bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUCCESSFUL CLOSURE OF A LARGE FULL-THICKNESS MACULAR HOLE SECONDARY TO AN IDIOPATHIC RETINAL VASOPROLIFERATIVE TUMOR USING THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE
Authors: Grondin Christelle , Lorenzi Umberto , Beral Laurence , Morane Sarah , Guillaumie Tremeur , David Thierry 
Published: July 2020

Purpose:
To report a case of large full thickness macular hole (MH) as an uncommon complication of an idiopathic retinal vasoproliferative tumor (RPVT) and the successful closure of the full-thickness MH by the inverted internal limiting membrane Flap technique.

Methods:
A case report. A 40-year-old woman was referred for a progressive and profound visual loss on the right eye. The fundus examination showed a full-thickness MH and the presence of an idiopathic RPVT surrounding by numerous exudates in the inferior temporal of the peripheral retina. In addition, the spectral domain optical coherence tomography imaging confirmed the large size of the full-thickness MH (740 μm-diameter). First, we treated the RPVT using the transconjunctival cryotherapy. Then, we performed the macular surgery including 25 Gauge vitrectomy, inverted internal limiting membrane flap technique, and gas tamponade.

Results:
In the postoperative period, the RPVT remained inactive with no recurrence of the MH or excessive gliosis proliferation on the internal limiting membrane flap area. Moreover, visual acuity rose up from 20/100 (0.2) at 1-month follow-up to 20/40 (0.5) at 6-month follow-up.

Conclusion:
In our patient, the full-thickness MH was precisely large and secondary to an RPVT. The treatment of the tumor by transconjunctival cryotherapy had been efficient and the postoperative follow-up after the macular procedure involving the inverted internal limiting membrane flap technique showed the anatomical and functional recovery of the macula.
Contact Lens Discomfort Management: Outcomes of Common Interventions
Authors: Arroyo-del Arroyo Cristina , Fernández Itziar , Novo-Diez Andrea , Blanco-Vázquez Marta , López-Miguel Alberto , González-García María Jesús 
Published: July 2020

Purpose:
To assess the consecutive implementation of habitual contact lens discomfort (CLD) management strategies: lid hygiene, daily disposable CL (DDCL) fitting, and artificial tear (AT) supplementation.

Methods:
Contact lens (CL) wearers with CLD symptoms (CLDEQ-8 ≥12 points) were included in the study. Subjects with Meibomian gland dysfunction (MGD) were instructed to perform lid hygiene. All participants were fitted with a DDCL (delefilcon A) and evaluated 1 month later. After, half of them were randomly assigned to use AT (Povidone-2%) at least three times/day, and all participants were evaluated 1 month later. Tests performed were: lower tear meniscus area (LTMA), bulbar, limbal, and tarsal hyperemia, noninvasive tear break-up time (NITBUT), and corneal and conjunctival staining. Weighted combined clinical scores (CS) were created to analyze signs. Changes in symptoms (CLDEQ-8) and CS were analyzed using linear mixed models.

Results:
Forty-two subjects (mean age: 23.2±4.9 years) completed the study. Two CS were created, CS 1 was composed of bulbar, limbal, and tarsal hyperemia and corneal staining, and CS 2 by NITBUT, LTMA, and conjunctival staining. CLDEQ-8 was reduced after lid hygiene (mean: −2.73±2.13; P=0.012) and DDCL use (mean: −10.1±3.54; P<0.01), but not after AT use (P=0.62). CS 1 did not change after any intervention. CS-2 was higher (P=0.04) in DGM subjects after lid hygiene, it decreased (P=0.04) after DDCL use.

Conclusions:
Lid hygiene is effective for reducing CLD symptoms in MGD patients. Refitting subjects with delefilcon A is an effective intervention for CLD to reduce symptoms and achieve a healthier ocular surface. Simultaneous administration of AT did not further improve CLD.
Zonisamide-induced Choroidal Effusion: A Case Report
Authors: Baradad Jurjo Maria C. , Sanz Moreno Sílvia , Moix Gil Eugènia , Lillo Sopena Juan , Caminal Mitjana Josep M. 
Published: July 2020

Purpose:
To describe a case of zonisamide-induced bilateral choroidal effusion.

Case Report:
A 72-year-old woman presented with a 4-day history of bilateral blurred vision 9 days after initiating oral zonisamide for essential tremor. Clinical examination revealed an asymmetric choroidal detachment with open anterior chamber angle and intraocular pressure within the normal range. Posterior segment ultrasonography and ultrasound biomicroscopy both confirmed the presence of bilateral ciliochoroidal effusion. Zonisamide treatment was discontinued. One month after treatment discontinuation, the ophthalmological examination was normal and no further treatment was needed.

Conclusion:
Zonisamide can cause an idiosyncratic reaction leading to choroidal effusion with or without acute angle closure. Early withdrawal of the causative agent is the key to reversing this condition. These findings indicate that zonisamide and other sulfa-derived drugs must be ruled out in the differential diagnosis of choroidal effusion of unknown cause.
Quantifying the educational benefit of additional cataract surgery cases in ophthalmology residency
Authors: Liebman Daniel L. , McKay Kenneth Matthew , Haviland Miriam J. , Moustafa Giannis A. , Borkar Durga S. , Kloek Carolyn E. 
Published: July 2020

Purpose:
To quantify the resident learning curve for cataract surgery using operative time as an indicator of surgical competency, to identify the case threshold at which marginal additional educational benefit became equivocal, and to characterize heterogeneity in residents' pathways to surgical competency.

Setting:
Academic medical center.

Design:
Large-scale retrospective consecutive case series.

Methods:
All cataract surgery cases performed by resident physicians as primary surgeon at Massachusetts Eye and Ear from July 1, 2010, through June 30, 2015, were reviewed. Data were abstracted from Accreditation Council for Graduate Medical Education case logs and operative time measurements. A linear mixed-methods analysis was conducted to model changes in residents' cataract surgery operative times as a function of sequential case number, with resident identity included as a random effect in the model to normalize between-resident variability.

Results:
A total of 2096 cases were analyzed. A marked progressive decrease in operative time was noted for resident cases 1 to 39 (mean change −0.17 minutes per additional case, 95% CI, −0.21 to −0.12; P < .001). A modest, steady reduction in operative time was subsequently noted for case numbers 40 to 149 (mean change −0.05 minutes per additional case, 95% CI, −0.07 to −0.04; P < .001). No statistically significant improvement was found in operative times beyond the 150th case.

Conclusions:
Residents derived educational benefit from performing a greater number of cataract procedures than current minimum requirements. However, cases far in excess of this threshold might have diminishing educational return in residency. Educational resources currently used for these cases might be more appropriately devoted to other training priorities.
Intraocular lens power calculation in the elderly population using the Kane formula in comparison with existing methods
Authors: Reitblat Olga , Gali Helena E. , Chou Linda , Bahar Irit , Weinreb Robert N. , Afshari Natalie A. , Sella Ruti 
Published: July 2020

Purpose:
To assess the accuracy of the Kane formula for intraocualr lens (IOL) power calculation in comparison with established formulas in the elderly population.

Setting:
Shiley Eye Institute, University of California San Diego, USA.

Design:
Retrospective cohort.

Methods:
Retrospective data from 90 patients (90 eyes) aged 75 years or older who underwent uneventful cataract surgery with SN60WF intraocular lens (IOL) implantation were evaluated. The first operated eyes of patients with final corrected distance visual acuity 20/40 or better and axial length 22 to 26 mm were included. Prediction errors were calculated for Barrett Universal (BU) II, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T formulas. A subgroup analysis based on age (75–84 and ≥85 years old) was performed.

Results:
Use of both BUII and Kane formulas resulted in the highest percentage of eyes with prediction errors within ±0.50 diopters (D) (72% each) and significantly higher than Hoffer Q, Holladay 1, and SRK/T (P = .001). Rates of predictability within ±0.25 D and ±1.00 D were 31% to 38% and 87% to 92%, respectively, with no significant differences between formulas. No statistically significant difference was seen between formulas in the median absolute error. These tendencies remained consistent in both age groups when analyzed separately. Subgroup analysis showed better predictability of all formulas in the younger age group.

Conclusions:
To the authors’ knowledge, this is the first study evaluating the Kane formula exclusively in the elderly population. The Kane formula was found to be of equal accuracy to the BUII and superior to the Hoffer Q, Holladay 1, and SRK/T formulas. Very elderly patients might have reduced refractive precision using all formulas.
The indocyanine green retention test as a noninvasive marker for esophageal varices in patients with hepatocellular carcinoma
Authors: Lu Hsiao-Sheng , Hsin I-Fang , Chen Ping-Hsien , Yang Tsung-Chieh , Chang Chung-Yu , Huang Yi-Hsiang , Hou Ming-Chih 
Published: July 2020

Background:
The indocyanine green 15-minute retention (ICG-r15) test was considered as a noninvasive marker of esophageal varices (EV) in cirrhotic patients. However, the performance of ICG-r15 in patients with hepatocellular carcinoma (HCC) has rarely been assessed. The aim of this study is to evaluate the value of ICG-r15 as a noninvasive marker of EV in patients with HCC.

Methods:
From October 2007 to December 2018, the study retrospectively enrolled 137 HCC patients with compensated hepatic function who received ICG-r15 tests and endoscopy screening for EV. The predictive value of the ICG-r15 test and other noninvasive markers was also evaluated for the diagnosis of EV, including the aspartate aminotransferase (AST)/alanine aminotransferase ratio, platelet count/spleen diameter ratio, AST/platelet ratio index, Lok index, FIB-4, and Park index.

Results:
In the study cohort, 30 (21.9%) patients had EV. The area under the receiver operating characteristic curve for determining EV by ICG-r15 was 0.784 (95% CI: 0.686–0.881, −2 ln (L): 77.889, Akaike information criterion: 79.889), and it had the best predictive value compared with other noninvasive markers. The cutoff value of ICG-r15 to identify EV was 31.0%, and it had 40.0% sensitivity and 98.1% specificity. The cutoff value to exclude EV was 9.5% with 86.7% sensitivity and 50.5% specificity. In the multivariate analysis, ICG-r15 (odds ratio [OR]: 1.062, 1.014–1.114; p = 0.015) and the Park index (OR: 1.535, 1.091–2.159; p = 0.014) were independently related to the presence of EV.

Conclusion:
ICG-r15 is a practical noninvasive marker with cutoff values of 9.5% for excluding EV and 31.0% for identifying EV in patients with HCC.
A Structural Equation Model of Gratitude, Self-efficacy, and Medication Adherence in Patients With Stage B Heart Failure
Authors: Cousin Lakeshia , Buck Harleah , Benitez Bryan , Mills Paul , Redwine Laura 
Published: July 2020

Background
Consistent self-care slows the progression of heart failure (HF). Gratitude, the practice of appreciating the positive aspects of life, may influence self-efficacy, which in turn is known to improve self-care. However, little is known about the relationships among gratitude, self-efficacy, and medication adherence in HF.

Objective
The aim of this study was to test a model to determine if self-efficacy mediates the relationship between gratitude and medication adherence in asymptomatic patients with HF.

Method
This is a secondary analysis of data from a prospective observational study. Data were analyzed using a structural equation model to examine associations between gratitude, cardiac-specific self-efficacy, and medication adherence in 153 patients with HF. Gratitude, self-efficacy, and medication adherence were assessed using the Gratitude Questionnaire-6, Cardiac Self-efficacy Scale–Maintain Function Subscale, and the Morisky Medication Adherence Scale, respectively.

Results
Patient mean (SD) age was 66 (11) years, and 95% of the participants were men. Patients were primarily white (79%), black (12%), or Asian (6%). Gratitude exerted an indirect effect on medication adherence through self-efficacy (b = 0.16; P < .05). Gratitude was positively related to self-efficacy (b = 0.50; P < .05), and self-efficacy was positively related to medication adherence (b = 0.31; P < .05). The model fit was acceptable (comparative fit index = 0.92, Tucker-Lewis index = 0.90, root-mean-square error of approximation = 0.08).

Conclusion
In this study, we found evidence that self-efficacy was a mechanism through which gratitude was associated with medication adherence in asymptomatic patients with HF, suggesting a way to improve self-care nonpharmacologically. Future work will examine whether gratitude intervention results in improved self-care.
Effects of an Active Music Therapy Program on Functional Fitness in Community Older Adults
Authors: CHAN Shu-Ya , CHEN Chun-Fei 
Published: July 2020

ABSTRACTBackgroundHealth problems common among older adults living in community settings include a lack of functional fitness. Many studies have confirmed that exercises and static music therapy improve physical and psychological health problems. Exercise programs involving music have a higher frequency of attendance and motivation than other exercise programs. Active participation in active group music therapy results in better therapeutic effects.PurposeThis study was designed to test the effectiveness of a 3-month active group music therapy program on the functional fitness of community older adults in Taiwan.MethodsA quasi-experimental design with repeated measures was applied. A convenience cluster sample of older adults was drawn from seven senior-citizen activity centers in southern Taiwan. All participants were assigned to either an experimental group (n= 77) or a comparison group (n= 69) based on the requests of each senior center. The experimental group participated in the active group music therapy program for 3 months (twice per week and 60 minutes per session). The comparison group maintained their daily activities. Each participant's level of functional fitness was measured at baseline and at 1 and 3 months after the start of the intervention.ResultsSeventy-one participants in the experimental group and 62 participants in the comparison group completed the 3-month study. At the 1-month measurement, the experimental group had greater improvements in cardiopulmonary fitness, upper body flexibility, lower body flexibility, upper limb muscle power, lower limb muscle endurance, and balance than the comparison group (allps < .05). These significant improvements persisted through the 3-month intervention (allps < .05).Conclusions/Implications for PracticeActive group music therapy is an effective complementary and alternative therapy for improving six items of functional fitness in community-dwelling older adults. Healthcare professionals may incorporate this active group music therapy program as a health promotion activity for older adults living in community settings.
Cone-Beam CT Image Guidance With and Without Electromagnetic Navigation Bronchoscopy for Biopsy of Peripheral Pulmonary Lesions
Authors: Verhoeven Roel L.J. , Fütterer Jurgen J. , Hoefsloot Wouter , van der Heijden Erik H.F.M. 
Published: July 2020

Background:
Bronchoscopic diagnosis of small peripheral lung lesions suspected of lung cancer remains a challenge. A successful endobronchial diagnosis comprises navigation, confirmation, and tissue acquisition. In all steps, 3-dimensional information is essential. Cone-beam computed tomography (CBCT) imaging can provide computed tomography information and 3-dimensional augmented fluoroscopy imaging. We assessed whether CBCT imaging can improve navigation and diagnosis of peripheral lesions by 2 clinical workflows with a cross-over design: (1) a primary CBCT and radial endobronchial ultrasound mini probe imaging–based approach and (2) a primary electromagnetic navigation (EMN) and radial endobronchial ultrasound mini probe imaging–based approach.

Methods:
All patients with a peripheral lung lesion biopsy indication were eligible for study inclusion and randomly assigned to study arms. Commercially available equipment was used. The main study goals were to assess CBCT-confirmed navigation success and diagnostic accuracy. Surgery or unambiguous clinical follow-up served as the gold standard.

Results:
Eighty-seven patients with 107 lesions were included. Lesion mean longest axis size in the CBCT arm was 16.6 mm (n=47) and 14.2 mm in the EMN arm (n=40). The primary CBCT approach and primary EMN approach had 76.3% and 52.2% navigation success, respectively. Addition of EMN to the CBCT approach increased navigation success to 89.9%. Addition of CBCT imaging to the EMN approach significantly increased navigation success to 87.5% per lesion. The overall diagnostic accuracy per patient was significantly lower than the navigation success, being 72.4%.

Conclusion:
CBCT imaging is a valuable addition to navigation bronchoscopy. Although overall navigation success was high, the diagnostic accuracy remains to be improved. Future research should focus on improving the tissue acquisition methodology.
Observer agreement and accuracy of 18F-sodium fluoride PET/computed tomography in the diagnosis of skull-base bone invasion and osseous metastases in newly diagnosed nasopharyngeal carcinoma
Authors: Xiao JingXing , Wang Dong , Guo Bin , Wang Lu , Su Min , Xu Hao 
Published: July 2020

Objectives
To evaluate the interobserver agreement and the diagnostic performance in 18F-sodium fluoride (18F-NaF) PET/computed tomography (CT) for the detection of skull-base bone invasion (SBBI) and osseous metastases in patients with newly diagnosed nasopharyngeal carcinoma (NPC).

Methods
One hundred seventeen patients with newly diagnosed NPC between 2017 and 2019 who underwent 18F-NaF PET/CT was in included. Two experienced observers independently evaluated the 18F-NaF PET/CT of SBBI and osseous metastases on a patient level using a two-category scale present on a dichotomous scale, respectively. On a patient level, the diagnostic performance was calculated using a sensitivity analysis.

Results
The interobserver agreement on a patient level of SBBI and osseous metastases were perfect on a patient-level (κ: 0.85), (κ: 0.808), respectively. On a lesion level of detection of osseous metastases, the observers agreed on the number as well as the location of osseous metastases in 101 (86.3%) patients. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of detection of SBBI and osseous metastases were ranged 0.911–0.962, 0.921–0.974, 0.932–0.957, 0.962–0.986, and 0.841–0.923, and ranged 0.917–0.958, 0.899–0.957, 0.906–0.949, 0.863–0.936, and 0.939–0.970, respectively.

Conclusion
The interobserver agreement of 18F-NaF PET/CT for the detection of SBBI and osseous metastases in patients with NPC were both very high among trained observers. Moreover, the diagnostic performance of NaF PET/CT was satisfactory, rendering NaF PET/CT a robust tool in the diagnostic armamentarium.
Patient Engagement in Breast Cancer Survivorship Care
Authors: Post Kathryn E. , Berry Donna L. , Shindul-Rothschild Judith , Flanagan Jane 
Published: July 2020

Background
Patient engagement (PE) is a key factor for early-stage breast cancer survivors during survivorship, yet little is known about what factors may contribute to PE.

Objectives
The aims of this study were to describe the relationship between sociodemographic factors, survivorship variables, and PE and explore how variations in these variables might contribute to PE in breast cancer survivors.

Methods
A cross-sectional, web-based self-report national survey was conducted to assess sociodemographic factors and survivorship variables: health-related quality of life (HRQOL) as measured by 7-item Functional Assessment of Cancer Therapy–General, fear of cancer recurrence, cancer health literacy, and 2 measures of PE (Patient Activation and Knowing Participation in Change) in breast cancer survivors. One open-ended question assessed additional survivorship concerns. Data were analyzed via bivariate associations and backward linear regression modeling in SPSS.

Results
The sample (N = 303), equally dispersed across the United States, was predominantly middle-aged (mean, 50.70 [SD, 14.01]), white, non-Hispanic women. Knowing Participation in Change and Patient Activation regression models indicate HRQOL was significantly associated with PE (P ≤ .001), whereas findings related to fear of cancer recurrence lacked significance. In the Knowing Participation in Change regression model, HRQOL, social support, and level of education were all significantly associated with PE (P ≤ .001).

Conclusions
Breast cancer survivors with higher HRQOL, greater social support, and higher levels of education were more likely to have higher levels of PE.

Implications for Practice
Findings may provide insight as to which survivors may be ready to engage in SC and those who may need more specific tailoring of resources and support.
Exploring the Positive Thinking of Patients With Prostate Cancer
Authors: Chien Ching-Hui , Chuang Cheng-Keng , Liu Kuan-Lin , Pang See-Tong , Wu Chun-Te , Chang Ying-Hsu 
Published: July 2020

Background
Research has explored the effectiveness of positive thinking on individuals, but only a few studies have investigated the factors that influence individual positive thinking, particularly among patients with prostate cancer.

Objectives
The aim of this study was to understand the factors that affect positive thinking among patients with prostate cancer and the mediating role of self-efficacy.

Methods
A cross-sectional design and a convenience sampling method were used to recruit patients with prostate cancer from 2 hospitals in Taiwan. Structured scales were used for data collection, including the General Self-efficacy Scale, Expanded Prostate Cancer Index Composite, Positive Thinking Scale, and Social Support Scale.

Results
The total average score for positive thinking among 201 patients was 66.1 (SD, 9.4). The factors that influenced the positive thinking of patients with prostate cancer included self-efficacy, treatment satisfaction, perceived health status, marital status, and appraisal support. The effects of treatment satisfaction and appraisal support on positive thinking were partly achieved through self-efficacy (partial mediation).

Conclusions
Self-efficacy is a mediator that affects the relationship of treatment satisfaction, appraisal support, and positive thinking.

Implications for Practice
In the course of the disease, healthcare providers can help patients with prostate cancer to promote and maintain appropriate positive thinking by improving treatment satisfaction; increasing appraisal support from family, relatives, and friends; strengthening self-efficacy; and modifying unrealistic expectations.