bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effort-Reward-Imbalance, Burnout, and Depression Among Psychiatrists 2006 and 2016-Changes After a Legislative Intervention
Authors: Beschoner Petra , von Wietersheim Jörn , Jarczok Marc N. , Braun Maxi , Schönfeldt-Lecuona Carlos , Viviani Roberto , Jerg-Bretzke Lucia , Kempf Maximilian , Brück Aniela 
Published: April 2021

Background: Physicians, especially psychiatrists, have a high risk of job-related stress, and mental impairment. In our study we examined changes in private and occupational stress factors and mental health within a decade. The legislative reduction of physicians' working hours in Germany during this period made it possible to investigate the impact of working hours in particular.Methods: Questionnaires were administered at two psychiatrist meetings (2006 and 2016) about job and family situation, depressiveness, burnout and effort-reward imbalance. A total of N = 1,797 datasets were analyzed.Results: Working hours and free weekends were associated with mental health indices. Correlation analyses showed that a reduction in weekly working hours and working days at weekends was related to reduced scores for effort-reward-imbalance, burnout and depression.Conclusions: Our data show changes in workplace stress and mental health in psychiatrists in a decade in which a reduction in working hours has been required by law. These results can provide indications of effective prevention strategies in the professional context of physicians working in psychiatry.
Barriers and Facilitators to Implementation of Value-Based Care Models in New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol
Authors: Goff Sarah L. , Gurewich Deborah , Alcusky Matthew , Kachoria Aparna G. , Nicholson Joanne , Himmelstein Jay 
Published: April 2021

Introduction: Massachusetts established 17 new Medicaid accountable care organizations (ACOs) and 24 affiliated Community Partners (CPs) in 2018 as part of a large-scale healthcare reform effort to improve care value. The new ACOs will receive $1.8 billion dollars in state and federal funding over 5 years through the Delivery System Reform Incentive Program (DSRIP). The multi-faceted study described in this protocol aims to address gaps in knowledge about Medicaid ACOs' impact on healthcare value by identifying barriers and facilitators to implementation and sustainment of the DSRIP-funded programs.Methods and analysis: The study's four components are: (1) Document Review to characterize the ACOs and CPs; (2) Semi-structured Key Informant Interviews (KII) with ACO and CP leadership, state-level Medicaid administrators, and patients; (3) Site visits with selected ACOs and CPs; and (4) Surveys of ACO clinical teams and CP staff. The Consolidated Framework for Implementation Research's (CFIR) serves as the study's conceptual framework; its versatile menu of constructs, arranged across five domains (Intervention Characteristics, Inner Setting, Outer Setting, Characteristics of Individuals, and Processes) guides identification of barriers and facilitators across multiple organizational contexts. For example, KII interview guides focus on understanding how Inner and Outer Setting factors may impact implementation. Document Review analysis includes extraction and synthesis of ACO-specific DSRIP-funded programs (i.e., Intervention Characteristics); KIIs and site visit data will be qualitatively analyzed using thematic analytic techniques; surveys will be analyzed using descriptive statistics (e.g., counts, frequencies, means, and standard deviations).Discussion: Understanding barriers and facilitators to implementing and sustaining Medicaid ACOs with varied organizational structures will provide critical context for understanding the overall impact of the Medicaid ACO experiment in Massachusetts. It will also provide important insights for other states considering the ACO model for their Medicaid programs.Ethics and dissemination: IRB determinations were that the overall study did not constitute human subjects research and that each phase of primary data collection should be submitted for IRB review and approval. Study results will be disseminated through traditional channels such as peer reviewed journals, through publicly available reports on the mass.gov website; and directly to key stakeholders in ACO and CP leadership.
Market Exclusivity of the Originator Drugs in South Korea: A Retrospective Cohort Study
Authors: Son Kyung-Bok 
Published: April 2021

Introduction:Generic entry is a well-known driver of competition and cost containment.Objectives:We aim to measure the market exclusivity of originator drugs and to determine what influences the entry of generics in South Korea.Methods:A list of originator drugs approved by the authority from 2000 to 2013 and their corresponding generics were paired. An event history model was applied for a statistical estimation for the duration until generic entry and to identify abbreviating or prolonging factors on the duration.Results:A total of 2,061 pairs of originator and generics were identified. The market exclusivity for the originator drugs, including NDAs and non-NDAs, has not notably changed. However, competition among non-NDAs was less common than we expected. We found delayed time to entry of generics in the long run, particularly for non-NDAs in injection forms and biologics, and this finding is partially associated with market attractiveness.Conclusion:The authority should address the delayed availability of certain types of generic drugs. The government could provide information on off-patent pharmaceuticals with no generic competition, designate their corresponding submissions as prioritized in the review process, and provide additional market exclusivity when entering the market via a long period of exclusivity.
Construyendo orden a través de la narración: narrador y narratarios en el Bellum Avaricum de Jorge de Pisidia
Authors: Kröll Nicole 
Published: April 2021

El objetivo de este trabajo es analizar las funciones del narrador y de los narratarios en el Bellum Avaricum de Jorge de Pisidia. El artículo postula que a través de la relación jerárquica entre narrador y narratarios, el poeta aspira a reflejar la forma ideal del reinado del emperador Cristiano Heraclio (610-641 d.C.) tanto a nivel secular como espiritual. Por lo tanto, el foco estará puesto en los tres interrogantes que siguen: ¿cómo se representa el narrador?, ¿cómo se dirige a sus narratarios y cómo se comunica con ellos? y ¿cuál es su objetivo ideológico al establecer y estructurar la narración? A partir de estudiar el poema especialmente en lo que respecta a sus técnicas narrativas vinculadas a la retórica y al panegírico, el análisis intenta profundizar en los conceptos sociopolíticos y espirituales de Bizancio al comienzo de siglo séptimo.
Role of Anterior Segment OCT in the Management of Primary Narrow Angle Disease
Authors: Muid Javeria , Farooq Sadia 
Published: April 2021

Purpose: To highlight the role of anterior segment OCT, in complementing gonioscopic findings in the management of angle closure glaucoma.
Study Design: Descriptive observational case series.
Study Place and Duration: Study was conducted at Eye department of Shifa International Hospital, from January 2019 to March 2019.
Methods: After taking informed consent from the patients, the study was conducted at Shifa International Hospital Islamabad. Patients were selected by convenient sampling technique. Patients were diagnosed on the basis of history and clinical examination. Patients with angle closure on Gonioscopy were included in this series. Detailed ocular examination including visual acuity for distance and near, tonometry, Gonioscopy and anterior segment OCT were performed. Data was collected and presented as case series.
Results: The median age 57 years with 50% more than 60 years and 50% less than 60 years of age. Presenting IOP was less than 21 mmHg in 50% and higher in remaining 50%. On examination 37.5% were categorized as PACS, 12.5% having PAC and 50% as PACG. After definitive treatment 12.5% still needed medical treatment to prevent progression in PACG and none in PACS and PAC.
Conclusion: In narrow angle disease, treatment is designed not only to control intraocular pressure (IOP) but also to keep angle open as much as possible. Appositional closure or peripheral anterior synechiae (PAS) can damage the trabecluar meshwork. Iridoplasty, peripheral Iridotomy (PI) and early lens extraction can defer the need for filtration procedure if done well in time.
Key Words: OCT anterior segment, Narrow angle, Optic nerve head.
Intra-operative and Immediate Post-operative Complications in a High Volume Cataract Surgery Center
Authors: Haider Muhammad Ali , Sattar Uzma , Amjad Muhammad 
Published: April 2021

Purpose: To find out the frequency of complications in a high volume phacoemulsification set up at a tertiary care eye hospital in Lahore.
Study Design: Quasi experimental study.
Place and Duration of Study: Al-Ehsan Eye Hospital, Lahore, from July 2017 to June 2019.
Methods: Surgical outcomes of 6902 patients who had undergone phacoemulsification were included. Patients were excluded if they had ocular infections, lid margin diseases, adnexal diseases, those requiring a secondary anterior chamber surgery and those unfit for the procedure due to medical grounds. Every patient underwent a detailed history and complete clinical examination. All patients underwent the standard phacoemulsification technique and at the end of each surgery, subconjunctival injections of dexamethasone and gentamycin were given to the patients. Complications encountered during high volume cataract surgery were recorded and their percentages were calculated.
Results: A total of 6902 patients underwent cataract surgery with 2.66% intra-operative and 6.94% immediate post-operative complications. The most common intra-operative complication was posterior capsular rupture (1.15%). In patients with capsular rupture the intra ocular lens was implanted within the sulcus in 61 cases (0.88%) while in 12 cases (0.17%) anterior chamber lens was implanted because of lack of capsular support. During the surgery intra ocular lens could not be implanted in 7 cases (0.10%) and they were left aphakic. The commonest immediate post-operative adverse outcome was corneal edema with striate keratopathy and decements folds in 197 cases (2.85%).
Conclusion: High volume cataract surgery using appropriate techniques and sterilization does not compromise the quality of outcomes.
Key Words: Cataract, Phacoemulsification, Vitreous loss.
Topical Cyclosporine in Treatment of Post-LASIK Symptomatic Dry Eye
Authors: Iqbal Muhammad Saeed , Latif Kanwal 
Published: April 2021

Purpose: To determine the role of 0.05% topical cyclosporine A (CsA) in treatment of symptomatic dry eye after LASIK (Laser-Assisted in Situ Keratomileusis).
Study Design: Interventional Case Series.
Place and Duration of Study: Ophthalmology Department, Sir Syed Hospital, Karachi, from July 2018 to Dec. 2019.
Methods: Seventy-five patients who underwent LASIK for myopic refractive error and presented with symptomatic dry eye and showed no response to artificial tears therapy after 1 month of LASIK were selected. The patient had ablation zone diameter of 6mm and flap diameter was 8.5mm to 9mm. Cyclisporine A 0.05% ophthalmic preparation was added to treatment regimen and response was observed at 1, 3 and 6 months. OSDI (Ocular Surface Disease Index) scores, Tear film break up time (TBUT), Schirmer's test (ST) values and Best Corrected Visual Acuity (BCVA) were recorded to analyze the treatment response at each visit. The statistical interpretation was done by using SPSS version 21. To interpret the correlation between pre-treatment and 6 month post treatment, Paired sample T test was applied with 95% Confidence Interval; CI and p-value of ≤ 0.05.
Results: The mean post-LASIK OSDI score of enrolled patients was 54.25 ± 10.81. After 6 months of treatment mean OSDI score was improved to 21.05 ± 5.13 (p < 0.001). Post-LASIK mean ST value was 5.2 ± 1.2 mm and mean TBUT value was 5.6 ± 1.3 seconds, which changed to 9.8 ± 1.0 mm and 8.9 ± 1.1 seconds respectively. BCVA improved from Log MAR 0.14 ± 0.09 to 0.01 ± 0.03 (p < 0.001).
Conclusion: Topical CsA 0.05% was effective in alleviating the symptoms of post-LASIK dry eye.
Key Words: LASIK, Dry eye, Ocular Surface Disease Index Score, Cyclosporine A.
Comparison of Steroid with Cyclosporine Eye Drops in Epidemic Keratoconjunctivitis
Authors: Rafe Abdul , Tariq Munawar Muhammad 
Published: April 2021

Purpose: To compare the effect of topical steroid with cyclosporine eye drops in recurrence of sub-epithelial corneal infiltrates in epidemic keratoconjunctivitis.
Study Design: Quasi Experimental study.
Place and Duration of Study: CMH Kharian from Jan 2017 to June 2018.
Methods: Eighty eight patients with epidemic keratoconjunctivitis were divided into two groups. Group A included patients who received topical steroid drops and group B received topical Cyclosporine eye drops. The inclusion criteria comprised of fresh cases of SEIs, between the ages of 20 to 50 years, having a vision of 6/6 before the illness. The exclusion criteria included patients suffering from allergic conjunctivitis, ocular surface disease like Sjogren syndrome, corneal ulcer, blepharitis, old corneal opacity, glaucoma and those who had been using steroids in the past e.g. uveitis. The patients were followed up at 2, 4, 8 and 12 weeks. On resolution of sub-epithelial infiltrates (SEIs), both regimen were tapered off in next two weeks. The patients were advised to continue monthly follow up for two months to see any recurrence.
Results: SEIs resolved in both the groups by week 12, however the resolution was slightly quicker in group A. SEIs resolved in 84.1% of cases in group A and in 70.4% cases in group B at the end of 4 weeks. Recurrence was higher in group A (11.3%) while it was 4.5% in group B.
Conclusion: Cyclosporine eye drops are a safe and equally effective treatment of epidemic keratoconjunctivitis related SEIs, with an added advantage of reduced recurrence rate.
Key Words: Epidemic, Keratoconjunctivitis (EKC), Cornea, Subepithelial Infiltrates, Cyclosporine.
Immediate Effect of Intravitreal Bevacizumab Injection on Intraocular Pressure
Authors: Zafar Rabeeah , Rizwan Amna , Naeem Badar-ud-din Ather , Asghar Asfandyar , Obaid Naila 
Published: April 2021

Purpose: To determine the immediate effect of intravitreal Bevacizumab on intraocular pressure (IOP) in eyes with retinal vascular disorders.
Study Design: Interventional case series.
Place and Duration of Study: Ophthalmology Department, Fauji Foundation Hospital, Rawalpindi, from January 2019to July 2019.
Methods: One hundred and thirty one patients were included in this study using non probability consecutive sampling. IOP was measured before intravitreal injection (baseline) and at 5 and 30 minutes post-injection. Descriptive statistics were obtained using SPSS version 21.0.
Results: One hundred and thirty one eyes of 131 patients were observed for IOP change after intra vitreal injection of Bevacizumab. Among them 23 (18%) were males and 108 (82.4%) were females. Mean age was 57.57 ± 13.09 years. Mean IOP at baseline was 16.16 ± 2.52 mmHg. At 5 minutes after injection, 108 eyes (82.4%) had raised IOP, maximum IOP recorded was 44 mmHg. There was a statistically significant correlation between IOP at baseline and 5 minutes with p = 0.005 (≤0.05). At 30 minutes, 94 eyes (71.7%) had IOP fallen back to normal. Statistically, an insignificant correlation was present between IOP at baseline and 30 minutes (p = 0.081) post-injection. IOP rise was not significantly correlated to gender, age, hypertension and asthma at any interval (p value > 0.05). However, IOP rise was significantly correlated in diabetic patients at 30 minutes.
Conclusion: IOP elevation has been observed after intravitreal bevacizumab in immediate post-injection period which warrants the monitoring of IOP in this critical period to avoid serious blinding complications.
Key Words: Bevacizumab, Vascular endothelial growth factor, Intraocular pressure, Goldmann applanation tonometer.
Indications And Outcomes Of Penetrating Keratoplasty at a Tertiary Hospital in Bangladesh
Authors: Uddin A S M Moin , Sultana Chandana , Shahid Md. A. Muntakim , Rashed Mohammed , Islam Mohammad Shamsal 
Published: April 2021

Purpose: To find out the indications and outcomes of Penetrating Keratoplasty at a tertiary eye hospital in Dhaka, Bangladesh.
Study Design: This was a retrospective hospital based study.
Place and Duration of Study: Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh from July 2011 and July 2018.
Methods: In this study, data was collected from the records of patients, who came for treatment at the cornea unit. Pre-operative evaluation and post-operative follow-up record was analyzed. Patents’ demographic information, visual acuity, management, pre and post-operative complications, follow-up visits and outcomes were recorded. A technical research team headed by a senior consultant determined the content validity and their comments were incorporated in finalizing the research instruments.
Results: A total of 213 penetrating keratoplasties (PK) were performed during the study period. The main indications were keratoconus (8.28%), Corneal scarring (41.42%), Adherent leukomas (25.59%), corneal dystrophy (3.84) and bullous keratopathy (7.25%). Rejection rates at 8 years were 5.62%. Keratoconus showed the best graft survival (79%). The percentage of patients with post-transplant best-corrected visual acuity of 6/36 at 8 years was 52%. There was a statistically significant reduced rejection rate in males.
Conclusion: Penetrating Keratoplasty is an effective treatment option for improving visual outcomes for people with visual impairment. There are many co-factors involved with a quality outcome of patients with Penetrating Keratoplasty such as immunological rejection, microbial keratitis and patient level of awareness, which continue to limit the success.
Key Words: Penetrating, Keratoplasty, Bangladesh, Keratoconus, Corneal Dystrophy.
Ocular Manifestations and Viral Prevalence in Conjunctival Secretions of Patients with COVID 19 – A Meta–Analysis
Authors: Shakeel Ayisha , Sultan Sharjeel , Ali Syed Imtiaz 
Published: April 2021

PubMed was searched using key words “COVID-19”, “coronavirus”, and “SARS CoV‑2” in conjunction with “ophthalmology” and “eye” on 17th May 2020. Total 483 articles were identified. After screening eleven articles were included in the analysis. The frequencies of ocular manifestations and the presence of virus in conjunctiva were analyzed and final results were compiled.Ten out of eleven articleswere analyzed for ocular manifestations. In our analysis a total of 2115 cases had Covid 19, out of which 77 patients developed ocular manifestations (3.64%, 95% CI 2.88 – 4.53). The most common being conjunctival congestion. Twelve patients had SARS – CoV-2 in their ocular secretions confirmed by RT PCR test (2.61%, 95% CI 1.36 – 4.52). This meta-analysis concludes that conjunctiva is neither a preferred site of infection nor a preferred gateway for entry of SARS CoV-2 in the body. As a low risk of infection does exist, eye protective equipment should be used when treating COVID – 19 patients.
Key Words: SARS CoV 2, COVID 19, Conjunctiva, Ophthalmology.
Outcomes of Rhegmatogenous Retinal Detachment
Authors: Riaz Sidrah , Khan Muhammad Tariq , Mirza Khurram Azam 
Published: April 2021

Purpose: To study demographic characteristics and treatment outcomes of Rhegmatogenous retinal detachment in a private Vitreo-retinal setup of Lahore.
Study Design: Cross sectional Observational study.
Place and Duration of Study: Private Vitreo-retinal setup, from March 2017 to April 2019.
Methods: Total 102 patients with Rhegmatogenous retinal detachment (RRD) were included. Patients with retinal detachment other than RRD were excluded. Detailed history and ocular examination was performed. Type of break, procedure adopted for RRD repair and type of endo-tamponade were also recorded. These patients had either 23 G pars plana vitrectomy (PPV) or scleral buckling (SB) procedures or combined sclera buckling with PPV. Patients were followed-up for six months.
Results: Out of 102 total RRD cases, 63.70% were males and 36.30%were females. Mean age was 47.44 ± 18.44. Macula was on in 48% and off in 52%. Phakic patients were 46.50%, pseudophakic 48.50% and 5.10% were aphakic. Position of break in RRD was superotemporal in 39.2%, inferotemporal in 30.4% and inferonasal in 2.9%. Total RD was observed in 27.5% patients. One or more breaks were identified in 82.4% patients and giant tear in 4.9%. Three ports 23 G PPV was done in 64.7%, PPV with IOL in 18.6%, scleral buckling in 10.8% and combined PPV + SB in 5.9% patients. The anatomical success rate was observed in 96.07%, 3.9% needed second surgery to get anatomical success in six months follow-up.
Conclusion: Anatomical success rates in retinal attachment surgeries in experienced hands is comparable with more developed retinal centers of the world.
Key Words: Rhegmatogenous retinal detachment, Pars plana vitrectomy, Scleral buckling, Silicon oil.
Effect of Fasting on Intraocular Pressure
Authors: Kamal Zahid , Jamil Ahmad Zeeshan , Khalid Muhammad , Ali Bahoo Muhammad Luqman , Junaid Iqbal Muhammad , Aziz Nauman 
Published: April 2021

Purpose: To determine the effect of fasting on intraocular pressure in fasting individuals.
Study Design: Cross sectional observational study.
Place and Duration of Study: District Headquarter Teaching Hospital/Sahiwal Medical College Sahiwal, from April 2020 to May 2020.
Methods: Four hundred eyes of two hundred healthy fasting subjects were included in this study. Intraocular pressure was measured one week before and during the second week of Ramadan. t-test was used to calculate the difference of means of intraocular pressure one week before and during the second week of Ramadan.
Results: Mean age of the subjects was 34.56 ± 12.52 years. IOP in male subjects before and during Ramadan was 14.23 mmHg and 13.20 mmHg respectively, while IOP in female subjects before and during Ramadan was 14.43 mmHg and 13.20 mmHg respectively. Before Ramadan mean intraocular pressure in the right eye was 14.38 ± 3.00 mmHg and in the left eye was 14.21 ± 2.79 mmHg. During Ramadan mean intraocular pressure in the right eye was 13.24 ± 2.87 mmHg and in the left eye was 13.15 ± 2.71 mmHg. t-test indicated that the difference in means of intraocular pressure for right eye one week before and during the second week of Ramadan was 25.74 (p = 0.000). Similarly, the difference in means of intraocular pressure for left eye one week before and during the second week of Ramadan was 41.54 (p = 0.000).
Conclusion: Fasting results in a decrease in intraocular pressure in normal population. There was no difference in intraocular pressure changes between male and female subjects. Intraocular Pressure was higher in older age group in both genders.
Key Words: Intraocular Pressure, Tonometry, Glaucoma.