bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREOPERATIVE DOMED MACULAR CONTOUR CORRELATES WITH POSTOPERATIVE VISUAL GAIN AFTER VITRECTOMY FOR SYMPTOMATIC EPIRETINAL MEMBRANE
Authors: Zeyer John C. , Parker Paul , Dajani Omar , MacCumber Mathew W. 
Published: June 2020

Purpose:
Evaluate macular features on preoperative ocular coherence tomography as indicators of postoperative visual gain following vitrectomy for epiretinal membrane (ERM).

Methods:
A retrospective chart review of 66 eyes that underwent vitrectomy with membrane and internal limiting membrane peeling for symptomatic ERM. Inclusion criteria required a pre-op visual acuity of at least 20/200 and minimum follow-up of 1 year. In addition, 31 of these eyes with complete 5-line raster pre-op ocular coherence tomography had segmentation analysis which included noncentral ERM to inner nuclear layer and ERM to outer plexiform layer measurements.

Results:
Eyes with “domed” pre-op macular contour had a mean preoperative acuity of 20/70 and gained a mean 2.4 lines at one year, compared with those with “flat” or “depressed” macular contour, having a 20/60 mean preoperative acuity and 0.6 lines gained (P = 0.02). Changes for other ocular coherence tomography features examined were not statistically significant. Paracentral ERM to inner nuclear layer measurements had moderate correlation, whereas paracentral ERM to outer plexiform layer measurements had weak correlation with gain in visual acuity.

Conclusion:
An inner macular-domed contour in eyes with ERM predicted better visual gain after vitrectomy with ERM and internal limiting membrane peeling compared with a flat or depressed contour.
VASCULAR COMPLEXITY ANALYSIS IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF DIABETIC RETINOPATHY
Authors: Alam Minhaj , Le David , Lim Jennifer I. , Yao Xincheng 
Published: June 2020

Purpose:
This study aimed to verify the feasibility of using vascular complexity features for objective differentiation of controls and nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) patients.

Methods:
This was a cross-sectional study conducted in a tertiary, subspecialty, academic practice. The cohort included 20 control subjects, 60 NPDR patients, and 56 PDR patients. Three vascular complexity features, including the vessel complexity index, fractal dimension, and blood vessel tortuosity, were derived from each optical coherence tomography angiography image. A shifting-window measurement was further implemented to identify local feature distortions due to localized neovascularization and mesh structures in PDR.

Results:
With mean value analysis of the whole-image, only the vessel complexity index and blood vessel tortuosity were able to classify NPDR versus PDR patients. Comparative shifting-window measurement revealed increased sensitivity of complexity feature analysis, particularly for NPDR versus PDR classification. A multivariate regression model indicated that the combination of all three vascular complexity features with shifting-window measurement provided the best classification accuracy for controls versus NPDR versus PDR.

Conclusion:
Vessel complexity index and blood vessel tortuosity were the most sensitive in differentiating NPDR and PDR patients. A shifting-window measurement increased the sensitivity significantly for objective optical coherence tomography angiography classification of diabetic retinopathy.
APPLICATION OF MODIFIED NEI VFQ-25 AFTER RETINAL DETACHMENT TO VISION-RELATED QUALITY OF LIFE
Authors: Potic Jelena , Bergin Ciara , Giacuzzo Clarice , Konstantinidis Lazaros , Daruich Alejandra , Wolfensberger Thomas J. 
Published: June 2020

Purpose:
We examined the postoperative visual recovery and quality of life after retinal detachment (RD) surgery.

Methods:
In addition to a baseline clinical examination, patients filled out the National Eye Institute Visual Functioning Questionnaire at three time points: preoperatively and 1 and 3 months postoperatively (M1 and M3, respectively). We analyzed the composite score and short-form scores (socioemotional scale [SFSES] and visual functioning scale [SFVFS]).

Results:
One hundred ninety-four patients were enrolled in this study; 47 (26 macula-ON RD and 21 macula-OFF RD) returned all three questionnaires. The best corrected visual acuity was Snellen equivalent 20/25, 20/25, and 20/20 at the preoperative, M1, and M3 assessment, respectively. At M3, we found a positive correlation between SFSES and best corrected visual acuity measures among macula-OFF patients (P < 0.001, R2 = 0.58). A significant correlation with the best corrected visual acuity among macula-ON patients was observed only at M3 with the SFVFS score (P < 0.001, R2 = 0.41).

Conclusion:
The quality of life differs between ON and OFF RD in regard to the composite score and especially SFSES and SFVFS. We found a transient decrease in the quality of life at M1 for macula-ON patients, whereas the quality of life improved throughout follow-up among macula-OFF patients. These data may help improve the management of patients' expectations after RD surgery.
Ocular Anterior Segment Pathology in the Emergency Department: A 5-Year Study
Authors: Tang Vincent D. , Safi Mustafa , Mahavongtrakul Angelique , Mahmood Bilawal , Ling Jennifer , Kyrillos Ralph , Li Jennifer , Mannis Mark 
Published: June 2020

Introduction:
Patients with ocular complaints frequently present to emergency departments (EDs) for care. Emergency department practitioners are often the first to evaluate these patients and determine the next steps in their care, which can be a challenging task. The purpose of this study is to determine the frequency of anterior segment pathology in the setting of the ED in hopes that this information will be useful in creating more effective management algorithms.

Methods:
A retrospective study based on electronic patient charts from the University of California Davis ED that included ophthalmology consults. We reviewed the charts for demographic data, as well as visual acuity (VA), intraocular pressure (IOP), and diagnosis as determined by ED and ophthalmology personnel, respectively.

Results:
The most common anterior segment diagnoses were uveitis, corneal abrasion, corneal ulcer, meibomian gland dysfunction/dry eyes/blepharitis/punctate epithelial erosions, and conjunctivitis/epidemic keratoconjunctivitis. Emergency Department personnel measured the VA and IOP in 40.8% and 16.7% of patients, respectively. The ophthalmologist measured the VA and IOP in 78.4% and 95.1% of patients, respectively. The percentage agreement in VA measurement between ophthalmology and ED was 11.8%. The percentage agreement in IOP measurement between ophthalmology and ED was 0.86%. The percentage agreement in diagnosis between ophthalmology and ED was 49.4%.

Conclusions:
Most ocular conditions that present in the ED are nonurgent and can be treated in an outpatient setting. However, ED personnel are often unable to obtain the proper “ocular vital signs” (the VA and IOP) and diagnoses. Our findings suggest a need for clear interprofessional discussion in creating an algorithm for triage and the management of eye conditions in the ED to deliver effective care.
Visual outcomes after toric intraocular lens implantation in pediatric eyes undergoing cataract surgery
Authors: Vasavada Vaishali , Shastri Lajja , Vasavada Abhay R. , Patel Priyanka , Agarwal Deepa , Vasavada Shail A. , Vasavada Viraj A. , Praveen Mamidipudi , Srivastava Samaresh 
Published: June 2020

Purpose:
To evaluate long-term visual outcomes and complications after toric intraocular lens (IOL) implantation in children with preexisting corneal astigmatism undergoing cataract surgery.

Setting:
Iladevi Cataract & IOL Research Center, Ahmedabad, India.

Design:
Prospective, interventional case series.

Methods:
Children with regular corneal astigmatism of at least 1.5 diopters (D) were included. A standardized surgical technique with in-the-bag implantation of a toric IOL was performed. All children were followed up on postoperative day 1 and periodically thereafter, until 36 months postoperatively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and residual refractive astigmatism were documented 36 months postoperatively. Rotational stability of toric IOL was also evaluated through the follow-up duration. Complications, particularly visual axis obscuration (VAO) and glaucoma, were documented.

Results:
In total, 76 eyes (51 children) were included in the study. Mean age at surgery was 7.41 ± 2.82 years (SD) and mean preoperative keratometric astigmatism was 1.56 ± 2.13 D. The CDVA (logarithm of the minimum angle of resolution [logMAR]) improved significantly from 0.59 ± 0.43 preoperatively to 0.23 ± 0.27 36 months postoperatively (P = .03). Mean postoperative UDVA was 0.32 ± 0.26 logMAR. Mean refractive astigmatism at final follow-up was −0.55 ± 0.40 D, with 74% patients having a UDVA of at least 20/40; 5% of eyes needed VAO treatment and none developed glaucoma. No eye required repositioning of toric IOL until final follow-up.

Conclusions:
Toric IOL implantation reduced postoperative refractive astigmatism and gave excellent UDVA at 36 months follow-up in pediatric eyes undergoing nontraumatic cataract surgery.
The efficacy of mindfulness-based interventions in acute pain: a systematic review and meta-analysis
Authors: Shires Alice , Sharpe Louise , Davies Jonathan N. , Newton-John Toby R.O. 
Published: June 2020

Abstract
Recent meta-analyses have shown mindfulness-based interventions (MBIs) to be effective for chronic pain, but no pooled estimates of the effect of MBIs on acute pain are available. This meta-analysis was conducted to fill that gap. A literature search was conducted in 4 databases. Articles were eligible if they reported on randomized controlled trials of MBIs for people with acute pain and one of the following outcomes: pain severity, pain threshold, pain tolerance, or pain-related distress. Two authors independently extracted the data, assessed risk of bias, and provided GRADE ratings. Twenty-two studies were included. There was no evidence of an effect of MBIs on the primary outcome of pain severity in clinical {Hedges' g = 0.52; (95% confidence interval [CI] −0.241 to 1.280)} or experimental settings (Hedges' g = 0.04; 95% CI [−0.161 to 0.247]). There was a beneficial effect of MBIs on pain tolerance (Hedges' g = 0.68; 95% CI [0.157-1.282]) and pain threshold (Hedges' g = 0.72; 95% CI [0.210-1.154]) in experimental studies. There was no evidence of an effect of MBIs compared to control for pain-related distress in clinical (Hedges' g = 0.16; 95% CI [−0.018 to 0.419]) or experimental settings (Hedges' g = 0.44; 95% CI [−0.164 to 0.419]). GRADE assessment indicated that except for pain tolerance, the data were of low or very low quality. There is moderate evidence that MBIs are efficacious in increasing pain tolerance and weak evidence for pain threshold. However, there is an absence of good-quality evidence for the efficacy of MBIs for reducing the pain severity or pain-related distress in either clinical or experimental settings.
The Impact of Adherence to Clinical Practice Guidelines on Medical Costs
Authors: Castillo Renan C. , Heins Sara , Feldman Dorianne , DuGoff Eva H. , Roberts Eric , Staguhn Elena D. , Wegener Stephen , Anderson Gerard , Trujillo Antonio 
Published: June 2020

Objective:To examine the association between non-adherence to clinical practice guidelines (CPGs) and medical and indemnity spending among back and shoulder injury patients.Methods:Workers compensation claims data was used from a large, US insurer (1999 to 2010). Least square regression models were created to examine the association between spending and guideline-discordant care.Results:Non-adherence to CPGs was associated with higher medical and indemnity spending for 11 of the 28 CPG indicators. Failure to adhere to the other CPGs did not increase medical or total spending. After covariate adjustment, non-adherence to these 11 CPGs was associated with spending increases that ranged from $16,000 for physical therapy (PT) to $114,000 for surgery.Conclusions:Our results demonstrate that failure to adhere to a subset of CPG indicators significantly predicts increased medical and indemnity spending for two important occupational injuries.
Role of 18F-FDG PET/CT in restaging of esophageal cancer after curative-intent surgical resection
Authors: Pande Shantanu S. , Purandare Nilendu , Puranik Ameya , Shah Sneha , Agrawal Archi , C.S. Pramesh , Prabhash Kumar , Agarwal Jai Prakash , Rangarajan Venkatesh 
Published: June 2020

Objective
The aim of the study was to evaluate diagnostic performance of FDG PET-CT in suspected recurrence of carcinoma esophagus after curative-intent surgical resection and impact of FDG PET-CT on intended management.

Material and methods
This was retrospective study of patients with clinical or radiological suspicion of recurrent esophageal carcinoma who were referred for PET-CT from January 2006 to December 2017. Diagnostic performance of PET-CT was evaluated for disease recurrence and its impact on management decisions. PET-CT findings were confirmed with tissue diagnosis. When tissue diagnosis was not available clinical and radiological follow-up was used as reference standard.

Results
Relevant clinical data were available in 68 patients which were considered for analysis. In 91% (62/68) patients FDG PET-CT findings were suggestive of disease recurrence. Histopathological confirmation was available in 43 patients, whereas in remaining patients recurrence was confirmed by radiological and clinical follow-up. Forty percent (28/68) patients were detected with distant metastases. Sensitivity, specificity, positive and negative predictive values of FDG PET-CT was found to be 98.4, 80, 98 and 80% with accuracy of 97%. Change in management was observed in 41% (28/68) of patients from salvage radiotherapy/surgery to palliative chemotherapy/best supportive care based on evidence of distant metastases seen on FDG PET-CT.

Conclusion
FDG PET-CT is highly sensitive in detection of recurrent disease in esophageal cancer patients after surgical resection. It can detect distant metastases in high proportion of patients thus changing the intent of management from radical salvage to palliative chemotherapy/best supportive care.
Optimization of the radiosynthesis of [68Ga]Ga-PSMA-11 using a Trasis MiniAiO synthesizer: do we need to heat and purify?
Authors: Reverchon Jérémy , Khayi Fouzi , Roger Marianne , Moreau Aurélie , Kryza David 
Published: June 2020

Introdution:
[68Ga]Ga-prostate specific membrane antigen (PSMA)-11 showed a clear gain in sensitivity for lesion detection in the biological recurrence of prostate cancer as compared to the standard [18F]fluorocholine radiopharmaceutical. To meet the strong demand for [68Ga]Ga-PSMA-11, we aimed to optimize an automated radiolabeling process by evaluating the influence of different key parameters on radiochemical purity and radiochemical yield.

Methods:
The radiosynthesis of [68Ga]Ga PSMA-11 was performed using a Trasis MiniAio synthesizer and a 68Ge/68Ga GalliaPharm generator supplied by Eckert & Ziegler, Berlin, Germany. Optimized labeling parameters were evaluated by variation of sodium acetate concentrations and temperature of radiolabeling as well as the purification process.

Results:
For each condition tested, radiochemical purity was higher than 99% in the final vial without batch failure, indicating a robust and fast radiosynthesis process. Radiosynthesis without the solid phase extraction purification process at room temperature in less than 5 min resulted in a radiolabeling efficiency of over 99% and remained stable at least 4 h without manual processing to limit operator radiation exposure.

Conclusion:
The procedure was completely automated and provided a high radiochemical yield. It can be performed several times a day, facilitating the clinical demand of this radiopharmaceutical.
A Challenge for Hemophilia Treatment: Hemophilia and Cancer
Authors: Koc Basak , Zulfikar Bulent 
Published: June 2020

Background:
The risk of developing cancer increases with age and also adverse environmental conditions. The same holds true in the aging people with hemophilia (PwH). Furthermore, cancer is an important challenge for physicians working in multidisciplinary hemophilia care centers.

Aim:
Here, the authors report 7 hemophiliacs with malignancies diagnosed and managed at our center.

Study Design:
Hemophilia A and B were included.

Method:
Patients with mild, moderate, or severe hemophilia A or B, who were followed-up in our center between January 1999 and December 2018 were included in the study. A total of 470 PwH (391 Hemophilia A and 79 Hemophilia B) were followed in this time period.

Results:
With a minimum 1 and maximum 20 years (median: 11.5 y) of the following time, 7 of 470 (1.48%) PwH were diagnosed with cancer. The diagnosed cancer types were acute lymphoblastic leukemia, acute myeloid leukemia, thyroid cancer, rectum cancer, malign melanoma, basal cell carcinoma, and gastric cancer. All patients except patients with leukemia had major surgical intervention and the hemostasis control was provided on the basis of institutional protocols. At the end of the study, all of the patients were alive besides the patient with acute myeloid leukemia.

Conclusions:
Nowadays, the management of PwH has improved immensely and the life span has progressively become similar to healthy male individuals. For accurate improvement and standardizing care, prospective data collection on the epidemiology of cancer in PwH is an important tool.
Reducing Delirium in Hospitalized Adults Through a Structured Sleep Promotion Program
Authors: Gode Autumn , Kozub Elizabeth , Joerger Kyla , Lynch Cassandra , Roche Maren , Kirven Justin 
Published: June 2020

Background:
Delirium affects approximately 1 in 4 patients during their hospitalization and is associated with numerous complications. Sleep deprivation is a significant risk factor for developing delirium and is a patient dissatisfier.

Problem:
An internal assessment revealed that up to 25% of all patients on medical-surgical units had a diagnosis of delirium while in the hospital.

Approach:
An evidence-based practice project was implemented to reduce the development of delirium through sleep promotion on 2 inpatient units. A dedicated time was selected, and key strategies were identified to promote sleep with minimal interruptions.

Outcomes:
Delirium decreased by 33% and 45% on the 2 units over 1 year. Overall, patient satisfaction for quietness at night survey responses also increased (P = .0005; CI, 0.05 to 0.67) with ongoing sustainment.

Conclusions:
Implementation of a dedicated period to sleep was associated with a reduction in delirium and increased patient satisfaction for quietness at night.
Patterns of Growth and Nutrition From Birth to 6 Months in Infants With Complex Congenital Cardiac Defects
Authors: Steward Deborah K. , Ryan-Wenger Nancy , Harrison Tondi M. , Pridham Karen F. 
Published: June 2020

Background
Infants with complex congenital heart defects (CCHDs) experience alterations in growth that develop following surgical intervention and persist throughout early infancy, but the roles of nutritional intake and method of feeding require further exploration as their roles are not fully explained.

Objectives
The purpose of this study was to characterize trends in growth and nutritional intake during the first 6 months of life in infants with CCHD.

Methods
We conducted a secondary analysis of growth and nutritional data from a pilot study designed to test the feasibility of nurse-guided participatory intervention with parents of infants with CCHD. Measures included demographic data, anthropometric data at birth, hospital discharge, and 6 months of age, nutritional intake at 2 and 6 months of age from parent-completed 24-hour nutrition diaries, and assessment of oral–motor skills between 1 and 2 months of age. Descriptive statistics and correlation and group differences were examined.

Results
Data for 28 infants were analyzed. Infants demonstrated a decrease in weight-for-age z score (WAZ) and length-for-age z score (LAZ) from birth to hospital discharge and an increase in WAZ and LAZ by 6 months of age. Many of the infants developed failure to thrive. Across the study period, one third of the infants were receiving enteral nutrition. Infants who were orally fed had better growth WAZ and LAZ at 6 months of age when compared to infants who were enterally fed.

Discussion
Infants with CCHD exhibit growth faltering throughout early infancy. Reliance on enteral nutrition did not improve growth outcomes in these infants. Findings suggest nutritional intake may not be enough to meet the nutrient requirements to stimulate catch-up growth.
Preconception Evaluation Before In Vitro Fertilization
Authors: Howell Elizabeth P. , Harris Benjamin S. , Kuller Jeffrey A. , Acharya Kelly S. 
Published: June 2020

Importance
Infertility poses a substantial public health problem for women of reproductive age, in the United States and globally. Infertility can be overcome with a variety of emerging assisted reproductive technologies (ARTs). In vitro fertilization (IVF) currently represents the most commonly utilized method of ART and is typically associated with the highest clinical pregnancy rate and live birth rate compared with other infertility treatment options. However, proper preconception evaluation and counseling is paramount for optimizing IVF and pregnancy outcomes.

Objective
This article aims to outline current guidelines and recommendations for comprehensive preconception evaluation before initiation of IVF.

Evidence Acquisition
Articles were obtained from PubMed, ACOG committee opinions 781 and 762, and relevant textbook chapters.

Results
A variety of recommendations and best practices exist for optimally managing patients seeking IVF. Special attention must be paid to the workup of certain patient populations, such as those with age older than 35 years, uterine abnormalities, comorbidities (especially hypertension, diabetes, and thrombophilias), and obesity. In addition, many lifestyle factors must be addressed before IVF initiation, such as smoking, illicit drug use, and inadequate nutrition. Preconception counseling and expectation management is key to optimizing pregnancy outcome.

Conclusions and Relevance
A myriad of patient and environmental factors impact the potential success rates of IVF in treating infertility. Providers must be equipped to provide data-driven, patient-centered counseling before initiation of IVF.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completion of this CME article, readers should be better able to explain the importance of IVF in treating infertility for a variety of patient populations; describe current recommendations and best practices for preconception workup and counseling; identify important risk factors and patient-specific comorbidities that warrant additional evaluation or attention before IVF treatment; and recommend patient-centered preconception counseling for their future patients seeking IVF.
Postoperative Narcotic Use in Patients With Ovarian Cancer on an Enhanced Recovery After Surgery (ERAS) Pathway
Authors: Kay Allison H. , Venn Monica , Urban Renata , Gray Heidi J. , Goff Barbara 
Published: June 2020

(Abstracted from Gynecol Oncol 2020;156:624–628)
In light of the current opioid epidemic, the medical community is exploring potential means to reduce postoperative narcotic use. This retrospective cohort study aimed to assess the impact of a gynecologic oncology enhanced recovery after surgery (ERAS) pathway on postoperative need for narcotics in the first 3 months after an open surgery in patients with ovarian cancer.