Endophthalmitis caused by the coagulase-negative staphylococci. 1. Disease spectrum and outcome.

PURPOSE: The coagulase-negative staphylococci are the most common causes of postoperative endophthalmitis. This study investigates the variability in the disease spectrum and visual outcome of coagulase-negative staphylococcal endophthalmitis in a large, single-center series. METHODS: Ninety consecutive cases of coagulase-negative staphylococcal endophthalmitis were investigated retrospectively from two time periods, 1978 to 1982 and 1985 to 1987, separated by a transitional period in cataract surgery technique. Using a detailed protocol, inpatient, outpatient, and microbiologic records were analyzed. Six-month visual acuity results were obtained. RESULTS: Diagnosis frequently was delayed, often suspected only after hypopyon development. Thirty-seven percent of patients presented more than 1 week after the inoculating event, and 13% presented after more than 1 month. Variable asymptomatic intervals and gradually worsening inflammatory prodromes are noted. Painless endophthalmitis occurred in 16%. Non-epidermidis infections comprised 28%. With vitrectomy/intraocular antibiotic management, 38% and 68% achieved visual acuities of 20/50 and 20/400, respectively. Overall, 10% of patients developed late retinal detachments. This occurred in only 4% of patients, with endophthalmitis occurring after cataract surgery. CONCLUSION: Ophthalmologists should become familiar with the emerging concepts of delayed-onset, chronic, and often painless endophthalmitis in which the coagulase-negative staphylococci play a prominent role.

Endophthalmitis caused by the coagulase-negative staphylococci. 2. Factors influencing presentation after cataract surgery.

PURPOSE: This study, comprising 60 patients with coagulase-negative staphylococcal endophthalmitis which occurred after cataract surgery, was designed to define the variation in disease presentation and visual outcome and to evaluate statistically the role of the primary surgery and its management. METHODS: An intensive evaluation of microbiological, inpatient, outpatient, and cataract surgery charts was made retrospectively using a standardized protocol. The predictive value of surgical, iatrogenic, and clinical factors was analyzed for their influence on defined aspects of the disease pattern and of the visual results using multiple regression models, via a stepwise technique. RESULTS: There was commonly a significant asymptomatic latent period after cataract surgery. The median diagnostic delay was 7 days; 22% of patients presented after 2 weeks and 12% after 1 month. Symptoms progressed longer than 3 days in 25% of patients. Ten percent had no pain. Clinical variation proved largely unrelated to cataract surgery events and postoperative management; bacterial factors were implicated. Good visual outcome was associated statistically with intensive topical corticosteroid in the symptomatic period, but was negatively associated with operative subconjunctival corticosteroid. CONCLUSIONS: The clinical variation in cases of postoperative coagulase-negative staphylococcal endophthalmitis poses particular problems for diagnosis in the outpatient setting. Surgical and perioperative events (except corticosteroid use) probably can be disregarded in studies of endophthalmitis management.

HDL-C Concentrations in Weight-Trained, Endurance-Trained, and Sedentary Females.

In brief: Serum high-density lipoprotein cholesterol (HDL-C) levels and percent HDL-C were significantly higher in nine female endurance runners than in equal groups of female weight trainers and sedentary female controls. Weight trainers and controls showed no significant differences in HDL-C and percent HDL-C. Subjects who had higher HDL-C levels were more likely to be non-smokers who consumed little alcohol and did not use oral contraceptives. No significant dose-response relationships were found for either runners or weight trainers when daily training duration, weekly training frequency, and weekly mileage were correlated with HDL-C. It was concluded that HDL-C levels in females are associated with specific training methods.

A factor analysis of the California Test of Personality--secondary level.

Sought to determine the construct validity of the California Test of Personality--Secondary Level to ascertain whether 12 components (factors) of personality as theorized by test authors are separate and meaningful (N = 1,800). Since personality assessment instruments are essential tools for those who study human behavior it is recognized that the usefulness of these instruments is related directly to their validity. The findings of this study indicate that the 180 items of the CTP are represented better as a 9-factor construct. Thirty-one percent of test items load significantly on 2 or more factors, and 10% of the test items do not contribute in a meaningful way to any one component (factor).

Values of baccalaureate nursing students in secular and religious schools.

This study examined if and how values held by baccalaureate nursing students in secular and religious schools changed during their school experience. The Rokeach Value Survey was used to measure and assess respondents' hierarchical arrangement of two kinds of values, instrumental and terminal. Two-way analysis of variance was done on each value to ascertain difference by class level or school orientation. Significant differences were found for 25 of the 36 values when the students were compared for school orientation, but for only 17 or the 36 values when freshmen and seniors were compared.