Markerwallace4062

PURPOSE To assess the effectiveness of intracameral phenylephrine/ketorolac during cataract surgery compared with postoperative topical steroids in reducing incidence of postoperative clinical cystoid macular edema (CME) confirmed via optical coherence tomography (OCT), breakthrough iritis, pain, and photophobia. SETTING Ambulatory surgical center/clinical practice. DESIGN Retrospective 2-cohort study. METHODS This study of cataract surgery patients compared the incidence of postoperative CME, breakthrough iritis, pain, and photophobia between patients receiving either intracameral phenylephrine/ketorolac 1.0%/0.3% during surgery or topical loteprednol 0.5% 2 days preoperatively, tapered postoperatively. Patients with prior CME or at high risk for postoperative CME, combined cataract/glaucoma surgery, and medication protocols different from those studied here were excluded. All eyes received bromfenac 2 days preoperatively and 10 weeks postoperatively. RESULTS The study enrolled 2218 eyes (n=1402). The phenylephrine/ketorolac treatment group included 1334 eyes (n=830) and the topical loteprednol control group included 884 eyes (n=572). The groups were comparable in age, race, gender, and perioperative characteristics. Clinical CME incidence was significantly lower in the phenylephrine/ketorolac group (0.52% vs 1.47%, P=0.021). The phenylephrine/ketorolac group also had significantly lower breakthrough iritis (1.72% vs 4.86%, P less then 0.001) and pain (1.27% vs 4.19%, P less then 0.001) than the topical loteprednol group. The incidence of photophobia trended lower for the phenylephrine/ketorolac group relative to the topical loteprednol group (0.90% vs 1.13%, respectively , P=0.590) but was not statistically significant. CONCLUSION Intracameral phenylephrine/ketorolac and topical NSAIDs without postoperative topical steroids significantly reduced postoperative clinical CME, breakthrough iritis, and pain after cataract surgery when compared with conventional perioperative topical steroids and NSAIDs.PURPOSE To assess safety of phenylephrine and ketorolac (PE/K) 1.0%/0.3% compared to phenylephrine (PE) 1.0% in children ages 0 to 3 years undergoing cataract surgery. The effect of PE/K to PE on intraoperative pupil diameter and postoperative pain were also compared. SETTING Multicenter study in the United States. DESIGN Randomized double-masked Phase 3 clinical trial. METHODS This study was powered to assess safety only. Depending on randomization, 4 mL of PE/K 1.0%/0.3% or PE 1.0% were injected into the surgical irrigation solution. Safety endpoints were assessed up to 90 days postoperatively. From surgical videos, a masked central reader measured change in pupil diameter from immediately prior to incision to wound closure. Postoperative pain was measured using Alder Hey Triage Pain Score at 3, 6, 9, and 24 hours following wound closure and recorded by parent/caregiver. RESULTS Seventy-two patients received masked intervention. There were no notable changes in vital signs or ophthalmological complications in either group. Mean change in pupil diameter was similar between PE/K 1.0%/0.3% and PE 1.0% (mean difference in AUC -0.071; P = 0.599). Postoperative ocular pain scores and overall mean scores were lower in PE/K group at all individual time points, and differences in overall mean scores were statistically significant at 6 and 24 hours (P=0.029 and 0.021, respectively). CONCLUSIONS Phenylephrine and ketorolac 1.0%/0.3% was safe for use in children and maintained mydriasis during cataract surgery. Postoperative pain levels were lower in the PE/K 1.0%/0.3% group.PURPOSE The study aims to assess the visual outcomes of pseudophakic cystoid macular oedema (CMO) as compared to age- and co-pathology matched controls, the costs of treatment and follow up, as well as the patient reported outcomes using the novel Cat-PROM5 questionnaire. SETTING West Suffolk NHS Foundation Trust, UK DESIGN Matched Case-Control Study METHODS 52 eyes of 49 patients developed CMO over an 18-month period. Age and co-pathology matched patients were identified from clinical records over the same time period in a 21 ratio (90 eyes). Post-operative clinical outcomes were recorded including treatments received, costs of treatments and patient recorded outcome measures using the Cat-PROM5 RESULTS Patients with CMO reported a significantly worse outcome from surgery than controls. Furthermore, CMO patients had significantly worse visual acuity after surgery than controls (CMO logMAR 0.40 ±0.33, n=37; controls 0.30 ±0.33; p less then 0.05) despite there being no difference in pre-operative visual acuity. In patients with epiretinal membrane (ERM), notably those with CMO had worse patient reported outcomes than controls with ERM, and only 18% received prophylactic corticosteroid injection at surgery compared with 63.6% of controls. CMO resulted in an excess of 266 outpatient appointments, with 388 weeks of topical therapy, 18 orbital floor injections, and 6 intravitreal steroid injections, 5 intravitreal anti-VEGF injections and one intravitreal dexamethasone implant with an excess expenditure of £216.81 per case. CONCLUSIONS Patients developing CMO following cataract surgery suffer with reduced visual acuity at 4 - 6 weeks, patient-reported visual outcomes, increased number of hospital appointments, treatments and costs.Robot-assisted gait training (RAGT) has been introduced in clinical practice to increase training intensity in patients with neurological disorders. In this observational study, we investigated the effect of the number of RAGT sessions on functional recovery in a heterogeneous cohort of patients. We included patients with a diagnosis of gait impairment due to a neurological disease. A set of demographic, clinical, functional and training parameters was collected for each participant. Each patient received RAGT with an exoskeleton (Lokomat; Hocoma, Volketswil, Switzerland) as part of a multidisciplinary rehabilitation program. We stratified the patients as good responders and poor responders and investigated the effect of varying the number of RAGT sessions with a series of logistic regression models. A total of 143 patients were included in this analysis (good responders = 65, poor responders = 78). Good responder patients spent more days in the hospital (P  less then  0.01) and underwent a higher number of RAGT sessions (P = 0.04) compared to poor responder patients. Logistic regression models estimated that adding six RAGT sessions mildly increased (by approximately 4%) the probability of a patient becoming a good responder. The rehabilitation phase (subacute/chronic) appeared to be the main determinant of the probability of being a good responder, and stroke patients appeared to be more sensitive to changes in the number of RAGT sessions. Our results seem to confirm previous observations that robotic therapy increases the intensity of rehabilitation, possibly leading to a greater functional recovery in subacute patients with greater impairment.Texture-modified food is a common strategy in dysphagia management for increasing safety of swallowing. It is essential for the patient to receive the prescribed diet based on clinical and instrumental examination of swallowing in order to be able to benefit from rehabilitation and avoid complications. Variations in terminology and definitions regarding texture-modified food and liquids demonstrate the need for international standardized terminology. We aimed to assess suitability of texture-modified diets used at a rehabilitation hospital in terms of the International Dysphagia Diet Standardization Initiative guidelines. A texture-modified main dish was analyzed for 5 days (15 samples of pureed and 10 samples of minced texture) at lunch time by 2 trained assessors using International Dysphagia Diet Standardization Initiative-recommended testing methods. read more The majority of pureed and minced food samples did not suit the comparable International Dysphagia Diet Standardization Initiative levels. The results underline the need for implementing the International Dysphagia Diet Standardization Initiative guidelines in order to provide an appropriate texture-modified diet for patients with neurogenic dysphagia and support dysphagia management within inpatient rehabilitation.BACKGROUND Caregivers contribute substantially to patients' management of and recovery from cardiovascular disease (CVD). Yet, the distress that many caregivers experience in this role continues to be underresearched and their needs undersupported. PURPOSE Situated within a patient engagement framework and adapted from experience-based co-design guidelines, the process of developing a comprehensive caregiver support resource with joint contributions from caregivers and healthcare providers representing multiple disciplines is described. A discussion of the challenges encountered during the development of the caregiver support resource and recommendations for future sites embarking on co-design work are noted. CONCLUSION Developing feasible and relevant approaches, such as informational support instruments, to meet the needs of the growing population of CVD caregivers is essential. CLINICAL IMPLICATIONS Although co-design processes are often complex, take more time and resources to implement, and involve multiple levels of an organization and community than traditional practices, these efforts may help to improve healthcare quality to stem the burden of CVD.BACKGROUND Overweight/obesity is a substantial global public health concern, which can be caused by genetic factors and energy balance-related behaviors (EBRBs). If it occurs in children with congenital heart disease (CCHD), it can yield an extra burden on their health. Most studies on CCHD have taken place in Western societies, leaving Asian populations understudied, especially children. OBJECTIVE We sought (1) to determine body mass index distribution among school-aged CCHD in Taiwan, (2) to ascertain whether the body mass index of CCHD differs from that of the general population, (3) to describe EBRBs in CCHD, and (4) to identify factors associated with underweight and overweight/obesity among CCHD. METHODS In this cross-sectional study, 97 child-parent dyads (53.6% boys; mean age, 9.73 years; 25.8% moderate-to-severe heart conditions) were enrolled. Self-administered questionnaires were used to collect demographics, medical factors, food frequency, physical activity, and sedentary behaviors. Anthropometric measurements were taken in the hospital. Independent predictors of EBRBs and health conditions were calculated through logistic regression analysis. RESULTS Among Taiwanese CCHD, 19.6% were underweight and 14.4% were overweight/obese. Children with moderate-to-severe heart defects were more often underweight. Body mass index did not differ between CCHD and children in the general population. More complex heart defects and asthma were associated with being underweight, whereas sedentary behaviors, cardiomegaly, and the New York Heart Association classification II to IV were associated with being overweight/obese. CONCLUSIONS Sedentary lifestyle is seemingly the only EBRB correlated with being overweight. Physical activity programs for children may help prevent and treat overweight or obesity in Asian CCHD, similar to Western countries.