Subsequent Complaints Research Articles

Understanding Risk Factors for Complaints Against Pharmacists: A Content Analysis.

Pharmacists constitute a crucial component of the healthcare system, significantly influencing the provision of medication services and ensuring patient safety. This study aims to understand the characteristics and risk factors for complaints against pharmacists through Health and Disability Commissioner (HDC) published decisions. This study adopts a retrospective, qualitative approach. An inductive content analysis technique was used to analyze 37 complaints against pharmacists published decisions from the New Zealand Health and Disability Commissioner website to investigate a range of underlying risk factors contributing to the occurrence of complaints against pharmacists. A set of 20 categories of risk factors emerged through the content analysis and were subsequently grouped into five overarching themes: pharmacist individual factors, organizational factors, system factors, medication-specific factors, and external environmental factors. The findings of this study provide valuable insights that expand the understanding of risk management in pharmacist practice, serving as a valuable resource for regulatory bodies, policymakers, educators, and practitioners. It is recommended not only to focus solely on individual pharmacists but also to consider integrating their environment and individual behaviors to proactively address situations prone to errors and subsequent complaints.

Loneliness, belonging and psychosomatic complaints across late adolescence and young adulthood: a Swedish cohort study

BackgroundLoneliness and belonging refer to social connectedness and are associated with young people’s health; however, the relationship between these constructs and their impact on health is still being discussed. A dual continuum model of belonging and loneliness has been suggested, consisting of four groups depending on the state of loneliness and belonging: socially fulfilled (low loneliness, high belonging), socially indifferent (low loneliness, low belonging), socially searching (high loneliness, high belonging), and socially distressed (high loneliness, low belonging). The aim of this study is to examine loneliness and belonging in a Swedish sample of 17–18-years-olds who were followed over 3 years, and the associations that these aspects share with young people’s psychosomatic complaints during these ages.MethodsSwedish cohort data collected among late adolescents (age 17–18 in 2019) who were followed up in young adulthood (age 20–21 in 2022) (n = 2684) was used to examine the associations between loneliness, belonging, and psychosomatic complaints. Loneliness and belonging were measured by single items and the cross-combinations of these. Three psychosomatic complaints were assessed: stomach ache, headache, and difficulties falling asleep, and a summary index was calculated.ResultsLinear regression analyses showed that loneliness was positively and belonging was negatively cross-sectionally associated with psychosomatic complaints. The socially fulfilled group reported fewer psychosomatic complaints compared to all other groups, while the socially distressed group reported the highest level of psychosomatic complaints. Additional adjustment for sociodemographic characteristics barely affected the estimates. The prospective analysis supported these patterns; however, after adjustment for earlier psychosomatic complaints, the only statistically significant difference in subsequent psychosomatic complaints was found between the socially fulfilled and the socially distressed groups.ConclusionsLoneliness and belonging (separately and the cross-combinations of these) were cross-sectionally associated with psychosomatic complaints in late adolescence and in young adulthood. Prospectively, only the most vulnerable group in the dual continuum model, the socially distressed group, experienced more psychosomatic complaints than the socially fulfilled group, indicating a temporal relationship. Knowledge about the more nuanced links may be useful for developing specific public health recommendations and interventions for youth, targeting the most vulnerable groups.

A Case of Anterior Single Tooth Implant with Fractured Zirconia Abutment due to Trauma.

In recent years, a wide variety of materials have been used in dental implant treatment. In selecting the superstructures and abutments to be used it is important to consider their potential effect on the stability and durability of the planned implant. Excessive force applied to an implant during maintenance commonly results in complications, such as fracture of the superstructure or abutment, and loosening or fracture of the screws. This report describes a case of implant treatment for a 23-year-old man with esthetic disturbance due to trauma to the maxillary anterior teeth. The left maxillary central incisor could not be conserved due to this trauma, which had been caused by a traffic accident. After extraction, the tooth was restored with an anterior bridge. The crown of the left maxillary lateral incisor was fractured at the crown margin and, at the patient's request, implant treatment was selected as the restorative treatment for the missing tooth. A thorough preoperative examination was performed using placement simulation software. One titanium screw-type implant was placed in the maxillary left central incisor under local anesthesia. An all-ceramic crown with a zirconia frame was placed as a screw-fixed direct superstructure. At one year postoperatively, however, the superstructure and abutment became detached due to trauma. The fractured zirconia abutment was removed and replaced with a remanufactured abutment and superstructure. The patient has reported no subsequent dental complaint over the last 11 years. In this case, a surface analysis of the fractured zirconia abutment was performed. The scanned images revealed a difference in the fracture surfaces between the tensile and compressive sides, and electron probe microanalysis demonstrated the presence of titanium on the fracture surface. It was inferred that the hard zirconia abutment had scraped the titanium from the internal surface of the implant.

How do veterinarians mitigate liability concerns with workforce shortages?

The challenge of meeting pet healthcare demands with inadequate staff resources creates legal and ethical considerations for the veterinary profession. Inadequate staffing can result in access to care issues that impact companion animal health, public health, and the human animal bond. An overburdened work environment may also result in liability issues related to standard of care, client dissatisfaction, and subsequent complaints. The following recommendations may ameliorate the legal and ethical impacts to include: a focus on how to optimize current resources (human and technology); improve client communications and medical record-keeping strategies; promote preventive care; develop and memorialize clinical standard operating procedures; and prioritize staff well-being to prevent burn out. These recommendations should be considered good practices when functioning under optimal conditions but are even more valuable to implement effectively in an overburdened companion animal medicine environment.

Loneliness, belonging and psychosomatic complaints across late adolescence and young adulthood

Abstract Loneliness and a sense of belonging refer to social connectedness and are associated with young people's health; however, the relationship between these constructs and their impact on health is still being discussed. The dual continuum model has been suggested (Lim et al., 2021) where these two constructs are regarded as independent but related. Four groups of individuals are defined in the model depending on the level of loneliness and belonging: socially fulfilled (low loneliness, high belonging), socially searching (high loneliness, high belonging), socially distressed (high loneliness, low belonging), and socially indifferent (low loneliness, low belonging). Swedish cohort data collected among late adolescents (age 17-18 at baseline in 2019) who were followed up in young adulthood (age 20-21 in 2022) (n = 2684) was used to examine the association between these distinct groups of individuals and psychosomatic complaints. Three psychosomatic complaints were measured: stomach aches, headaches, and sleeping difficulties, and a summary index (range 3-15) was calculated. Linear regression analyses showed that loneliness and a sense of belonging were cross-sectionally associated with psychosomatic complaints (additional adjustment for sociodemographic characteristics barely affected the estimates). The socially fulfilled group reported fewer psychosomatic complaints compared with the other groups, while the socially distressed group reported the highest level of psychosomatic complaints. Furthermore, the socially indifferent group reported fewer psychosomatic complaints than the socially searching group. The prospective analysis supported these patterns; however, after adjustment for earlier psychosomatic complaints, only the socially distressed group showed a significant positive association with subsequent psychosomatic complaints. These findings confirm that the dual continuum model reflects the complexity of social needs and their association with health complaints. Key messages • The categorisation of the conjoint relationship of loneliness and belonging helps to reveal more nuanced links between these two constructs and psychosomatic complaints in young people. • Knowledge of the more nuanced links between loneliness, belonging, and health complaints can be beneficial for developing specific, targeted public health recommendations and interventions for youth.

Abstract Number ‐ 71: Management of Delayed Carotid Stent Fracture with an Overlapping Open Cell Design Stent: Case Report

Introduction Stent fracture after carotid angioplasty and stenting is rare. Risk factors include presence of angulation, calcification, and restenosis increasing the risk of stent fracture. Although literature indicates that not all carotid stent fractures are associated with adverse outcomes, there is limited details on successful endovascular management of this entity. We describe a unique case of carotid stent fracture with symptomatic restenosis treated with an overlapping open cell stent with no residual stenosis and resolution of symptomology. Methods Case Report. Results A 79‐year‐old man with medical history of right sided symptomatic carotid artery stenosis which had been previously treated with endarterectomy and subsequently carotid stenting after a follow up carotid ultrasound demonstrated recurrence of severe right internal carotid artery (RICA) stenosis. Approximately 2 years after this index procedure, the patient returned with acute onset of left‐hand numbness. Cerebral angiography was performed that demonstrated 85% stenosis with a fractured carotid stent at segment of stenosis (Figure 1A, B). Furthermore, the lesion was found to be heavily calcified. This was determined to be the primary contributing factor in resultant artery wall stress, which over time led to carotid stent fracture. Angioplasty with placement of a new open cell stent and distal embolic protective device was performed successfully. The open cell stent was chosen for this approach as closed cell stents have been associated with an increased odds of in‐hospital stroke/death for carotid lesions, attributable to the lower degree of conformability with closed cell stents. After our stent placement, there was no significant residual stenosis visualized (Figure 1C, D). The patient’s symptoms resolved without any subsequent complaints on follow‐up visit. Conclusions While carotid stent fractures are a rare occurrence, we report a case of symptomatic carotid artery restenosis with a fractured stent due to significant lesion calcification and wall stress. This case was successfully treated with angioplasty and new open cell stent placement due to its potential advantages over closed cell stents in carotid artery lesions. Current literature indicates that carotid stent fractures have a low prevalence. However, there is a paucity of studies on the mechanism of stent fracture as well as optimal management of these fractured stents, suggesting a need for further study and characterization.

Four reasons why we should screen for dissociation in competitive sports

Four reasons why we should screen for dissociation in competitive sports

Evolution of awareness for cognitive decline across several cognitive domains in stable vs clinically progressing participants.

AbstractBackgroundAwareness of memory impairment has been shown to vary across the AD spectrum with an initial heightened awareness at the preclinical stage, and a subsequent loss of awareness with AD progression (Hanseeuw et al.,2020). Whether there are potential differences in the evolution of awareness for cognitive domains other than memory is unknown. In this study, we investigated the evolution of awareness in visuospatial, language, planning, divided attention and organization in cognitively older adults that later progressed versus those who remained stable.MethodsOur study included 621 cognitively normal (CN) ADNI participants (Tab1). Individuals were considered Stable or Progressors (n = 147) on the basis on the Clinical Dementia Rating scale global score (stable: scores at first and last observation both 0, progression:last score≥0.5). Cognitive complaints were recorded using the Everyday Cognition (ECog) questionnaire, using both participant’s and informant’s average complaints in each of the six subscales: divided attention, language, memory, organization, planning and visuo‐spatial. Generalized linear mixed‐effect models were run to predict complaints within each subscale, using time, the source of complaint (informant vs participant), and their interaction as independent variables, adjusting for age, gender and education. Jonhson‐Neyman Points (JNP) were computed for significant interactions, and simple slopes analyses were performed.ResultsStable participants displayed a similar evolution of both informant and participant complaints (Fig1, left panels). Among progressors, all models showed significant interactions with participants expressing greater, and subsequent lower complaints than informants (Fig1, right panels). JNP analyses revealed that, while on some subscales this transition occurred only after/close to progression (i.e., divided attention, language, memory and organization), it could be observed years before progression in others (i.e., planning and visuo‐spatial).ConclusionsProgressive participants expressed greater, and then lower complaints as compared to their informant, demonstrating a transition from heightened to reduced awareness over time. Our results attest that, while most studies are focusing on memory awareness, other domains might also show early changes in awareness. This advocates for including the informant’s appraisal in the examination process, as well as to expand the focus to other cognitive abilities.

Colonic pouch reconstruction after low anterior rectal resection

For many decades the coloanal anastomosis was traditionally created as an end-to-end anastomosis. Despite successful surgical restoration of the intestinal passage after low rectal resection and total mesorectal excision (TME), physiological continence and evacuation function cannot be achieved in many cases using end-to-end anastomosis. Subsequent complaints, such as fecal incontinence and urge problems, evacuation difficulties and high stool frequency (so-called low anterior resection syndrome, LARS) are the result. The combination of symptoms after TME known as LARS is described in the literature in up to 60% of cases. The increased occurrence of the imperative urge to defecate, frequent bowel movements and problems with fecal incontinence motivated surgeons to look for alternative anastomosis techniques. Side-to-end anastomosis, coloplasty pouch and colonic J‑pouch have been shown in various studies to be superior to end-to-end anastomosis in terms of functional results. Current studies could show that the side-to-end anastomosis (even if this is not apouch in the actual sense) and the two pouch techniques show comparable results in terms of functional outcome and the rate of anastomotic leakage. The alternative to coloanal anastomosis after TME is the abdominoperineal resection. Most, especially younger patients, prefer to try to maintain continence with the risk of the described functional problems. If the patients are well selected, TME can be carried out with the current techniques in such away that continuity is maintained and agood defecation function is achieved for alarge proportion of patients using the pouch-anal anastomosis or the side-to-end techniques.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Innovating into trouble: When innovation leads to customer complaints

This paper examines the unintended consequences of innovation. We show that innovative activity can have adverse outcomes in the form of increased customer complaints with the potential for reputational and financial damage. Complaints may arise directly from adverse reactions to innovative services or indirectly from service failures where firms over-prioritise innovation. Our empirical analysis focuses on legal services in England and Wales. Survey data on innovation by legal service providers is matched with complaints data from the Legal Ombudsman for England and Wales. This allows us to identify the links between innovation activity and subsequent customer complaints. Our analysis reveals that higher levels of innovation activity increase the probability and number of consumer complaints. We identify how firms can reduce the potential for consumer complaints by adopting collaborative innovation strategies. In addition, firms with international competitors are less likely to face complaints. Our results have strategic, regulatory and policy implications.

Childhood chronic condition and subsequent self-reported internalizing and externalizing problems in adolescence: a birth cohort study

Chronic conditions are common in childhood. We investigated the associations of childhood chronic conditions reported by parents with subsequent self-reported internalizing and externalizing problems in adolescence. A sample of 6290 children (3142 boys and 3148 girls) with data on chronic condition reported by parents both at 7 and at 16 years of age was obtained from the Northern Finland Birth Cohort 1986 (NFBC 1986), which is a longitudinal 1-year birth cohort (n = 9432) from an unselected, regionally defined population. Internalizing and externalizing problems were measured at 8 years of age with Rutter Children’s Behavioral Questionnaire by teachers and at 16 years of age with Youth Self-Report by adolescents. When studying the effects of history of chronic conditions on these problems at 16 years of age, childhood internalizing and externalizing problems and social relations were adjusted. A history of chronic condition predicted subsequent somatic complaints among all adolescents. Early-onset chronic conditions were related to subsequent externalizing (OR 1.35; 1.02–1.79) and attention problems (OR 1.33; 1.01–1.75) and later onset of chronic conditions with internalizing (OR 1.49; 1.22–1.82) and thought problems (OR 1.50; 1.18–1.92). The effect was specific for sex and the type of chronic condition.Conclusion: Childhood chronic conditions predicted internalizing and externalizing problems in adolescence. To prevent poor mental health trajectories, children with chronic conditions during their growth to adolescence need early support and long-term monitoring.What is Known:• Childhood adversities increase the risk of mental disorders.• Internalizing and externalizing problems have been suggested for measuring childhood and adolescent psychopathologies.What is New:• Having a chronic condition (CC) before the age of 7 or later but before the age of 16 had different outcomes in adolescence. The early onset predicted externalizing problems, whereas the late onset predicted internalizing problems and thought problems in adolescence. The risk of somatic complaints was increased regardless of CC onset time. These findings can reflect more restricted ability to mental processing in the younger children.

Cognitive, EEG, and MRI features of COVID-19 survivors: a 10-month study.

Background and objectivesTo explore cognitive, EEG, and MRI features in COVID-19 survivors up to 10 months after hospital discharge.MethodsAdult patients with a recent diagnosis of COVID-19 and reporting subsequent cognitive complaints underwent neuropsychological assessment and 19-channel-EEG within 2 months (baseline, N = 49) and 10 months (follow-up, N = 33) after hospital discharge. A brain MRI was obtained for 36 patients at baseline. Matched healthy controls were included. Using eLORETA, EEG regional current densities and linear lagged connectivity values were estimated. Total brain and white matter hyperintensities (WMH) volumes were measured. Clinical and instrumental data were evaluated between patients and controls at baseline, and within patient whole group and with/without dysgeusia/hyposmia subgroups over time. Correlations among findings at each timepoint were computed.ResultsAt baseline, 53% and 28% of patients showed cognitive and psychopathological disturbances, respectively, with executive dysfunctions correlating with acute-phase respiratory distress. Compared to healthy controls, patients also showed higher regional current density and connectivity at delta band, correlating with executive performances, and greater WMH load, correlating with verbal memory deficits. A reduction of cognitive impairment and delta band EEG connectivity were observed over time, while psychopathological symptoms persisted. Patients with acute dysgeusia/hyposmia showed lower improvement at memory tests than those without. Lower EEG delta band at baseline predicted worse cognitive functioning at follow-up.DiscussionCOVID-19 patients showed interrelated cognitive, EEG, and MRI abnormalities 2 months after hospital discharge. Cognitive and EEG findings improved at 10 months. Dysgeusia and hyposmia during acute COVID-19 were related with increased vulnerability in memory functions over time.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00415-022-11047-5.

Magnetic Resonance Imaging Findings of the Asymptomatic Shoulder May Impact Performance, Not Future Injury List Placement in Major League Baseball Pitchers

PurposeTo evaluate preseason shoulder magnetic resonance images (MRIs) obtained from pitchers entering either major or minor league baseball (MLB) and correlate findings with subsequent injury, operative repair, and placement on the injured list (IL).MethodsPreseason-MRI of the throwing shoulders of professional-level baseball pitchers, taken during routine evaluations at a single organization (2004-2017) were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with known injuries prior to pre-signing imaging. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of abnormalities in the rotator cuff (RTC), labrum, capsule, long-head of the biceps tendon (LHBT), and humeral head. Binary imaging findings were correlated to future placement on the IL for subsequent shoulder complaints. Bivariate statistics using Student’s t-tests and Fisher exact tests (both α = .05) were used in this study.ResultsA total of 38 asymptomatic pitchers with shoulder MRIs were included. Pitchers had a mean (±SD) age of 28.2 ± 4.9 and had pitched an average of 119.6 ± 143.8 career games. Pitchers with partial articular-sided RTC tears (P = .04) or intra-articular BT hyperintensity (P = .04) on preseason MRI demonstrated an association with the need for future surgery. Pitchers with evidence of labral heterogeneity demonstrated greater total career pitch counts (10,034.1 vs 2,465.3; P = .04). Evidence of a posterior-superior humeral cyst was associated with decreased strikeouts per 9 innings (6.1 vs 8.0; P = .039) and total strikeout percentage (16.1% vs 23.2%; P = .04).ConclusionAlthough there was a significant difference in the percent of various radiographic findings between the injured and healthy cohort, no MRI findings were predictive of future IL placement or duration of placement. The presence of a posterior superior humeral cyst was associated with decreased strikeout rates at 2 and 3 years, the presence of a labral tear was associated with decreased earned run average (ERA) at 3 years and decreased career strikeout percentages, and increased capsular signal was associated with decreased 5-year ERA.Level of EvidenceLevel IV, retrospective study.

HUMAN ADJUVANT DISEASE SECONDARY TO FOREIGN SUBSTANCE INJECTIONS AS A CAUSE OF SECONDARY LOWER EXTREMITY LYMPHEDEMA

Non-FDA approved foreign substances injected in areas such as the hips and buttocks for aesthetic purposes have resulted in significant complications including secondary lymphedema. We sought to demonstrate lymphoscintigraphic abnormalities in a group of patients with lower extremity edema following infiltration of foreign substances in but-tocks and hips to confirm secondary lymphedema. This retrospective and observational study examined 10 lower extremities for lymphoscintigraphic abnormalities from patients with history of infiltration of foreign substances and subsequent complaints about lower extremity edema. Clinical evaluation, lymphedema index, lymphoscintigraphy, and Transport Index (TI) were evaluated. The average lymphedema index documented in each limb was 236.45 categorizing most of our patients in a lower limb lymphedema stage I. The average TI was 15.7 points (8.6 - 22.8 points) demonstrating that all patients show abnormal lymphoscintigraphy (LSG) patterns. LSG findings confirm the diagnosis of lower extremity lymphedema secondary to injection of foreign substances in the buttocks and hips in the group of patients studied.

Fallvignetten aus der neurologischen Rehabilitation bei Patienten mit Post-COVID-Syndrom

Case vignettes from neurological rehabilitation in patients with post-COVID syndrome – Suggested discussion for performance diagnosticsC. Dettmers, C. Weich, C. Herrmann, R. Saile, M. Preuss, S. H. Chanyalew, L. Schleicher, D. Klaasen van Husen, J. Randerath, S. Stoll, M. Tempfli, M. Vieten, M. JöbgesAbstractSecondary illness after a previous infection with SARS-CoV-2 covers a wide spectrum in terms of organ damage, symptoms, duration, course and, above all, the severity of the disease. In patients who have been ventilated for a long time in an intensive care unit, one will look very carefully for lung damage and other organ damage, including cerebral, peripheral neurogenic and myogenic damage, and clarify to what extent the remaining deficits can be attributed to this. At the other end of the spectrum are patients who were not hospitalized during the primary infection, for whom fatigue, headache, muscle, limb or other symptoms are in the foreground and whose symptoms often fluctuate in intensity over the course of the disease. For employees in the health sector, a primary infection acquired at work may be recognized as an occupational disease. Subsequent complaints are often subsumed under “post-COVID” by the patient and then also by the attending physician, without proving a causal connection to COVID-19. We present individual case studies from this specific and non-representative group. We were surprised that there were many psy-chological, psychosomatic and psychiatric comorbidities. In the second part we present our diagnostics for cognitive, emotional and motor fatigue and fati-gability. Particularly in this initially non-hospitalized patient group, a thorough somato-psychological differential diagnosis is required in order to determine the causes and the socio-psychosomatic set of conditions. An identification of the different components within the post-COVID complaint complex should enable the most efficient therapy possible in order to initiate reintegration into social life in everyday life and at work. Keywords: Post-COVID syndrome, comorbidity, psychosomatics, fatigue, fatigability, differential diagnostics

I saw you like this now I wanna know

In this paper, we focus on how interactants accomplish different forms of participation in the “one-to-many” context of social media interactions, where single users frequently have a wide audience of potential recipients to their posts. How do social media users ascertain who might be a relevant recipient to these posts, and how do other users who interact with these posts position themselves within a relevant participation framework? We explore these questions by examining how participants on Twitter orient to the act of “liking” a post as a resource for moving into the participation framework of the talk, and we show how this orientation allows likes to serve as possible pathways for launching new actions and activities. We examine these practices using the framework of conversation analysis (CA), showing how participants use public noticings of another user’s likes as a preface to, and justification for, a subsequent invitation sequence or complaint sequence. We additionally show how the specific media affordances of Twitter, which render likes publicly visible to others, facilitates the noticing of likes as a device for inciting new courses of action.

The construction of future and hypothetical dialogues in third-party complaints as enactments of a subsequent direct complaint

This article shows that third-party complaints can orient to future or possible actions to solve an ongoing conflictive or problematic situation with the absent complainees. Relying on data from naturally occurring interactions among speakers of Spanish and Galician, the article analyses instances of future and hypothetical dialogues in complaint sequences about absent parties and demonstrates that these are designed as enactments of a direct complaint to be addressed to such people. Sequentially positioned in the complaint development, these enactments serve to rehearse this confrontation as a future remedial action, inviting audience's assessments, as well as to reinforce the legitimacy of the complaints by demonstrating how these can be defended in addressing to the complainees. In so doing, even though in a fictitious way, complainers can vent their feelings of indignation against these people, avoiding the problems of real direct complaints as face-threatening acts (Brown and Levinson, 1987).

Who Is At-Risk? An Examination of the Likelihood and Time Variation in the Predictors of Repeated Police Misconduct

Increasing transparency and accountability in policing is a top priority for police administrators, community groups, academics, and many others. The internal affairs process is an accountability tool designed to hold officers and agencies accountable to the citizens they serve, yet very little is known about the effect of internal investigative units on such outcomes as subsequent complaints and temporal distances between complaints. This current study examines two critical aspects of the internal affairs process, the likelihood of subsequent complaints and temporal distance between the first and a subsequent complaint of misconduct. Officers’ complaint data were collected from the internal affairs unit of a large, metropolitan police agency in the southwestern United States. Results indicate that a longer time to initial complaint and regional patrol assignment were related to a reduced likelihood of receiving future complaints. Moreover, of those officers who received a subsequent complaint after their initial complaint, more than half did so within the first year, and 94% did so within the first three years of receiving their initial complaint. Finally, we discuss the implications of our findings on policy and training opportunities, supervision, mentoring, accountability, and Early Intervention (EI) systems.

The value of the visual evoked potentials test in the assessment of the visual pathway in head trauma.

:Background:The research was done to evaluate the value of the visual evoked potentials test in the assessment of visual pathways function in cases with head trauma and minimal findings on routine testing.Methods:A prospective case series evaluating use of visual evoked potentials testing in patients with a history of head trauma and suffering from visual symptoms with no significant clinical and neuroimaging findings, referred for further work up.Results:Thirty-four patients with a history of head trauma and subsequent visual complaints were included. 27 cases (79.4%) were male and 7 cases (20.6%) were female. The mean elapsed time after the trauma was 47.6 weeks (range: 3.5 to 320 weeks). Twenty-five cases had unilateral and 9 cases had bilateral visual complaints. History of coma with mean duration of 12 days was present in 4 cases. The best-corrected visual acuity was less than 1 Log MAR (legally blind) in 21 eyes. In 4 eyes (12%) the relative afferent papillary defect test was positive. Mild to moderate optic disc pallor was present bilaterally in 4 cases and unilaterally in 3 cases. Hemorrhagic patches were reported on MRI in 2 cases; no other cases had pathologic MRI findings. In unilateral cases, there was a statistically significant difference between the involved eye-sided lobe and the sound eye-sided lobe implicit time and amplitude. In patients with bilateral complaints, by testing each eye, the VEP amplitudes of both eyes showed significant differences with the International Society for Clinical Electrophysiology of Vision standards, whereas the implicit times showed not-statistically significant differences.Conclusions:The visual evoked potentials test shows not only additional diagnostic value, not seen on routine clinical and neuroimaging testing, but also rather a high validity in tracing visual disability in traumatic brain injury.