bluuebunny/crossref_metadata_2025_split huggingface dataset:
ALTERATIONS OF MACULAR BLOOD FLOW IN SUPERFICIAL AND DEEP CAPILLARY PLEXUSES IN THE FELLOW AND AFFECTED EYES OF PATIENTS WITH UNILATERAL IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Coppe Andrea M. , Lapucci Giuliana , Gilardi Marta , Petruzzella Francesca , Ripandelli Guido 
Published: July 2019

Purpose:
Previous research suggests that proliferation of the idiopathic epiretinal membrane (IERM) is related to microbreaks in the inner limiting membrane, which are caused by posterior vitreous detachment. In this study, we used optical coherence tomography angiography to determine whether a vascular defect in the inner retina is present before the mechanical damage caused by posterior vitreous detachment.

Methods:
For patients with unilateral IERM (N = 23), optical coherence tomography angiography with blood flow measurement was performed in both eyes at the superficial capillary plexuses (SCP) and deep capillary plexuses (DCP) with 6 mm × 6-mm scans and ETDRS grids centered on the fixation point. These values were then compared with 45 healthy control eyes (CEs).

Results:
The optical coherence tomography angiography data showed that blood flow was lower in the fellow eyes of IERM patients than in CEs when the whole enface macula (SCP: P = 0.031, DCP: P = 0.004) and extramacular area (SCP: P = 0.048, DCP: P = 0.026) were compared between groups. The blood flow was also lower in the affected eyes compared with CEs in both whole en face macula (SCP: P < 0.001, DCP: P < 0.001) and extramacular areas (SCP: P = 0.011, DCP: P < 0.001).

Conclusion:
Data from this study revealed that blood flow is significantly reduced in the fellow eyes of patients with unilateral IERM when compared with CEs. Overall, the data suggest that a vascular retinal defect could produce changes in the inner retina, preceding and influencing the formation of microbreaks occurring at the time of posterior vitreous detachment in the inner limiting membrane. Understanding the upstream mechanism of inner limiting membrane microbreaks may provide a therapeutic target aimed to ultimately prevent Müller cells, astrocyte, and fibroblast migration, which cause IERM proliferation.
CLOSTRIDIAL ENDOPHTHALMITIS: CLINICAL PRESENTATIONS, MANAGEMENT OUTCOMES, AND REVIEW OF LITERATURE
Authors: Dave Vivek P. , Joseph Joveeta , Pathengay Avinash , Pappuru Rajeev R. , Das Taraprasad 
Published: July 2019

Purpose:
To describe the clinical presentations, diagnosis and management outcomes of clostridial endophthalmitis, and a review of the previous literature.

Design:
Retrospective, interventional case series from January 2005 to March 2018 and a literature review.

Methods:
The study included seven eyes of seven patients with culture-proven Clostridium sp. endophthalmitis. Identification of Clostridium sp. was confirmed by the VITEK 2 system using the ANC card. When VITEK failed to identify the organism, MALDI-TOF was used. Data regarding demography, clinical presentations, interventions received, and final visual and anatomical outcomes were noted.

Results:The
mean age of the patients was 28.28 ± 22.35 years (median 21 years). By the etiology of infection, 5 (75%) eyes were post–open-globe injury, 1 (12.5%) was post-trabeculectomy, and 1 (12.5%) was postintravitreal injection. The mean follow-up was 9.71 ± 12.03 months, median 6 months. Two samples were positive for Clostridium perfringens, one each for C. subterminale, C. difficile, and C. tertium, and two were unidentified clostridial species. Favorable anatomical outcome was seen in 3/7 eyes (42.85%). Favorable functional outcome was seen in 2/7 eyes (28.57%). These were comparable with the outcomes of the pooled pre-existing literature. There was a trend toward better functional and anatomical outcomes and lesser evisceration/enucleation rates with vitrectomy instead of a vitreous tap, although not statistically significant. All cases showed susceptibility to empirically used intravitreal antibiotic vancomycin.

Conclusion:
Commonest setting of clostridial endophthalmitis is post–open-globe injury. Despite treatment with appropriate antibiotics, the visual and anatomical outcome is unsatisfactory because of high organism virulence. Early vitrectomy may allow for globe salvage and potential vision.
Descemet Membrane Endothelial Keratoplasty Under Failed Penetrating Keratoplasty Without Host Descemetorhexis for the Management of Secondary Graft Failure
Authors: Alió del Barrio Jorge L. , Montesel Andrea , Ho Vivian , Bhogal Maninder 
Published: July 2019

Purpose:
To evaluate the safety and efficacy of the treatment of secondary graft failure in penetrating keratoplasty (PK) by performing Descemet membrane endothelial keratoplasty (DMEK) without host descemetorhexis.

Methods:
This is a retrospective case series study of 8 eyes from 8 patients who underwent non host Descemet membrane stripping DMEK surgery under a previously failed PK. The DMEK graft diameter was either matched or 0.25 to 0.5 mm undersized in relation to the PK diameter. Six-month postoperative data are presented. Primary outcome measures were safety and anatomical success.

Results:
No intraoperative complications were registered. Postoperatively, 1 case developed a PK host–donor junction dehiscence in relation to a previous early suture removal, requiring PK resuturing and DMEK rebubbling. Only 1 additional case required DMEK rebubbling. No primary graft failure was detected, and all cases achieved full PK transparency within 2 weeks. Corrected distance visual acuity improved from a median of counting fingers (CF-0.2) to 0.57 (0.05–0.7). Median central corneal thickness improved from 650.5 (497–897) to 464 (372–597) μm. Median endothelial cell density was 1080 (581–2043) cells/mm2. Rebubbling rate (25%) was lower than that previously reported. All patients had extensive preoperative ocular comorbidity.

Conclusions:
DMEK under PK without host descemetorhexis is a feasible surgical alternative for the treatment of graft failure after PK. It is associated with equivalent levels of efficacy and safety compared with Descemet membrane stripping DMEK techniques but simplifies the surgical procedure and avoids potential intraoperative complications associated with Descemet stripping. Further studies with a larger sample and a longer follow-up are necessary to confirm our preliminary outcomes.
A Simple 60-Second Swelling Technique for More Consistent Ultrathin DSAEK Graft Preparation
Authors: Farbman Neil H. , Y. Li Jennifer , Ling Jennifer , Conwell Chris , Ramirez Tiffany 
Published: July 2019

Purpose:
The purpose of this study is to describe a simple but novel 60-second swelling technique for ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation. In addition, we aim to demonstrate the effectiveness of this technique in obtaining thinner DSAEK grafts more consistently without compromising graft quality.

Methods:
We performed a retrospective case–control study comparing standard DSAEK preparation using an ML7 Microkeratome Donor Cornea System (Med-Logics Inc, Athens, TX) with an additional 60 seconds of stromal swelling with a balanced salt solution after the removal of the epithelium but before the microkeratome pass. Thirty cases using this novel swelling technique were compared with controls matched by age, sex, and precut corneal thickness. Donor characteristics and both precut and postcut graft characteristics were analyzed.

Results:
DSAEK grafts prepared with our simple swelling method were approximately 13 μm thinner on average than those prepared with our conventional ultrathin DSAEK preparation technique (P = 0.001). The frequency of grafts less than 100 μm was much greater with swelling (93.3% vs. 63.3% with conventional technique, P = 0.0052). There were no significant differences in postcut cell counts or decrease in cell counts between the groups.

Conclusions:
A simple 60-second swelling technique can yield significantly thinner DSAEK tissue in a more consistent range without a significant impact on the endothelial cell count.
Management of Orbital Complications of Acute Rhinosinusitis in Pediatric Patients
Authors: Trivić Aleksandar , Cevik Muge , Folić Miljan , Krejovic-Trivić Sanja , Rubino Salvatore , Micić Jelena , Stevanović Goran , Milovanović Jovica , Jotić Ana , Barać Aleksandra 
Published: July 2019

Background:
The major clinical dilemma managing acute rhinosinusitis (ARS) in pediatric population is distinguishing uncomplicated rhinosinusitis from a complicated bacterial ARS and orbital complications, the latter requiring antimicrobials and surgical intervention. However, factors associated with severe orbital complications and the optimum management strategy remains controversial. The objectives of this study were to characterize the clinical outcomes of children with orbital complications of ARS and to identify risk factors associated with disease severity.

Methods:
This retrospective cohort analysis evaluated the clinical outcomes of 61 children admitted for orbital complications between January 1, 2002 and December 31, 2017. Descriptive statistics were performed to examine the demographics and clinical findings. We compared groups using Mann-Whitney U test for continuous variables and χ2 for categorical variables.

Results:
Although two-thirds of children had received prehospital antibiotics, half of the cohort presented with post-septal orbital complications. While 83% of isolates obtained from the same patients were susceptible to the prehospital antibiotics given, the majority of those who received prehospital antibiotics nevertheless required surgical intervention. We observed significant association between the age of presentation and disease severity. Children >5 years of age presented with more severe orbital complications despite prehospital antibiotics and were more likely to require surgical intervention (
P
< 0.001).

Conclusions:
In this study, stage II/III orbital complications at presentation and older age were the most important determinants of medical treatment failure. Early referral to eye, nose and throat (ENT) should be considered for children >5 years with ARS due to worse orbital complications despite prehospital antibiotics.
An Interprofessional Geriatric Experiential Learning Experience: Its Impact on Physical and Occupational Therapist Students
Authors: Dockter Mary , Lundeen Heather , Parker Michael G. 
Published: July 2019

Introduction.
Accreditation standards for physical therapist (PT) education require the inclusion of interprofessional education (IPE) in order to prepare health care professionals to work in collaborative environments. Additional guidelines document the need to educate PT students in the care of older adults; however, a gap in readiness for entry-level practice exists. Therefore, there were three purposes of this study that were to 1) examine the impact of an IPE experiential learning project on PT and occupational therapist (OT) students' knowledge and attitudes toward each other's professions, 2) examine students' comfort, value, and ability to work with another profession, and 3) assess the project's impact on PT and OT students' attitudes toward older adults.

Methods.
Physical therapist and OT student groups, under the supervision of faculty, evaluated a community dwelling older adult over 3 visits and developed a comprehensive wellness program, which was provided by the students on visit 4. Students completed 2 surveys: the Interprofessional Socialization and Valuing Scale (ISVS) and Kogan's Attitude Towards Old People Scale (KAOP), prior to and at the conclusion of the project.

Results.
The Wilcoxon’s signed rank test showed significant increases after the completion of the IPE project in the total ISVS (P < .001) median scale scores for all students and on the subscales regarding the ability (P < .001), value (P < .001), and comfort (P < .001) in working with others. Significant increases were observed for all students on the total KAOP scale scores (P < .001) and the positive subscale scores (P < .001); significant decreases were observed in the negative subscale scores (P < .001).

Discussion and Conclusion.
This study demonstrates a successful IPE experiential learning project used to enhance PT and OT students' abilities, values, and comfort with collaborative practice and enhancement of PT and OT student groups' attitudes toward older adults.
Idiopathic anaphylaxis: What you do not know may hurt you
Authors: Chan Suzanne , John Rita Marie 
Published: July 2019

ABSTRACT
Idiopathic anaphylaxis (IA), like immunologic and nonimmunologic anaphylaxis, is a life-threatening, sometimes fatal allergic disease. Although the priority is immediate recognition and initiation of treatment, long-term care planning is important to help reduce anxiety and promote healthy growth and development. Learning to recognize, manage, and stabilize the child is an essential part of improving the family dynamics. Despite advancements in the management of anaphylaxis, research has shown a need for continued patient education and training to improve timely recognition and treatment. This article focuses on elucidating the clinical presentation, theories of pathogenesis, and diagnosis, treatment, and management of IA.
Readiness for the epidemic: The adult nonalcoholic fatty liver disease toolkit for primary care nurse practitioners
Authors: Casler Kelly , Trees Karen , Bosak Kelly 
Published: July 2019

ABSTRACT

Background and purpose:
Nonalcoholic fatty liver disease (NAFLD) prevalence has reached epidemic proportions, and the severe form, nonalcoholic steatohepatitis, can result in cirrhosis and liver failure. The growing prevalence requires primary care (PC) providers to be adept at recognition and management; however, they experience significant knowledge gaps that can result in delayed access to interventions that could improve outcomes. This study's aim was to develop and evaluate a toolkit to improve knowledge gaps and support evidence-based practice (EBP) among PC nurse practitioners caring for patients with NAFLD in a midwestern state.

Methods and intervention:
The Adult NAFLD Toolkit was designed using the Knowledge to Action framework and guidelines from the Agency for Healthcare Research and Quality. The success of the toolkit was evaluated by administering the NAFLD survey for general practitioners in a pre–post evaluation design.

Results:
Pre–post survey scores (N = 11) were compared for statistically significant change using the Wilcoxon signed rank test for matched pairs and showed improvement in overall knowledge (p = .011), perceived preparedness to care for NAFLD (p = .007), intention to recommend weight loss for management (p = .008), and intention to use the NAFLD fibrosis score for patient monitoring (p = .008).

Conclusions:
The results of this pilot study demonstrate successful implementation and positive outcomes of an EBP toolkit and support its expanded use. Continued evaluation on a larger scale is needed. Health care providers can use the process described in this article to develop and implement toolkits to support EBP of other PC issues.
An integrative review of system-level factors influencing dementia detection in primary care
Authors: Romano Raymond R. , Carter Michael A. , Anderson Alison R. , Monroe Todd B. 
Published: July 2019

ABSTRACT

Background and purpose:
The incidence of Alzheimer disease (AD) is increasing in the United States, yet more than half of the people with AD are diagnosed late in the course of the disease. Most are identified outside primary care. New approaches to prevention and treatment mean that early detection of AD may improve the quality of life of those affected by the disease. Nurse practitioners (NPs) have an important role in increasing early diagnosis of AD.
The purpose of this systematic literature review is to identify health care system factors that contribute to missed or delayed diagnosis of dementia by primary care providers.

Methods:
Articles were identified through a systematic electronic search of the following databases: MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO.

Conclusions and implications for practice:
Results indicate considerable variation in the diagnostic accuracy of dementia by primary care providers. Missed or underdiagnosis of dementia results from organizational, provider, and patient factors. New treatments are under investigation that may slow the progression of AD much better than current therapy, emphasizing the need to improve early detection by clinicians, especially primary care NPs.
HIV, Tuberculosis, and Otogenic Intracranial Sepsis: A Devastating Disease With a Subtle Presentation
Authors: Yakobi Akhona , Porterfield James Zachary , Toman Julia , Spock Todd , Kapil Narain , de Meyer Jenine , Kejner Alex , Rea Peter , Gleeson Michael , Enicker Basil , Michaelides Elias , Saman Yougan 
Published: July 2019

Objectives:
To undertake a large-scale review of otogenic intracranial sepsis in an area of highly prevalent HIV and tuberculosis (TB) to re-examine and inform early diagnosis and treatment efforts.

Methods:
Seventy-seven consecutive cases of otogenic intracranial sepsis in KwaZulu-Natal, South Africa were reviewed for demographics, presentation, imaging, HIV status, culture results, and outcomes.

Results:
The most common intracranial complications were intracranial abscess (46.8%), hydrocephalus (31.2%), subdural empyema (28.6%), and epidural empyema (26.0%). Ear discharge (87.0%), postauricular abscess (29.9%), and hearing loss (29.9%) were notable presenting symptoms. Overall mortality was 15.6%. Of the 45.5% of patients with HIV testing, 54.2% were HIV+, Mortality among HIV+ patients was 15.8% but only 6.3% in HIV− patients (p = 0.61, OR = 2.8). Eight patients (10.4%) had culture or histological evidence of TB infection.

Conclusions:
Otogenic intracranial complications continue to present late and are associated with significant mortality and morbidity, despite advances in diagnostic and treatment modalities. This study represents one of the largest case-series in the literature, and the first to specifically evaluate the effects of HIV and TB infection.
Patient presentation and severity of illness varied; however, a majority of patients presented with ear discharge and no focal neurological signs. An effect size for higher mortality among HIV+ patients compared with HIV− patients was noted but was not significant. Tuberculosis infection was prevalent compared with previous studies.
This study reinforces the need for enhanced screening and early treatment of ear disease to minimize associated mortality and morbidity, particularly in immunocompromised patients.
Hypotympanic Sound Baffle for Amelioration of Pulsatile Tinnitus due to Carotid and Jugular Bulb Dehiscence
Authors: Liu George S. , Blevins Nikolas H. , Vaisbuch Yona 
Published: July 2019

Objective:
To share our experience with treating pulsatile tinnitus by insulating a dehiscent carotid artery with a hypotympanic sound baffle, and compare outcomes with a similar resurfacing approach for jugular bulb wall anomalies.

Study Design:
Retrospective case series.

Setting:
Tertiary academic medical center.

Patients:
Adult patients with troublesome pulsatile tinnitus with radiologic evidence of carotid artery dehiscence or jugular bulb wall anomaly within the temporal bone.

Intervention:
Hypotympanic exposure of vessel followed by resurfacing using hydroxyapatite cement (carotid dehiscence) or autologous tissue (jugular bulb wall anomalies).

Main Outcomes Measures:
Alleviation or reduction of pulsatile tinnitus.

Results:
Two patients presented with unilateral, debilitating pulsatile tinnitus and history and imaging consistent with carotid dehiscence and underwent hypotympanic resurfacing with hydroxyapatite cement. Both had considerable initial improvement of tinnitus, and 40% resolution of tinnitus with improved quality of life at an average follow-up of 13.5 months. Two patients with jugular bulb dehiscence/diverticulum treated by resurfacing had complete elimination of symptoms at an average follow up of 17.3 months. There were no major adverse outcomes (permanent hearing loss, vascular injury, or intracranial hypertension).

Conclusion:
Creation of a hypotympanic sound baffle offers promise as a means of reducing pulsatile tinnitus emanating from a dehiscent carotid artery transmitted to the tympanum, with substantial improvement in reported functional ability. Treatment of venous etiologies of pulsatile tinnitus with similar techniques demonstrates higher success rates, which may be attributable to incomplete resurfacing of carotid artery dehiscence along its extent towards the petrous apex due to safety concerns.
The Efficacy of a Home Treatment Program Combined With Office-Based Canalith Repositioning Procedure for Benign Paroxysmal Positional Vertigo—A Randomized Controlled Trial
Authors: Piromchai Patorn , Eamudomkarn Nuntakarn , Srirompotong Somchai , Ratanaanekchai Teeraporn , Yimtae Kwanchanok 
Published: July 2019

Objectives:
To compare the efficacy of the home treatment program combined with office-based canalith repositioning procedure (CRP) versus office-based CRP alone for benign paroxysmal positional vertigo (BPPV).

Study Design:
Randomized controlled trial.

Method:
One hundred six patients with BPPV were randomly assigned to the home treatment program combined with office-based CRP group and the office-based CRP only group. The canalith repositioning procedure was performed in all patients at an out-patient clinic. The patients in the home treatment group were additionally instructed to do the exercise tailored for their affected canal at home every day. The presence of nystagmus was recorded. The symptom of vertigo and its impact on daily life were evaluated by the Dizziness Handicap Inventory (DHI) and a visual analog scale (VAS). All outcomes were evaluated at 1, 2, and 4 weeks after the initial treatment. A cure was defined as a patient having no nystagmus on the appointment date.

Results:
The success rate of the home treatment program combined with office-based CRP group and the office-based CRP only group were 100 and 91.67%, respectively (p = 0.043). The nystagmus duration, latency, DHI, and VAS scores decreased significantly from baseline at 1, 2, and 4 weeks for both groups (p < 0.001). No significant side effects were noted in either of the groups.

Conclusion:
The office-based CRP plus home treatment program was more effective than the CRP only group for BPPV. Both groups were effective in reducing the symptom of vertigo and its impact on daily life.

Trial Registration:
Clinicaltrials.in.th/TCTR20160810001.