Papers by Russell S Gonnering
Journal of the American Medical Informatics Association
How to deliver best care in various clinical settings remains a vexing problem. All pertinent hea... more How to deliver best care in various clinical settings remains a vexing problem. All pertinent healthcare-related questions have not, cannot, and will not be addressable with costly time- and resource-consuming controlled clinical trials. At present, evidence-based guidelines can address only a small fraction of the types of care that clinicians deliver. Furthermore, underserved areas rarely can access state-of-the-art evidence-based guidelines in real-time, and often lack the wherewithal to implement advanced guidelines. Care providers in such settings frequently do not have sufficient training to undertake advanced guideline implementation. Nevertheless, in advanced modern healthcare delivery environments, use of eActions (validated clinical decision support systems) could help overcome the cognitive limitations of overburdened clinicians. Widespread use of eActions will require surmounting current healthcare technical and cultural barriers and installing clinical evidence/data cur...
Radiographics, Nov 1, 1989
The spectrum of ocular and orbital pathology in the pediatric age group is quite different from t... more The spectrum of ocular and orbital pathology in the pediatric age group is quite different from that of adults. Imaging studies serve an important role in the diagnosis and management of many of these abnormalities. This review outlines the various abnormalities of the pediatric eye and orbit for which imaging studies are often required, including: infection, neoplasm, inflammation and infiltration, developmental anomalies, and trauma. The computed tomographic appearances of these abnormalities are emphasized. Additionally, the pertinent findings recorded with magnetic resonance imaging, scintigraphy, and radiography are described. Correlation of the results of imaging studies with pertinent clinical information allows the determination of specific diagnoses in most instances of pediatric orbital pathology.
Ophthalmic Plastic and Reconstructive Surgery, Nov 1, 1998
This study was designed to evaluate the characteristics of human orbital fat and connective tissu... more This study was designed to evaluate the characteristics of human orbital fat and connective tissue. Two exenteration specimens were studied by light microscopy with special stains. Four distinct regions were identified on the basis of their connective tissue septa, which contained blood vessels and were composed of elastin and collagen types I, III, and IV. Transmission electron microscopy was performed on the opposite orbits. The fibroblasts and adipocytes appeared metabolically inactive and showed no regional differences. The fat was phase extracted from the connective tissue and subjected to biochemical analysis. No regional differences were found in the content of fatty acids and protein. The fatty acids included palmitic acid (22-24.6%), oleic acid (45-51.5%), and linoleic acid (15-18.6%). Despite demarcation of the orbital fat into distinct regions by the connective tissue septa, ultrastructural and biochemical analysis revealed no regional variations in the fat. The diagnostic and therapeutic implications of these findings are discussed.
American Journal of Ophthalmology, May 1, 1985
builds on the successes of the previous versions by improving on the format and expanding the con... more builds on the successes of the previous versions by improving on the format and expanding the contents. The basic presentation of this new edition is unchanged. The book is divided into seven chapters: external infections of the eye, bacteria, viruses, fungi, immunology of the eye, noninfectious inflammations of the external eye, and laboratory techniques. After an introductory chapter dealing primarily with the general clinical manifestations of external infections (conjunctivitis, blepharitis, keratitis, and dacryocystitis), subsequent chapters deal in detail with the microbiology and clinical disease caused by each class of microbes. Specific bacteria, viruses, and fungi and the diseases they engender are discussed under the larger subheadings. Each organism is discussed in terms of morphology, culture requirements, resistance, pathogenicity, ocular findings, and treatment. Additions to this most recent edition include a summary chapter on basic ocular immunology and a chapter on noninfectious external inflammatory disease. Other new sections are those dealing with antibacterial and antifungal therapy in the eye. The text has been updated to include newer nomenclature as well as more recently defined entities such as the acquired immune deficiency syndrome. The slightly larger format and the pleasing print style make this edition very attractive. The photographs and illustrations are, with the exception of a few of the clinical entities, excellent. The photographs of cultures and cytologic smears are particularly good. For those who enjoy having the illustrations adjacent to the text, this volume will be a bit frustrating, because once again the authors have chosen to group all of the illustrations at the back of the book, requiring the reader to flip back and forth to the photographs when they are referred to in the text. This makes the book slightly less than handy to use. Nonetheless, the authors have given us a new, improved version of what is an excellent manual and atlas of external eye disease. It is well worth purchasing for residents, general ophthalmologists, and sub-' specialists alike.
The Journal of Pediatrics, Jul 1, 1991
RefDoc Bienvenue - Welcome. Refdoc est un service / is powered by. ...
Ophthalmic Plastic and Reconstructive Surgery, Dec 1, 1993
Ophthalmic Plastic and Reconstructive Surgery, Jul 1, 1999
To identify lymphatic vessels in the human orbit. Lymphatic and blood capillaries were distinguis... more To identify lymphatic vessels in the human orbit. Lymphatic and blood capillaries were distinguished histochemically by light microscopy using a 5'-nucleotidase (5'-Nase) and alkaline phosphatase (ALPase) double staining method. Identification of lymphatic vessels was based on strict morphologic criteria combined with specific 5'-Nase staining. The presence of conjunctival lymphatics was confirmed and used as a control tissue. Lymphatic vessels were identified in the lacrimal gland and in the dura mater of the optic nerve. Structures demonstrating positive 5'-Nase staining at the orbital apex were highly suggestive of lymphatics but did not meet the morphologic criteria established. Lymphatic vessels were not identified in the extraocular muscles or orbital fat. To the authors' knowledge, this study presents the first evidence for lymphatic capillaries in the dura mater of the human optic nerve and lacrimal gland.
Archives of Ophthalmology, Mar 1, 1978
ABSTRACT
Archives of Ophthalmology, Aug 1, 1990
A high-powered argon blue-green laser coupled to a 300-microns quartz fiberoptic catheter was use... more A high-powered argon blue-green laser coupled to a 300-microns quartz fiberoptic catheter was used to create intranasal dacryocystorhinostomy fistulas in fresh-frozen cadaver heads. The procedure, which we term endonasal laser dacryocystorhinostomy, is described. Cadaver specimens were examined postoperatively. Laser rhinostomies were found to involve the posteroinferior portion of the lacrimal sac fossa. Tissues surrounding the fistula site showed no signs of damage. We report on the first patient to undergo endonasal laser dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction, with 10 months of follow-up. We believe endonasal laser dacryocystorhinostomy offers the following advantages over standard external dacryocystorhinostomy: (1) Tissue injury is limited to the discrete fistula site. (2) The cutaneous scar and cosmetic blemish of an external dissection are eliminated. (3) Excellent hemostasis is maintained. (4) Minimal operative and postoperative morbidity permits outpatient surgery, with faster resumption of normal daily activities and increased cost-effectiveness. (5) Patients prefer endonasal laser dacryocystorhinostomy to external dacryocystorhinostomy.
British Journal of Ophthalmology, Mar 1, 1988
Three cases of atypical, extratarsal chalazia are presented. All three patients initially present... more Three cases of atypical, extratarsal chalazia are presented. All three patients initially presented with a history of an inflammatory mass close to the lid margin. Inferior migration subsequently occurred, with loss of connection to the tarsus, causing confusion in the diagnosis. The basis for this migration is postulated to be the anatomical relationships of the tarsus, postorbicular fascia, and lower eyelid retractors. A good response was obtained with standard surgical therapy. Although it is one of the commonest benign tumours of the eyelid, 2 the lowly chalazion does not stir much interest or excitement in most ophthalmologists. Because the presentation is usually common and characteristic, of more importance are other lesions, such as sebaceous gland carcinoma, masquerading as chalazia.34 The following three cases represent the opposite circumstance, where an atypical presentation of a chalazion with an extratarsal location caused concern.
Archives of Ophthalmology, Feb 1, 1989
International Ophthalmology Clinics, 1993
Page 1. Pharmacology of Botulinum Toxin Russell S. Gonnering, MD Protein toxins are produced by v... more Page 1. Pharmacology of Botulinum Toxin Russell S. Gonnering, MD Protein toxins are produced by various strains of Clostridium botulinum, Clostridium butyricum, and Clostridium barati [1]. The neurotoxin produced by these ...
Ophthalmic Plastic and Reconstructive Surgery, Nov 1, 2014
The European Year of Cultural Heritage in 2018 highlighted and celebrated the values of cultural ... more The European Year of Cultural Heritage in 2018 highlighted and celebrated the values of cultural heritage and its role as a driver of social cohesion and economic development, which requires an integrated approach in policy making. The consultation process to help develop these policies reflected the right of all in society to participate in cultural heritage. This paper describes the work that took place in identifying traditional and emerging professions in the field of cultural heritage and specifically issues around the transfer of skills and knowledge. Dialogues initiated by the European Commission were facilitated by the mechanisms of the Open Method of Coordination and the Voices of Culture under the Work Plan for Culture.
Ophthalmic Plastic and Reconstructive Surgery, 1988
Over a period of 163 weeks, 223 injections of botulinum A toxin were administered to 38 patients ... more Over a period of 163 weeks, 223 injections of botulinum A toxin were administered to 38 patients with facial spasm syndromes. The maximum cumulative toxin dose was 553 units, the maximum number of injections in any given patient was 16, and the maximum dosage of any given injection was 52.5 units. Sera from these patients showed no antibody production when measured with a standard mouse lethality bioassay.
Ophthalmic Plastic and Reconstructive Surgery, 1988
Two patients with previously stable thyroid-associated orbitopathy presented with the fairly sudd... more Two patients with previously stable thyroid-associated orbitopathy presented with the fairly sudden onset of apparent upper eyelid retraction in their nondominant eye, accompanied by asymmetry of the eyebrows, with elevation on the side without the eyelid retraction. No other signs of worsening of the orbitopathy were present, and instillation of 2.5% phenylephrine hydrochloride in the contralateral, dominant eye relieved the eyelid retraction and normalized the eyebrow position. At surgery, both patients were found to have levator aponeurogenic ptosis in the eyelid that appeared to be "normal." This occurrence is explained by Hering's law and should be considered in planning surgery to reestablish palpebral fissure symmetry in such patients.
Current Opinion in Ophthalmology, Sep 1, 2018
Purpose of review There is confusion in all of healthcare, including oculofacial surgery, as to w... more Purpose of review There is confusion in all of healthcare, including oculofacial surgery, as to what is 'complex' and what is 'merely complicated'. Although in common usage, these terms tend to be interchangeable, the distinction is more than trivial. A different and somewhat unfamiliar toolset is needed to successfully navigate complex problems. This review will explore a methodology for the physician to understand what is complex in oculofacial surgery, the tools needed to optimize performance in a complex healthcare system and successfully manage patients with complex diseases. Recent findings A specific understanding of complexity science in oculofacial surgery is only in its nascent beginnings at this point. Nevertheless, recent advances in closely related fields can provide concrete applications. The practice of oculofacial surgery is optimized within a healthcare network of supporting professionals. Moreover, a newer understanding of the 'complex' nature of disease common to oculofacial surgery, such as neoplasia and inflammation, will direct the physician to recognize the most appropriate therapies. Summary Oculofacial surgery, like all of medicine, is a fluid mixture of problems that are complex and those that are merely complicated. As a different toolset is needed to deal with each, physicians need to recognize these differences and acquire those tools.
Pan Stanford Publishing eBooks, May 22, 2014
Archives of Ophthalmology, Mar 1, 1986
Archives of Ophthalmology, Aug 1, 1987
Ophthalmic Plastic and Reconstructive Surgery, 1986
Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Op... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Ophthalmic Plastic & Reconstructive Surgery. Enter your Email address: Wolters Kluwer Health may email you for journal alerts ...
Uploads
Papers by Russell S Gonnering
transformation of medical records into an electronic medical record
(EMR) format is spreading rapidly. Proponents of transformation to the EMR promised a number of improvements in healthcare, but disturbing signs of possible adverse effects have surfaced. In particular, we are concerned about the inability of the current records to adequately communicate the complex, information-in-context contained in many medical records as well as the emergence of diagnosis that results from time-dependent analysis and review of a problem. We investigated the complexity of structure in three Electronic Medical Records (EMR) as an initial step, and contrasted these findings with those in transcribed paper records, dictated reports and articles in biomedical journals. A marked difference in Function Words was found, suggesting a limitation on the transfer of information-in-context in the EMR. When the wide choice of narrative and its extensive vocabulary is exchanged for limited choices in
a list, the length of the message must be extended to transmit the same amount of information. This limitation on contextual information in turn has subtle, yet profoundly significant, implications for the behavior of physicians and other healthcare professionals.
When Caesar spoke, people marched.
Leadership is not simply speech. It is
speech that makes people march.”
---Marcus Porcius Cato Uticensis, paraphrased by Tichy and Bennis
How do words make people march?
In The Three Laws of Performance, Zaffron and Logan
describe generative, future-based language as critical in
determining organizational performance. Pennebaker has
shown that the precise words used in communication
shape the underlying message in significant, yet sometimes
unseen, ways. Linguistic Inquiry and Word Count (LIWC)
is a computerized text analysis program that computes the
characteristics of written or transcribed communication.
Dzindolet, et al, used this program to investigate group
decision making. Wedeking reported on using it to
evaluate cognitive complexity of Supreme Court decision
making.
We were curious if this tool could shed light on the decision
process in the asynchronous email communications of a
group discussing a new project.
Poster for 2015 meeting of American Association for Physician Leadership.
Poster for Collective Intelligence 2015 meeting