bluuebunny/crossref_metadata_2025 huggingface dataset:
Play Interventions for Hospitalized Children With Disability
Authors: Dumitru Cristina
Published: October 2022

Hospitalization is an unpleasant experience, and children with disabilities feel even more unsafe and confused, aggravating their level of anxiety and frustration, manifesting in negative behaviors. The most urgent need for a child with disability in the clinical setting and for the medical staff is to find a common ground that could facilitate communicational process, the comprehensiveness of care, the expression of what and how the child feels to be able to identify ways to describe their pain level and the sensations, to accept the treatment, and to explain the disease and the condition from which the child suffers. It is within a well-structured therapeutic play intervention that children with disabilities are more likely to reduce the anxiety that arises from threatening experiences. The lack of play can delay recovery, aggravate the symptoms, also can result in emotional withdrawal, diverse negative and regressive behaviors, tantrum episodes, and disrupted sleep patterns.
Play Strategies for Children With Intellectual Disabilities
Authors: Mastrogiuseppe Marilina
Published: October 2022

This chapter aims to illustrate the characteristics that can make the playful dimension an element capable of including children with intellectual disabilities (IDs) within health and social care contexts. Participating in ‘play activities' is an inalienable right for children with IDs. These classify amongst the prerequisites for supporting children's development and well-being. If adequately solicited and supported, playing can become a unique opportunity for children with IDs to grow, gain skills, and empower themselves. For these reasons, it is paramount for care-providers to learn and develop specific skills in terms of knowledge and methodologies. After illustrating the early developmental trajectories of play in children with IDs, emphasis will be given to strategies that will help care-providers support playing by considering each child's needs and preferences.
CDSS Architecture
Authors: Dosyn Dmytro
Published: October 2022

Patient-oriented data-driven CDSS architecture, based on adaptive ontology, is proposed as a perspective for a future development of intelligent medical decision support systems. A human body (anatomy and physiology) knowledge base should be the basic component of the system with the possibility to permanently automated update the deeply structured data, both general and personal, using the technologies of ontology learning, natural language processing, and automated planning. Already existing information technologies, standards, and protocols allow implementing such an approach in a healthcare domain in a framework of FHIR HL7.org standard.
Perception, Trust, and Accountability Affecting Acceptance of Artificial Intelligence
Authors: Choudhury Avishek , Saremi Mostaan Lotfalian , Urena Estfania
Published: October 2022

Artificial intelligence (AI) is intended to help clinicians exercise their professional judgment in making appropriate decisions for a given patient. Recently, research has exhibited the phenomenal performance of AI in healthcare, portraying the technology as an effective and efficient assistant. However, the acceptance and use of AI in healthcare are very limited. It is essential to understand that the overall skepticism against AI arises due to multiple factors and should be addressed as a systems problem. This chapter focuses on three major determinants of AI acceptance in healthcare: clinicians' perception, trust, and accountability. According to this chapter, moving forward, research should view AI as a socio-technical system and emphasize its ecological validity. Researchers should consider users' needs, capabilities, and interactions with other work system elements to ensure AI's positive impact in transforming healthcare.
Severity of Breast Mass Prediction in Mammograms Based on an Optimized Naive Bayes Diagnostic System
Authors: Desuky Abeer S.
Published: October 2022

Mammography is the most effective tool for breast mass screening. It is a special CT scan technique used only to detect breast tumors early and accurately. Detecting tumors in its early stage has improved the survival rate for breast cancer patients. Computer-aided diagnostic systems help physicians to detect breast cells abnormalities earlier than other traditional procedures. The main aim of this chapter is to increase physicians' ability to determine the severity of a mammographic mass lesion from the BI-RADS features and the patient's age using the bio-inspired chicken swarm optimization (CSO) algorithm for Naive Bayes (NBC) classifier. The mammographic mass dataset is used to analyze the proposed method (CSO-NBC). The dataset is preprocessed and divided to train the CSO-NBC system and test it by the 5-fold cross-validation technique. The performance of the proposed classification system is compared with the results from other research to show the efficiency of the system in predicting the severity of breast tumors with the highest accuracy.
Research
Authors: Daniels Sarah , Brasher Shawn
Published: October 2022

Although the value of research has long since been acknowledged in the child life profession, limited resources exist that prescribe concrete steps for child life leaders to take which promote research in daily work efforts. Whether working on research part-time or full-time, it is important that child life specialists take on research activities as part of their job responsibilities. With options to work fully remote or to have boots on the ground, the impact of a child life research specialist reaches patients and families; professionals and students; the academic, psychosocial, and biomedical scholarly communities; and beyond. Throughout this chapter, readers will obtain justification and inspiration for the proposal of this unique position into their own programs. Further, this chapter will offer concrete tools and suggestions for implementing this role successfully.
Organ, Tissue, and Eye Procurement
Authors: Reilly Alli
Published: October 2022

Organ, tissue, and eye donation is an essential component of healthcare necessary to save and enhance the lives of others. The decision to honor a loved one's designation, or consent to donation on the behalf of an eligible donor, is a choice fraught with a multitude of competing factors which may provide stress among family decision-makers, and the bereavement journey does not end once recovery is completed. Certified Child Life Specialists are expertly equipped with the knowledge, skills, and abilities to effectively and compassionately offer donation opportunities during potentially traumatizing or crisis-laden situations as family services coordinators. As indispensable members of any organ procurement organization, family services coordinators collaborate with clinical recovery coordinators, hospital services individuals, and hospital critical care teams to ensure families are poised to make well-informed decisions, honor their loved one in a uniquely profound and rare way, and provide ongoing bereavement and grief support to families experiencing the loss of a loved one.
Dimensions of Perceived Value That Influence the Intention to Adopt the Metaverse
Authors: Mereu Sebastiano
Published: October 2022

This chapter examines antecedents and dimensions of perceived value that influence the intention to adopt metaverse experiences provided by popular spectator sports organisations. It further offers recommendations for the conceptualisation and implementation of immersive virtual experiences. Recommendations are based upon an extensive literature review and empirical research undertaken specifically for this publication. The chapter first defines what the metaverse is and explores examples of how it can offer new opportunities for spectator sports brands to attract fans to experience the metaverse. A conceptual model is then offered upon a discourse on the relevant dimensions of perceived value and their antecedents. The analysis and discussion of the collected quantitative data (n=504) offers the foundation for recommendations on how spectator sports organisations can design and promote immersive metaverse experiences and foster continuous fan engagement.
E-Commerce
Authors: Santos Vasco , Augusto Tatiana , Vieira Jorge , Bacalhau Lara , Sousa Bruno Miguel , Pontes Daniel
Published: October 2022

E-commerce is a business model that allows organizations to explore global markets. The objective of this study is to identify all the key points involved in e-commerce business, along with several sub-themes related to e-commerce, namely the concept of e-business and e-marketing. Next, it was noted that e-commerce could express the connections between many purchase actors but is mainly used through the B2C model. The adoption of e-commerce is linked to different internet techniques and tools, which has several advantages and risks. This study also highlights the connections of e-commerce with globalization, e-marketplaces, and platforms. Finally, the authors present the KPIs in terms of sales, marketing, and customer service that the e-sellers should take into account when they are defining the e-commerce strategy and the age segmentation criteria that must be used to create homogeneous groups of e-buyers.
Cybersecurity as a Digital and Economic Enabler
Authors: Dawar Sunny , Kudal Pallavi , Dawar Prince
Published: October 2022

Cybersecurity is an extremely important matter in the current business world due to increasing cyber threats. Cyber attackers have increased their cyber-attacks on almost all the business operations using various advanced techniques. All kind of business organization ranging from small scale to large organizations have been impacted. So, cybersecurity has become a necessity for all kinds of firms, and adopting the secured techniques of business transactions has become a prerequisite of the business. The authors wish to find the conceptual framework of cybersecurity, associated risks related to cybersecurity, ways for ensuring cybersecurity in businesses, emerging trends in cybersecurity, and different initiatives taken in India for ensuring cybersecurity.
Transition to Blended Learning in a Limited Resource Setting
Authors: Roy Goutam , Abdin Md. Minhazul
Published: October 2022

From the online learning experiences during the COVID-19 pandemic, the higher educational institutions of Bangladesh are considering integrating online education into traditional face-to-face learning. Research showed several challenges in implementing blended learning strategies, including having limited resources. This chapter explores how the administrators and teachers at the higher education institutes of Bangladesh could start blended learning with limited resources. The administrators and teachers of two universities in Bangladesh, who were directly involved in the decision-making process, were interviewed. The findings showed that while the administrators and teachers were willing to start blended learning, there were several challenges due to the limited resources aligned with the problems of online education. Administrators and teachers considered blended education as a way to respond to an education disruption caused by emergencies such as natural disasters, political unrest, and pandemics. This chapter provides some recommendations.
Impact of Technology on Educational Patterns
Authors: Banerjee Shayantani , Zina Ayushi , Kumar Navinandan , Kumar Nilesh
Published: October 2022

With innovations in technology, educational practices and expectations are changing at a rapid pace. The virtual reality on electronic devices is at a stark contrast with traditional classroom teaching and ethics. This chapter aspires to trace the changes that the use of ICT tools has brought to conventional pedagogy, teacher's adaptability, and teacher's anxiety in coping with the inclination of education toward technology. For the study, various sets of data were collected from different institutions, and then the data were observed. Apart from ICT tools, the popularity of social media elicits teachers to explore its educational use. However, the tempting distraction of this technology could make teachers anxious about its pedagogical use. Thus, the aim of this chapter will be to analyze the impact of technology on factors like school culture versus online teaching, attitude towards social media, professional development of teachers, learning goals, and content-building in the curriculum.
What to Keep, What to Discard
Authors: Hai-Jew Shalin
Published: October 2022

As humanity seems to be moving ahead from the novel SARS-CoV-2/COVID-19 pandemic, people are reckoning with the changes adopted during the high-stress period, of unprecedented threats to lives and health, lockdowns and reopenings, social tensions, and political strife. Instructional design (ID) work at a university also underwent some seminal changes. This work explores what changes to keep and what to discard, based on a SWOT (strengths, weaknesses, opportunities, and threats) analysis and a grounding of some 17 years of ID work and decades of prior college and university teaching work.
Going Through the Motions
Authors: Hai-Jew Shalin
Published: October 2022

With the learning slippage that occurred in the aftermath of the SARS-CoV-2/COVID-19 pandemic, learning advantages that may be achieved are a topic of special interest. The popularization of online learning has riveted focus to digital learning methods and contents. In formal higher education, various contemporary digital infographics are in use: static, motion, interactive, and immersive. This work explores some of the publicly available and open infographics used in formal learning in higher education to better understand these digital contents. The search for “infographics” is based on a popular referatory for web-hosted digital learning resources, but with a new search feature that goes beyond the curated and peer-reviewed contents that captures the newest relevant contents from the web. The works are analyzed for modalities, topics, pedagogical value, and design for transience to protect against cognitive overload. This is an exploratory research work.
Wear Optimization of Aluminium and Hybrid Reinforcement Metal Matrix Composites Using Response Surface Methodology
Authors: Muzeer S. , Sivaganesan S.
Published: October 2022

Aluminum 6061 alloy-based alloys were used to make various motor vehicle parts such as connecting wire, O-ring, circular blocks, disc brakes and aircraft primary components, but the use of alloys was restricted in some of their applications due to their low strength, poor stiffness and high friction wear resistance. Hybrid Aluminium Metal Matrix Composites are achieved the potential mechanical properties compared to single reinforced composite materials. Tribological behaviour of hybrid composites were optimized by Response Surface Methodology (RSM) using Design of experiment statistical analysis. The contribution of various parameters rotational speed, sliding distance and axial load on hybrid composite materials were evaluated by Analyses of Variance (ANOVA). For each output response, a multilayer linear equation was used to examine the relationship between the parameters. According to the results, hybrid compounds provide greater adaptability and reliability in the development of a component of the product depending on the reinforcement composition and structure.
Evaluation of a Green Roof for Heat Mitigation in a Building Located in a City with a Hot and Humid Climate
Authors: Cardoso Vinicius C. , Louro Gabriel S.S. , Stroke Ananda A. , Assumpção Isabela M. , Brigagão George V. , da Costa Bruno B.F.
Published: October 2022

The expansion of the urban population has contributed to the formation of urban agglomerates; whose spatial morphology favors the formation of heat islands. The installation of Green Roofs (GR) is a strategy that can be applied to mitigate the effects of this phenomenon, especially in regions lacking vegetation cover. The objective of this paper is to evaluate, through Computational Fluid Dynamics (CFD), the potential to reduce the internal temperature of a building located in the city of Rio de Janeiro, Brazil. The temperatures of the inner surface of the roof were measured in two buildings, one with GR and one without GR. This information was used as input data into Solidworks software to simulate the heat distribution inside the building. Results indicated that the temperature was reduced by about 2°C in the building with GR, proving the technology's effectiveness, notably in the hottest months of the year.
Fabrication of AA7050 Hybrid Composite Reinforced with Nano Al2O3/ Micro ZrO2 Particles by Stir Casting Method and Study of Mechanical and Tribological Properties
Authors: Sekar Kannan
Published: October 2022

AA7050 aluminum alloy with desirable mechanical properties like strength, stress corrosion resistance, and toughness widely used in aerospace applications. In this study AA7050/Al2O3/ZrO2, hybrid composites fabricated with different wt. % of reinforcement materials (0.5, 1, 1.5 wt. % ZrO2, and 1wt. % Al2O3 constant for all composites) by using stir casting process. The SEM image has shown the uniform distribution of the reinforcement particles in the AA7050 matrix with the addition of 1wt% Al2O3 and 1wt% ZrO2 reinforcement. The compressive strength is increased from 9.41% to 10.47% and tensile strength 4.74% to 10.27% for the composite of 1wt %Al2O3 and varying 0.5 and 1 % wt ZrO2 compare to base alloy. From the dry wear studies, the composite with 1wt% Al2O3 and 1wt% ZrO2 have observed minimum wear loss and coefficient of friction at sliding velocity from 1.9896 to 3.9793m/s and at varying load condition from 20N to 60N compared to base alloy.
Investigation on Mechanical Properties of Regular and Engineered Fiber Built up Polymer Composites
Authors: Shirke Makarand B. , Shelke Santosh N.
Published: October 2022

Standard fibers have attracted the attentiveness of technocrats, specialists, experts, and researchers throughout the globe as elective support for fiber built up polymer composites, due to their predominant properties like high explicit strength, low weight, minimal expense, truly incredible mechanical properties, non-grating, eco-accommodating, and bio-degradable qualities. Here of view, a short survey has been completed to utilize normal strands, (for example, jute, Kenaf, pineapple, sisal, and so forth) bounteously accessible in India. Glass Fiber Reinforced Polymers are blending in with normal filaments to build Engineering and Technology applications. This paper presents an examination of the mechanical characteristics of regular fibers and hybrid fibers supported by polymer composites. Seven Sample composite covers of the various mix without alkali treatment has been prepared. The physical, Mechanical properties need to reveal for the better composition of the reinforced elements as per ASTM standard. The specimen has been prepared as per ASTM Standard for Mechanical Characterization. The tensile strength of the hybrid specimen shows maximum ultimate tensile strength 97.24Mpa with yield tensile strength is 67.11Mpa and Young’s Modulus 6673.64Mpa at maximum force of 6.56 KN. This is the highest among all configurations. From the consolidated result of flexural strength of all seven combinations, it is come to notice that, the flexural strength of the hybrid specimen composite shows maximum flexural strength 207.84 MPa. It is observed that the impact strength of the hybrid material is 42% more than Kenaf and E-glass material combination and 54% more than the Jute and E-glass material combination.
TREATMENT OF ADVANCED SYSTEMIC MASTOCYTOSIS WITH MIDOSTAURIN: PRACTICAL GUIDANCE FOR OPTIMAL THERAPY AND MANAGEMENT
Authors: Papayannidis Cristina , Federico Vincenzo , Fianchi Luana , Pregno Patrizia , Pugliese Novella , Romano Alessandra , Grifoni Federica Irene
Published: October 2022

Systemic mastocytosis (SM) is a rare disease with a range of clinical presentations, and the vast majority of patients have a KIT D816V mutation that results in gain of function. The multikinase/KIT inhibitor midostaurin inhibits the D816V mutant, and has a well-established role in treatment of advanced SM. Even if considered the standard of therapy, some open questions remain on how to optimize the management of midostaurin in daily practice. The current review presents the opinions of a group of experts who met to discuss routine practice with the use of midostaurin in patients with advanced SM. The efficacy and safety of midostaurin in Phase 2 trials are overviewed, followed by practical guidance for optimal management of therapy and adverse events during therapy with midostaurin. Specific guidance is given for initiating therapy and evaluating response with midostaurin in terms of general assessment and laboratory, instrumental, pathological, and molecular exams. Special consideration is given to dose interruption, reduction, and discontinuation of therapy as well as adverse event management and supportive therapy. Patients should be informed about possible side effects and receive not only practical advice to avoid or limit them, but also antiemetic prophylaxis so that therapy with midostaurin can continue as long as clinical benefit is observed or until unacceptable toxicity occurs. Lastly, considerations on the use of midostaurin during the ongoing Covid-19 pandemic are made. The overall scope is to provide guidance that can be useful in daily practice for clinicians using midostaurin to treat patients with advanced SM.
Samir Ballas Obituary
Authors: Leone Giuseppe G.M.
Published: October 2022

no abstract
Low Incidence of Vitamin D Levels Deficiency in Anesthesiology Residents
Authors: Tantri Aida Rosita , Soenarto Ratna Farida , Firdaus Riyadh , Theresia Sandy , Anakotta Vircha
Published: October 2022

Background:

Vitamin D deficiency is now a major global health problem. The prevalence of vitamin D deficiency in Indonesia is 60–90% in various studies. Age, race, sunscreen use, medication, and malabsorption diseases are all factors that affect vitamin D levels. Recent studies also show the relation between COVID-19 and vitamin D deficiency in severity and disease mortality. Vitamin D deficiency causes skeletal and extra-skeletal consequences. With limited studies on vitamin D levels of anesthesiology residents in Indonesia, we aim to determine the average vitamin D level and the affecting factors in this population.

Materials and Methods:

Sixty-nine anesthesiology residents working in a tertiary care hospital were enrolled in this study. The participants were asked to complete the questionnaire, and blood samples were drawn to measure serum 25(OH)D. The factors that influence vitamin D levels were recorded for analysis. Statistical analysis was performed using SPSS version 20.

Results:

The mean vitamin D level in anesthesiology residents was 39.99 ng/mL. There were no significant relationships between vitamin D levels among anesthesiology residents with vitamin D consumption, high-calcium foods, frequency of exercise, history of COVID-19 infection, comorbidities, and duration of exposure to sunlight.

Conclusion:

Prevalence of vitamin D deficiency/insufficiency was low among anesthesiology residents. Vitamin D levels were optimal in professionals who are taking vitamin D supplements.
Comparison of Intraperitoneal Dexamethasone, Dexmedetomidine, and Dexamethasone–Dexmedetomidine Combination on Postoperative Nausea, Vomiting, and Analgesics Requirement after Gynecological Laparoscopy
Authors: Srivastava Vinit Kumar , Shree Pooja , Agrawal Sanjay , Pandey Ambikesh , Babbar Kavita , Manju Kumari
Published: October 2022

Background:

Female patients who undergo gynecological laparoscopic surgery are more likely to suffer from postoperative nausea and vomiting (PONV). The study aimed to probe and investigate the effectiveness of intraperitoneal administration of dexamethasone, dexmedetomidine, and combination in reducing the incidence of PONV and postoperative analgesic requirements in laparoscopic hysterectomies.

Materials and Methods:

One hundred ninety-two female patients undergoing laparoscopic hysterectomies were randomly assigned to four groups. Anesthesia was identical in each group. Patients in the group D1 received dexamethasone 8 mg, group D2 received dexmedetomidine 1 μg/kg, group D3 received dexamethasone 8 mg + dexmedetomidine 1 μg/kg combination, and group D4 received 20 mL normal saline intraperitoneally at the end of the surgery, before trocar removal. The primary outcome was the incidence of PONV experienced by the patients within 24-h postoperative period.

Results:

In the first 24 h postoperatively, the incidence of PONV was significantly reduced in D1, D2, and D3 groups compared with D4 (P = 0.001); however, there were no significant differences among the three groups. The requirement for rescue antiemetic and rescue analgesic was similar among the groups but significantly decreased compared with the control group (group D4) (P = 0.002 and P = 0.0003, respectively).

Conclusion:

Intraperitoneal administration of dexamethasone, dexmedetomidine, and a combination of dexamethasone–dexmedetomidine in laparoscopic hysterectomies significantly reduces both PONV and postoperative analgesics requirements compared with the control group.
Pulmonary Hypertension Crisis Management in Adult Atrial Septal Defect Surgical Closure
Authors: Adriane Prieta , Sedono Rudyanto , Dewi Ni Luh Kusuma
Published: October 2022

Atrial Septal Defect (ASD) is the most common congenital disorder found in adulthood, accounting for 35% of Adult Congenital Heart Disease (ACHD). In ASD, there is a defect in the septum/wall between right and left atria, resulting in left-to-right shunt which lead to an increase of the right heart volume and pulmonary circulation. If left untreated, increased pulmonary resistance develop to pulmonary hypertension (PH) which results in a progressive decrease in right ventricular function, causing right heart failure and death. Although ASD surgical closure is not a complicated procedure, patients with complication of PH and right heart failure have a high mortality rate if not managed properly. Increase in mortality was mainly due to perioperative pulmonary hypertensive crisis (PH crisis), condition of an acute increase in mean pulmonary arterial pressure (mPAP) exceeding mean systemic arterial pressure (MAP). In this case report, we will discuss the management of postoperative adult patients with ASD closure complicated by intraoperative pulmonary hypertensive crisis who are treated in the intensive care unit (ICU).
Corneal endothelial changes following cataract surgery in hard nuclear cataract
Authors: Singh Ritu , Sharma Arun K , Katiyar Vishal , Kumar Gaurav , Gupta Sanjiv K
Published: October 2022

Purpose:

To evaluate and compare endothelial cell changes in phacoemulsification and manual small-incision cataract surgery (MSICS) in patients with uncomplicated senile cataracts.

Methods:

This was a prospective, tertiary care hospital-based, randomized, double-blinded interventional study. In total, 152 patients with an uncomplicated senile cataract of nuclear grade III and above were recruited. Exclusion criteria included patients with preoperative endothelial cell density (ECD) less than 1500 cells/mm3, a history of previous ocular surgery, any other coexisting ocular disease, and intraoperative or postoperative surgical complications. Preoperative and postoperative values of ECD and central corneal thickness (CCT) were measured, analyzed, and correlated with various factors.

Results:

Patients were randomized into two interventional groups-MSICS and phacoemulsification. Factors associated with significant drop in postoperative ECD following phacoemulsification were patients with advanced age (P = 0.01), higher grades of cataract (P = 0.01), and longer effective phacoemulsification time (P = 0.007). Shallow anterior chamber depth (ACD) was strongly associated with greater ECD loss in both groups (P < 0.0001). A threshold value of 2.86 mm of ACD was defined for minimal endothelial cell loss following phacoemulsification. CCT was observed to slightly increase postoperatively in both groups but was insignificant (P > 0.05).

Conclusion:

Both MSICS and phacoemulsification have similar postoperative visual outcomes. An increase in postoperative CCT is insignificant following surgery. Greater postoperative ECD loss is associated with phacoemulsification with advanced age, hard nuclear cataracts, and longer effective phacoemulsification time. ACD can be used as an essential parameter preoperatively to determine the choice of surgical technique between MSICS and phacoemulsification.
Tunnel-floor entry continuous curvilinear capsulorhexis technique
Authors: Ravindra MS , Bali Jatinder , Adarsh Deepthi C , Bali Ojasvini
Published: October 2022

Continuous circular capsulorhexis (CCC) was demonstrated independently by Thomas Neuhann, Kimiya Shimizu, and Howard Gimbel in the 1980s and it finds mention in the landmark paper by Gimbel and Neuhann. The authors describe a technique of achieving the rhexis in a stable, viscoelastic-filled anterior chamber using the tunnel floor as the entry. This gets covered by the roof of the tunnel postoperatively and, therefore, does not leak. There is no oar-locking or striae even when cystitome goes beyond the edge of the tunnel. As there is no escape of the viscoelastic substance, there is no change in the pressure or shallowing of the anterior chamber. It is a useful technique for beginners. It is of great help in difficult cases like intumescent cataracts, shallow anterior chambers, hyperopes, nanophthalmos, pseudoexfoliation, small non-dilating pupils, intraoperative floppy iris syndrome (IFIS), and phacomorphic glaucoma.
Closed chamber manual phacofragmentation in manual small-incision cataract surgery
Authors: Boramani Jagannath , Bali Jatinder , Boramani Priyanka , Bali Ojasvini
Published: October 2022

Manual small-incision cataract surgery (MSICS) has existed as an alternative to conventional phacoemulsification since its inception. The size of the incision has been becoming smaller in MSICS to reduce the surgically induced astigmatism. Smaller incisions go hand in hand with nucleus debulking and fragmenting techniques which have been practiced over almost four decades. Such techniques have a learning curve and require meticulous execution. The authors describe a technique to achieve nucleus bisection or trisection or debulking in a closed anterior chamber. This technique has been in use for a long time; it has shown excellent results and has a shorter learning curve. Since it is done in a closed chamber, the risk to the corneal endothelium is minimized as the anterior chamber remains deep throughout the procedure. Sudden escape of the viscoelastic and shallowing of the chamber are prevented, and the corneal endothelium is well protected. It uses iris as support and reference. The specially designed chopper is an inexpensive addition to the instruments. Fragmentation is achieved in the proximal half of the chamber where control over instruments is maximum. Pristine clear cornea on day 1 is the rule rather than the exception with this technique. This is a safe and repeatable technique for phacofragmentation in cataract extraction.
Incidence of vitreous loss and visual outcome following cataract surgery by surgeons with various levels of experience at a tertiary eye care center in North India
Authors: Sharma Dushyant Kumar , Bharti Gaurav , Pegu Julie , Bhumbla Shayana , Paul Lagan , Agarwal Manisha , Shah Gaurav , Mathur Umang
Published: October 2022

Purpose:

To determine the incidence of vitreous loss and visual outcome after a vitreous loss during cataract surgery performed by surgeons with various levels of experience in adults >40 years of age at a tertiary eye care center in North India.

Methods:

The study was conducted at a tertiary eye care center in North India. This was an observational, retrospective, cross-sectional study of patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. All adult cataract cases who were operated on from August 1, 2011 to July 31, 2014 and who experienced vitreous loss during their surgery were included in the study. The visual outcomes of these patients who experienced vitreous loss during cataract surgery in uncomplicated cataract and were managed using standard automated vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, small-incision, and phacoemulsification) as well as at different levels of skill of the operative surgeon (consultant, short term fellow, and long-term fellow). Details of the postoperative period and best-corrected visual acuity (BCVA) were collected from patient records by the principal investigator on day 1, 1 week, 4 weeks, 6 weeks, and 3 months post cataract surgery.

Results:

Vitreous loss occurred in 374 out of 18,430 patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. The overall incidence of vitreous loss in our study was found to be 2.03% with consultants having a rate of 1.66%, short-term fellows at 5.19%, and long-term fellows at 2.02%. Two hundred eighty-eight patients of the 374 cases followed up for 3 months at the hospital and 75.69% of these patients had a final visual acuity of ≥6/18.

Conclusion:

In an institute with a structured training program for residents/trainees, the vitreous loss rate is low during cataract surgery. Early intervention and proper management with the standard microsurgical technique by experienced hands can improve the final visual outcome in eyes with vitreous loss. Cystoid macular edema and corneal edema were the most common causes of poor postoperative vision.
Posterior polar cataract
Authors: Ravindra M S , Bali Jatinder , Adarsh Deepthi C , Bali Ojasvini
Published: October 2022

A posterior polar cataract is a discoid posterior polar plaque-like cataract with a thin and fragile to absent posterior capsule with adherent acellular opacity to the capsule reported in the literature. It is a stationary or slowly progressive opacity. A higher risk of complications such as posterior capsular tear and nucleus drop makes this a challenging surgery. The techniques described in the literature include bimanual irrigation aspiration, leaving the plaque for later Yag, bimanual micro phaco, Lambda technique with dry aspiration, Phaco if opacity <4 mm and soft nucleus, pars plana vitrectomy (PPV), pars plana lensectomy (PPL) if opacity >4 mm and soft nucleus, intra-capsular cataract extraction (ICCE) and scleral fixated intraocular lens (IOL) if opacity >4 mm with the hard nucleus, viscodissection, 3 ports PPL, PPV, low parameters phaco, modified epinucleus removal, inverse horse-shoe technique, standard phacoemulsification, chip and flip for soft cataracts, stop and chop for hard cataracts, layer-by-layer phacoemulsification, standard lens aspiration, pars plicata posterior vitrecto-rhexis, manual small-incision cataract surgery, and conventional extracapsular extraction. A posterior capsule rupture rate of 0 to 36% is reported in different series for cataract extraction. To prevent this dreaded complication, surgeons used many modifications. Minimal hydrodissection in posterior polar cataract extraction was described by Fine et al. The authors describe a technique of low flow manual small-incision cataract surgery with minimal hydrodissection and nucleus rotation with no associated posterior capsule rent. This demonstrates that if the fluidics is understood and corrected, then minimal hydrodissection and nucleus rotation is not taboo in posterior polar cataract extraction by manual small-incision cataract surgery.
An objective evaluation of simulated surgical outcomes among surgical trainees using manual small-incision cataract surgery virtual reality simulator
Authors: Sankarananthan R , Prasad R Senthil , Koshy Tony Alex , Dharani Padam , Bacchav Ashish , Lansingh Van Charles , Ahiwalay Chetan , Balagiri K , Shekhar Madhu
Published: October 2022

Purpose:

The purpose of this study was to evaluate trainee performance across six modules of a virtual reality (VR) simulator.

Methods:

A retrospective observational study was conducted on 10 manual small-incision cataract surgery (MSICS) trainees who practiced cataract surgery on an MSICS VR simulator for one month. They were assessed in six major steps which included scleral groove, tunnel dissection, keratome entry, capsulorhexis, nucleus delivery, and intraocular lens (IOL) insertion under a trainer’s supervision. The information included in their score metrics was collected, and their overall performance was evaluated.

Results:

Thirty attempts were evaluated for scleral groove, tunnel dissection, and capsulorhexis and 15 attempts for keratome entry. Candidates had varied results in the dimensional aspects and their rates of complications with a mean satisfactory score of 3.1 ± 4.17, 6.8 ± 5.75, 5.8 ± 7.74, and 1.8 ± 2.57, respectively. Nucleus delivery (n = 5) had more of iris pull and IOL insertion (n = 5) had more of lost IOL as complications but both had a higher satisfactory outcome.

Conclusion:

A VR simulator is a useful tool for training surgeons before their entry into live surgery. It is an effective method for evaluating objectively the structural characteristics of each phase in MSICS and their associated complications, helping them anticipate it earlier during live surgery by giving them a near real world experience.
Fish hook technique for nucleus management in manual small-incision cataract surgery
Authors: Anand Abhishek , Singh Vivek , Kumari Rashmi , Mishra Deepak , Kumar Rajesh R , Singh Anil K
Published: October 2022

Manual small-incision cataract surgery (MSICS) preserves its utility as a cost-effective and efficient strategy for mitigating cataract-associated blindness. Numerous techniques of nucleus delivery in MSICS have been described in the literature. The fish hook technique of nucleus extraction was advocated in 1997 and has been popular for high-volume surgery in limited pockets of the world. This article describes in detail the steps involved in the construction of a fish hook, tips of nucleus extraction with the help of a fish hook, and the pros and cons of fish hook-based MSICS through text, diagram, and video supplement.
Outcome of superior manual small-incision cataract surgery in pediatric age group - A five year retrospective study at a tertiary eye hospital in Karnataka
Authors: Gangrade Aashish Kumar , Kavitha V , Heralgi Mallikarjun M
Published: October 2022

Purpose:

To analyze intraoperative difficulties and visual and surgical outcomes following pediatric cataract surgery.

Methods:

This five-year retrospective study (2014–2019) included 138 eyes (85 children) with cataract aged between 12 months and 18 years (either sex). All children had undergone best-corrected visual acuity (BCVA), anterior and posterior segment evaluation, intraocular lens (IOL) power calculation, superior manual-small-incision cataract surgery (MSICS) with or without posterior capsulotomy/anterior vitrectomy and IOL implantation under general or local anesthesia, visual rehabilitation, and had been followed up for a minimum period of 12 months.

Results:

The mean age was 111.27 ± 4.84 months. Preoperative BCVA distance: 113 (81.88%)eyes had BCVA < 6/60; near BCVA: 114 (82.6%) eyes had ≤N36. At last postoperative follow-up (mean: 20.98 ± 13.08 months): distant BCVA- ≥6/60 had been recorded in 120 (86.96%) eyes; near BCVA- >N36 in 123 (89.13%) eyes. Improvement in BCVA was statistically significant. Intraoperative scleral tunnel difficulties were seen in three eyes (thin flap in two, and buttonhole in one eye); in the majority of the eyes 113 (81.88%), IOL was placed in the bag. Twenty eyes had early postoperative inflammation. At last follow-up: posterior capsular opacity was recorded in six eyes, IOL decenteration in two eyes, secondary glaucoma in six eyes, and severe amblyopia in 36 (26.09%) eyes. The mean myopic shift was − 1.11 ± 0.89 D and was statistically significant.

Conclusion:

Superior MSICS as a treatment for pediatric cataract has minimal intraoperative complications and satisfactory visual and surgical outcomes.
Evaluation of scleral incisions and their effects on corneal curvature in manual small-incision cataract surgery
Authors: Nada Manisha , Rohit D , Singh SV , Khurana AK , Lochab Sakshi , Kharolia Anjali
Published: October 2022

Purpose:

Incisions in cataract surgery can be modified in various ways in terms of size, shape, and axis to reduce or tailor astigmatism. This study was conducted to examine the effect of site (superior vs, temporal) and shape (frown vs. V-shaped, chevron) of scleral incisions for cataract surgery on corneal curvature.

Methods:

The prospective study was carried out on 200 consecutive patients with senile cataract and who were planned for surgery at a tertiary eye hospital in north India. The placement of the incision was decided by the steeper corneal meridian—whether superior or temporal—and then patients of these two groups were randomized for frown and V-shaped incision; in this way, four groups of 50 patients each were formed. Follow-up was done on day 1, at 2 weeks, 4 weeks, 8 weeks, and 12 weeks. At each follow-up, post-operative keratometry with routine postoperative examination was done. The results were statistically analyzed by using student’s t-test, Chi-squared test, and the Pearson correlation coefficient.

Results:

In all the four groups, the difference of preoperative astigmatism and surgically-induced astigmatism was statistically highly significant. The analysis of uncorrected visual acuity (UCVA) was statistically significant (P < 0.05) on postoperative day 1 and at 2, 4, and 12 postoperative weeks; it was statistically insignificant (P > 0.05) at postoperative week 8.

Conclusion:

Temporal incisions result in lesser postoperative surgically induced astigmatism (SIA) than superior incisions. Chevron incisions result in minimal change in corneal curvature. This effect can be utilized to tailor the postoperative astigmatism.
Complications of manual small-incision cataract surgery
Authors: Goel Ruchi , Shah Shalin , Malik Krishan Pal Singh , Sontakke Ruchita , Golhait Priyanka , Gaonker Tanvi
Published: October 2022

The manual small-incision cataract surgery (MSICS) is instrumental in tackling cataract-induced blindness in developing countries, especially with a sizeable proportion being hard brunescent cataracts. MSICS has a unique set of complications related to wound construction, the creation of the capsular opening, and the technique of nuclear delivery. A poorly constructed sclero-corneal tunnel or a small capsulorhexis hampers the nuclear extraction, and the extensive intracameral maneuvers increase the chances of postoperative corneal edema and iritis. Though MSICS has been shown to have universal applicability, producing replicable visual outcomes requires a significant learning curve. This article reviews the relevant published literature on complications of MSICS utilizing the databases of PubMed, Medline, Cochrane, and Google Scholar.
Evaluation of striate keratopathy after manual small-incision cataract surgery and its final outcomes in a tertiary hospital
Authors: Rajappa Suresha A , Bhatt Kunal P
Published: October 2022

Purpose:

To study the demographic profile, contributing and precipitating factors, the severity of striate keratopathy and its relation with endothelial cell count, and evaluate the final treatment outcome of striate keratopathy.

Methods:

This observational analytical cohort study was conducted on 75 patients developing striate keratopathy after MSICS in the immediate postoperative period. Demographic profile, preoperative risk factors, and intraoperative complications were evaluated retrospectively. Postoperatively, slit-lamp grading of striate keratopathy was done, and specular microscopy of both eyes was taken. Treatment of striate keratopathy was initiated, and patients were followed up for 6 to 10 weeks for improvement.

Results:

Striate keratopathy was most commonly associated with surgeries performed by resident surgeons (92%), longer duration of surgery, associated predisposing factors, and intraoperative or postoperative complications. On postoperative day 1, the majority of patients had moderate and severe striate keratopathy (66% and 32%, respectively). It was associated with significant endothelial cell loss (ECL) at the final follow-up (P = 0.0016). Striate keratopathy resolved in 97.3% of patients, irrespective of the treatment with hypertonic saline. At 6 to 10 weeks, 92% of patients achieved a BCVA of ≥6/9.

Conclusion:

A careful preoperative evaluation, adequate training of resident surgeons, meticulous surgical technique, and prompt management of postoperative complications can lead to a decrease in the incidence of striate keratopathy in the majority of cases. The use of hypertonic saline eye drops does not change the final outcome, and most cases resolve spontaneously during follow-up.
Catquest-9SF questionnaire shows greater visual functioning in bilateral cataract populations
Authors: Seth Ishith , Bulloch Gabriella , Thornell Erin , Lundström Mats , Agarwal Smita
Published: October 2022

Purpose:

Visual functioning evaluated by the Catquest-9SF questionnaire has shown to be a valid measure for assessing a patient’s prioritization for cataract surgery. This study adapted Catquest-9SF for visual function outcomes post uni-lateral cataract surgery or bi-lateral cataract surgery.

Methods:

Visual functioning was assessed before and after uni-lateral or bi-lateral cataract surgery using the Catquest-9SF questionnaire. Patients were enrolled to this study prior to their cataract surgery between March 29 and April 30, 2021 at Shellharbour Hospital, Australia. Catquest-9SF questionnaires were completed prior to and 3 months post surgery. Resulting data were assessed for fit to a Rasch model using WINSTEPS software (version 4.2.0). Catquest-9SF data analysis of Chi-square, Wilcoxon sum test, and Fischer’s test were performed in R (version 4.1.0). P value <.05 was considered statistically significant.

Results:

Sixty-one patients (mean age = 73.2 years, 62% female) were included for analysis. Catquest-9SF response thresholds, adequate precision (person separation index = 2.58, person reliability = 0.87, Cronbach’s alpha = 0.74), uni-dimensionality, and no misfits (infit range 0.65–1.33; outfit range 0.64–1.31) were recorded. The mean of item calibration for patients was -0.22 post-operatively. There was significant (P <.05) improvement (16.3%) in visual functions across all nine Catquest 9-SF items. There was a significant mean visual function difference between patients with uni-lateral (10.1%) and bi-lateral cataract surgery (22.3%) pre-operatively and post-operatively.

Conclusion:

The Catquest-9SF questionnaire showed excellent psychometric properties and can assess visual functioning in an Australian population. There was a significant improvement in patient visual function post cataract surgery and higher functioning with bi-lateral cataract surgery.