP) and oral methotrexate (MTX).Case summary: (Case 1) A 52-year-old man, smoker, with hyperthyroidism presented with a 3-months history of TED. The initial clinical activity score (CAS) was 5 (total score of 7). High-dose intravenous MP and oral MTX failed to improve the symptoms. He was treated with four doses of 162 mg TCZ-SC at an interval of 2 weeks. Pre-treatment laboratory test results were within normal limits. CAS was reduced to 2 weeks after the final injection, and there were no recurrences during the 6-month follow-up. (Case 2) A 37-year-old woman, non-smoker, with a 3-months history of hyperthyroidism presented with conjunctival injection and upper eyelid erythema. The initial CAS was 4, and thyroid-stimulating immunoglobulin level was raised (475% of normal). The symptoms did not improve with 7.5 g intravenous MP and oral MTX. The patient was treated with 162 mg TCZ-SC. Pre-treatment laboratory test results were within normal limits. CAS was reduced to 1 after the final injection, and there were no recurrences during the 6-months follow-up. @*Conclusions@#TCZ-SC improves symptoms of corticosteroid-resistant TED, and may be a reasonable option in recalcitrant TED cases. However, further studies are required to justify the use of TCZ-SC for TED.
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The Korean Intermittent Exotropia Multicenter Study (KIEMS), which was initiated by the Korean Association of Pediatric Ophthalmology and Strabismus, is a collaborative multicenter study on intermittent exotropia in Korea. The KIEMS was designed to provide comprehensive information, including subjective and objective findings of intermittent exotropia in a large study population. A total of 65 strabismus specialists in 53 institutions contributed to this study, which, to date, is one of the largest clinical studies on intermittent exotropia. In this article, we provide a detailed methodology of the KIEMS to help future investigations that may use the KIEMS data.
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Purpose@#To investigate the clinical features of strabismus in patients with congenital optic disc anomaly and compare and analyze the characteristics of patients who showed changes in the strabismus pattern with those who did not. @*Methods@#Medical records of the patients who were diagnosed with both strabismus and congenital optic disc anomaly and followed-up for ≥1 year were reviewed retrospectively. Clinical characteristics and ophthalmic features at the initial visit and final follow-up were assessed. Patients with a change in the direction of strabismus or a difference of >10 prism diopters in the deviation angle during the follow-up period were allocated to the changed group. The remaining patients were assigned to the unchanged group. The clinical characteristics of the two groups were compared. @*Results@#Twenty-eight patients (15 boys) were included (mean age, 39.0 months; range, 5–150 months). Three (10.7%) patients were born preterm and four (14.3%) had other underlying systemic disease. Sixteen (57.1%) patients had exotropia, and 12 (42.9%) had esotropia. Concurrent vertical strabismus was present in three (10.7%) patients. Strabismus features changed in 14 (50.0%, changed group) patients and remained unchanged in 14 (50.0%, unchanged group) patients. Age, sex, and laterality did not differ between groups. Preterm birth history (n = 3) and combined systemic disease (n = 4) were only observed in the changed group (p = 0.111 and p = 0.049, respectively). @*Conclusions@#Considering the possibility of changes in strabismic features, close monitoring of patients with strabismus combined with congenital disc anomaly is essential, particularly in those with preterm birth history or underlying systemic conditions.
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Purpose@#To report a case of spontaneously improved visual acuity in a patient with suprasellar meningioma.Case summary: A 55-year-old female presented with decreased visual acuity for 1 week. She had chronic headache and ocular pain. Her visual acuity of the right eye was 0.1 and temporal and inferior visual field defects were found. Relative afferent pupillary defect was observed in the right eye. On orbital magnetic resonance image, a homogenous enhancing mass with a broad dural base at the jugum sphenoidale was found. This was likely to represent a meningioma and was referred to neurosurgery. The patient refused the surgery and did not receive any treatment. After 1 month, the visual acuity of the right eye improved to 0.5. The improved vision remained until 6 months later. @*Conclusions@#Visual loss associated with meningioma can spontaneously improve and this should be considered when making diagnostic and treatment decisions for meningioma.
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Purpose@#Chondroid syringoma of the skin is a rare subcutaneous tumor and localization in the eyelid and orbital region that has rarely been described. We report a case of chondroid syringoma that involved the sub-brow region and was accompanied by hair loss. Case summary: A 57-year-old women presented with a mass on the lateral side of the left sub-brow region which was observed 25 years earlier. The mass, which recurred 2 months after surgery at another hospital through a skin incision was accompanied by an itching sensation. The mass was not tender or ulcerated but was reddish with superficial blood vessels and had a smooth surface with hair loss at the site of the mass. The mass showed high signal intensity on a T2-weighted magnetic resonance image and a round echogenic nodule with an irregular hypoechoic portion was observed on ultrasonography. A full-thickness excision including the adjacent normal tissue of the sub-brow mass and direct closure were subsequently performed. The pathological diagnosis was chondroid syringoma which was revealed as numerous tubular structures with various lumens in a collagenous stroma. Mucinous and fibrous findings were also observed. No recurrence was detected during the first 2 years after surgery. @*Conclusions@#Chondroid syringoma in the eyelid and sub-brow region is uncommon. Complete resection is required to differentiate it from a malignancy and reduce the possibility of recurrence. Incomplete resection or capsular rupture during removal of the tumor could induce recurrence or a malignant change in the tumor.
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Purpose@#To report a case of spontaneously improved visual acuity in a patient with suprasellar meningioma.Case summary: A 55-year-old female presented with decreased visual acuity for 1 week. She had chronic headache and ocular pain. Her visual acuity of the right eye was 0.1 and temporal and inferior visual field defects were found. Relative afferent pupillary defect was observed in the right eye. On orbital magnetic resonance image, a homogenous enhancing mass with a broad dural base at the jugum sphenoidale was found. This was likely to represent a meningioma and was referred to neurosurgery. The patient refused the surgery and did not receive any treatment. After 1 month, the visual acuity of the right eye improved to 0.5. The improved vision remained until 6 months later. @*Conclusions@#Visual loss associated with meningioma can spontaneously improve and this should be considered when making diagnostic and treatment decisions for meningioma.
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Purpose@#Chondroid syringoma of the skin is a rare subcutaneous tumor and localization in the eyelid and orbital region that has rarely been described. We report a case of chondroid syringoma that involved the sub-brow region and was accompanied by hair loss. Case summary: A 57-year-old women presented with a mass on the lateral side of the left sub-brow region which was observed 25 years earlier. The mass, which recurred 2 months after surgery at another hospital through a skin incision was accompanied by an itching sensation. The mass was not tender or ulcerated but was reddish with superficial blood vessels and had a smooth surface with hair loss at the site of the mass. The mass showed high signal intensity on a T2-weighted magnetic resonance image and a round echogenic nodule with an irregular hypoechoic portion was observed on ultrasonography. A full-thickness excision including the adjacent normal tissue of the sub-brow mass and direct closure were subsequently performed. The pathological diagnosis was chondroid syringoma which was revealed as numerous tubular structures with various lumens in a collagenous stroma. Mucinous and fibrous findings were also observed. No recurrence was detected during the first 2 years after surgery. @*Conclusions@#Chondroid syringoma in the eyelid and sub-brow region is uncommon. Complete resection is required to differentiate it from a malignancy and reduce the possibility of recurrence. Incomplete resection or capsular rupture during removal of the tumor could induce recurrence or a malignant change in the tumor.
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Background@#To evaluate the patterns of distribution and clinical manifestations of ocular injuries referred to the level 1 trauma center of Pusan National University Hospital (PNUH) in Korea. @*Methods@#We analyzed 254 of 4,287 patients who were referred to the Department of Ophthalmology at the level 1 trauma center of the PNUH, from January 2016 through December 2018. Data on the incidence of ocular injuries, sex, age, monthly and seasonal distribution, day and time of injury, side of injury, cause, residence of patients, referral time to an ophthalmologist and subsequent examination time, final visual acuity (VA), and complications were obtained from medical records and retrospectively reviewed. The patients were grouped according to their main diagnosis using the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS). @*Results@#The incidence of ocular injuries with major trauma was higher in men (n = 207, 81.5%), the median age at time of injury was 54 years, and Pusan recorded the most cases.The incidences of ocular injury were 1.47/100,000, 1.57/100,000, 1.48/100,000 in 2016, 2017 and 2018, respectively. The most common cause was by a motorbike accident, followed by a pedestrian traffic accident and falls. According to the BETTS classification, open-globe injuries represented 4% of cases, closed-globe injuries represented 12.6%, and other injuries represented 83.1%. Open-globe injuries were significantly associated with low final VA (P = 0.01). In the OTS, 79.4% of patients received 4 or 5 points and 13.7% of patients received 1 or 2 points. The patients who received 1 or 2 points in the OTS score showed final VA below hand movement (P < 0.001), except for two patients. Lid laceration and low initial VA were highly correlated with poor final VA (P < 0.001). @*Conclusion@#This is the first study on the epidemiology and clinical manifestations in trauma patients with ocular injuries at a level 1 trauma center. The incidences of ocular injuries with major trauma were about 1.47–1.57/100,000. BETTS, OTS, lid laceration and initial VA were associated with final VA. We expect our study to provide a basis of data for the evaluation, prevention, and management of ocular injuries in patients with systemic trauma.
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The Korean Intermittent Exotropia Multicenter Study (KIEMS), which was initiated by the Korean Association of Pediatric Ophthalmology and Strabismus, is a collaborative multicenter study on intermittent exotropia in Korea. The KIEMS was designed to provide comprehensive information, including subjective and objective findings of intermittent exotropia in a large study population. A total of 65 strabismus specialists in 53 institutions contributed to this study, which, to date, is one of the largest clinical studies on intermittent exotropia. In this article, we provide a detailed methodology of the KIEMS to help future investigations that may use the KIEMS data.
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Purpose@#To investigate the clinical features of strabismus in patients with congenital optic disc anomaly and compare and analyze the characteristics of patients who showed changes in the strabismus pattern with those who did not. @*Methods@#Medical records of the patients who were diagnosed with both strabismus and congenital optic disc anomaly and followed-up for ≥1 year were reviewed retrospectively. Clinical characteristics and ophthalmic features at the initial visit and final follow-up were assessed. Patients with a change in the direction of strabismus or a difference of >10 prism diopters in the deviation angle during the follow-up period were allocated to the changed group. The remaining patients were assigned to the unchanged group. The clinical characteristics of the two groups were compared. @*Results@#Twenty-eight patients (15 boys) were included (mean age, 39.0 months; range, 5–150 months). Three (10.7%) patients were born preterm and four (14.3%) had other underlying systemic disease. Sixteen (57.1%) patients had exotropia, and 12 (42.9%) had esotropia. Concurrent vertical strabismus was present in three (10.7%) patients. Strabismus features changed in 14 (50.0%, changed group) patients and remained unchanged in 14 (50.0%, unchanged group) patients. Age, sex, and laterality did not differ between groups. Preterm birth history (n = 3) and combined systemic disease (n = 4) were only observed in the changed group (p = 0.111 and p = 0.049, respectively). @*Conclusions@#Considering the possibility of changes in strabismic features, close monitoring of patients with strabismus combined with congenital disc anomaly is essential, particularly in those with preterm birth history or underlying systemic conditions.
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Purpose@#The purpose of this study was to investigate the motor subtypes of delirium in patients in a Surgical Intensive Care Unit (SICU), and identify the factors related to the characteristics of patients according to the motor subtypes of delirium. @*Methods@#Data were collected in the SICU of a tertiary hospital in * city from October 2018 to June 2019. Delirium was detected using the Confusion Assessment Method for the ICU (CAM-ICU) and motor subtypes of delirium were measured with the Delirium Motor Subtype Scale (DMSS)-4. Patients’ characteristics were obtained by using the electronic medical records. Descriptive statistics were used to analyze the data. @*Results@#Among 1,112 patients, 172 patients showed delirium (15.5%). After excluding dementia patients and patients refusing to participate in the study, 126 patients included in the final analysis. Delirium patients were classified as hyperactive delirium (32.5%), hypoactive delirium (42.9%), mixed delirium (11.9%), and non-motor subtype delirium 12.7%). @*Conclusion@#The study results suggest that hypoactive delirium is the most prevalent motor subtype of delirium in SICU. More application of ventilators, more administration of sedatives, more use of catheters, and higher nursing severity were reported for hypoactive delirium cases than hyperactive ones. Therefore, it is necessary to assess early the motor subtypes of delirium using structured tools and develop appropriate nursing interventions suitable for each subtype of delirium.
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Purpose@#To compare the clinical effects of Guardcel® (Genewel. Co, Seongnam, Korea) and Nasopore®(Polyganics, Rozenburglaan, Groningen, The Netherlands), two types of absorbable nasal packing materials after endonasal dacryocystorhinostomy. @*Methods@#A total of 41 patients (49 eyes) who underwent endonasal dacryocystorhinostomy from March 2017 to January 2019 were studied retrospectively. Twenty seven eyes were packed with Guardcel® and twenty two eyes with Nasopore®. We compared the postoperative anatomical and functional surgical success rates between the groups at 1 week, 1 month, 2 months, and 6 months , as well as the frequency of postoperative complications including bleeding. @*Results@#There was no significant difference between the Guardcel® and Nasopore® groups in the postoperative anatomical and functional surgical success rate at 1 week, 1 month, 2 months, or 6 months. Also, there was no significant group difference in the incidence of postoperative complications. @*Conclusions@#The anatomical and functional surgical success rates and incidence of postoperative complications, including bleeding, synechiae, infection, granuloma, and revision were similar between the Guardcel® and Nasopore® groups. Therefore, Guardcel® can be used safely and effectively as an absorbable nasal packing material in endonasal dacryocystorhinostomy treatment.
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PURPOSE: To evaluate the efficacy of modified Anderson procedure in infantile nystagmus with face turn less than 30 degrees. METHODS: This study was a retrospective review of the medical records of 13 consecutive patients who underwent a modified Anderson procedure for abnormal head position in infantile nystagmus at Pusan National University hospital from February 2002 to March 2017. We compared best-corrected visual acuity (logarithm of minimal angle of resolution, logMAR), refraction, degree of face turn, ocular motility, and angle of deviation preoperatively and at 1 week postoperatively, 6 months postoperatively, and the final visit. Recession of the yoke rectus muscles responsible for the slow phase of nystagmus was performed, depending on the direction of face turn; the medial rectus muscle of the eye to which the head was turned was recessed 10 mm, whereas the lateral rectus muscle of the contralateral eye was recessed 12 mm. RESULTS: The mean age of the patients was 8.9 (2–25) years, and the mean follow-up period after surgery was 51.3 (6–183) months. Twelve patients (92.3%) had no residual head posture or <10° at 6 months postoperatively, and three patients (23.1%) achieved this outcome with an additional operation. The mean degrees of face turn were 22.30° before surgery and 3.85° post-operatively (p = 0.001). Best-corrected visual acuity (logMAR) was 0.41 in the better eye and 0.50 in the worse eye before surgery; this improved to 0.34 and 0.45 at 6 months postoperatively (p = 0.068 and p = 0.228, respectively). Despite the large recessions involved, only one patient showed mild limitation of abduction after surgery. CONCLUSIONS: The modified Anderson procedure may be effective for correcting abnormal head position in infantile nystagmus with face turn less than 30 degrees; patients were not overcorrected.
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Humans , Follow-Up Studies , Head , Medical Records , Muscles , Posture , Retrospective Studies , Visual AcuityABSTRACT
PURPOSE: To report two cases of orbital apex syndrome caused by blunt orbital trauma without structural damage of the orbit. CASE SUMMARY: (Case 1) A 50-year-old male came to our clinic complaining of visual loss after blunt orbital trauma by a metal bar. The best-corrected visual acuity was no light perception and light reflex was not observed in the affected eye. He also presented with complete ptosis and ophthalmoplegia with relative sparing of adduction and depression. High signal intensity of the orbital soft tissue including the optic nerve sheath was revealed using a T2-weighted image in magnetic resonance imaging. After starting steroid pulse therapy, his visual acuity improved to counting fingers on the third day. Ocular movement and levator function recovered to the normal range while visual acuity remained counting fingers. (Case 2) A 64-year-old female presented with complete ptosis after trauma to her right eyeball. The best-corrected visual acuity was 20/25 in the right eye. Complete ptosis and ophthalmoplegia with relative sparing of abduction and depression in the right eye were observed at the initial presentation. Magnetic resonance images showed enhancement of the right periphery optic nerve and distal rectus muscle. Two months after undergoing steroid pulse therapy, levator function and ocular movement recovered completely, and visual acuity improved to 20/20. CONCLUSIONS: The orbital apex syndrome caused by blunt orbital trauma showed good response to steroid pulse therapy. Steroid treatments may therefore be considered for the treatment of traumatic orbital apex syndrome.
Subject(s)
Female , Humans , Male , Middle Aged , Depression , Fingers , Magnetic Resonance Imaging , Ophthalmoplegia , Optic Nerve , Orbit , Reference Values , Reflex , Visual AcuityABSTRACT
Musculoskeletal (MSK) infections, such as osteomyelitis, infectious arthritis and spondylitis have variable radiographic findings depending on their underlying cause and clinical infection stage. Other disease entities, ranging from simple degenerative lesions to tumorous bone conditions, in which there is no evidence of infectious origin, can share similar radiographic findings. It is important to be aware, when interpreting radiographic features that are typically associated with MSK infections, that a non-infectious MSK disease may be mimicking the radiographic findings of infectious diseases.
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PURPOSE: To report a case of an orbital mass diagnosed as metastasis from small cell lung cancer and to provide a review of the literature. CASE SUMMARY: A 66-year-old male with a history of diabetes mellitus and hypertension presented with decreased visual acuity and exophthalmos in his left eye. He had been diagnosed with age-related macular degeneration 13 years prior and had a history of pneumonia that was treated for one month. The best corrected visual acuity was hand-motion in the right eye and 0.04 in the left eye. Optic disc swelling and splint hemorrhage of the left eye was observed on fundus examination. The left eye was protruded and eye movement was limited. On orbital magnetic resonance imaging, an irregular mass in the left intraconal space was found. Incisional biopsy was performed, and histopathologic examination revealed a small round tumor. According to the results of immunohistochemical staining, metastatic tumors were suspected. After systemic evaluation, the patient was diagnosed with primary small cell lung cancer with multiple metastases. After 2 months, the visual acuity was hand-motion and proptosis was not resolved. CONCLUSIONS: In patients with orbital masses, the possibility of metastatic tumors should be considered during differential diagnosis and early biopsy should be performed.
Subject(s)
Aged , Humans , Male , Biopsy , Diabetes Mellitus , Diagnosis, Differential , Exophthalmos , Eye Movements , Hemorrhage , Hypertension , Macular Degeneration , Magnetic Resonance Imaging , Neoplasm Metastasis , Orbit , Pneumonia , Small Cell Lung Carcinoma , Splints , Visual AcuityABSTRACT
PURPOSE: This study was done to examine the prophylactic effect of transparent film dressing on the sacrum and coccyx sites to reduce pressure ulcers. METHODS: The participants were 317 patients admitted to an SICU in Seoul, Korea. Of the patients, 175 were assigned to the experimental group and 142 to the control group. For participants in the experimental group, a prophylactic transparent film dressing was applied on the sacrum and coccyx. The control group received the usual care. The nurses checked for pressure ulcers on the sacrum and coccyx at least once every duty. When pressure ulcer occurred, it reported on the record form. The results were analyzed using Poisson and Hierarchical logistic regression. RESULTS: The prevalence and risk of pressure ulcer was lower in the experimental group compared to the control group but the difference was not significant. The ICU length of stay was significantly associated with pressure ulcer risk. CONCLUSION: Findings indicate that prophylactic transparent film dressing helps to reduce pressure ulcer in SICU patients.
Subject(s)
Humans , Bandages , Coccyx , Critical Care Nursing , Korea , Length of Stay , Logistic Models , Pressure Ulcer , Prevalence , Sacrum , Seoul , Skin CareABSTRACT
PURPOSE: To compare surgical success rates and complications of silicone tube intubation using 0.64-mm- and 0.94-mm-diameter tubes in adult patients with nasolacrimal duct stenosis. METHODS: In 62 eyes of 36 patients diagnosed with nasolacrimal duct stenosis who had undergone silicone tube intubation, we surveyed sex, age, symptom duration, time of tube removal, mean follow-up period, and surgical success rate between two groups divided by silicone tube diameter, 0.64 mm and 0.94 mm. By preoperative syringing test and dacryocystography, we examined the surgical results and complications of the two groups. RESULTS: The silicone tube diameter was 0.64 mm in 43 eyes (69.4%) and 0.94 mm in 19 eyes (30.2%). The surgical success rates in the two groups were 84.1% (36 eyes) and 78.9% (15 eyes), respectively, but the difference was not significant statistically. The surgical success rate was higher in partial stenosis than in complete stenosis but was not different according to silicone tube diameter according to preoperative syringing test and dacryocystography. Silicone tube disconnection and bending were only observed in 0.94-mm-diameter silicone tubes. CONCLUSIONS: In silicone tube intubation for nasolacrimal duct stenosis in adults, silicone tube diameter does not affect operation success. However, silicone tube disconnection and bending were observed only in the 0.94 mm silicone tube.