bluuebunny/crossref_metadata_2025_split huggingface dataset:
ULTRA-WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY FOR RETINAL DETACHMENT WITH PROLIFERATIVE VITREORETINOPATHY
Authors: Takahashi Hiroyuki , Uramoto Kengo , Ohno-Matsui Kyoko 
Published: February 2020

Purpose:
To evaluate the efficacy of using preoperative and postoperative ultra-widefield optical coherence tomography) images in the treatment of proliferative vitreoretinopathy.

Methods:
The preoperative and postoperative images of a 62-year-old man with proliferative vitreoretinopathy accompanied by a rhegmatogenous retinal detachment were analyzed.

Patient:
At the initial examination, the vision was 20/400. It was difficult to obtain clear images of the fundus by color fundus photography because of synechia iridis posterior and mild vitreal opacities. Three-dimensional ultra-widefield optical coherence tomography images showed that the posterior hyaloid membrane was adherent to the retinal surface at a region superior to the macula. A space was present between the hyaloid membrane and retina in the images. During surgery, the hyaloid membrane was pierced over this space without injuring the retina, and the membrane was successfully removed. After surgery, the retina was reattached and a remnant of the proliferative tissue was detected in the ultra-widefield optical coherence tomography images. Four months after the surgery, the vision improved to 20/40.

Conclusion:
Ultra-widefield optical coherence tomography can be used to examine the spatial relationship between a proliferative membrane and the retina in eyes with proliferative vitreoretinopathy even when the preoperative fundus images obtained by conventional methods are not clear.
Long-term Progression of Ocular Surface Disease in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis
Authors: Yoshikawa Yamato , Ueta Mayumi , Fukuoka Hideki , Inatomi Tsutomu , Yokota Isao , Teramukai Satoshi , Yokoi Norihiko , Kinoshita Shigeru , Tajiri Kensuke , Ikeda Tsunehiko , Sotozono Chie 
Published: February 2020

Purpose:
To investigate the details of the long-term progression of ocular surface cicatrization in eyes with ocular sequelae caused by Stevens–Johnson syndrome (SJS)/toxic epidermal necrosis (TEN).

Methods:
In 105 eyes of 66 patients with SJS/TEN, the severity of ocular sequelae was retrospectively evaluated using an ocular surface grading score (OSGS) at 2 time points separated by a greater than 5-year interval. The OSGS included 7 ocular surface components (conjunctivalization, neovascularization, opacification, keratinization, symblepharon, and upper/lower conjunctival-sac shortening) evaluated into grades 0 to 3 (maximum total OSGS: 21), with the worsening of each component and total OSGS evaluated at the greater than 5-year interval. Moreover, we evaluated whether upper-tarsus and lid-margin scarring are factors that affect ocular surface cicatrization progression.

Results:
In 35 (33.3%) of 105 eyes, the total OSGS worsened during the follow-up period. Partial conjunctivalization (score 1–2) progressed more frequently to total conjunctivalization (score 3) than to no conjunctivalization (score 0) (OR [95% CI]; 5.6 [1.6–20.3]). Partial keratinization (score 1–2) also had a high risk of progression into total keratinization (41.0 [6.3–266.5]). In all cases, keratinization progressed only in the eyes with total conjunctivalization (conjunctivalization score 3). Severity of upper-tarsus scarring or lid-margin scarring affected the worsening of the total OSGS.

Conclusions:
In 66 patients with chronic-phase SJS/TEN, ocular surface cicatrization progressed in 33.3% of the 105 eyes during the long-term follow-up period of over 5 years. More than 50% of the partial conjunctivalization eyes progressed toward total conjunctivalization. The partial keratinization eyes had a high possibility of progressing to total keratinization; that is, the so-called “end-stage” status.
Diffuse lamellar keratitis associated with tabletop autoclave biofilms: case series and review
Authors: Sorenson Andrew L. , Holland Simon , Tran Kathy , Evans David J. , Lin Meng C. , Mamalis Nick , Chang David F. 
Published: February 2020

Purpose:To report a diffuse lamellar keratitis (DLK) cluster attributed to autoclave reservoir biofilm and to review the risk and prevention of DLK and toxic anterior segment syndrome (TASS) caused by such biofilms.Setting:Refractive Surgery Center, University of California, Berkeley.Design:Observational case–control study and review of literature.Methods:Eyes were evaluated for DLK following laser in situ keratomileusis (LASIK) over a 5-year period. Multiple changes in surgical and operating room protocols were prompted by a cluster of DLK cases. The autoclave reservoir chamber wall was cultured for microbial contamination. The MEDLINE database was used to identify relevant past publications.Results:From January 7, 2010, to December 18, 2014, 1115 eyes received LASIK. Between September 2, 2010, and June 11, 2012, 147 eyes of 395 LASIK cases developed DLK (37.2%). Systematic modifications in surgical protocols were unsuccessful in ending the prolonged cluster of DLK cases until the STATIM 2000 autoclave was replaced with a new STATIM autoclave and a reservoir sterilization and surveillance protocol implemented. Over the subsequent 30 months, DLK incidence was reduced to 2.2% (14 DLK cases from 632 total LASIK cases,P< .0001). The retired autoclave reservoir chamber wall cultures grewPseudomonas aeruginosaand theBurkholderia cepaciacomplex.Conclusions:Fluid reservoirs of tabletop steam autoclaves can readily develop polymicrobial biofilms harboring microbial pathogens, whose inert molecular byproducts can cause DLK and TASS when introduced to the eye by surgical instruments. Stringent reservoir cleaning and maintenance may significantly reduce this risk by preventing and removing these biofilms.
Axial length measurement and detection rates using a swept-source optical coherence tomography–based biometer in the presence of a dense vitreous hemorrhage
Authors: Wang Qinmei , Huang Yingying , Gao Rongrong , Chen Hao , Song Benhao , Tu Ruixue , Zhao Yune , McAlinden Colm , Huang Jinhai 
Published: February 2020

Purpose:
To evaluate axial length (AL) measurements and detection rates using a swept-source optical coherence tomography (SS-OCT) biometer (OA-2000) compared with the IOLMaster, LENSTAR, and ultrasound (US) measurements in eyes with vitreous hemorrhage.

Setting:
Eye Hospital of Wenzhou Medical University, China.

Design:
Comparative evaluation of a diagnostic test or technology.

Methods:
Patients were adults with vitreous hemorrhage in one or both eyes. Lens Opacities Classification System III was used to determine they type and severity of cataract and the Forrester system was used to classify the grade of vitreous hemorrhage. The AL measurement was taken with the OA-2000, IOLMaster (v5.4), and LENSTAR (v2.1), and with US (Axis-II). The Bland-Altman test was used to assess the agreement between devices.

Results:
Forty eyes were scanned with each of the 4 biometers. For Forrester grade III, the detection rate was 100%, 41.7%, and 41.7% with the OA-2000, IOLMaster, and LENSTAR, respectively. For Forrester grades I and II, the detection rate was 46.4%, 3.57%, and 3.57% with the OA-2000, IOLMaster, and LENSTAR, respectively. The detection rate with US was 100% for all grades. The Bland-Altman limits of agreement between the 4 biometers indicated an excellent agreement: OA-2000 vs IOLMaster (95% limits of agreement −0.15 to 0.05 mm), OA-2000 vs LENSTAR (−0.04 to 0.12 mm), and OA-2000 vs US (−0.3 to 0.56 mm).

Conclusions:
In vitreous hemorrhage, the detection rate with the SS-OCT OA-2000 biometer was better than that with the IOLMaster and LENSTAR. In cases in which all biometers were able to acquire an AL measurement an excellent agreement was found.
Photorefractive intrastromal corneal crosslinking for treatment of low myopia: clinical outcomes using the transepithelial approach with supplemental oxygen
Authors: Sachdev Gitansha Shreyas , Ramamurthy Shreyas , Dandapani Ramamurthy 
Published: February 2020

Purpose:
To evaluate the safety and efficacy of photorefractive intrastromal corneal crosslinking (PiXL) for the treatment of low myopia using the epithelium-on approach with supplemental oxygen.

Setting:
The Eye Foundation, Coimbatore, India.

Design:
Prospective interventional case series.

Methods:
Myopic nonectatic eyes underwent PiXL using the Mosaic system. Ultraviolet-A (UV-A) irradiation of 365 nm wavelength was delivered in an accelerated (30 mW/cm2) pulsed approach to provide a total fluence of 15 J/cm2. Supplemental oxygen (concentration greater than 95%) was provided to increase the efficacy of the epithelium-on approach during the UV-A irradiation. Efficacy was determined by improvement in mean refractive spherical equivalent (MRSE), uncorrected distance visual acuity (UDVA), and keratometric flattening. Safety was determined by loss of lines of corrected distance visual acuity, endothelial cell loss, and adverse events.

Results:
Fifty eyes of 26 patients with a mean age of 22.73 ± 3.74 years were included. A significant improvement in UDVA from baseline (logarithm of the minimum angle of resolution [logMAR] 0.63 ± 0.25) was noted at the 3-month (logMAR 0.08 ± 0.15) and 6-month (logMAR 0.13 ± 0.18) follow-up visits (P < .001). Significant keratometric flattening from baseline was noted at all follow-up visits (P < .001). No significant endothelial cell loss or adverse effects were noted. A significant correlation was noted between the change in MRSE and preoperative corneal biomechanics (deformation amplitude ratio, P = .029).

Conclusions:
Transepithelial PiXL with supplemental oxygen might be a safe and effective approach for reduction of myopia. The change in MRSE and keratometric flattening was greater in comparison with earlier protocols, including the epithelium-off approach.
Astigmatism prediction in small-incision lenticule extraction
Authors: Gyldenkerne Anders , Hjortdal Jesper , Ivarsen Anders 
Published: February 2020

Purpose:
To investigate whether postoperative-induced refractive astigmatism after small-incision lenticule extraction (SMILE) could be predicted by preoperative objective astigmatism measured with autorefraction, keratometry, and Scheimpflug tomography.

Setting:
University eye clinic.

Design:
Retrospective case series.

Methods:
Only eyes without preoperative subjective astigmatism treated with SMILE for myopia were included. Postoperative subjective astigmatism was compared with preoperative objective astigmatism. Examinations were performed before SMILE and 3 months postoperatively and included subjective refraction, keratometry, autorefraction, and Scheimpflug tomographer measurements. Astigmatism was analyzed using double-angle plots and multivariate statistics.

Results:
A total of 358 eyes of 358 patients were included. The mean preoperative sphere was −7.33 diopter (D) ± 1.46 (SD). The postoperative spherical equivalent was −0.30 ± 0.49 D. Postoperatively, 79.6% and 98.9% of patients had a subjective cylinder ≤0.50 D and ≤1.00 D, respectively. Preoperative objective astigmatism measured with keratometry, autorefraction, and Scheimpflug tomography was significantly different (P < .05) from postoperative subjective refraction when all patients were analyzed; for patients with postoperative refractive astigmatism ≥0.50 D, preoperative astigmatism with keratometry and Scheimpflug tomography was not significantly different from postoperative refractive astigmatism. Preoperative objective astigmatism ≥0.50 D increased the risk ratio of postoperative subjective astigmatism ≥0.50 D by 2.2 (P < .001).

Conclusions:
Preoperative objective astigmatism could not be directly interchanged with postoperative subjective astigmatism, but the presence of preoperative astigmatism ≥0.50 D doubled the risk of inducing a postoperative subjective astigmatism ≥0.50 D. Extra care when performing subjective refraction should be taken in the presence of high objective astigmatism.
Level of agreement of intraocular lens power measurements between an image-guided system and partial coherence interferometry
Authors: Labiris Georgios , Panagiotopoulou Eirini-Kanella , Ntonti Panagiota , Gkika Maria , Konstantinidis Aristeidis , Perente Irfan , Dardabounis Doukas , Ioannakis Konstantinos 
Published: February 2020

Purpose:
To evaluate the level of agreement of partial coherence interferometry (IOLMaster) and an image-guided system (Verion) in terms of keratometric values and intraocular lens (IOL) power calculation.

Setting:
Department of Ophthalmology, University Hospital of Alexandroupolis, Greece.

Design:
Prospective comparative study.

Methods:
Keratometric (K) values and IOL power calculations were compared for 3 toric IOL models (SN6ATx, TFNTx0, and SV25Tx) using 4 formulas (SRK/T, Holladay 1, Hoffer Q, and Haigis) in patients who had cataract surgery in a consecutive-if-eligible way.

Results:
Ninety-eight eyes from 54 patients were included in the study (mean age: 60.2 ± 9.2 years). Compared with the IOLMaster, the Verion measured significantly steeper K1, K2, and Km values (P < .05), but no significant difference was observed in astigmatism power and vectors J0 and J45 (P > .05). With the SRK/T formula, the SN6ATx IOL showed significant difference in the mean IOL power calculated by the 2 devices, whereas no significant difference was observed in the TFNTx0 IOL and the SV25Tx IOL. However, with the Holladay 1, Hoffer Q, and Haigis formulas, a significant difference was found in the mean IOL power of all 3 toric IOL models. Generally, the Verion calculated a significantly lower mean IOL power for almost all formulas and IOL models. For 35 toric implantations, the mean residual astigmatism power, 6 months postoperatively, was 0.29 ± 0.24 diopter.

Conclusions:
The IOLMaster and the Verion seemed to present differences in IOL calculation and surgical planning that could lead to unexpected residual refractive error. When discrepancy is detected in IOL calculation, using the IOLMaster as the primary biometry and the Verion as a digital marker alone could provide excellent outcomes in terms of astigmatism correction.
Comparison of clinical outcomes between vector planning and manifest refraction planning in SMILE for myopic astigmatism
Authors: Jun Ikhyun , Kang David Sung Yong , Arba-Mosquera Samuel , Reinstein Dan Z. , Archer Timothy J. , Jean Seung Ki , Kim Eung Kweon , Seo Kyoung Yul , Lee Hyung Keun , Kim Tae-im 
Published: February 2020

Purpose:
To compare clinical outcomes of small-incision lenticule extraction (SMILE) between manifest refraction (MR) and vector planning for myopic astigmatism with high ocular residual astigmatism (ORA).

Setting:
Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea.

Design:
Prospective, randomized, comparative case series.

Methods:
Patients with myopic astigmatism and ORA of 0.75 diopters (D) or greater were randomized into the MR or vector planning group and underwent SMILE without applying any nomogram for cylinder correction. Visual acuity, MR, corneal topography, and corneal aberration were measured preoperatively and postoperatively. Outcomes at 6 months postoperatively were compared between the groups.

Results:
The study comprised 114 patients (114 eyes): 58 eyes in MR planning and 56 eyes in vector planning. The mean uncorrected and corrected distance visual acuity, safety and efficacy indices were comparable between the 2 groups. Postoperative refractive cylinder reached statistically significant differences between the groups (−0.22 ± 0.18 D and −0.14 ± 0.16 D in the MR and vector planning groups, respectively, P = .02). Postoperative corneal toricity and ORA reached statistically significant lower in the vector planning group.

Conclusions:
In myopic astigmatism with high ORA, MR and vector planning in SMILE were effective with comparable visual outcomes; vector planning showed statistically significant lower postoperative refractive and corneal astigmatism and ORA. Use of vector planning may improve refractive outcomes in SMILE cases with high ORA. However, the results may have been different had a nomogram adjustment been applied, as is often used for cylinder corrections with SMILE.
Improvement of Physical and Occupational Therapy Referral Process to Reduce Unskilled Consults
Authors: Bednarczyk Matt , Pritchard Kevin , Barquin Will , Beyer Abram , Stankiewicz Christine 
Published: February 2020

Purpose:
Baseline data collected for 9 months showed that physical (PT) and occupational therapy (OT) services were consulted 14.5% of the time for unskilled therapy needs. The goal of this performance improvement project was to identify whether acute care physical and occupational therapists can reduce unskilled consults using a multidisciplinary education intervention.

Methods:
Therapists were trained on how to define and use each of 4 categories of unskilled consults. An interdisciplinary focus group was formed to gain feedback from providers with regard to the culture of mobility, the role of PT and OT, skilled versus unskilled consults, and strategies to reduce these unskilled consults. After discussion, the focus group determined that the primary strategy to reduce unskilled consults is to incorporate mobility and activities of daily living (ADL) discussion for each patient into interdisciplinary rounds (IDR).

Results:
Data show that PT and OT services collectively were consulted for unskilled therapy needs 3.05% of the time, compared with baseline data of 14.5%, which is a clinically meaningful decrease.

Conclusion:
Results provide preliminary evidence that an interdisciplinary approach using IDR can assist with reducing unskilled consults. Establishing a focus group can assist the initiatives through education on what defines an unskilled consult, collaboration, and improved communication regarding patient mobility and ADL performance while hospitalized.
The Value Transformation Framework: An Approach to Value-Based Care in Federally Qualified Health Centers
Authors: Modica Cheryl 
Published: February 2020

ABSTRACT

Background:
With the transition toward value-based care, health care organizations have a business imperative to simultaneously focus on improved health outcomes, improved patient and staff experience, and reduced costs (the Quadruple Aim). For federally qualified health centers—which provide care to some of nation's most vulnerable populations—balancing the complex task of systems change in the face of overwhelming volumes of information and best practices is challenging and can be supported through a guiding framework.

Purpose:
This need for synthesis and translation of evidence in an actionable and practical way led to the design of a model for health center systems change. This article describes the development process and defines the resulting conceptual framework.

Methods:
Deployed a four-step process between 2016 and 2018 to develop and test a framework for value transformation in health centers.

Results:
NACHC's Quality Center developed the Value Transformation Framework to guide health center systems change toward high value care. The framework identifies 15 change areas across three Domains: infrastructure, care delivery, and people and summarizes evidence-based action steps within the change areas.

Conclusions:
The framework shows promise in supporting health center efforts to adapt, transform, and balance competing demands as they advance value-based models of care.
Anticoagulation reversal for intracranial hemorrhage in the era of the direct oral anticoagulants
Authors: Strein Micheal , May Scott , Brophy Gretchen M. 
Published: February 2020

Purpose of review
This review focuses on recent relevant literature that examines the reversal of direct oral anticoagulants (DOACs) in patients with intracranial hemorrhage (ICH). The aim of this review is to provide an insightful description of available reversal agents and their clinical utility.

Recent findings
Increases in prescribing of DOACs has led to the introduction of drug-specific reversal agents. The clinical trials that evaluated these agents did not include a comparator arm making it difficult to determine if they are clinically superior to nonspecific reversal agents.

Summary
Numerous options for reversal of DOAC-associated ICH are currently available. Recent clinical trials have demonstrated drug-specific reversal agents are effective in this setting, but additional research is needed to determine whether these agents should be routinely preferred over nonspecific reversal agents.
Dietary management of blood glucose in medical critically ill patients with overweight/obesity
Authors: Srinath Reshmi , Mechanick Jeffrey I. 
Published: February 2020

Purpose of review
As the obesity epidemic continues, there is a greater proportion of patients with overweight, obesity, and other forms of adiposity-based chronic disease that require intensive care. Nutrition therapy in the ICU is a vital part of critical care but can be challenging in this setting because of the increased risk of stress hyperglycemia and adverse impact of obesity- and diabetes-related complications.

Recent findings
Current guidelines favor early nutritional therapy with a hypocaloric, high-protein diet in patients with overweight/obesity. More aggressive protein intake may be useful in those with greater severity of overweight/obesity with an upper limit of 3 g/kg ideal body weight per day. Although there is no specific recommendation, choosing enteral formulas with higher fat content and slower digesting carbohydrates may assist with glucose control. Supplementation with immunonutrients is recommended, given their known benefits in obesity and in reducing inflammation, but must be done in an individualized manner.

Summary
Aggressive nutritional therapy is crucial in patients with overweight/obesity to support ongoing metabolic demands. Although a hypocaloric high-protein feeding strategy is a starting point, nutritional therapy should be approached in an individualized manner taking into account age, weight and BMI, basal metabolism, nutrition status, complications, and comorbidities.