Review of Surgical Management for Closed-Angle Glaucoma

Closed-angle glaucoma, also known as angle-closure glaucoma, is one of the major types of glaucoma. Glaucoma is a term used to describe a broad group of ocular diseases that damage the optic nerve. The type of angle closure with which the patient presents, whether acute, subacute, or chronic, will dictate their treatment. Management of these three presentations will be discussed at length later in this article. In the United States, closed-angle glaucoma is less common than open-angle glaucoma, which often has a gradual onset of intraocular pressure (IOP) elevation and optic nerve damage

Roscoe Reid Graham (1890 to 1948): a Canadian pioneer in general surgery.

Roscoe Reid Graham, a Canadian surgeon trained at the University of Toronto, was a true pioneer in the field of general surgery. Although he may be best known for his omental patch repair of perforated duodenal ulcers-often referred to as the Graham patch -he had a number of other significant accomplishments that decorated his surgical career. Dr. Graham is credited with being the first surgeon to successfully enucleate an insulinoma. He ventured to do an essentially brand new operation based solely on his patient\u27s symptoms and physical findings, a courageous move that even some of the most talented surgeons would shy away from. He also spent a large portion of his career dedicated to the study of rectal prolapse, working tirelessly to rid his patients of this awful affliction. He was recognized by a number of different surgical associations for his operative successes and was awarded membership to those both in Canada and the United States. Despite all of these accolades, Dr. Graham remained grounded and always fervent in his dedication to the patient and their presenting symptom(s), reminding us that to do anything more would be meddlesome. In an age when medical professionals are often all too eager to make unnecessary interventions, it is imperative that we look back at our predecessors such as Roscoe Reid Graham, for they will continually redirect us toward our one and only obligation: the patient

Mary H. Gibbon: teamwork of the heart.

Mary Maly Hopkinson Gibbon was born on September 25, 1903, to an affluent New England family who encouraged her to embrace her intelligence and to follow that by which she was intrigued. In doing this, Maly pursued work in scientific research, where she ultimately met her first husband, Dr. John ‘‘Jack’’ H. Gibbon. Jack and Maly were partners in every sense of the word. Their collaboration, both within and beyond the walls of the research laboratory, made it possible for the Gibbon dream of the heart–lung machine to be realized

Some Ethical Issues in Treating and Caring for People with Dementia

This paper explores several issues regarding the treatment and care for patients suffering from dementia, including a discussion of the relatively low time and money spent on dementia research compared to research on cancer and cardio-vascular disease. It will also discuss the special relationship between the person suffering from dementia and their carer, who is often a loved one. The paper employs principlism and so examines these issues from a consideration of autonomy, non-maleficence, beneficence, and justice

Telling Patients the Truth

This article discusses the ethical necessity of health care workers telling their patients the truth about both their diagnosis and prognosis. This necessity is based upon respect for persons, utility, and kindness. Within this ethical obligation to tell the truth, however, there are several different ways in which the truth can be told. In particular, this paper stresses that telling patients the truth is best thought of as a process that unfolds over time, and which is driven by what the patient knows and what they want

Discrimination against Mixed-Status Families and its Health Impact on Latino Children

Background and Objective: Restrictive immigration policies and discrimination are associated with negative health outcomes for immigrant and Latino families. Mixed-status families represent a unique subpopulation of Latinos affected by restrictive immigration policies. This qualitative study explored discrimination against mixed-status families and its potential health impact on Latino children from the perspective of Latina mothers. Methods: In 2017, twenty in-depth interviews with Latina mothers of mixed-status families living in northwestern North Carolina were conducted, transcribed, and analyzed. Constant comparison, an approach to grounded theory development, was used. Results: Nine themes emerged that reflected experiences with discrimination and its negative impact on children. Themes included more frequent and severe discrimination during and after the 2016 US presidential election, determination to stay together and remain in the US, experiences of discrimination in multiple settings, the impact of discrimination on child health and well-being, the impact of fear and stress on meeting the needs of children, the burden on children serving as liaisons between families and services, the inability of citizenship to protect against the effects of discrimination, positive and hopeful responses to discrimination, and the potential role of education in building a foundation for reducing discrimination (and thus promoting the health and well-being of Latino children) in the future. Conclusions: Discrimination against mixed-status Latino families constitutes a critical threat to the health and well-being of Latino children. Further research should inform immigration policies that support (rather than threaten) the health, well-being, and health care practices that mitigate the stresses experienced by Latino children

Spatial Aspects of Gardens Drive Ranging in Urban Foxes (Vulpes vulpes): The Resource Dispersion Hypothesis Revisited.

Red foxes are a well-established species of urban ecosystems in the UK and worldwide. Understanding the spatial ecology of foxes in urban landscapes is important for enhancement of urban biodiversity and effective disease management. The Resource Dispersion Hypothesis (RDH) holds that territory (home range) size is linked to distribution and richness of habitat patches such that aggregation of rich resources should be negatively associated with range size. Here, we tested the RDH on a sample of 20 red foxes (Vulpes vulpes) in the city of Brighton and Hove. We focused on residential garden areas, as foxes were associated with these in previous studies. We equipped 12 male and 8 female foxes with GPS collars recording at 15 min intervals during discrete seasons over four years. We regressed fox core area size against garden size, number of garden patches, and edge density within and between patches as extracted from GIS in a series of bivariate linear mixed models. We found that foxes used smaller core areas where gardens were large and well-connected and larger core areas where numerous, smaller gardens were fragmented by internal barriers (e.g., fences, walls) or bisected by other habitats such as managed grassland or built-up areas. Our findings confirm the RDH and help to inform future urban planning for wildlife

Developing an Action Learning Community Advocacy/Leadership Training Program for Community Health Workers and Their Agencies to Reduce Health Disparities in Arizona Border Communities

Community health workers (CHWs) make unique and important contributions to society. They serve as patient advocates, educators, and navigators in our health care system and a growing body of research indicates that they play an important role in the effective delivery of prevention and treatment services in underserved communities. CHWs also serve as informal community leaders and advocates for organizational and community change, providing valuable insiders\u27 insights about health promotion and the interrelatedness of individuals, their community, its institutions, and the surrounding environment. Accion Para La Salud or Action for Health (Accion) is a CDC-funded community based participatory research (CBPR) project addressing the social determinants of health affecting health-related behaviors with the ultimate goal of creating a mode in which community advocacy to address the systems and environmental factors influencing health is integrated into the role of CHWs working in chronic disease prevention. Kingdon\u27s three streams theory and the social ecological model provide an overarching conceptual framework for Accion. The curriculum and training are also grounded in the theory and principles of action learning, which emphasizes learning by doing, teamwork, real-world projects, and reflection. The curriculum was delivered in four workshops over thirteen months and included longitudinal team projects, peer support conference calls, and technical assistance visits. It is now being delivered to new groups of CHWs in Arizona using a condensed two-day workshop format

The Effectiveness of JeffWLP for Weight Loss and General Nutritional Knowledge in Obese Patients

PURPOSE: The increasing prevalence of obesity urgently requires effective management strategies. This study evaluates the effectiveness of Jefferson Weight Loss Program (JeffWLP), a trained medical student-delivered health education program in a predominantly African-American patient cohort. METHODS: A randomized controlled trial was performed enrolling 30 patients with an average socioeconomic status of 5.8 (10 maximum). The intervention group (n=18) completed JeffWLP, a low-cost, 12-week health coaching program combining education sessions with graded step exercises. The control group (n=12) received usual care. Mean baseline age, BMI, and General Nutritional Knowledge Questionnaire (GNKQ) scores were: 46±13 years, 38±5, and 14.7±1.9 (maximum score=17) respectively. RESULTS: Patients completing JeffWLP achieved greater weight loss, with mean weight loss of 6.1±7.8 pounds (p=0.01) compared to 4.4±7.5 pounds weight gain in controls (p=0.14). This corresponded to 2.7±3.3% weight reduction (p=0.01) and 2.0±3.5% weight gain (p=0.15). Mean endpoint GNKQ scores decreased overall slightly to 14.5±1.9, but improvement correlated with total, group, and 1:1 class attendance (R=0.81, 0.75, 0.77, p=0.0004, 0.002, 0.001 respectively). CONCLUSIONS: The significant weight reduction of 2.7±3.3% achieved in just 12 weeks of JeffWLP suggests meaningful progress towards improving cardiovascular health. Correlation of GNKQ scores to attendance suggests that patients acquired knowledge facilitating these positive outcomes. Our results support the establishment of student-delivered patient education programs to help combat the obesity epidemic.https://jdc.jefferson.edu/aoa_research_symposium_posters/1010/thumbnail.jp