An Examination of the Factors Determining Successful Implementation of an Electronic Medical Record (EMR) System in a Regional Hospital

A Thesis Presented to the Faculty of the College of Business and Public Affairs Morehead State University in Partial Fulfillment of the Requirements for the Degree Master of Science by Mehrdad Motamed in July of 2014

Evaluation of the Effect of Intravenous Ondansetron versus Placebo before Anesthesia on Vomiting after Endoscopy and Colonoscopy Procedures

Background: Vomiting is a common complication after endoscopic procedures in children. Different medications could be administered to control vomiting after endoscopy. The goal of this study is to evaluate anti-emetic effects of ondansetron in children who undergo endoscopic procedures.Methods: In this clinical randomized trial, 198 children (103 female/95 male) were randomly assigned into one of the following two studied groups. Case group (G1): Fentanyl 1 µg/kg + propofol 2.5 mg/kg + ondansetron 0.15 mg/kg and control group (G2): Fentanyl 1 µg/kg + propofol 2.5 mg/kg + 2 cc normal saline.Results: The mean age was 6.3 ± 3.5 years (6.2 ± 3.6 years in G1 vs. 6.4 ± 3.5 years in G2). The most common cause of endoscopy procedure in both groups was hematochezia. Vomiting, recovery time, Paediatric Anesthesia Emergence Delirium (PAED), and Aldrete scores were compared. Rate of vomiting after recovery and Aldrete score were significantly different between the two groups.Conclusions:Ondansetron is effective in controlling vomiting after colonoscopy and upper gastrointestinal endoscopic procedures. Also, patients in intervention group experienced better recovery time

Hemi-Central Retinal Vein Occlusion in a Premature Infant: A Case Report

Background: This study reports the case of an infant patient with organized vitreous hemorrhage (VH) due to hemi-central retinal vein occlusion (Hemi-CRVO) secondary to thrombocytosis.Case report: A twenty-seven-day-old female infant with the gestational age of 30 weeks and 2040 grams weight at the time of birth and the history of a twenty-five-day admission in a neonatal intensive care unit (NICU) due to idiopathic hydrops was referred to the retinopathy of prematurity (ROP) clinic of the Khatam-al-Anbia Eye Hospital, for usual ROP screening. We found an organized VH in her left eye; so, we vitrectomized her eye. With the diagnosis of hemi-CRVO due to thrombocytosis, she is under observation.Conclusion: In this report, thrombocytosis showed to be a cause of hemi-CRVO; and the patient’s laboratory test review is important in such case

Traumatic rosette cataract

Key Clinical Message One of the clinical presentations of traumatic cataracts is a rosette‐shaped posterior capsular opacity. The severity of vision loss, the patient's age, and the cornea, macula, and optic nerve states are major determinants of the therapeutic approach

Choroidal metastasis and bilateral optic nerve involvement as presenting sign of metastatic lung adenocarcinoma: A case report

Abstract A 49‐year‐old male presented with a gradually progressive loss of vision in both eyes. Funduscopic examination revealed bilateral optic disc swelling and two yellowish elevated choroidal lesions in the left eye. Ophthalmic imaging raised suspicion of choroidal metastasis. Adenocarcinoma of the lung was detected in further systemic evaluation

Trauma and chorioretinal shockwave injury from intra‐orbital foreign body

Key Clinical Message High‐velocity projectile trauma could lead to intra‐orbital foreign body and concomitant chorioretinal shockwave injury in the absence of open‐globe injury. Management depends on the types, size, and location of foreign bodies

Vogt–Koyanagi–Harada disease with a unilateral presentation in a patient with marijuana overuse: Role of multimodal imaging in suspected patients

Key Clinical Message Harada disease could uniquely present with only unilateral symptoms, as was seen in our patient. However, multimodal imaging including ICG angiography could show bilateral involvement. Considering the immunomodulatory effects of Cannabis, the absence of inflammatory findings and the unusual presentation of the disease, in our case, may have been caused by the use of marijuana. Abstract To report a patient addicted to marijuana with the diagnosis of Vogt–Koyanagi–Harada (VKH) disease with a unilateral presentation. A 24‐year‐old man presented to us with painless decreased vision in his right eye (RE) and photophobia 3 days ago. No history of significant family or past medical history was documented. Spectral‐domain optical coherence tomography (SD‐OCT) of the RE showed multiple areas of subretinal fluid in the macula. Indocyanine green angiography (ICGA) revealed round hypocyanescent dark dots (HDD) of similar size, evenly distributed in both eyes. With the diagnosis of VKH disease, anti‐inflammatory treatment was started. To our knowledge, this is the first reported case of suspected VKH in a patient with marijuana overuse. Regarding the complex effects of tetrahydrocannabinol (THC), the active ingredient of marijuana, on the vascular and immune systems, reaching a definite conclusion is not possible. This report shows the value of multimodal imaging in patients with unusual presentations

Macular retinal and choroidal thickness profile in patients with thyroid‐associated orbitopathy compared to healthy individuals: A cross‐sectional study

Abstract Background and Aims To evaluate the macular thickness profile and central subfoveal choroidal thickness in patients with thyroid‐associated orbitopathy (TAO) compared to healthy subjects. Methods We used the convenience sampling method and divided all participants into the patients and control groups. Based on the clinical activity score (CAS) in the first examination, the patient group was divided to two subgroups: the patients with CAS < 3 and the patients with CAS ≥ 3. Complete ophthalmologic examinations and optical coherence tomography imaging were performed for all participants. Results The mean ± SD of central choroidal thickness was 277 ± 76.58 microns for the control and 326.07 ± 56.574 micron for the patient group which was statistically significant (p = 0.003). We also found that the parafoveal inner thickness is significantly lower in patients compared to healthy subjects (p = 0.02). A comparison of neuro‐structural data between the two subgroups of patients showed a significant difference in central choroidal thickness (p = 0.05). Conclusion This study showed that central choroidal thickness in patients with CAS ≥ 3 compared to those with CAS < 3 and also in the patient group compared to healthy individuals have a significantly increasing trend

Macular microvasculature in patients with thyroid-associated orbitopathy: a cross-sectional study

Abstract Purpose The aim of this study was to evaluate macular blood flow in patients with thyroid-associated orbitopathy (TAO) as compared to healthy subjects. The inflammatory nature of the disease, as well as the vascular congestion caused by the increase in the volume of orbital soft tissue and extraocular muscles, rationalize the assessment of retinal blood flow changes in these patients. Methods This is a cross-sectional study with the convenience sampling method. Macular flow density was assessed using optical coherence tomography angiography (OCTA) and compared between patients with TAO and healthy individuals. We also compared macular flow density in two subgroups of patients based on clinical activity score (CAS). Results Eighty–five cases, including 30 healthy individuals and 55 patients with TAO, participated. The foveal avascular zone (FAZ) area was significantly larger in the patient group than in the control. Patients with active TAO with CAS 3 or more had significantly larger FAZ areas than those with CAS less than 3 (p = 0.04). Conclusion We showed that the FAZ area is larger in active TAO patients and can be considered a possible candidate feature for monitoring disease activity and thyroid-associated vasculopathy

Fulminant endogenous endophthalmitis caused by Brucella melitensis, a case report

Key Clinical Message Ocular brucellosis is a potential cause of endogenous endophthalmitis in endemic areas, which can be associated with sight‐threatening complications. Abstract To report a patient with unusual fulminant endogenous endophthalmitis due to Brucella melitensis. A 25‐year‐old woman with a history of fever and right shoulder pain from 4 months ago and a positive Wright test presented with acute panuveitis in her right eye. All laboratory tests were unremarkable except for the positive polymerase chain reaction (PCR) test of the vitreous sample for B. melitensis. Despite the therapeutic efforts, including multiple vitreoretinal surgeries, and intravitreal and systemic antibiotics, the patient's final follow‐up examination after 6 months revealed hand motion vision, hypotonia, and pre‐phthisis bulbi status. The fellow eye was entirely normal. Brucella endogenous endophthalmitis can be fulminant and result in poor visual outcomes. It is suggested to consider ocular brucellosis as a potential cause of endogenous endophthalmitis in endemic areas