bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postsurgical Cataract Prophylaxis With Intravitreal “Triamcinolone-Moxifloxacin” May Not Be Optimal For Preventing Endophthalmitis
Authors: Kowalski Regis P. , Romanowski Eric G. , Shanks Robert M. Q. , Mammen Alex , Dhaliwal Deepinder K. 
Published: June 2018

Purpose:
Intravitreal injections of antibiotics and anti-inflammatories are used by some cataract surgeons for surgical prophylaxis. To support this prophylaxis, intravitreal triamcinolone–moxifloxacin (TM) and triamcinolone–moxifloxacin–vancomycin (TMV) were tested for preventing Staphylococcus aureus (SA) endophthalmitis in rabbits.

Methods:
Trademark formulations of TM (15/1 mg/mL) and TMV (15/1/10 mg/mL) were intravitreally injected into seven groups of eight rabbits each (A–G). Before intravitreal injection, the vitreous was first challenged with clinical SA endophthalmitis isolates (5,000 colony-forming unit) with varying minimum inhibitory concentrations (MICs in μg/mL) to moxifloxacin (denoted by the MIC at the end of each group listed): A) TMV-10, B) TM-10, C) Saline-10, D) TM-2, E) Saline-2, F) TM-0.032, and G) Saline-0.032. After 24 hr, the rabbit eyes were graded for clinical endophthalmitis and cultured for viable SA.

Results:
Rabbits treated with TMV and challenged by SA with a moxifloxacin MIC of 10 μg/mL did not present with endophthalmitis (0/8, no eyes with endophthalmitis). For SA with moxifloxacin MICs of 10.0 and 2.0 μg/mL, TM did not prevent endophthalmitis (16/16, 100% of eyes with endophthalmitis). For SA with a moxifloxacin MIC of 0.032 μg/mL, endophthalmitis was prevented with TM (0/8, no eyes with endophthalmitis). All saline-treated eyes developed endophthalmitis (23/23, 100% of eyes with endophthalmitis).

Conclusions:
Intravitreal monotherapy with TM did not provide consistent prevention of SA endophthalmitis, whereas intravitreal TMV successfully prevented endophthalmitis because of SA with elevated MIC values to moxifloxacin. Cataract surgeons need to be aware that vancomycin seems to be essential for intravitreal prophylaxis to cover moxifloxacin resistance.
Circular Keratotomy Combined With Wedge Resection in the Management of High Astigmatism After Penetrating Keratoplasty
Authors: Çakir Hanefi , Genç Selim , Güler Emre 
Published: June 2018

Objective:
To evaluate the effectiveness of circular keratotomy combined with wedge resection for the management of high astigmatism after penetrating keratoplasty (PK).

Methods:
The study included seven eyes of seven patients with previous PK who underwent circular keratotomy combined with wedge resection. The uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), spherical equivalent (SE) refraction, and keratometric powers obtained by corneal topography were evaluated. The power vector method was used to analyze the astigmatic change postoperatively.

Results:
The mean follow-up period was 18.42±8.56 months (range 12–33 months). Uncorrected visual acuity, BCVA, and SE were improved in all eyes postoperatively. The mean preoperative astigmatism reduced from 15.11±5.48 D (range, 10.0–24.4 D) to 4.98±3.01 D (range, 2.2–9.6 D), postoperatively. According to the vector analysis, the overall mean surgically induced astigmatism at last visit was 12.87±6.20 D. The most common complication was the loosening of sutures occurred in five eyes within 2 months.

Conclusions:
Circular keratotomy combined with corneal wedge resection is a favorable option for the management of high astigmatism after PK.
Comparison of Different Corneal Power Readings From Pentacam in Post-laser In Situ Keratomileusis Eyes
Authors: Ng Alex L. K. , Chan Tommy C. Y. , Cheng Arthur C. K. 
Published: June 2018

Objectives:
To compare the various Pentacam-measured K-readings with the clinical history method (CHM) in eyes that have undergone myopic laser in situ keratomileusis (LASIK).

Methods:
In this prospective study, Pentacam examination was performed in 71 eyes 1 month after myopic LASIK. The true net power (TNP) 4 mm, total corneal refractive power (TCRP) 4 mm, equivalent K-reading (EKR) 4.0 mm, and EKR 4.5 mm obtained from the same scan were compared with the K derived from CHM.

Results:
The average baseline spherical equivalence was −5.44±2.38 D. After LASIK, the mean KCHM was 37.67±2.13 D, TCRP4mm was 37.14±1.79 D, TNP4mm was 36.88±1.76 D, EKR4.0mm was 37.58±1.94 D, and EKR4.5mm was 37.51±1.94 D. TCRP4mm, TNP4mm, and EKR4.5mm showed a statistically significant deviation from the KCHM, with the mean error being 0.53 D, 0.79 D, and 0.16 D, respectively (P<0.05). Only the EKR4.0mm showed no statistically significant difference from the KCHM (mean error 0.09 D, P=0.23). The EKR4.0mm also had the narrowest 95% limits of agreement (LoA) (−1.10 to +1.28 D), whereas both TCRP4mm and TNP4mm had a wider LoA (−0.88 to +1.95 D and −0.62 to +2.20 D, respectively). All four Pentacam K-readings had a strong and statistically significant correlation with the KCHM.

Conclusions:
Using the CHM as reference, the EKR4.0mm demonstrated the closest agreement when compared with the EKR4.5mm, TNP4mm, and TCRP4mm obtained from the same scan.
Predictability of the Achieved Lenticule Thickness in Small Incision Lenticule Extraction for Myopia Correction
Authors: Zhou Jiaqi , Zhang Yan , Li Meiyan , Sun Ling , Zhou Xingtao 
Published: June 2018

Purpose:
To investigate the predictability of the achieved lenticule thickness in small incision lenticule extraction (SMILE) for the correction of myopia.

Methods:
In this prospective study, a total of 80 eyes of 45 patients who underwent the SMILE procedure were included. A Scheimpflug camera was used to measure the preoperative and postoperative corneal topography. Achieved lenticule thicknesses at the pupil center and corneal vertex were calculated by subtracting the postoperative corneal thickness at the pupil center and corneal vertex from preoperative corresponding values. Predictability between the achieved and VisuMax readout at different locations (the pupil center and corneal vertex) and postoperative visits (postoperative day 1 and 6 months) were evaluated using a general linear model.

Results:
Achieved lenticule thickness at the pupil center and corneal vertex showed good correlation at both postoperative day 1 (pupil center: r=0.914, corneal vertex: r=0.903) and 6 months (pupil center: r=0.886, corneal vertex: r=0.866). The achieved lenticule thickness at postoperative day 1 was 8.5-μm thinner at the pupil center and 9.6-μm thinner at the corneal vertex than the VisuMax readout.

Conclusions:
This study suggests that the predictability between the achieved and VisuMax readout is favorable. The lenticule thickness at the pupil center is closer to the VisuMax readout than corneal vertex.
Office-Based Diagnosis of Demodex Using Smartphone
Authors: Kaya Abdullah , Gürdal Canan 
Published: June 2018

Abstract:
Demodex is an important pathogen in ophthalmology. It is believed to cause a variety of eyelid and eyelash diseases. Currently, light microscopes are being used for imaging demodex. However, microscopes are not available everywhere. Also, it is not cost-effective to perform light microscopy in every case. In this case, we demonstrate a new method: imaging demodex using cell phone. A 90-diopter noncontact double aspheric lens was attached to the posterior camera of the smartphone with clear tape. An eyelash of a patient with blepharitis was removed. A video was taken using smartphone. There was a moving demodex parasite in the root of the eyelash. A clear video image could be taken using the smartphone. A smartphone and a 90-diopter lens are adequate for the imaging and diagnosis of demodex.
Comparison Between Diclofenac and Ketorolac Ophthalmic Drops for Pain Management After Photorefractive Keratectomy: A Randomized Clinical Study
Authors: Mohammadpour Mehrdad , Heidari Zahra , Molani Ratishta 
Published: June 2018

Objectives:
To assess and compare the efficacy of two nonsteroidal anti-inflammatory drugs (NSAIDs), namely diclofenac and ketorolac, for pain control after photorefractive keratectomy (PRK).

Methods:
In this double-masked clinical study, 60 patients treated bilaterally with PRK were randomly allocated into two groups. Postoperatively, one group of patients received diclofenac 0.1% drops and the other group was prescribed ketorolac 0.5% ophthalmic drops in both eyes every 6 hr on the first day and then, no NSAID was applied until the third day. No oral analgesic drug was used after surgery. Patients completed the Visual Analog Scale questionnaire to determine the degree of pain and ocular discomfort (tearing, foreign body sensation, blurred vision, and photophobia) on the first and the third day after surgery.

Results:
Pain relief was achieved with both medications after surgery, and there was no significant intergroup difference in the level of pain reduction at 24 and 72 hr postoperatively (P>0.05). The ketorolac group experienced less tearing and photophobia only at 24 hr postoperatively (P=0.01), and by 72 hr after surgery, the results were similar in two groups (P>0.05). There was no significant intergroup difference in terms of foreign body sensation or blurred vision on the first or third postoperative days (P>0.05).

Conclusions:
Both diclofenac and ketorolac are effective in reducing pain and ocular discomfort after PRK, and ketorolac may have greater control on tearing and photophobia during the first 24 postoperative hours.
The Impact of Sleep Duration on Performance Among Competitive Athletes: A Systematic Literature Review
Authors: Kirschen Gregory W. , Jones Jason J. , Hale Lauren 
Published: June 2018

Abstract:
The athletic advantage of sleep, although commonly touted by coaches, trainers, and sports physicians, is still unclear and likely varies by sport, athletic performance metric, and length of sufficient or insufficient sleep. Although recent literature reviews have highlighted circadian and nutritional factors that influence different aspects of athletic performance, a systematic summary of the effects of sleep duration and sleep quality on performance among competitive athletes is lacking. Here we systematically review the relationship between sleep duration and sleep quality and objective athletic performance among competitive athletes across 19 studies representing 12 sports. Taken holistically, we find that the sports requiring speed, tactical strategy, and technical skill are most sensitive to sleep duration manipulations. Furthermore, longer-term sleep manipulations are more likely than acute sleep manipulations (whether deprivation or extension) to affect athletic performance. Thus, the importance of sleep for competitive athletes to achieve high performance is dependent on the demands of the sport as well as the length of sleep interventions. In light of the limited number of studies investigating sleep quality and performance, the potential relevance of subjective sleep quality remains an interesting question for future work.
Association Between Clinical and Imaging Outcomes After Therapeutic Loading Exercise in Patients Diagnosed With Achilles or Patellar Tendinopathy at Short- and Long-Term Follow-up: A Systematic Review
Authors: Rabello Lucas M. , van den Akker-Scheek Inge , Brink Michel S. , Maas Mario , Diercks Ron L. , Zwerver Johannes 
Published: June 2018

Objective:To determine the association between clinical and imaging outcomes after therapeutic loading exercise in Achilles tendinopathy (AT) and patellar tendinopathy (PT) populations at both short- and long-term follow-up.Data Sources:The PUBMED and EMBASE databases were searched (up to June 2017) to identify articles that meet the inclusion criteria: (1) patients diagnosed with AT (insertional or midportion) or PT; (2) rehabilitation based on therapeutic loading exercise; and (3) assessment of clinical outcomes and tendon structure using an imaging modality.Main Results:Two independent reviewers screened 2894 search results, identifying 21 suitable studies. According to the studies included in this review, clinical results showed significant improvements for patients with AT and PT after eccentric exercise (ECC) and heavy slow resistance (HSR) at short- and long-term follow-up. Imaging outcomes were not consistent. Moderate-to-strong evidence for patients with AT suggested an association between clinical outcomes and imaging outcomes (tendon thickness and tendon neovascularization) after ECC at long-term follow-up. For patients with PT, there was moderate evidence supporting an association between clinical outcomes (questionnaire score and pain) and imaging (tendon thickness and tendon neovascularization) after ECC at short-term follow-up. For both the AT and PT groups, there was moderate evidence for an association between clinical outcomes and tendon thickness and neovascularization after HSR exercise. Results related to the HSR exercise should be interpreted with caution because of the small number of studies.Conclusions:Based on the findings of the present review, the use of imaging outcomes as a complementary examination to the clinical assessment was confirmed. Overall, an improvement in clinical outcomes seems to be associated with a reduction in tendon thickness and tendon neovascularization. Clinicians should be aware that during the interpretation of the imaging outcomes, factors such as tendinopathy location, exercise modality performed, and a follow-up period should be considered.
Challenges of Rapid Plasma Reagin Interpretation in Syphilis Screening in Uganda: Variability in Nontreponemal Results Between Different Laboratories
Authors: Hamill Matthew M. , Mbazira Kimeze J. , Kiragga Agnes N. , Gaydos Charlotte A. , Jett-Goheen Mary , Parkes-Ratanshi Rosalind , Manabe Yukari C. , Nakku-Joloba Edith , Rompalo Anne 
Published: June 2018

Background
Syphilis is a cause of morbidity and mortality and is of particular concern in pregnancy in low-income countries because of the risks associated with maternal-fetal transmission. Ugandan national guidelines recommend a nontreponemal rapid plasma reagin (RPR) followed by treponemal testing for diagnosis of syphilis. The RPR test confirms a reactive specific treponemal test, or confirms serological “cure” with a 4-fold dilutional decrease; RPR is beset with technical and biological limitations, making accurate diagnosis and appropriate treatment problematic. The aim of this analysis was to compare performance of RPR testing in different laboratories.

Methods
Stored, freeze-thawed sera from 215 participants were additionally tested for RPR and dilutional titer in 2 different reference laboratories. Discrepant results were tested at a third reference laboratory which served as a tie-breaker. Equivalence in RPR titer was defined as within 2-fold or less. All patients with reactive rapid tests were treated as per Ugandan National Guidelines.

Results
Of 215 sera, 97 (45.1%) were RPR reactive in clinic laboratory A, 81 (37.7%) and 65 (30.2%) were RPR reactive in laboratories B and C, respectively. All reported positive in laboratory C were positive in laboratory B. Discrepant results were tested in laboratory D. χ2 Test was highly significant (P = <0.001) for difference between each dyad of laboratories (A and B, A and C, and B and C) RPR results. There were significant differences between RPR titers by paired t test and Wilcox rank test (P = <0.001); with up to a 3-fold difference between laboratories. Two one-sided test approach demonstrated nonequivalence. Agreement between laboratories B-D, and C-D: 48 (98.0%) of 49 and 34 (69.4%) of 49, respectively (P = <0.001). Laboratories B and D showed no significant difference and had equivalent RPR titers. Laboratories C and D had different titers (P = <0.001) and were not equivalent.

Conclusions
We found significant interlaboratory discrepant RPR results. A 3-fold difference in results is likely to be clinically significant and could result in undertreatment or overtreatment. These data demonstrate a key limitation of the RPR test and underline the urgent need for a more reproducible quantitative test than the current RPR for diagnosing and determining cure of syphilis.
Disclosure of Sexual Behavior Is Significantly Associated With Receiving a Panel of Health Care Services Recommended for Men Who Have Sex With Men
Authors: Singh Vidisha , Crosby Richard A. , Gratzer Beau , Gorbach Pamina M. , Markowitz Lauri E. , Meites Elissa 
Published: June 2018

Background
Men who have sex with men (MSM) are at high risk for sexually transmitted infections (STIs). National guidelines recommend that MSM receive HIV, syphilis, gonorrhea, and chlamydia screening at least annually, and hepatitis A and B and human papillomavirus vaccinations. We investigated associations between disclosure of male-male sexual orientation/behavior and receipt of this panel of services.

Methods
Gay, bisexual, and other MSM aged 18 through 26 years were enrolled from health clinics serving lesbian, gay, bisexual, and transgender communities in Los Angeles and Chicago during 2012 to 2014. Participants completed a computer-assisted self-interview regarding health care services, disclosure of sexual orientation/behavior, and recent HIV test results. Proportions receiving recommended care, prevalence ratios (PRs), and 95% confidence intervals (CIs) were calculated using SAS 9.4.

Results
Overall, 817 participants visited a provider within the past year. Of these, 525 (64.3%) had disclosed, and 749 (91.7%) felt they could disclose if important to health. In total, 548 (67.1%) received all STI screenings, and 74 (9.1%) received all vaccinations. Only 105 (12.9%) received any human papillomavirus vaccination. More disclosing participants received all recommended screenings (adjusted PR [aPR],1.4; 95% CI, 1.3–1.6) and all recommended care components (aPR, 2.2; 95% CI, 1.4–4.3) than nondisclosing participants.

Conclusions
Despite national recommendations, receipt of a complete panel of STI care services was low among young MSM. Vaccine uptake was lower than STI screening. However, most participants visited a health care provider in the past year and most disclosed, suggesting opportunities to improve services. Providers might encourage disclosure by improving sexual history taking and education, which could increase opportunities for MSM to receive recommended care.
Preventability of 28-Day Hospital Readmissions in General Internal Medicine Patients: A Retrospective Analysis at a Quaternary Hospital
Authors: Shuster Constantin , Hurlburt Andrew , Yung Terence , Wan Tony , Staples John A. , Tam Penny 
Published: June 2018

Background:
Unplanned hospital readmissions are associated with increased patient mortality and health care costs, yet only a fraction are likely to be preventable. This study's objective was to identify preventable hospital readmissions of general internal medicine patients, and their common causes.

Methods:
Patients who were discharged from the general internal medicine teaching service and readmitted to hospital within 28 days for 24 hours or more were recruited to the study; they were identified via the hospital electronic medical record system. Data were gathered via structured review of hospital charts/electronic medical records, along with standardized patient interviews. Unique to our study, a multidisciplinary panel of physicians, nurses, and hospital administrators adjudicated preventability and identified common causes of readmission.

Results:
Fifty-five hospital readmissions were identified; 53% were adjudicated to be preventable. There was no difference in any variable analyzed between preventable and nonpreventable readmissions. The most common causes of preventable readmissions were inadequate coordination of community services upon discharge, insufficient clinical postdischarge follow-up, and suboptimal end-of-life care.

Conclusion:
This study identified a higher proportion of preventable 28-day hospital readmissions when compared with prior research. Increased involvement of palliative care during initial hospitalization for appropriate conditions and improvements in care after discharge may reduce preventable hospital readmissions.
Creating and Sustaining Care Teams in Primary Care: Perspectives From Innovative Patient-Centered Medical Homes
Authors: Howard Jenna , Miller William L. , Willard-Grace Rachel , Burger Elizabeth Stewart , Kelleher Kelly J. , Nutting Paul A. , Hahn Karissa A. , Crabtree Benjamin F. 
Published: June 2018

Objective:
To learn from the experiences of innovative primary care practices that have successfully developed care teams.

Research Design:
A 2½-day working conference was convened with representatives from 10 innovative primary care practices, content experts, and researchers to discuss experiences of developing care teams. Qualitative data included observation notes, transcripts of conference sessions and interviews, and narrative summaries of innovations. Case summaries of practices and an analysis matrix were created to identify common themes.

Participants:
Ten practices known nationally for innovations in team-based care participated in the conference represented by 1 to 2 practice members.

Results:
Two domains emerged related to creating effective teams and funding them. Participants emphasized the importance of making practice values explicit and involving everyone in the change process, standardizing routine processes, and mitigating resistance. They also highlighted that team-based care adds comprehensiveness, not necessarily productivity. They, thus, highlighted the need for a long-term financial vision, including resourcefulness and alternate funding.

Conclusions:
Team-based care is possible and valuable in primary care. It is difficult to develop and sustain, however, and requires dedicated time and resources. The challenges these highly motivated practices described raise the question of feasibility for more average practices in the current funding environment.
Getting New Test Results to Patients
Authors: Graybill Sky , Kluesner Joseph , True Mark , Folaron Irene , Tate Joshua , Colburn Jeffrey , Beckman Darrick , Wardian Jana 
Published: June 2018

New diagnostic results are constantly arriving to outpatient practices. It is imperative to effectively communicate these results and their implications to patients.

Methods:
We surveyed 100 patients and our clinic personnel to assess opinions regarding methods of communication in common scenarios.

Results:
Response rate was 79% from patients and 75% from clinic personnel. Most patients thought letters were an appropriate way to receive normal test results (83%). They also felt medical-technician calls were appropriate for normal results (88%), medication dose changes (75%), or need for additional studies (71%). Respondents considered nurse calls acceptable in most scenarios except for new diagnoses of cancer or need for surgery; the consensus was that physicians should directly communicate to patients in these situations.

Conclusions:
Providers should take the time to discuss results with patients that lead to significant interventions, but employ support staff to disseminate information about normal results, medication dose changes, and need for additional diagnostic testing.