bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current Trends in Scleral Lens Prescription, Management, and Evaluation
Authors: Schornack Muriel M. , Nau Cherie B. , Harthan Jennifer , Shorter Ellen , Nau Amy , Fogt Jenny 
Published: January 2023

Objectives:
To report current trends in scleral contact lens prescription and management, including lens designs prescribed, care products recommended, and procedures performed during routine scleral lens (SL) evaluation.

Methods:
An online survey was designed by the Scleral Lenses in Current Ophthalmic Practice Evaluation study team and administered to eye care practitioners attending a specialty contact lens meeting. The survey was available from November 8, 2019, through March 31, 2020. Participants' demographic data were collected, along with information on lens diameters, landing zone (LZ) designs, recommended care products, and components of routine SL evaluation.

Results:
In total, 715 participants responded to at least one of the survey items of interest. Most lenses prescribed (63%) were 16 mm or more in diameter. Lenses with toric LZs were the most frequently prescribed (48%), followed by spherical (40%), quadrant-specific (8%), and impression-based or image-based designs (3%). Most participants (61%) recommended hydrogen peroxide products for lens care. Nonpreserved saline in a single-use vial was most frequently recommended to fill the bowl of the lens before application. Intraocular pressure was measured during SL evaluation by 45% of participants; 38% of participants routinely measured corneal thickness.

Conclusions:
Practitioners increasingly are prescribing SLs with advanced LZ designs. Most practitioners recommend hydrogen peroxide–based disinfection systems and single-use vials of nonpreserved saline for lens care and application. Because differences in components of routine SL evaluations were reported, clinicians may benefit from reaching a consensus on essential components of SL evaluation.
Higher-Order Aberrations and Visual Performance in Myopic Children Treated With Aspheric Base Curve-Designed Orthokeratology
Authors: Chen Changxu , Ma Wei , Wang Jianglan , Yang Bi , Liu Tong , Liu Longqian 
Published: January 2023

Objectives:
To investigate the impact of aspheric base curve (BC)-designed orthokeratology (ortho-k) (AOK) lenses on higher-order aberrations (HOA) at different pupil diameters and visual performance.

Methods:
This prospective clinical study included subjects randomized to wear spherical BC-designed ortho-k (SOK) or AOK lenses. The Pediatric Refractive Error Profile (PREP) questionnaire was completed before and after 3 months of lens wear. The Strehl ratio (SR) and root mean square of ocular higher-order aberrations (HOAs), spherical aberration (SA), coma, and trefoil were measured under 4-mm, 5-mm, and 6-mm pupil diameters at baseline and 3-month visits. Corneal topography, uncorrected low-contrast (LC) visual acuity (VA), and high-contrast (HC) VA were measured at baseline and at 1 day, 1 week, 1 month, and 3 month follow-ups.

Results:
Sixty-five participants completed the study. After 3 months with the ortho-k lens, there were no significant differences in ocular HOA, SA, coma, or trefoil between the SOK group and AOK group at 4-mm, 5-mm, and 6-mm pupil diameters (all P>0.05), except for a significant increase in SA in the AOK group (P=0.01). Stratified analyses showed that the AOK group exhibited greater HOA and SA at 5-mm and 6-mm pupil diameters in the lower myopia subgroup and greater SA at 6 mm in the higher myopia subgroup (all P<0.05). There were no significant differences between the groups in SR, HC VA, LC VA, or PREP scores (all P>0.05).

Conclusion:
Aspheric BC-designed ortho-k lenses produced a significantly greater SA than SOK lenses, with more significance at lower diopters, without sacrificing subjective visual performance.
Cost-Effectiveness of Screening for Open Angle Glaucoma Compared With Opportunistic Case Finding
Authors: Anton Alfonso , Serrano David , Nolivos Karen , Fatti Gianluca , Zmuc Natasa , Crespo Carlos , Monleon-Getino Toni , Sotelo Katia , Morilla Antonio , García Virginia , Comas Merce , Castells Xavier 
Published: January 2023

Précis:
The manuscript evaluates cost-effectiveness of glaucoma screening with imaging devices and telemedicine based on a screening campaign performed in Spain. The screening strategy implemented in our analysis was cost-effective compared with opportunistic case finding.

Introduction:
Open angle glaucoma is an asymptomatic ocular disease that represents one of the first causes of blindness. Diagnosis is currently made by opportunistic case finding, usually by community optometrists or general ophthalmologists. The aim of this study was to assess the cost-effectiveness of a screening strategy based on optical coherence tomography and fundus photographs in glaucoma detection.

Materials and Methods:
A cost-effectiveness analysis was carried out to compare 2 alternative strategies: opportunistic finding versus screening. A Markov tree model was carried out with 10 health states according to disease progression. Quality-adjusted life years (QALYs) were used as a measure of effectiveness. We included short-term and long-term direct health costs and a discount rate of 3%. We performed a probabilistic sensitivity analysis and several 1-way sensitivity analyses.

Results:
The cohort in the screening program entailed an increase in 0.097 QALYs and additional costs of €1187 versus opportunistic finding, with an incremental cost-effectiveness ratio of about €12.214/QALY. The 1-way sensitivity analysis showed that inputs related to age and screening program (cost and detection rate) were those most strongly influencing the results of the analysis. Probabilistic sensitivity analyses showed that the model was robust to significant changes in the main variables of the analysis.

Conclusions:
The screening strategy implemented in our analysis was cost-effective compared with opportunistic finding in patients with glaucoma in this Spanish setting.
Early Lensectomy in Patients With Pseudoexfoliation: Long-Term Effectiveness and Safety Outcomes
Authors: Rodríguez-Una Ignacio , Fernández-Vega Cueto Andrés , Rodríguez-Calvo Pedro P. , García Montserrat , Fernández-Vega Cueto Luis , Cobián-Tovar Ramón , Merayo-Lloves Jesús , Alfonso José F. 
Published: January 2023

Précis:
Early lensectomy in patients presenting pseudoexfoliation (PXF) in an asymmetric clinical stage resulted in effective, safe, and predictable long-term results. Good intraocular pressure (IOP) was found, thus it might be considered as a possible surgical approach in these patients.

Purpose:
The purpose of this study is to assess the long-term effectiveness, predictability, and safety of cataract surgery performed in patients with capsular PXF at an early stage of the disease.

Materials and Methods:
This retrospective, comparative study included PXF patients who underwent phacoemulsification with hydrophobic acrylic intraocular lens implantation in both eyes with a postoperative follow-up ≥5 years. Patients were classified in 2 groups: symmetric PXF (n=102) and asymmetric PXF (n=59). Preoperative and postoperative uncorrected and corrected distance visual acuity, manifest refraction, IOP, number of hypotensive drugs, visual field mean deviation, and the incidence of complications were registered.

Results:
The mean follow-up time was 8.5±2.8 years. Six months after cataract surgery, monocular uncorrected and corrected distance visual acuity were 0.3±0.4 and 0.1±0.3 logMAR, respectively, for the symmetric PXF, and 0.2±0.2 and 0.1±0.2 logMAR, respectively, for the asymmetric group. Total 95% and 96% of eyes were within ±1.00D in symmetric and asymmetric groups, respectively. At the final follow-up, IOP decreased only in the asymmetric group (P=0.004), with a reduction in the number of medications in both eyes (P<0.001). Mean deviation changed from −8.8 to −11.6 dB in the symmetric group (P<0.001), and from −5.0±6.2 to −7.9±10.6 dB (P=0.42) in the asymmetric group. Intraoperative complications were only registered in the symmetric group: 7 (3.4%; P=0.04). Ten cases (4.9%) of late intraocular lens dislocation were found, all from the symmetric group (P=0.03).

Conclusions:
Early lensectomy in patients with PXF before its symmetric presentation resulted in effective, safe, and predictable long-term results.
Evolving Landscape of Practice Patterns in the Management of Localized Low-Risk Prostate Cancer: A NCDB Study
Authors: Mao Shifeng , Samiei Arash , Yin Yue , Schorr Rebecca , Wegner Rodney E. , Fuhrer Russell , Lyne John , Sanguino Angela , Miller Ralph , Cohen Jeffrey 
Published: January 2023

Introduction:
Most patients with low-risk prostate cancer (LRPC) are candidates for active surveillance (AS) or definitive local treatment, including radical prostatectomy (RP), external beam radiotherapy (EBRT), or prostate seed implant (PSI). In this study, we analyzed the treatment pattern of patients with LRPC using a large patient population provided by the National Cancer Database (NCDB).

Methods:
Patients with LRPC, as defined by the National Comprehensive Cancer Network criteria, between 2004 and 2015 from the NCDB were analyzed. Patients, with no or minimal comorbidity, were categorized according to treatment modalities, including RP, EBRT, PSI, and no local therapy (NLT). Chi-square tests were used to analyze the association among demographic variables and treatments. Multivariate logistic regression analyses were conducted to determine the likelihood of choosing NLT.

Results:
In total, 195,452 patients diagnosed with LRPC between 2004 and 2015 were identified. There was a significant change in practice patterns with increased utilization of NLT over time, from 11.3% in 2004 to 53.5% in 2015, with a turning point in 2009. RP utilization peaked at 41.6% in 2008, EBRT peaked at 24.3% in 2006, and PSI peaked at 35.3% in 2004. However, it dropped to 17.6%, 18.1%, and 10.8%, respectively, in 2015. Academic/research programs (A/RP), older age, lower income, poorer education, lack of insurance, African Americans, and other races were associated with increased NLT use. The difference between White and African American, and older and younger patients in odds ratios were less after 2010.

Conclusions:
There was a significant shift in treatment patterns between 2004 and 2015. AS, as represented by the NLT in this study, has become the dominant treatment of choice for patients with LRPC. A/RPs were leading this trend, particularly in younger patients. Socioeconomic factors played roles in choosing NLT, but the racial difference became less apparent after 2010.
Validation of nonalcoholic fatty liver disease (NAFLD) related steatosis indices in metabolic associated fatty liver disease (MAFLD) and comparison of the diagnostic accuracy between NAFLD and MAFLD
Authors: Chen Jie , Mao Xueying , Deng Mingming , Luo Gang 
Published: January 2023

Background
Metabolic-associated fatty liver disease (MAFLD) is a new term of nonalcoholic fatty liver disease (NAFLD), with newly proposed diagnostic criteria. The applicability of common noninvasive testing for screening NAFLD is unclear for the detection of MAFLD and requires reevaluation. We aimed to validate the effectiveness of traditional NAFLD-related steatosis indices for diagnosing MAFLD and to determine the optimal cutoff values as well as compare their accuracy between NAFLD and MAFLD diagnosis.

Methods
This study enrolled 1866 participants from the National Health and Nutrition Examination Survey (NHANES) database (2017–2018). The diagnostic performances of fatty liver index (FLI), Framingham Steatosis Index (FSI), Zhejiang University index (ZJU), lipid accumulation product (LAP), hepatitis steatosis index (HSI) and visceral adiposity index (VAI) were evaluated using the area under the receiver operator characteristic (AUROC) curve and the optimal cutoff points were calculated according to maximum Youden’s index.

Results
FLI had the highest AUROC (0.840) for predicting MAFLD in the whole population, with a cutoff value of 56.93. The AUROCs of FLI, FSI, ZJU, LAP, HSI and VAI for predicting MAFLD/NAFLD were 0.840/0.812, 0.833/0.811, 0.826/0.811, 0.826/0.799, 0.814/0.803 and 0.747/0.729, respectively. The AUROC values of all indices decreased in the subgroup of the population with overweight or diabetes.

Conclusion
The NAFLD-related scores would be equally useful to screen MAFLD and seemed to be more compatible with MAFLD. The FLI was optimal in both MAFLD and NAFLD diagnoses. However, a new predictive indicator suitable for various characteristics of the population is worth further development in the future.
Breast Reconstruction Decision Aids Decrease Decisional Conflict and Improve Decisional Satisfaction: A Randomized Controlled Trial
Authors: Mardinger Cynthia , Steve Anna K. , Webb Carmen , Sherman Kerry A. , Temple-Oberle Claire 
Published: January 2023

Background:
Decision aids are useful adjuncts to clinical consultations for women considering breast reconstruction. This study compared the impact of two online decision aids, the Breast RECONstruction Decision Aid (BRECONDA) and the Alberta Health Services (AHS) decision aid, on decisional conflict, decisional satisfaction, and decisional regret.

Methods:
This randomized controlled trial included 60 women considering whether or not to undergo breast reconstruction. Two online decision aids, the AHS and the BRECONDA, were compared using randomized two-arm equal allocation. Participants responded to questionnaires at baseline, after the first and second consultations, and at 6 weeks and 6 months after deciding to, or not to, undergo reconstruction. Change in decisional conflict scores was compared between the BRECONDA and the AHS decision aid. Secondary outcomes included decisional regret and decisional satisfaction.

Results:
Both groups were similar in demographic, clinical, and behavioral characteristics. Women spent more time consulting the BRECONDA in comparison to women using the AHS decision aid (56.7 ± 53.8 minutes versus 28.4 ± 27.2 minutes; P < 0.05). Decisional conflict decreased (P < 0.05), and decisional satisfaction improved over time in both groups (P < 0.05). However, there were no differences based on the type of decision aid used (P > 0.05). Both decision aids had a similar reduction in decisional regret (P > 0.05).

Conclusions:
Decision aids decrease decisional conflict and improve decisional satisfaction among women considering breast reconstruction. Physicians should therefore offer patients access to decision aids as an adjunct to breast reconstruction consultations to help patients make an informed decision.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, I.
Evaluating Shared Decision-Making in Treatment Selection for Dupuytren Contracture: A Mixed Methods Approach
Authors: Kane Robert L. , Wood Shannon M. , Cichocki Meghan N. , Chung Kevin C. 
Published: January 2023

Background:Patients with Dupuytren contracture can receive a variety of surgical and nonsurgical treatments. The extent to which patients participate in the shared decision-making process is unclear.Methods:An explanatory-sequential mixed-methods study was conducted. Participants completed the Nine-Item Shared Decision-Making Questionnaire and the brief Michigan Hand Outcomes Questionnaire before completing semi-structured interviews in which they described their experience with selecting treatment.Results:Thirty participants [25 men (83%) and five women (17%); mean age, 69 years (range, 51 to 84 years)] received treatment for Dupuytren contracture (11 collagenase injection, six needle aponeurotomy, and 13 limited fasciectomy). Adjusted mean scores for the Shared Decision-Making Questionnaire and brief Michigan Hand Outcomes Questionnaire were 71 (SD 20) and 77 (SD 16), respectively, indicating a high degree of shared decision-making and satisfaction. Patients who received limited fasciectomy accepted invasiveness and prolonged recovery time because they believed it provided a long-term solution. Patients chose needle aponeurotomy and collagenase injection because the treatments were perceived as safer and more convenient and permitted rapid return to daily activities, which was particularly valued by patients who were employed or had bilateral contractures.Conclusions:Physicians should help patients choose a treatment that aligns with the patient’s preferences for long-term versus short-term results, recovery period and postoperative rehabilitation, and risk of complications, because patients used this information to assist in their treatment selection. Areas of improvement for shared decision-making include equal presentation of all treatments and ensuring realistic patient expectations regarding the chronic and recurrent nature of Dupuytren contracture regardless of treatment received.
A Longitudinal Study of Improvement in Nasal Airway Obstruction after Secondary Cleft Rhinoplasty
Authors: Carlson Anna R. , Kosyk Mychajlo S. , Zapatero Zachary D. , Kalmar Christopher L. , Swanson Jordan W. , Jackson Oksana A. , Low David W. , Bartlett Scott P. , Taylor Jesse A. 
Published: January 2023

Background:
Nasal airway obstruction is an increasingly recognized phenomenon in patients with cleft lip and/or palate and has the potential to significantly affect quality of life in this patient population. To date, the effect of secondary cleft rhinoplasty on cleft-related nasal airway obstruction has not been studied.

Methods:
Patients undergoing secondary cleft rhinoplasty at the Children’s Hospital of Philadelphia from 2015 to 2021 were identified. Preoperative and postoperative Nasal Obstruction Symptom Evaluation scores were recorded. Alterations in scores were evaluated for variation depending on patient characteristics, operative maneuvers, and postoperative nasal stenting.

Results:
Nasal airway obstruction was present in mild to moderate severity in patients before secondary cleft rhinoplasty. Postoperatively, obstruction improved or resolved in the domains of nasal blockage/obstruction, trouble breathing through the nose, and ability to get enough air through the nose during exertion (P < 0.05). Overall composite Nasal Obstruction Symptom Evaluation scores improved (P < 0.05). Lateral crural strut grafting was associated with improvement in nasal blockage, whereas alar revision and tip sutures were associated with worsening in specific nasal symptoms. Patients who underwent nasal stenting were found to report less trouble breathing after surgery than patients who did not (P < 0.05).

Conclusions:
Nasal airway obstruction is present in mild to moderate severity in patients with cleft lip and/or palate, and the subjective severity of obstruction is decreased by secondary cleft rhinoplasty. Specific operative maneuvers are associated with alterations in nasal airway obstructive symptoms, and nasal stenting is associated with an improvement in trouble breathing after secondary cleft rhinoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Orthoplastic Treatment of Open Lower-Limb Fractures Improves Outcomes: A 12-Year Review
Authors: D’Cunha Estelle M. , Penn-Barwell Jowan G. , McMaster John , Fries Charles A. 
Published: January 2023

Background:
The British Orthopaedic Association Standards for Orthopaedics and Trauma 4 (BOAST 4) inform the management of open lower-limb fractures. The authors conducted repeated reviews of performance against these standards over a 12-year period. This latest iteration has shown further improvements in outcomes concomitant with changes in service delivery.

Methods:
Data on Gustilo-Anderson grade IIIB or IIIC open lower-limb fractures were collected from a prospectively constructed departmental database and analyzed using Excel. Outcomes assessed included time to stabilization, time to definitive soft-tissue coverage, and deep infection rates.

Results
A total of 69% of patients in our cohort received care that aligned with BOAST 4 guidelines. Median time to stabilization was 14.2 hours and to soft-tissue coverage was 47 hours, with 71% of cases compliant with BOAST 4 guidelines. The overall deep infection rate was 6.5% in our cohort. There was a significantly lower deep infection rate in BOAST 4–compliant cases (2%) versus noncompliant cases (16%), respectively (P = 0.05). A total of 41 of 61 patients had fixation and soft-tissue coverage in a single operation (fix and flap), eight had staged operations, and 12 required local flap closure. There was no significant difference in deep infection rates among these approaches.

Conclusions:
Compliance with the BOAST 4 guidelines and time to definitive soft-tissue coverage have improved at our center since the last review. Deep infection rates were significantly lower in BOAST 4–compliant cases, further validating this approach. The fix and flap technique was introduced during the study period and reduces operative burden for patients. These results support a joint orthoplastic approach as the optimal management for these complex injuries.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Geriatric assessment and treatment decision-making in surgical oncology
Authors: Chesney Tyler R. , Daza Julian F. , Wong Camilla L. 
Published: January 2023

Purpose of review
Present an approach for surgical decision-making in cancer that incorporates geriatric assessment by building upon the common categories of tumor, technical, and patient factors to enable dual assessment of disease and geriatric factors.

Recent findings
Conventional preoperative assessment is insufficient for older adults missing important modifiable deficits, and inaccurately estimating treatment intolerance, complications, functional impairment and disability, and death. Including geriatric-focused assessment into routine perioperative care facilitates improved communications between clinicians and patients and among interdisciplinary teams. In addition, it facilitates the detection of geriatric-specific deficits that are amenable to treatment. We propose a framework for embedding geriatric assessment into surgical oncology practice to allow more accurate risk stratification, identify and manage geriatric deficits, support decision-making, and plan proactively for both cancer-directed and non–cancer-directed therapies. This patient-centered approach can reduce adverse outcomes such as functional decline, delirium, prolonged hospitalization, discharge to long-term care, immediate postoperative complications, and death.

Summary
Geriatric assessment and management has substantial benefits over conventional preoperative assessment alone. This article highlights these advantages and outlines a feasible strategy to incorporate both disease-based and geriatric-specific assessment and treatment when caring for older surgical patients with cancer.
Burnout of healthcare professionals in supportive and palliative care: a summary of recent literature
Authors: Oldenburger Eva , De Roo Maaike L. 
Published: January 2023

Purpose of review
Burnout is a complex phenomenon where several personal and work-related factors interact with each other. Palliative care is a challenging branch of healthcare, which can be especially demanding for the professionals providing it. This review presents an overview of the most recent literature on causes, identification, and consequences of burnout as well as articles on interventions to reduce burnout in the professional palliative healthcare provider setting.

Recent findings
With a few exceptions, research on burnout in the palliative care provider setting is focused on further insight on the different aspects that cause burnout on an individual, social, and organizational level. Unfortunately, only a few studies were found on interventions to prevent burnout. While the results of these interventions were promising, long-term results or data on how these diminish actual healthcare provider dropout were not available.

Summary
Research on burnout faced by palliative healthcare professionals seems to focus mainly on gaining further insight of different aspects of the complex syndrome that is burnout and how different individual, social, and organizational factors interact with each other. Further research on the prevention and treatment of burnout is necessary.