Papers by Gabrielle Willey
JCRS Online Case Reports, 2017
Poly-DL-lactide polymer implants absorb over a period of 6 to 12 months and have been used with i... more Poly-DL-lactide polymer implants absorb over a period of 6 to 12 months and have been used with increasing frequency for repair of orbital fractures. The authors describe the case of a 7-year-old boy who presented with orbital inflammation 10 months following repair of a white-eyed blowout fracture with a poly-DL-lactide implant. Rapid improvement in symptoms followed initiation of oral steroids, with excellent long-term result. Clinical presentation and treatment response implicated a foreign body inflammatory reaction as the underlying etiology of symptoms. Ophthalmologists and orbital surgeons should be aware that absorbable implants can demonstrate this late idiosyncratic complication.
Background: After initial surgical treatment of differentiated thyroid cancer (DTC) residual
lymp... more Background: After initial surgical treatment of differentiated thyroid cancer (DTC) residual
lymph node metastases are often found at the time of radioactive iodine (131-I) therapy.Recurrence of DTC is due to persistent disease not removed at initial surgery and that did not respond to 131-I treatment. This study aimed at determining locations of, and reasons for, residual nodal metastases detected by 131-I scans with SPECT/CT obtained prior to radioiodine therapy following surgical treatment of DTC.
Methods: This is a retrospective study of 352 patients with intermediate and high-risk DTC treated with 131-I therapy at the University of Michigan from 2007–2014. All patients underwent total thyroidectomy with or without lymph node dissection followed by radioiodine therapy. Pre-ablation diagnostic 131-I scans with SPECT/CT were used
postoperatively to localize nodal metastases, which were then compared with the cervical lymph node basins dissected at the time of surgery to determine the reason for residual nodal metastases: incomplete nodal dissection versus preoperative unrecognized nodal
metastases.
Results: 146/352 (41.5%) patients had residual nodal metastases detected on 131-I scans with SPECT/CT following initial surgery, but prior to 131-I therapy. Among the 146 patients with residual disease, there were a total of 218 distinct nodal metastases. Relative to the
primary tumor, 71.6% (n=156) of metastases were ipsilateral, 22.0% (n=48) were contralateral, and 6.4% (n=14) were non-sided in the central neck (level VI/VII). Cervical lymph node levels VI, III, and II had the greatest frequencies of residual metastases (33.9%, 22.9%, 18.8%, respectively). Residual metastases occurred because of incomplete nodal dissection (49.3%), lack of preoperative identification (37.7%), or a combination of both (13%).
Conclusion: Residual nodal metastasis following initial surgical treatment for regionally advanced differentiated thyroid cancer is rather common on highly sensitive 131-I scans with SPECT/CT and is due to both unrecognized nodal involvement preoperatively and incomplete removal of metastatic lymph nodes during compartment-orientated nodal
dissection. The surgical management of high-risk DTC should include preoperative imaging to evaluate for nodal metastases in the central and lateral neck and compartment-orientated nodal dissection of involved compartments. Attention should be given to complete dissection in levels VI, III, and II, particularly when dissecting compartments ipsilateral to the primary tumor.
Journal of Aging Science, 2018
Purpose: This study surveys current low vision rehabilitation practice methodologies among French... more Purpose: This study surveys current low vision rehabilitation practice methodologies among French practitioners and it describes
their opinions about the utility of using virtual reality as a tool for low vision rehabilitation training in patients with age-related macular
degeneration.
Methods: An online questionnaire was distributed between October 2017 and February 2018. 471 orthoptists (110 students
and 361 graduates) responded to the survey. Questions concerned the orthoptist’s educational and demographic background, extent
of training in virtual reality as a reeducation tool, and mode of practice including frequency of patient visits, goals, and methods of
rehabilitation training.
Results: Out of 361 practicing orthoptists, 47.75% were low vision rehabilitation providers, and 52.25% were not. A provider’s
likelihood of using low vision rehabilitation immediately after graduating from university was positively correlated to his confidence in
the training he had received. Most respondents were receptive to using virtual reality as a reeducation tool.
Conclusions: Analysis of current low vision rehabilitation practice demonstrates no standardization of treatment protocols
among providers. Although orthoptists overall acknowledge the benefits of virtual reality as a rehabilitation tool, orthoptist curriculum
varies greatly across universities, which thus affects a provider’s likelihood of offering low vision rehabilitation. Moreover, this lack
of standardization is a problem worldwide, which suggests a need for better clinical guidelines in low vision rehabilitation practice.
A 41-year-old man undergoes replantation of his dominant thumb. He is a habitual coffee drinker a... more A 41-year-old man undergoes replantation of his dominant thumb. He is a habitual coffee drinker and consumes chocolate daily. He is advised to eliminate caffeine and chocolate for 2 weeks after surgery and questions this recommendation.
Background: Medical students often report dissatisfaction with the feedback they receive on their... more Background: Medical students often report dissatisfaction with the feedback they receive on their clerkships. This study evaluates the performance of the Minute Feedback System (MFS), a web-based tool designed to facilitate medical student acquisition of same day written feedback from surgery residents and faculty. Methods: System-generated data, targeted surveys, and end of clerkship questionnaires were used to evaluate MFS performance over a one-year period. Results: 170 students made 3190 feedback requests and received 1978 responses (62% response rate). Students felt the system was easy to use (90%), provided useful feedback (74%), and allowed them to obtain more feedback than they would have in its absence (81%). Concerns were raised regarding the quality of electronic feedback and whether the data generated would be used for summative assessment. Conclusions: The MFS encourages same-day assessment and increases documented medical student feedback. Further development is required to improve feedback quality, response rates, and feedback application. Summary: The Minute Feedback System is a web-based tool designed to facilitate medical student acquisition of written feedback from surgery residents and faculty. It is easy to use, encourages same-day assessment, and increases documented medical student feedback. Further development is required to improve feedback quality, response rates, and data application.
Hypothesis: Patients are usually advised not to consume caffeine following digital replantation o... more Hypothesis: Patients are usually advised not to consume caffeine following digital replantation owing to concerns of compromised perfusion. This study examined the effect of caffeine on blood flow distal to the site of anastomosis in the femoral arteries of rats. Methods: Twenty-eight Sprague-Dawley rats were used for this study. The femoral arteries were exposed bilaterally, and baseline blood volume flow measurements were taken on intact arteries using a transit time flow-meter probe. All rats underwent transection and microvascular anastomosis of the femoral artery on the right side while the left side remained intact. The rats were then divided into 2 groups. In group one, we administered caffeine immediately following completion of the anastomosis (intraperitoneal injection of 40mg caffeine/kg bodyweight dissolved in saline) and in group two, no caffeine was administered. In both groups, bilateral flow measurements were recorded at 30 and 60 minutes after completion of the anastomosis. Results: Caffeine had no statistically significant effect on blood flow. In the anastomosed arteries, average blood flow increased above pre-op levels by 35% at 30 minutes and by 44% after 60 minutes. There was no statistically significant difference between the caffeinated and the non-caffeinated rats (Figure 1). The control arteries that did not undergo anastomosis also displayed an increase in average blood flow of 42% at 30 minutes and 67% at 60-minutes with no statistically significant difference between the caffeinated and the non-caffeinated rats (Figure 2). Summary Point: Caffeine did not have a statistically significant effect on blood flow following anastomosis of the rat femoral artery. Hypothesis: We hypothesized that Luna, an indocyanine green laser angi-ography imaging system, could replace or supplement the use of clinical and Doppler examination for evaluation of upper extremity perfusion. Our goal was to demonstrate the immediate, accurate, and minimally-invasive evaluation of upper extremity tissue perfusion with the Luna. S17
Background: The feedback medical students receive during clinical rotations, traditionally verbal... more Background: The feedback medical students receive during clinical rotations, traditionally verbal and not formally captured, plays a critical role in student development. This study evaluates written daily feedback given to students through a novel web-based feedback system. Methods: A Minute Feedback System was used to collect feedback given to medical students during their surgery clerkship from May 2015-April 2016. Using qualitative content analysis , feedback comments were categorized as: encouraging, corrective, specific, and nonspecific. Effective feedback was a combination of specific and either corrective or encouraging feedback; ineffective feedback contained only nonspecific comments; mediocre feedback contained elements of both effective and ineffective comments. Results: 3191 feedback requests were sent by medical students and 2029 faculty/resident feedback responses were received. The overall response rate was 62%. Nonspecific feedback comprised 80% of faculty, 83% of senior resident, and 78% of junior resident comments. Specific feedback was given by only 35% of faculty, 17% of senior residents, and 26% of junior residents. Faculty provided Effective feedback in only 16% of comments, senior residents 8%, and junior residents 17%. Mediocre feedback comprised 13% of faculty, 9% of senior resident, and 7% of junior resident comments. Ineffective feedback comprised 67% of all feedback: 60% of faculty, 72% of senior resident, and 68% of junior resident feedback. Conclusions: The majority of resident and faculty feedback to medical students using an electronic, email-based application during their surgery clerkship was nonspecific and encouraging and therefore of limited effectiveness. This presents an opportunity for resi-dent/faculty development and education regarding optimal feedback techniques.
Background: Thrombosis is a common source of failure in anastomoses, flaps, and vascular grafts. ... more Background: Thrombosis is a common source of failure in anastomoses, flaps, and vascular grafts. Ensuring vessel patency is critical to the success of micro-vascular procedures. Any tool that can accurately predict the patency of an anastomosis intraoperatively would enable the surgeon to detect and correct flow restrictions while the patient is still in the operating room.Methods: The authors used transit-time ultrasound technology in this pilot study to investigate whether a minimal cutoff value for quantitative postop-erative blood flow (in milliliters per minute) could be established that would reliably predict sustained vessel patency at 24 hours postoperatively. Surgical end-to-end anastomoses were performed on 56 Sprague-Dawley rat femoral ar-teries with diameters ranging from 0.6 to 1.2mm. Postoperative blood volume flow measurements were taken at 20-minute intervals up to 1 hour, and then again at 24 hours, to assess patency.Results: Forty-seven anastomoses (83.9 percent ) were patent 24 hours after surgery. Nine anastomoses (16.1 percent ) thrombosed within 24 hours. Based on a receiver operating characteristic curve analysis, the optimal cutoff value for immediate postoperative flow for predicting thrombosis within 24 hours of microvascular anastomosis is 0.21ml/minute.Conclusions: At 20 minutes postoperatively, blood flows greater than 0.30ml/minute are highly suggestive of patency, and flows less than 0.21ml/minute are highly suggestive of failure. The authors therefore recommend a minimal cutoff flow value of 0.30ml/minute for vessels ranging from 0.6 to 1.2mm in diameter to predict long-term postoperative vascular patency.(Plast. Reconstr. Surg. 139: 1400, 2017.)
Introduction: Community-engaged research (CEnR) allows researchers and community organizations to... more Introduction: Community-engaged research (CEnR) allows researchers and community organizations topartner together to improve health outcomes and to decrease health disparities. While prevalent inother fields of medicine, it is rarely used in ophthalmology.Areas covered: A comprehensive search of Ovid MEDLINE, NLM PubMed, Ovid Embase, Scopus and theCochrane Library for the Medical Subject Headings (MeSH)‘Community-based participatory research’and text word variations including participatory research, community engagement, communityresearch, partnered research, community–institutional relations, CEnR, CBPR in addition to variationson ophthalmology, eye diseases, vision disorders and eye injuries yielded 451 unique references. Two ophthalmologists (KHN, PANC) reviewed the titles and abstracts and identified 37 relevant studies.Expert consultation yielded an additional reference. After reviewing the full texts and excluding non-English texts, 18 articles met the necessary criteria. The eighteen articles all utilized at least one of thenine principles of CEnR.Expert commentary: Ophthalmology is perfectly positioned to benefit from CEnR. Increased commu-nity engagement in ophthalmic research would expand the reach of our work and address some of themost difficult problems in vision disparities and outcomes.
A 77-year-old man presented with stromal keratitis that began shortly after he had selective lase... more A 77-year-old man presented with stromal keratitis that began shortly after he had selective laser trabeculoplasty (SLT). The patient had no history of keratitis. One week after SLT, the corrected distance visual acuity (CDVA) had decreased from 20/25 to 20/40. Anterior segment optical coherence tomography (AS-OCT) showed near full-thickness corneal stromal opacification without thinning. The patient was empirically treated for herpes simplex virus keratitis with oral antiviral and topical corticosteroid medications. He ultimately developed a corneal scar, and 1 year after the procedure, the CDVA stabilized at 20/50. Although uncommon, keratitis after SLT can be an idiopathic condition or the result of herpes virus reactiva-tion. This case shows the diagnostic challenge associated with diagnosing and managing post-SLT keratitis and is 1 of the first cases of this type using corneal imaging obtained with AS-OCT.
Purpose : To describe the functional impairments of patients with different causes of low vision ... more Purpose : To describe the functional impairments of patients with different causes of low vision at a tertiary eye hospital in Tamil Nadu, India. Methods : We performed a prospective survey of consecutive patients undergoing initial evaluation by the Low Vision Service at Aravind Eye Care System, Madurai, India. Patients were asked whether they had any difficulty performing 13 different instrumental and non-instrumental tasks of daily living as a result of their vision. The primary cause of patients' low vision was determined by the treating provider. The Fisher exact test was used to compare response data across diagnoses. Results : 90 patients with low vision were surveyed about performance of 13 different tasks (Figure 1). Patients had a mean age of 41.4 ± 19.8 years, 63.3% were male, and 21.1% were not employed. Identifying the faces of other people was the most commonly impaired task across all low vision diagnoses, while reading bus numbers was cited nearly as frequently. The proportion of patients reporting impaired mobility varied significantly by diagnosis (p=0.04). Patients with congenital eye disease (83.3%) or glaucoma (75.0%) were most likely to report impaired mobility, while those with retinal pathology (excluding retinitis
Original Article 8 Terai N, Spoerl E, Pillunat LE, Stodtmeister R. The effect of caffeine on reti... more Original Article 8 Terai N, Spoerl E, Pillunat LE, Stodtmeister R. The effect of caffeine on retinal vessel diameter in young healthy subjects. Acta Ophthalmol (Copenh) 2012;90(7):e524-e528 Journal of Reconstructive Microsurgery Caffeine Does Not Reduce Blood Flow Shaughness et al.
Journal of Bodywork and Movement Therapies, 2011
The Journal of hand surgery, 2015
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Papers by Gabrielle Willey
lymph node metastases are often found at the time of radioactive iodine (131-I) therapy.Recurrence of DTC is due to persistent disease not removed at initial surgery and that did not respond to 131-I treatment. This study aimed at determining locations of, and reasons for, residual nodal metastases detected by 131-I scans with SPECT/CT obtained prior to radioiodine therapy following surgical treatment of DTC.
Methods: This is a retrospective study of 352 patients with intermediate and high-risk DTC treated with 131-I therapy at the University of Michigan from 2007–2014. All patients underwent total thyroidectomy with or without lymph node dissection followed by radioiodine therapy. Pre-ablation diagnostic 131-I scans with SPECT/CT were used
postoperatively to localize nodal metastases, which were then compared with the cervical lymph node basins dissected at the time of surgery to determine the reason for residual nodal metastases: incomplete nodal dissection versus preoperative unrecognized nodal
metastases.
Results: 146/352 (41.5%) patients had residual nodal metastases detected on 131-I scans with SPECT/CT following initial surgery, but prior to 131-I therapy. Among the 146 patients with residual disease, there were a total of 218 distinct nodal metastases. Relative to the
primary tumor, 71.6% (n=156) of metastases were ipsilateral, 22.0% (n=48) were contralateral, and 6.4% (n=14) were non-sided in the central neck (level VI/VII). Cervical lymph node levels VI, III, and II had the greatest frequencies of residual metastases (33.9%, 22.9%, 18.8%, respectively). Residual metastases occurred because of incomplete nodal dissection (49.3%), lack of preoperative identification (37.7%), or a combination of both (13%).
Conclusion: Residual nodal metastasis following initial surgical treatment for regionally advanced differentiated thyroid cancer is rather common on highly sensitive 131-I scans with SPECT/CT and is due to both unrecognized nodal involvement preoperatively and incomplete removal of metastatic lymph nodes during compartment-orientated nodal
dissection. The surgical management of high-risk DTC should include preoperative imaging to evaluate for nodal metastases in the central and lateral neck and compartment-orientated nodal dissection of involved compartments. Attention should be given to complete dissection in levels VI, III, and II, particularly when dissecting compartments ipsilateral to the primary tumor.
their opinions about the utility of using virtual reality as a tool for low vision rehabilitation training in patients with age-related macular
degeneration.
Methods: An online questionnaire was distributed between October 2017 and February 2018. 471 orthoptists (110 students
and 361 graduates) responded to the survey. Questions concerned the orthoptist’s educational and demographic background, extent
of training in virtual reality as a reeducation tool, and mode of practice including frequency of patient visits, goals, and methods of
rehabilitation training.
Results: Out of 361 practicing orthoptists, 47.75% were low vision rehabilitation providers, and 52.25% were not. A provider’s
likelihood of using low vision rehabilitation immediately after graduating from university was positively correlated to his confidence in
the training he had received. Most respondents were receptive to using virtual reality as a reeducation tool.
Conclusions: Analysis of current low vision rehabilitation practice demonstrates no standardization of treatment protocols
among providers. Although orthoptists overall acknowledge the benefits of virtual reality as a rehabilitation tool, orthoptist curriculum
varies greatly across universities, which thus affects a provider’s likelihood of offering low vision rehabilitation. Moreover, this lack
of standardization is a problem worldwide, which suggests a need for better clinical guidelines in low vision rehabilitation practice.
lymph node metastases are often found at the time of radioactive iodine (131-I) therapy.Recurrence of DTC is due to persistent disease not removed at initial surgery and that did not respond to 131-I treatment. This study aimed at determining locations of, and reasons for, residual nodal metastases detected by 131-I scans with SPECT/CT obtained prior to radioiodine therapy following surgical treatment of DTC.
Methods: This is a retrospective study of 352 patients with intermediate and high-risk DTC treated with 131-I therapy at the University of Michigan from 2007–2014. All patients underwent total thyroidectomy with or without lymph node dissection followed by radioiodine therapy. Pre-ablation diagnostic 131-I scans with SPECT/CT were used
postoperatively to localize nodal metastases, which were then compared with the cervical lymph node basins dissected at the time of surgery to determine the reason for residual nodal metastases: incomplete nodal dissection versus preoperative unrecognized nodal
metastases.
Results: 146/352 (41.5%) patients had residual nodal metastases detected on 131-I scans with SPECT/CT following initial surgery, but prior to 131-I therapy. Among the 146 patients with residual disease, there were a total of 218 distinct nodal metastases. Relative to the
primary tumor, 71.6% (n=156) of metastases were ipsilateral, 22.0% (n=48) were contralateral, and 6.4% (n=14) were non-sided in the central neck (level VI/VII). Cervical lymph node levels VI, III, and II had the greatest frequencies of residual metastases (33.9%, 22.9%, 18.8%, respectively). Residual metastases occurred because of incomplete nodal dissection (49.3%), lack of preoperative identification (37.7%), or a combination of both (13%).
Conclusion: Residual nodal metastasis following initial surgical treatment for regionally advanced differentiated thyroid cancer is rather common on highly sensitive 131-I scans with SPECT/CT and is due to both unrecognized nodal involvement preoperatively and incomplete removal of metastatic lymph nodes during compartment-orientated nodal
dissection. The surgical management of high-risk DTC should include preoperative imaging to evaluate for nodal metastases in the central and lateral neck and compartment-orientated nodal dissection of involved compartments. Attention should be given to complete dissection in levels VI, III, and II, particularly when dissecting compartments ipsilateral to the primary tumor.
their opinions about the utility of using virtual reality as a tool for low vision rehabilitation training in patients with age-related macular
degeneration.
Methods: An online questionnaire was distributed between October 2017 and February 2018. 471 orthoptists (110 students
and 361 graduates) responded to the survey. Questions concerned the orthoptist’s educational and demographic background, extent
of training in virtual reality as a reeducation tool, and mode of practice including frequency of patient visits, goals, and methods of
rehabilitation training.
Results: Out of 361 practicing orthoptists, 47.75% were low vision rehabilitation providers, and 52.25% were not. A provider’s
likelihood of using low vision rehabilitation immediately after graduating from university was positively correlated to his confidence in
the training he had received. Most respondents were receptive to using virtual reality as a reeducation tool.
Conclusions: Analysis of current low vision rehabilitation practice demonstrates no standardization of treatment protocols
among providers. Although orthoptists overall acknowledge the benefits of virtual reality as a rehabilitation tool, orthoptist curriculum
varies greatly across universities, which thus affects a provider’s likelihood of offering low vision rehabilitation. Moreover, this lack
of standardization is a problem worldwide, which suggests a need for better clinical guidelines in low vision rehabilitation practice.