bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Analysis Framework for Electronic Health Record Systems
Authors: Berry D. , Bisbal J. 
Published: November 2009

Summary
Background: The timely provision of complete and up-to-date patient data to clinicians has for decades been one of the most pressing objectives to be fulfilled by information technology in the healthcare domain. The so-called electronic health record (EHR), which provides a unified view of all relevant clinical data, has received much attention in this context from both research and industry. This situation has given rise to a large number of research projects and commercial products that aim to address this challenge. Different projects and initiatives have attempted to address this challenge from various points of view, which are not easily comparable.
Objectives: This paper aims to clarify the challenges, concepts, and approaches involved, which is essential in order to consistently compare existing solutions and objectively assess progress in the field.
Methods: This is achieved by two different means. Firstly, the paper will identify the most significant issues that differentiate the points of view and intended scope of existing approaches. As a result, a framework for analysis of EHR systems will be produced. Secondly, the most representative EHR-related projects and initiatives will be described and compared within the context of this framework.
Results: The main result of the present paper is an analysis framework for EHR systems. This is intended as an initial step towards an attempt to structure research on this field, clearly lacking sound principles to evaluate and compare results, and ultimately focusing its efforts and being able to objectively evaluate scientific progress.
Conclusions: Evaluation and comparison of results in medical informatics, and specifically EHR systems, must address technical and nontechnical aspects. It is challenging to condensate in a single framework all potential views of such a field, and any chosen approach is bound to have its limitations. That being said, any well structured comparison approach, such as the framework presented here, is better than no comparison framework at all, as has been the current situation to date. This paper has presented the first attempt known to the authors to define such a framework.
Semantic Interoperability in Czech Healthcare Environment Supported by HL7 Version 3
Authors: Hanzlícek P. , Precková P. , Ríha A. , Dioszegi M. , Seidl L. , Zvárová J. , Nagy M. 
Published: November 2009

Summary
Objectives: The data interchange in the Czech healthcare environment is mostly based on national standards. This paper describes a utilization of international standards and nomenclatures for building a pilot semantic interoperability platform (SIP) that would serve to exchange information among electronic health record systems (EHR-Ss) in Czech healthcare. The work was performed by the national research project of the “Information Society” program.
Methods: At the beginning of the project a set of requirements the SIP should meet was formulated. Several communication standards (open EHR, HL7 v3, DICOM) were analyzed and HL7 v3 was selected to exchange health records in our solution. Two systems were included in our pilot environment: WinMedicalc 2000 and ADAMEKj EHR.
Results: HL7-based local information models were created to describe the information content of both systems. The concepts from our original information models were mapped to coding systems supported by HL7 (LOINC, SNOMED CT and ICD-10) and the data exchange via HL7 v3 messages was implemented and tested by querying patient administration data. As a gateway between local EHR systems and the HL7 message-based infrastructure, a configurable HL7 Broker was developed.
Conclusions: A nationwide implementation of a full-scale SIP based on HL7 v3 would include adopting and translating appropriate international coding systems and nomenclatures, and developing implementation guidelines facilitating the migration from national standards to international ones. Our pilot study showed that our approach is feasible but it would demand a huge effort to fully integrate the Czech healthcare system into the European e-health context.
Comparison of Optic Disc Topography in Non-Glaucomatous Eyes of Children with Juvenile Diabetes Mellitus and Normal Children
Authors: Elgin Ufuk , Cankaya Bülent , Simsek Tulay , Batman Aygen 
Published: November 2009

Purpose:
To compare the optic disc topography parameters of children with juvenile diabetes mellitus and normal children using the Heidelberg Retinal Tomograph (HRT III) (Heidelberg Engineering, Heidelberg, Germany).

Methods:

The topographic optic disc parameters (cup volume, cup area, rim volume, rim area, disc area, mean cup-to-disc ratio, and mean cup depth) of 28 non-glaucomatous eyes of 28 children with type 1 diabetes mellitus and 28 eyes of 28 age-matched healthy children were compared using the nonparametric Mann–Whitney
U
test.

Results:

No statistically significant differences were found between cup volume (
P
= .782), cup area (
P
= .878), rim volume (
P
= .853), disc area (
P
= .452), mean cup-to-disc ratio (
P
= .852), and mean cup depth (
P
= .711) of eyes of cases with diabetes mellitus and normal subjects.

Conclusion:
This result suggests that non-glaucomatous eyes of children with type 1 diabetes mellitus and healthy subjects have similar topographic optic disc characteristics.
Anterior Transposition of the Inferior Oblique Muscle in the Treatment of Unilateral Superior Oblique Palsy
Authors: Keskinbora Kadircan H. 
Published: November 2009

Purpose:
To determine whether unilateral inferior oblique anterior transposition alone could be an effective procedure for treating superior oblique palsy with inferior oblique overaction.

Methods:
The records of 38 patients who underwent unilateral inferior oblique anterior transposition for unilateral superior oblique palsy with inferior oblique overaction were evaluated. A comprehensive ocular examination including best-corrected visual acuity measurements, ductions, versions, and deviations at near and distance, head tilt test, abnormal head position, dilated fundus examination, and Titmus test was performed prior to and after surgery.

Results:
The mean patient age was 29 years, the mean follow-up was 32 months, the mean preoperative hypertropia in primary position was 14.29 ± 7.7 prism diopters (PD), and the mean inferior oblique overaction was 3.63 ± 0.67. Anterior transposition of the inferior oblique muscle was effective across a wide range of preoperative primary position hypertropia (4 to 35 PD) with a mean reduction in postoperative hypertropia of 12 PD. Inferior oblique overaction was reduced in all patients. No patient demonstrated postoperative primary position hypotropia. Surgery improved stereoacuity nearly two units using the Titmus stereoacuity scale.

Conclusion:
Anterior transposition of the inferior oblique muscle is effective in correcting inferior oblique overaction and primary position hypertropia in the treatment of unilateral superior oblique palsy.
Atropine Treatment of Amblyopia: Is a Swap in Fixation Necessary?
Authors: Leone Josephine , Georgievski Zoran , Koklanis Konstandina 
Published: November 2009

Purpose:
To investigate the impact of fixation on vision outcomes in patients with amblyopia undergoing atropine treatment and the validity of the “cyclo-swap test” (CST) as a method of predicting atropine efficacy.

Method:
Sixteen children with amblyopia were included. The initial examination included a vision assessment and CST, in which fixation was assessed at 1/3 m, 6 m, and at distances less than 1/3 m. Children were treated for 10 weeks and reviewed at 5-week intervals with cessation of atropine 4 days prior. Vision and fixation were assessed at the follow-up visits. Children demonstrating no fixation swap initially were additionally observed after 1 week of atropine treatment under maximum cycloplegia.

Results:
Eight children demonstrated a fixation swap (FS group) to the amblyopic eye during the CST at either 1/3 or 6 m, and 8 demonstrated no fixation swap (NFS group). By the end of the 10-week treatment period, both groups demonstrated a mean visual acuity improvement of between 2 and 3 lines (FS = 0.22 log units; NFS = 0.27 log units). Six of the 8 children in the NFS group demonstrated improvement in vision, all of whom also demonstrated a fixation swap at some stage.

Conclusion:
Vision improvement in patients using atropine is likely to be attributable to a fixation swap that occurs during the treatment phase. The CST performed at 1/3 and 6 m has little value in predicting improvements in vision; however, when performed at distances of less than 1/3 m, it may provide valuable clinical information about atropine efficacy.
Comparative Study of Unilateral and Bilateral Surgery in Moderate Exotropia
Authors: Menon Vimla , Singla M. Ashok , Saxena Rohit , Phulijele Swati 
Published: November 2009

Purpose:
To evaluate the surgical outcome of unilateral versus bilateral rectus recession for the correction of moderate exotropia.

Methods:
This was a prospective study of 20 consecutive cases of intermittent exotropia ranging from 15 to 25 prism diopters (PD) randomized into two groups and operated on by a single surgeon. In the unilateral group, a recession of 7.0 to 7.5 and 8.0 to 8.5 was done for 15 to 20 PD and 21 to 25 PD of exotropia, respectively. In the bilateral group, a recession of 5.0 to 5.5 and 6.0 to 6.5 mm was done for 15 to 20 PD and 21 to 25 PD of exotropia, respectively. Surgical results of both groups were compared 3 months postoperatively.

Results:
The mean age of patients was 8.5 years in the unilateral group and 11 years in the bilateral group. The mean preoperative exotropia was 21.0 ± 3.77 PD in the unilateral group and 22.9 ± 3.03 PD in the bilateral group. The mean postoperative deviation at 3 months was 5.5 ± 4.03 PD in the unilateral group and 2.8 ± 3.91 PD in the bilateral group. Consecutive persistent small-angle esotropia was seen in one patient in the bilateral group. There was no significant incomitance at 3 months in either group.

Conclusion:
Unilateral and bilateral rectus recession are equally effective in mild to moderate exotropia.
Incidence of Retinopathy of Prematurity in a Neonatal Intensive Care Unit in Nepal
Authors: Shrestha Jyoti Baba , Bajimaya Sanyam , Sharma Anand , Shresthal Jeevan , Karmacharya Purna 
Published: November 2009

Purpose:
To determine the incidence of retinopathy of prematurity (ROP) in low birth weight premature infants admitted to the neonatal intensive care unit of a children’s hospital in Kathmandu.

Methods:
A hospital-based prospective study was performed in neonates with a gestational age of less than 36 weeks or birth weight of less than 2,000 g during 1 year. Ophthalmologic examination was performed 2 to 4 weeks after birth and patients were observed until the retinal vascularization was complete. ROP was classified using the revised International Classification of Retinopathy of Prematurity.

Results:

A total of 78 infants fulfilled the screening criteria. ROP was detected in 29.5% (n = 23) of neonates. Thirteen infants (16.7%) had stage 1 disease and 5 each (6.4%) were found to have stage 2 and stage 3 ROP. Threshold disease was present in 3.8% (n = 3) of infants with a gestational age of less than 32 weeks and birth weight less than 1,500 g who required laser treatment per Early Treatment of ROP criteria. Low birth weight (
P
< .01) and low gestational age (
P
< .01) were significantly associated with the incidence of ROP.

Conclusion:
Prematurity and low birth weight were found to be major risk factors for ROP. ROP screening should be performed in such infants for early detection because its incidence is likely to increase as more premature infants survive with improved neonatal care.
Pentacam Scheimpflug Evaluation of Corneal Volume After LASIK
Authors: Gadelha P. Diniz Camila M. , Hazarbassanov Rossen M. , Yamazaki Ester , Murata Celina , Mallmann Felipe , Campos Mauro 
Published: November 2009

Purpose:
To assess the change in corneal volume and laser ablation volume over time after LASIK using a rotating Scheimpflug camera.

Methods:
Twenty-six patients (49 eyes) underwent LASIK. Pentacam Scheimpflug measurements were performed pre- and postoperatively at 1, 3, 7, 15, and 30 days. Central corneal thickness, total corneal volume (10-mm diameter), and partial corneal volumes (3, 5, and 7 mm) based on the apex of the cornea, were measured. Main outcome measures were differences between pre- and postoperative volume measurements of total and partial corneal regions, volume changes over time postoperatively, and comparison between laser ablation volume and corneal volume.

Results:

A strong linear relationship was noted between spherical equivalent refraction and laser ablation volume (r=−0.931,
P
<.0001). Furthermore, 30 days after LASIK, a strong linear relationship was noted between planned thickness and achieved thickness (r=0.9457,
P
<.001). Corneal volumes for 3-, 5-, and 7-mm diameter regions significantly decreased over time postoperatively (one-way analysis of variance,
P
<.05).

Conclusions:
Alterations in corneal volume correlated with laser ablation volume when the diameter of the region considered was 3, 5, or 7 mm from the corneal apex.
Sequential in Vivo Confocal Microscopy Study of Corneal Wound Healing After Cross-Linking in Patients with Keratoconus
Authors: Croxatto J. Oscar , Tytiun Adriana E. , Argento Carlos J. 
Published: November 2009

Purpose:
To evaluate the short- and long-term sequential histological changes of the cornea in vivo after corneal collagen cross-linking (CXL) in patients with keratoconus.

Methods:
Eighteen patients with keratoconus (Amsler-Krumeich classification: stages I, II, and III) underwent CXL with riboflavin/ultraviolet A (UVA) in one eye. The corneas were examined preoperatively and within 5 hours, 7 and 14 days, and 1, 3, 6, 9, 12, 18, 24, and 36 months after the procedure using in vivo confocal microscopy.

Results:
Early changes included edema, superficial nerve loss, cellular modifications, and isolated endothelial damage. At intermediate time points, there was nerve fiber regeneration, increased reflectivity of the extracellular matrix, enlarged keratocytes and extracellular deposits, and remodeling of the endothelial layer (two eyes). At later time points, loss of keratocytes and remodeling of the extracellular deposits were noted.

Conclusions:
Although the cornea has no significant tissue modifications clinically after CXL, this study has shown that corneal wounding by riboflavin/UVA collagen CXL induces cellular wound-healing mechanisms and alters the normal structure and cellularity of the cornea for up to 36 months.
Intraoperative Videokeratography in Penetrating Keratoplasty and Excimer Laser-Assisted Lamellar Keratoplasty for Keratoconus
Authors: Spadea Leopoldo , Fiasca Arianna , Federici Simone 
Published: November 2009

Purpose:
To evaluate the usefulness of intraoperative computerized corneal topographic data in excimer laser-assisted lamellar keratoplasty (ELLK) and penetrating keratoplasty (PK).

Methods:
Prospective, comparative, interventional case series. Intra- and postoperative videokeratography (Keratron Scout) evaluation was performed on 30 eyes of 30 consecutive patients affected by keratoconus (16 men and 14 women; mean age 32.63±8.02 years) submitted to ELLK (15 eyes) using 16 interrupted 10-0 nylon stitches or to PK (15 eyes) using a 12-bite 10-0 nylon double-running continuous suture.

Results:
In the ELLK group, the mean intraoperative keratometric astigmatism was 12.06±4.86 diopters (D), which changed to 5.19±2.51 D after topography-guided intraoperative suture adjustment. In the PK group, intraoperative keratometric astigmatism was 10.18±3.88 D, which changed to 3.49±0.41 D. After 24 months (sutures out), the mean videokeratographic keratometric astigmatism was 3.35±1.96 D in the ELLK group and 3.37±0.92 D in the PK group. The Alpins method of vector analysis showed some significant changes especially in the ELLK group.

Conclusions:
In keratoplasty surgery, videokeratography is useful for suture adjustment. In the PK group, using a double-running suture technique, the postoperative astigmatism (after all sutures were removed) was similar to the astigmatism measured intraoperatively by videokeratography.
Prophylactic Treatment of Age-Related Macular Degeneration Report Number 2: 810-Nanometer Laser to Eyes With Drusen: Bilaterally Eligible Patients
Authors: Friberg Thomas R. , Brennen Peter M. , Freeman William R. , Musch David C. ,   the PTAMD Study Group
Published: November 2009

Background and Objective:
To determine the prophylactic and therapeutic value of a single subthreshold 810-nanometer laser treatment in patients with high risk drusen as a manifestation of dry age-related macular degeneration in both eyes.

Patients and Methods:
The Prophylactic Treatment of Age-related Macular Degeneration study enrolled 1,278 eyes of 639 participants who were 50 years or older with at least 5 drusen 63 µm or more in diameter in each eye. Treatment consisted of the placement of an annular grid of 48 extrafoveal, subthreshold 810-nm diode laser applications centered at but sparing the foveola in one eye of each participant, with the fellow eye serving as a control. Development of choroidal neovascularization and change in best-corrected visual acuity were compared between treated and untreated eyes.

Results:

Subthreshold laser treatment did not decrease the incidence of choroidal neovascularization in treated versus untreated eyes. A modest visual acuity benefit in treated eyes was found at 24 months (1.5 letter difference;
P
= .04) and in the treated eyes of participants with a baseline visual acuity between 20/32 and 20/63 (4.0 letter difference;
P
= .0034). However, this treatment effect was not sustained at 3 years.

Conclusion:
A single subthreshold 810-nanometer laser treatment to eyes of participants with bilateral high risk drusen is not an effective prophylactic strategy against choroidal neovascularization.

[Ophthalmic Surg Lasers Imaging 2009;40:530–538.]
Surgical Outcome of Scleral Buckling Compared With Scleral Buckling With Vitrectomy for Treatment of Macula-off Retinal Detachment
Authors: Dayani Pouya N. , Blinder Kevin J. , Shah Gaurav K. , Holekamp Nancy M. , Joseph Daniel P. , Wilson Bradley , Thomas Matthew A. , Grand M. Gilbert 
Published: November 2009

Background and Objective:
To compare the surgical outcome of scleral buckling (group 1) versus scleral buckling with pars plana vitrectomy (group 2) for the repair of macula-off rhegmatogenous retinal detachment without proliferative vitreoretinopathy.

Patients and Methods:
A retrospective chart review was performed.

Results:

Eighty-three patients were identified in group 1 and 63 patients in group 2. Presenting visual acuity was 4/200 in group 1 and 3/200 in group 2. Median duration of detachment prior to surgery was 5 days in group 1 and 6 days in group 2. There was no statistical difference in best-corrected (
P
= .59) or most recent (
P
= .75) visual acuity between groups. Median best-corrected visual acuity was 20/30 and median most recent visual acuity was 20/40 in both groups. Significantly more additional procedures were performed in group 1 than in group 2 (21.7% vs 7.9%, respectively;
P
= .024). The final reattachment rate was 96.4% in group 1 and 98.4% in group 2. Proliferative vitreoretinopathy developed in 15.7% of patients in group 1 and 4.8% in group 2 (
P
= .037).

Conclusion:
Visual outcome of scleral buckling is similar to scleral buckling with pars plana vitrectomy for the treatment of macula-off rhegmatogenous retinal detachment in patients without proliferative vitreoretinopathy. Patients undergoing scleral buckling only are at an increased risk of developing proliferative vitreoretinopathy and requiring additional procedures.

[Ophthalmic Surg Lasers Imaging 2009;40:539–547.]
Spectral Domain Optical Coherence Tomography in Diabetic Macular Edema
Authors: Pournaras Jean-Antoine C. , Erginay Ali , Lazrak Zineb , Gaudric Alain , Massin Pascale 
Published: November 2009

Background and Objective:
To compare the images obtained from Stratus time domain optical coherence tomography (OCT) (Carl Zeiss Meditec, Inc., Dublin, CA) and Cirrus spectral domain OCT (Cirrus HD-OCT 4000 model; Carl Zeiss Meditec, Inc.) in patients with diabetic macular edema.

Patients and Methods:
This observational retrospective case series was created using the charts of 20 patients with diabetes mellitus diagnosed as having diabetic macular edema. All patients had both Stratus and Cirrus OCT imaging completed on the same day. Qualitative comparisons were performed by two experienced clinicians in an unmasked fashion. Central macular thickness and central foveal thickness were recorded.

Results:
Thirty-six eyes of 20 patients with diabetes mellitus were analyzed. Features such as cystoid spaces, highly reflective lesions, vitreoretinal interface, serous retinal detachment, and photoreceptors inner/outer segments were more often detected with the Cirrus OCT than with the Stratus OCT. Considering the same reference lines for evaluation of central macular thickness and central foveal thickness, the same values were obtained with both devices.

Conclusion:
Cirrus OCT enables easier observation of normal structures and retinal abnormalities than the Status OCT. Furthermore, lesions may be accurately identified and quantified by the Cirrus OCT.

[Ophthalmic Surg Lasers Imaging 2009;40:548–553.]
Photodynamic Therapy With and Without Adjunctive Intravitreal Triamcinolone Acetonide: A Retrospective Comparative Study
Authors: Chan Annie , Blumenkranz Mark S. , Wu Kathy H. C. , Wang Gloria , Berker Nilufer , Parast Layla M. , Sanislo Steven R. 
Published: November 2009

Background and Objective:
To compare photodynamic therapy (PDT) with and without adjunctive intravitreal triamcinolone acetonide (IVTA) in the treatment of choroidal neovascularization secondary to age-related macular degeneration.

Patients and Methods:
Sixty-six eyes received PDT with IVTA and 73 eyes received PDT only. Outcome measures included changes in visual acuity and greatest linear dimension (GLD), the presence of angiographic leakage, the re-treatment rate, and adverse events.

Results:

Patients treated with PDT with IVTA had reduced mean GLD compared to patients treated with PDT only at all study time points (3 [
P
= .0049], 6 [
P
= .003], and 12 [
P
= .05] months). Forty-four percent of patients in the PDT with IVTA group and 22% of patients in the PDT only group achieved angiographic closure at 3 months (
P
= .027). There were no significant differences in the final visual acuity outcome or the re-treatment rate between the two groups.

Conclusion:
PDT with IVTA therapy has a favorable outcome on GLD. There is a modest improvement in visual acuity with PDT with IVTA therapy, which diminishes over time.

[Ophthalmic Surg Lasers Imaging 2009;40:561–569.]