bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular Problems in Low-Income and Minority Children
Authors: Frick Daniel J. , Olitsky Scott E. , Campbell Annette , Glaros Alan G.
Published: February 2014

Purpose:

To report the prevalence rates of screen failures for uncorrected refractive error, abnormal or excessive levels of hyperopia, problems in binocular vision, and deficiency of near point acuity as related to age and ethnicity in children.

Methods:

Vision screening tests were administered to 9,743 African-American, Hispanic, and white children aged 6 to 11 years in the Kansas City (United States) metropolitan area. Screening was performed by health professions students using HOTV charts for refractive errors, hyperopia, and near point acuity and a Random Dot E test for binocular vision. Children were screened in their elementary schools, located in primarily poor, urban neighborhoods. The main outcome measure was pass/fail outcomes from screenings, with confirmation of screen fails by licensed health care professionals.

Results:

For African-American children, 14.1% failed one or more vision screening tests. The corresponding screen failure rates for Hispanic and white children were 14.2% and 11.0%, respectively. There were significant differences in screening failure rates as a function of age and ethnicity, depending on the specific test. The highest rates of screen failures occurred in the 9 to 11 year old age range.

Conclusions:

Vision screening failures were frequently associated with age and ethnicity. Screening performed by health professions students can successfully identify potential visual problems at rates similar to those reported in studies using more complex, sophisticated testing performed by specially trained individuals.

[J Pediatr Ophthalmol Strabismus 2013;50(6):363–368.]
Clinical Manifestations of Congenital Aniridia
Authors: Singh Bhupesh , Mohamed Ashik , Chaurasia Sunita , Ramappa Muralidhar , Mandal Anil Kumar , Jalali Subhadra , Sangwan Virender S.
Published: February 2014

Purpose:

To study the various clinical manifestations associated with congenital aniridia in an Indian population.

Methods:

In this retrospective, consecutive, observational case series, all patients with the diagnosis of congenital aniridia seen at the institute from January 2005 to December 2010 were reviewed. In all patients, the demographic profile, visual acuity, and associated systemic and ocular manifestations were studied.

Results:

The study included 262 eyes of 131 patients with congenital aniridia. Median patient age at the time of initial visit was 8 years (range: 1 day to 73 years). Most cases were sporadic and none of the patients had parents afflicted with aniridia. The most common anterior segment abnormality identified was lenticular changes. Cataract was the predominant lens finding, observed in 93 of 231 (40.3%) phakic eyes. Other lens abnormalities were subluxation, coloboma, posterior lenticonus, and microspherophakia. Corneal involvement of varying degrees was seen in 157 of 262 (59.9%) eyes, glaucoma was identified in 95 of 262 (36.3%) eyes, and foveal hypoplasia could be assessed in 230 of 262 (87.7%) eyes. Median age when glaucoma and cataract were noted was 7 and 14 years, respectively. None of the patients had Wilm’s tumor.

Conclusions:

Congenital aniridia was commonly associated with classically described ocular features. However, systemic associations were characteristically absent in this population. Notably, cataract and glaucoma were seen at an early age. This warrants a careful evaluation and periodic follow-up in these patients for timely identification and appropriate management.

[J Pediatr Ophthalmol Strabismus 2014;51(1):59–62.]
Association Between Video Display Terminal Use and Dry Eye Disease in School Children
Authors: Moon Jun Hyung , Lee Mee Yon , Moon Nam Ju
Published: February 2014

Purpose:

To evaluate the risk factors of dry eye disease in school children associated with video display terminal use.

Methods:

Two-hundred eighty-eight children were classified in either a dry eye disease group or control group according to the diagnostic criteria of dry eye disease. The results of ocular examinations, including best-corrected visual acuity, slit-lamp examination, and tear break-up time, were compared between groups. The results of questionnaires concerning video display terminal use and ocular symptoms were also compared.

Results:

Twenty-eight children were included in the dry eye disease group and 260 children were included in the control group. Gender and best-corrected visual acuity were not significantly different between the two groups. Smartphone use was more common in the dry eye disease group (71%) than the control group (50%) (
P
= .036). The daily duration of smartphone use and total daily duration of video display terminal use were associated with increased risk of dry eye disease (
P
= .027 and .001, respectively), but the daily duration of computer and television use did not increase the risk of dry eye disease (
P
= .677 and .052, respectively).

Conclusions:

The results showed that smartphone use is an important dry eye disease risk factor in children. Close observation and caution regarding video display terminal use, especially smartphones, are needed for children.

[J Pediatr Ophthalmol Strabismus 2014;51(2):87–92.]
Comparison of the Effectiveness and Safety of Transscleral Cyclophotocoagulation and Endoscopic Cyclophotocoagulation in Pediatric Glaucoma
Authors: Kraus Courtney L. , Tychsen Lawrence , Lueder Gregg T. , Culican Susan M.
Published: February 2014

Purpose:

Among the options for surgical management of pediatric glaucoma, destruction of the ciliary body reduces aqueous production and, consequently, intraocular pressure (IOP). Compared to more invasive filtering and shunt procedures, cyclodestruction is an attractive option for control of IOP in pediatric glaucomas.

Methods:

The relative reduction in IOP, duration of effect, and comparable safety and efficacy of transscleral cyclophotocoagulation (TSCP) and endoscopic cyclophotocoagulation (ECP) in pediatric patients with glaucoma was studied in this retrospective chart review.

Results:

A reduction in IOP of 28.6% and 33.2% with TSCP and ECP, respectively, was found. Eyes treated with ECP underwent an average of 3.24 cyclodestructive procedures; eyes treated with TSCP underwent an average of 2.29 cyclodestructive treatments. These differences were not statistically significant. A final success rate of 67.6% after TSCP and 62% after ECP failed to significantly differ between the two groups. Consequently, two-thirds of the patients were able to avoid penetrating surgery and the associated risks after one or more cyclodestructive procedures.

Conclusions:

TSCP and ECP are safe, effective, and comparable treatments for pediatric glaucomas. The results suggest that TSCP and ECP may be considered first-line therapy to achieve control of IOP in all forms of pediatric glaucoma.

[J Pediatr Ophthalmol Strabismus 2014;51(2):120–127.]
Health Screening Dialouges
Authors: Swarbrick Margaret A. , Cook Judith , Razzano Lisa , Yudof Jay , Cohn Jen , Fitzgerald Christina , Redman Betty , Costa Maureen , Carter Tina , Burke Karen , Yost Chantelle
Published: February 2014

Nurses can play an important role in community-based health screenings, which are a practical resource to empower people living with mental and substance use disorders to make positive lifestyle changes. The experiences, struggles, and strengths of screening participants provides insights for nurses to engage people in health and wellness dialogues. [
Journal of Psychosocial Nursing and Mental Health Services, 51
(12), 22–28.]
Disseminating an Evidence-Based Course to Teach Self-Management of Auditory Hallucinations
Authors: Buffum Martha D. , Buccheri Robin Kay , Trygstad Louise Nigh , Dowling Glenna A.
Published: February 2014

This multi-site project extended course dissemination of the 10-session Behavioral Management of Auditory Hallucinations Course to U.S. Department of Veterans Affairs (VA) mental health outpatient settings. The VA Quality Enhancement Research Initiative (QUERI) model and Rogers’ theory of diffusion of innovations served as the theoretical framework. The course was taught to mental health professionals using teleconferencing, electronic media, and monthly conference calls across 24 VA mental health outpatient sites. Twenty course leaders provided feedback. One hundred percent reported being better able to communicate with patients about their voices and 96% reported improved understanding of the voice-hearing experience. Thirty-three course participants provided feedback. Ninety-four percent would recommend the course, 85% reported being better able to communicate with staff about their voices, and 66% reported being better able to manage their voices. Facilitators and barriers to course implementation are described. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(4), 32–41.]
Use of a Sensory Room on an Intensive Care Unit
Authors: Smith Suzanne , Jones Julia
Published: February 2014

This study explores the use of a sensory room on a psychiatric intensive care unit (PICU), with a particular focus on the effect on seclusion rates and staff and patients’ experiences of using the sensory room. A mixed method research design was used, with the collection of seclusion data before and after a sensory room was introduced followed by qualitative interviews with staff and patients. No significant reduction in seclusion rates was noted with the introduction of the seclusion room. However, the interviews revealed a perception among staff that there had been a reduction in seclusion rates. Other findings from the interviews were that staff and patients viewed the sensory room as a positive therapeutic intervention, and use of the sensory room had improved staff-patient communication and patients’ overall experience of the PICU. The use of a sensory room should be an intervention considered by other PICUs and inpatient psychiatric settings. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(5), 22–30.]
Gabapentin for Substance Use Disorders: Is it Safe and Appropriate?
Authors: Howland Robert H.
Published: February 2014

Gabapentin is effective for the treatment of alcohol dependence and can be used for treating anxiety, insomnia, headaches, and/or pain in patients who have comorbid substance use disorders (SUDs) or who are at high risk of substance abuse. Deaths from unintentional drug overdoses are increasing, are the leading cause of injury death in the United States, and are mostly attributable to prescription drugs, in particular opioid agents. Compared to other psychotropic drugs, gabapentin is not especially harmful or lethal. Gabapentin misuse is possible, similar to other medications not typically considered drugs of abuse, but it should be considered safe and appropriate for use in patients with all types of SUDs, including patients who take opioid drugs. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(2), 13–16.]
Near-Hanging and its Management in the Acute Inpatient Mental Health Setting
Authors: Molloy Luke , Brady Marie , Beckett Paul , Pertile Joy
Published: February 2014

Being admitted to an inpatient mental health unit does not necessarily protect a patient against suicidal behavior. Given their purpose and design, these clinical areas can provide a safe environment for reducing hanging deaths. Strategies for reducing suicide by hanging in acute inpatient units should include ongoing review of the safety of the environment and the emergency management of near-hanging. After receiving a request from inpatient nursing staff to develop an education program focused on the emergency management of near-hanging, the authors undertook a review of the literature to (a) identify the evidence base within this area and (b) establish an effective means to promote safe practice with the staff. This article provides a synthesis of the literature review and its implications for nursing practice. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(5), 41–45.]
Characteristics of TEMPER TANTRUMS in Preschoolers with Disruptive Behavior in a Clinical Setting
Authors: Eisbach Shelly S. , Cluxton-Keller Fallon , Harrison Joyce , Krall Jenna R. , Hayat Matthew , Gross Deborah
Published: February 2014

The purpose of this study was to describe clinician-observed, naturally occurring temper tantrums in preschoolers ages 2 to 5.5 diagnosed with severe behavior problems. Participants were 24 mother–child dyads enrolled in an intensive outpatient treatment program. Clinicians timed and observed 330 temper tantrums, rated their intensity, and recorded occurrence of 16 behaviors, tantrum precipitants, and interventions; parents completed the Achenbach Child Behavior Checklist pre- and posttreatment. Data were analyzed using descriptive statistics, Pearson chi square, paired
t
tests, and generalized linear modeling. Mean tantrum duration was 3.4 minutes (range = 0.2 to 26.5 minutes); most tantrums were low in intensity. Noncompliance precipitated 52% of tantrums. Aggressive behaviors were more likely to occur early in tantrums, with distress behaviors occurring later. Parent surveys indicated perceptions of behavioral improvement but no change in tantrum behavior. Study findings corroborate those of previous studies using retrospective parent reports. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(5), 32–40.]
Black Southern Rural Adolescents’ HIV Stigma, Denial, and Misconceptions and Implications for HIV Prevention
Authors: Piper Kendra , Enah Comfort , Daniel Melanie
Published: February 2014

The HIV/AIDS epidemic is becoming increasingly concentrated among African Americans who live in the rural South. HIV denial, stigma, and misconceptions have been identified as helping spread the virus among adults. However, little is known about these psychosocial factors among African American rural adolescents. This article presents findings from a study aimed at exploring the role HIV denial, stigma, and misconceptions play in the disproportionate impact of HIV/AIDS on African American adolescents in the rural South. A mixed-method study, which included questionnaires and focus group discussions, was used. Results indicated that the majority of participants had average HIV knowledge levels and that HIV denial, stigma, and misconceptions played a role in the current HIV/AIDS epidemic among rural African American adolescents. Nurses and health care professionals can play a key role in understanding and addressing HIV stigma, denial, and misconceptions among African American adolescents in the rural South to reduce HIV/AIDS health disparities among this population. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(6), 50–56.]
New Technique of Intracorneal Ring Segments Suturing After Migration
Authors: Jarade Elias , Dirani Ali , Fadlallah Ali , Antonios Rafic , Cherfan Georges
Published: February 2014

PURPOSE:

To describe a new technique for suturing of the intracorneal ring segments to stabilize it in the proper location and to prevent recurrent displacement of the ring.

METHODS:

Two patients with recurrent ring segment migration toward the incision were treated with this new surgical technique between 2010 and 2013. The first case had Intacs ring (Addition Technology, Fremont, CA) and migration occurred 2 months after implantation. The second case had Keraring segment (Mediphacos, Belo Horizonte, Brazil) and migration occurred 1 week postoperatively. The ring segments were fixated to the cornea with a 10-0 nylon suture through the channel. The suture was removed at 1 month postoperatively.

RESULTS:

Ring segments remained in the desired location with a follow-up period of at least 6 months after implantation.

CONCLUSIONS:

This newly described ring suturing technique is an effective procedure that can be used to treat ring segment migration in the channel.

[
J Refract Surg.
2013;29(12):855–857.]
Achromobacter xylosoxidans
Keratitis Masquerading as Recurrent Erosion After LASIK
Authors: Riaz Kamran M. , Feder Robert S. , Srivastava Arth , Rosin Jonathan , Basti Surendra
Published: February 2014

PURPOSE:

To describe the clinical stages and management of
Achromobacter xylosoxidans
keratitis with post-LASIK epithelial ingrowth in two patients.

METHODS:

Retrospective chart review.

RESULTS:

Both patients had been treated with topical antibiotics and corticosteroids for several weeks prior to presentation. Examination at presentation revealed significant areas of epithelial ingrowth without signs of acute inflammation, prompting an erroneous initial diagnosis of recurrent corneal erosion. A corneal infiltrate was eventually observed and
A. xylosoxidans
was cultured from both patients. Clinical resolution occurred with treatment consisting of topical fortified antibiotics. In one patient, the flap was lifted to obtain cultures and irrigate the stromal bed with fortified antibiotics.

CONCLUSIONS:

Post-LASIK epithelial ingrowth may have served as a risk factor for
A. xylosoxidans
infection. Classic signs of infectious keratitis were absent, delaying the diagnosis. Three clinical stages described herein may assist the clinician with diagnosis and customized management obviating the need for penetrating keratoplasty.

[
J Refract Surg.
2013;29(11):788–790.]
Refractive and Keratometric Stability in High Myopic LASIK With High-Frequency Femtosecond and Excimer Lasers
Authors: Kanellopoulos Anastasios John , Asimellis George
Published: February 2014

PURPOSE:

To evaluate safety, efficacy, ergonomy, and refractive and keratometric stability in high myopia LASIK procedures using a novel femtosecond and excimer laser surgery platform.

METHODS:

One hundred sixteen eyes in consecutive cases of high myopic LASIK (⩾ −6.00 diopters [D]) with the Alcon-WaveLight FS200 femtosecond and EX500 excimer lasers (Alcon Laboratories, Fort Worth, TX) were evaluated preoperatively and postoperatively for the following parameters: refractive error, corrected distance visual acuity, uncorrected distance visual acuity, spherical equivalent correction, keratometry (with Placido topography and Scheimpflug tomography), and refractive astigmatism. Average follow-up time was 6.2 months (range: 3 to 12 months).

RESULTS:

Postoperative average refractive error was −0.37, −0.43, and −0.25 D for the 3-, 6-, and 12-month period, compared to −7.67 ± 1.55 D preoperatively. At 3, 6, and 12 months postoperatively 94%, 96.3%, and 100% of eyes, respectively, were within 1.0 D defocus equivalent. Postoperative refractive astigmatism was −0.21, −0.21, −0.13 D for the 3-, 6-, and 12-month period compared to −1.07 ± 1.91 D preoperatively. The proportion of eyes with postoperative astigmatism within 0.25 D was 85.3%, 81.5%, and 100%, for the 3-, 6-, and 12-month visit, respectively. Keratometric stability was within 0.22 D after the 12-month visit. There was no epithelial ingrowth or diffuse lamellar keratitis in any case.

CONCLUSIONS:

Clinical outcomes with this technique and technology appear to be promising in high level uncorrected visual rehabilitation of high myopia. There was small regression potential in the sample evaluated.

[
J Refract Surg.
2013;29(12):832–837.]
Indications for and Outcomes of Tertiary Referrals in Refractive Surgery
Authors: Patryn Eliza K. , Vrijman Violette , Nieuwendaal Carla P. , van der Meulen Ivanka J.E. , Mourits Maarten P. , Lapid-Gortzak Ruth
Published: February 2014

PURPOSE:

To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery.

METHODS:

A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of any kind (ie, corneal laser surgery, conductive keratoplasty, radial keratotomy, phakic implants, refractive lens exchanges, or any combination thereof). Data analysis was performed on all demographic and clinical aspects of this cohort, including the initial complaint, type of referral, number of complaints, procedure previously performed, diagnosis at our center, type of advice given, and rate and type of surgical intervention.

RESULTS:

One hundred thirty-one eyes (69 patients) were included. Corneal refractive surgery was performed in 82% (108 eyes), and 11% (14 eyes) were seen after phakic intraocular lens (PIOL) implantation and 7% (9 eyes) after refractive lens exchange. The most common diagnoses were tear film dysfunction (30 eyes, 23%), residual refractive error (25 eyes, 19%), and cataract (20 eyes, 15%). Most patients (42 patients, 61%) were treated conservatively. In 27 patients (39%), 36 eyes (28%) were managed surgically. Severe visual loss was seen in 1 eye.

CONCLUSIONS:

No major problems were found in most second opinions after refractive surgery referral. Dry eyes, small residual refractive error, or higher-order aberrations were the most common complaints. Surgical intervention was needed in 36 eyes (28%), almost half of which were cataract extractions. Severe visual loss was seen in 1 eye with a PIOL. There was no incidence of severe visual loss in keratorefractive and refractive lens exchange procedures.

[
J Refract Surg.
2014;30(1):54–61.]
Histological Sections of Corneal Incisions in OCT-Guided Femtosecond Laser Cataract Surgery
Authors: Schultz Tim , Tischoff Iris , Ezeanosike Edak , Dick H. Burkhard
Published: February 2014

PURPOSE:

To investigate the quality and accuracy of three-dinensional spectral-domain optical coherence tomography (OCT)-guided corneal incisions with the Catalys precision femtosecond laser system (OptiMedica, Sunnyvale, CA) in living human tissue.

METHODS:

In vivo cataract and intrastromal corneal incisions were made with a femtosecond laser designed for cataract surgery with a patient scheduled for enucleation.

RESULTS:

An accurate correlation between the pre-incision spectral-domain OCT and the post-incision histology was demonstrated.

CONCLUSIONS:

The OCT-guided femtosecond laser is capable of creating accurate, precise, and histologically demonstrable incisions in preselected intrastromal locations.

[
J Refract Surg.
2013;29(12):863–864.]
LASIK Versus Photorefractive Keratectomy for High Myopic (> 3 Diopter) Astigmatism
Authors: Katz Toam , Wagenfeld Lars , Galambos Peter , Darrelmann Benedikt große , Richard Gisbert , Linke Stephan Johannes
Published: February 2014

PURPOSE:

To compare the efficacy, safety, predictability, and vector analysis indices of LASIK and photorefractive keratectomy (PRK) for correction of high cylinder of greater than 3 diopters (D) in myopic eyes.

METHODS:

The efficacy, safety, and predictability of LASIK or PRK performed in 114 consecutive randomly selected myopic eyes with an astigmatism of greater than 3 D were retrospectively analyzed at the 2- to 6-month follow-up visits. Vector analysis of the cylindrical correction was compared between the treatment groups.

RESULTS:

A total of 57 eyes receiving PRK and 57 eyes receiving LASIK of 114 refractive surgery candidates were enrolled in the study. No statistically significant difference in efficacy [efficacy index = 0.76 (±0.32) for PRK vs 0.74 (±0.19) for LASIK (
P
= .82)], safety [safety index = 1.10 (±0.26) for PRK vs 1.01 (±0.17) for LASIK (
P
= .121)], or predictability [achieved astigmatism < 1 D in 39% of PRK- and 54% of LASIK-treated eyes, and < 2 D in 88% of PRK- and 89% of LASIK-treated eyes (
P
= .218)] was demonstrated. Using Alpins vector analysis, the surgically induced astigmatism and difference vector were not significantly different between the surgery methods, whereas the correction index showed a slight and significant advantage of LASIK over PRK (1.25 for PRK and 1.06 for LASIK,
P
< .001).

CONCLUSIONS:

LASIK and PRK are comparably safe, effective, and predictable procedures for excimer laser correction of high astigmatism of greater than 3 D in myopic eyes. Predictability of the correction of the cylindrical component is lower than that of the spherical equivalent.

[
J Refract Surg.
2013;29(12):824–831.]
Impact of Fluorescein on the Antimicrobial Efficacy of Photoactivated Riboflavin in Corneal Collagen Cross-linking
Authors: Richoz Olivier , Gatzioufas Zisis , Francois Patrice , Schrenzel Jacques , Hafezi Farhad
Published: February 2014

PURPOSE:

To investigate the effect of fluorescein on the antimicrobial efficacy of photoactivated riboflavin in corneal collagen cross-linking (CXL) in vitro.

METHODS:

The ultraviolet light-A (UVA) absorption by fluorescein and riboflavin in different concentrations was analyzed with a spectrophotometer. The killing rate of
Staphylococcus aureus
strains after CXL with UV-A irradiation using different solutions containing riboflavin and/or fluorescein, was evaluated in vitro.

RESULTS:

Fluorescein absorbed UV-A to a significant extent, which augmented with increasing concentration. Moreover, addition of fluorescein to the riboflavin solution contributed to a significant reduction of the killing rate of
S. aureus
strains after 30 minutes of UV-A irradiation in vitro with a killing rate of 85%, whereas it was 47% in the presence of 2% fluorescein (
P
= .0247).

CONCLUSIONS:

The results indicate that fluorescein competes with riboflavin for the absorption of UV-A during CXL and reduces the antimicrobial effect of the procedure. The authors recommend that physicians treating infectious ulcerative keratitis by CXL should not stain the cornea with fluorescein for visualization of the corneal ulceration prior to CXL.

[
J Refract Surg.
2013:29(12):842–845.]
Comparative Outcomes of Bimanual MICS and 2.2-mm Coaxial Phacoemulsification Assisted by Femtosecond Technology
Authors: Alió Jorge L. , Soria Felipe , Abdou Ahmed A. , Peña-García Pablo , Fernández-Buenaga Roberto , Javaloy Jaime
Published: February 2014

PURPOSE:

To compare the efficacy and safety outcomes of bimanual microincision cataract surgery (MICS) versus 2.2-mm coaxial phacoemulsification assisted by Femtosecond LenSx (Alcon-LenSx Inc., Aliso Viejo, CA).

METHODS:

This prospective, randomized, observational, comparative case series comprised 50 cataractous eyes of 50 patients receiving femtosecond laser refractive lens surgery followed by a bimanual MICS technique with two 1-mm incisions (25 patients) (FemtoMICS group) and a coaxial phacoemulsification technique with a 1-mm paracentesis and a 2.2-mm principal incision (25 patients) (FemtoCoaxial group). The main outcomes measures were: ultrasound power, effective phacoemulsification time, postoperative spherical equivalent, higher-order aberrations (corneal and internal), corneal thickness, endothelial cell count, macular thickness, and complications during and after surgery. Both groups were absolutely comparable for all variables preoperatively.

RESULTS:

Mean ultrasound power was 1.8% ± 0.9% for MICS and 14.7% ± 4.9% for 2.2-mm incisions (P< .001). Effective phacoemulsification time values for MICS and 2.2-mm incisions were 1.5 ± 0.9 and 4.5 ± 2.9 sec, respectively (P= .002). Mean postoperative spherical equivalent was −0.26 for FemtoMICS and −0.33 for FemtoCoaxial (P> .05). The efficacy index at 1 month postoperatively was 160.2% for FemtoMICS and 149% for FemtoCoaxial. No significant differences were found in corneal thickness, endothelial cell count, and macular thickness. Complications included posterior capsule rupture (4%) and anterior capsule rupture with no posterior capsule tear (4%) for FemtoMICS and bridges due to incomplete capsulorhexis (4%) for FemtoCoaxial.

CONCLUSIONS:

MICS and coaxial phacoemulsification techniques assisted by the Femtosecond LenSx achieved excellent safety and efficient outcomes. The FemtoMICS technique was surgically and statistically more efficient than the FemtoCoaxial technique.

[J Refract Surg.2014;30(1):34–40.]
Agreement Between Placido Topography and Scheimpflug Tomography for Corneal Astigmatism Assessment
Authors: Delrivo Marianella , Ruiseñor Vázquez Pablo R. , Galletti Jonatán David , Garibotto Martín , Bonthoux Fernando Fuentes , Pförtner Tomás , Galletti Jeremías Gastón
Published: February 2014

PURPOSE:

To evaluate inter-device agreement between Placido topography (iTrace; Tracey Technologies, Houston, TX) and Scheimpflug tomography (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany) for measuring corneal power and cylinder and axis of astigmatism.

METHODS:

Observational case series of 54 eyes from 54 subjects with no ocular disease. Main outcome measures were corneal power, cylinder power, and axis of astigmatism and their agreement was assessed by Bland–Altman analysis.

RESULTS:

For corneal power and corneal cylinder, 95% limits of agreement (LoA) were considered good (−0.38 to 0.45 diopters [D] and −0.49 to 0.27 D, respectively). In contrast, the 95% LoA for corneal astigmatism axis exceeded the clinically relevant margins (−14.8 to 13.5): 28 eyes (52%) had a greater than 5° difference, 10 eyes (19%) had a greater than 10° difference, and 4 eyes (7%) had a greater than 20° difference between instruments. This absolute difference was significantly correlated with average corneal cylinder (Spearman’s
r
= −0.379,
P
= .005) but not with average corneal power. In eyes with corneal astigmatism 2 D or greater, the 95% LoA for axis were −8.7° to 6.7°, whereas in those with corneal astigmatism less than 1 D, the 95% LoA for axis were −19.1° to 16.6°.

CONCLUSIONS:

Placido topography and Scheimpflug tomography show good agreement for corneal power and cylinder, but not for corneal astigmatism axis. These instruments could be used interchangeably only in eyes with corneal astigmatism of 2 D or greater.

[
J Refract Surg.
2014;30(1):49–53.]
Optimizing Precision in Toric Lens Selection by Combining Keratometry Techniques
Authors: Browne Andrew W. , Osher Robert H.
Published: February 2014

PURPOSE:

To increase precision in toric intraocular lens selection by reducing the frequency of outliers that arise from technology-dependent variability during the preoperative assessment for routine cataract surgery.

METHODS:

Mean preoperative values for absolute sphere, amount of astigmatism, and steepest cylindrical axis were obtained for 87 eyes (54 patients) each with a manual keratometer and four automated keratometers. The mean sphere, amount of astigmatism, and steepest cylindrical axis across five technologies for each eye were defined as the
meld
sphere,
meld
astigmatism, and
meld
axis, respectively. Each technology was evaluated against the
meld
by Bland–Altman analysis, Student’s paired
t
test, and correlation coefficients. Further comparison between individual technologies and the
meld
quantified the number of outlier measurements each technology produced.

RESULTS:

The number of outliers between individual keratometers and the
meld
differed with specific measurement of sphere, axis, or amount of astigmatism. Although statistical analysis using Bland–Altman plots, correlation coefficients, and paired
t
tests suggested insignificant difference from
meld
measurements for each parameter, precision-guided analysis presented more clinically significant outliers. The number of outliers can be reduced for sphere (range: 2%–46% to 1%–6%), astigmatism (range: 6%–23% to 0%–2%), and axis outliers (range: 15%–27% to 3%–6%) by averaging measurements from automated and manual keratometers.

CONCLUSIONS:

Although multiple keratometry technologies produced similar, average measurements, the authors found a disturbing number of outliers that may be overlooked when employing a single technology. Measurement errors can be dramatically reduced by averaging measurements from manual keratometry with any automated technology to make toric lens selection more precise.

[
J Refract Surg.
2014;30(1):67–72.]
Participation Changes in Sexual Functioning after Mild Stroke
Authors: Seymour Lisa M. , Wolf Timothy J.
Published: February 2014

The purpose of this study was to explore the extent to which people with mild stroke experience changes in participation in sexual activity post stroke. A cross-sectional study was completed with adults 6 to 18 months post mild stroke ( N = 13); a brief case study was also done with one of the participants. Participants completed an assessment battery over the telephone that included the modified Quality of Sexual Function scale, the Stroke Impact Scale (SIS), and the Patient Health Questionnaire-9. The sample reported mild problems with sexual dysfunction (mean = 10.77, SD = 4.09). Sexual dysfunction post stroke was highly correlated ( r = −0.372 to −0.875) with all of the domains on the SIS. Several participants in this study reported that they would have liked more information about sexual functioning post stroke. These findings suggest that individuals with mild stroke are experiencing decreased participation in sexual activities post stroke and would like more information from the health care community on the potential for sexual changes.
The Complexity of Older Adults’ Social Support Networks
Authors: Chaichanawirote Uraiwan , Higgins Patricia A.
Published: February 2014

The purpose of this study was to provide a detailed snapshot of the diversity of social support networks of 95 independent-living older adults (mean age = 76). Participants in the convenience sample were recruited from senior centers and a retirement community. Using the Arizona Social Support Interview Schedule and egocentric network analysis, participants’ networks are described in terms of patterns, density, size of positive networks (available and utilized), size of negative networks (available and utilized), support need, and support satisfaction. Each participant and the identified members of his or her network were considered a complex adaptive system. Network boundary was 7 members; average network size was 6.22 members (SD= 1.50); network density was moderate (mean = 0.53,SD= 0.33); positive interaction networks were larger than negative networks; and overall, participants reported moderate support need (mean = 2.5,SD= 0.7) and high support satisfaction (mean = 5.9,SD= 1.0).

[Res Gerontol Nurs. 2013; 6(4):275–282.]
Potential Prescription Drug Misuse in Assisted Living
Authors: Castle Nicholas G. , Handler Steven M. , Wagner Laura M.
Published: February 2014

Prescription drug misuse among older adults includes inappropriate and harmful use of these drugs. In this study, prescription drug misuse in assisted living settings as reported by direct care workers (DCWs) was examined. Data came from DCWs in 45 assisted living settings located in Pennsylvania. A total of 944 DCWs completed a questionnaire on their opinions of prescription drug misuse. DCWs believed most assisted living residents take prescription medications. In addition, 10% of DCWs observed or had evidence that residents used unnecessarily high doses, 30% were preoccupied with the cost of prescription drugs, and 26% had problems understanding the complexity of their drug treatment regimen. Prescription drug misuse may be a problem of importance in assisted living settings. Assisted living has experienced rapid growth in capacity, yet the ability of these settings and their residents to manage prescription drugs may not have kept pace with this growth.

[Res Gerontol Nurs. 2014;7(1):25–32.]
Key Neuropsychiatric Symptoms in Common Dementias: Prevalence and Implications for Caregivers, Clinicians, and Health Systems
Authors: Sadak Tatiana I. , Katon Jodie , Beck Cornelia , Cochrane Barbara B. , Borson Soo
Published: February 2014

The purpose of this study was to compare neuropsychiatric symptoms (NPS) among people with common dementias and equip interdisciplinary clinicians and health services planners with large-sample data necessary to plan care for patients and families. We analyzed selected variables from baseline assessments of older adults with dementia of one or more etiologies (
N
= 3,768) from the National Alzheimer’s Coordinating Center data repository. Dementias included Alzheimer’s disease (AD), Lewy body dementia (DLB), behavioral variant frontotemporal dementia (bvFTD), and vascular dementia (VaD). We compared the prevalence of four NPS clusters (agitation/aggression, depression/dysphoria, anxiety, irritability/lability) across dementia etiologies and stages using logistic regression and AD as the reference group. NPS profiles differed significantly across dementia types and stages. Compared with primary AD, DLB was associated with greater odds of depression/dysphoria (OR = 1.68, 95% confidence interval [CI] 1.28, 2.20) and anxiety (OR = 1.80, 95% CI 1.37, 2.36), with similar findings when DLB was diagnosed in combination with AD (depression/dysphoria: OR = 1.79, 95% CI 1.11, 2.89; anxiety: OR = 1.88, 95% CI 1.17, 3.02). Primary bvFTD was associated with greater odds of agitation/aggression (OR = 1.59, 95% CI 1.17, 2.18). The prevalence of anxiety and irritability/lability was highest in moderate stages of dementia, and agitation/aggression was most prevalent in severe dementia. Differential diagnosis and staging of dementias and inclusion of single and overlapping etiologies is important for planning and implementing appropriate strategies to anticipate, report, and intervene with key NPS that complicate home and health care.

[Res Gerontol Nurs. 2014;7(1):44–52.]
Predictors of Diminished Levels of Social Integration in Older Adults
Authors: Nicholson Nicholas R. , Dixon Jane K. , McCorkle Ruth
Published: February 2014

The purpose of this secondary analysis of prospective longitudinal data was to determine the variables predictive of diminished social integration in older adults over time. Using generalized estimating equations to model diminished levels of social integration over the 12-year study period, the following variables were predictive of diminished levels of social integration over time: bad overall health (odds ratio [OR] = 2.31, 95% confidence interval [CI] 1.39, 3.83), depressive symptoms (OR = 1.36, 95% CI 1.13, 1.65), positive smoking status (OR = 1.40, 95% CI 1.15, 1.71), and decreased religious engagement (OR = 1.81, 95% CI 1.04, 2.19). A better understanding of predictive factors could positively impact resource allocation, prioritization, and case management for older adults.

[Res Gerontol Nurs. 2014;7(1):33–43.]
Cascade Iatrogenesis: A Case-Control Study to Detect Postoperative Respiratory Failure in Hospitalized Older Adults
Authors: Thornlow Deirdre K. , Oddone Eugene , Anderson Ruth
Published: February 2014

During hospitalization, older adults are at high risk for cascade iatrogenesis, the serial development of complications. In this retrospective, descriptive, case-control pilot study, 28 patients (cases) who developed respiratory failure after an elective surgical procedure were compared to 28 matched controls who did not develop postoperative respiratory failure. The type, frequency, and timing of events that preceded the development of postoperative respiratory failure in hospitalized older adults (age 65 and older) and the presence and timing of similar events for matched controls during a postoperative period of the same length were recorded. Cases experienced certain trigger events, including atelectasis and fluid overload, at significantly higher rates than controls. Cases and controls experienced similar rates of oversedation and delirium, yet controls were less likely to aspirate following these episodes. Patients who developed postoperative respiratory failure were less likely to ambulate early and experienced more calls to rapid response or code teams, more transfers to higher levels of care, longer lengths of stay, and more deaths than matched controls.

[Res Gerontol Nurs. 2014; 7(2):66–77.]
The Effect of Programs to Improve Oral Hygiene Outcomes for Older Residents in Long-Term Care: A Systematic Review
Authors: Coker Esther , Ploeg Jenny , Kaasalainen Sharon
Published: February 2014

Nurses have a critical role in promoting oral health in dependent older adults residing in long-term care or having extended hospital stays. Strategies aimed at improving the quality of oral hygiene care nurses provide may contribute to better oral hygiene outcomes. The purpose of this systematic review was to examine the effect of intervention programs designed to enhance the ability of nurses or those to whom they delegate care to improve oral hygiene outcomes in frail older adults. Studies reported an educational program, either alone or augmented in some way. The study interventions consisted of: (a) single in-service education sessions; (b) single in-service education sessions supplemented by a “train-the-trainer” approach; and (c) education sessions supplemented with ongoing active involvement of a dental hygienist. None of the approaches emerged as being desirable over the others, as methodologically strong studies with good intervention integrity were lacking, and a variety of oral health outcomes were used to measure effectiveness of the interventions, making comparisons across studies difficult.

[Res Gerontol Nurs. 2014; 7(2):87–100.]
Potentially Inappropriate Medications in Community-Dwelling Older Adults
Authors: Shade Marcia Y. , Berger Ann M. , Chaperon Claudia
Published: February 2014

Potentially inappropriate medication (PIM) use is a significant worldwide public health problem. Community-dwelling older adults are susceptible to the negative outcomes associated with the use of PIMs. A database search (January 1991–June 2013) produced 19 prospective correlational and 10 intervention studies. The current state of the science reveals that conceptual clarity is lacking regarding the use of PIMs. The prevalence of PIM use is well documented in an abundance of descriptive studies. However, researchers have not examined an intervention’s effects on health outcomes in community-dwelling older adults. Although independent older adults can acquire PIMs outside of a provider, current interventions aim to change the behavior of the prescribing physician and pharmacist. Nurses need to collaborate with other disciplines in PIM use research. Priority needs are to design interventions that reduce the use of PIMs and negative health outcomes.

[Res Gerontol Nurs. 2014; 7(4):178–192.]
Comparison of Fundus Autofluorescence Between Fundus Camera and Confocal Scanning Laser Ophthalmoscope–based Systems
Authors: Park Sung Pyo , Siringo Frank S. , Pensec Noelle , Hong In Hwan , Sparrow Janet , Barile Gaetano , Tsang Stephen H. , Chang Stanley
Published: February 2014

BACKGROUND AND OBJECTIVE:

To compare fundus autofluorescence (FAF) imaging via fundus camera (FC) and confocal scanning laser ophthalmoscope (cSLO).

PATIENTS AND METHODS:

FAF images were obtained with a digital FC (530 to 580 nm excitation) and a cSLO (488 nm excitation). Two authors evaluated correlation of autofluorescence pattern, atrophic lesion size, and image quality between the two devices.

RESULTS:

In 120 eyes, the autofluorescence pattern correlated in 86% of lesions. By lesion subtype, correlation rates were 100% in hemorrhage, 97% in geographic atrophy, 82% in flecks, 75% in drusen, 70% in exudates, 67% in pigment epithelial detachment, 50% in fibrous scars, and 33% in macular hole. The mean lesion size in geographic atrophy was 4.57 ± 2.3 mm
2
via cSLO and 3.81 ± 1.94 mm
2
via FC (
P
< .0001). Image quality favored cSLO in 71 eyes.

CONCLUSION:

FAF images were highly correlated between the FC and cSLO. Differences between the two devices revealed contrasts. Multiple image capture and confocal optics yielded higher image contrast with the cSLO, although acquisition and exposure time was longer.

[
Ophthalmic Surg Lasers Imaging Retina.
2013;44:536–543.]
Assessment of Novel Guarded Needle to Increase Patient Comfort and Decrease Injection Time During Intravitreal Injection
Authors: Eaton Alexander M. , Gordon Gabriel M. , Wafapoor Hussein , Sgarlata Adam , Avery Robert L.
Published: February 2014

BACKGROUND AND OBJECTIVE:

To determine whether a novel guarded 33-gauge injection device can make the intravitreal injection procedure faster and more comfortable for patients.

PATIENTS AND METHODS:

Single-center, prospective, randomized interventional study. Seventy participants receiving bilateral injections on the same day had one eye injected with the 33-gauge injection device without a speculum and the other eye injected with a standard 30-gauge needle using a speculum. Length of time needed for the injection procedure was assessed, and subjects were asked to complete a questionnaire regarding their comfort level with each device during the injection procedure as well as immediately after, later that evening, and the next day.

RESULTS:

Intravitreal injections using the 33-gauge injection device were significantly faster, but there was no significant difference in the incidence or levels of pain between the two needle types.

CONCLUSION:

The 33-gauge injection device may offer advantages over a standard 30-gauge needle when performing an intravitreal injection.

[
Ophthalmic Surg Lasers Imaging Retina.
2013;44:561–568.]
Fundus Autofluorescence and Photoreceptor Bleaching in Multiple Evanescent White Dot Syndrome
Authors: Joseph Anthony , Rahimy Ehsan , Freund K. Bailey , Sorenson John A. , Sarraf David
Published: February 2014

The authors present three cases of multiple evanescent white dot syndrome (MEWDS) with characteristic fundus autofluorescence (FAF) findings, including one patient without any visible white dots on funduscopic examination and another with many more hyperautofluorescent lesions than seen ophthalmoscopically. Additionally, the findings support an alternative mechanism for the hyperautofluorescent lesions in MEWDS, whereby photoreceptor loss causes unmasking of normal underlying retinal pigment epithelium autofluorescence. This hypothesis is demonstrated in two cases by optical coherence tomography showing clear ellipsoid zone attenuation with registration to hyperautofluorescent lesions. It is further supported in two cases by photoreceptor bleaching in successive FAF images captured in the same session leading to diminished autofluorescence intensity of the characteristic dots.

[
Ophthalmic Surg Lasers Imaging Retina.
2013;44:588–592.]
Optical Coherence Tomography Findings in Ocular Argyrosis
Authors: Rahimy Ehsan , Beardsley Robert , Ferrucci Steven , Ilsen Pauline , Sarraf David
Published: February 2014

A 68-year-old Caucasian man with a remote history of daily colloidal silver ingestion presented for ophthalmic examination in which he was noted to have a distinct slate gray skin discoloration. Funduscopy revealed confluent perimacular drusenoid deposits bilaterally, most of which localized at the level of or anterior to the inner segment ellipsoid band by optical coherence tomography (OCT) imaging. Enhanced depth imaging OCT demonstrated marked choroidal thinning. Fluorescein angiogram displayed a dark or silent choroid. Confirmatory serum silver levels were found to be markedly elevated. This report describes a unique geographic maculopathy with large drusenoid deposits anterior to the ellipsoid layer and severe choroidal thinning in association with ocular argyrosis.

[
Ophthalmic Surg Lasers Imaging Retina.
2013;44:E20–E22.]