Lauesensheehan1318

To present a surgical technique that allows rescue (repositioning) of a dislocated Crystalens model intraocular lens (IOL) using scleral sutures.

The surgical technique is described with supplemental video.

The technique was used in one patient with 3 months of followup information. The IOL was well positioned and the visual acuity is 20/20, without adverse events.

Scleral suture techniques for repositioning of the Crystalens offers a suitable alternative to IOL exchange.

Scleral suture techniques for repositioning of the Crystalens offers a suitable alternative to IOL exchange.Health care systems have encountered unprecedented challenges during the coronavirus disease-2019 (COVID-19) pandemic, such as standardizing care in the absence of high-quality data. As an emblematic example, preliminary data and early anecdotal experience suggested that a major driver of COVID-19 pathophysiology was hypercoagulability, suggesting the need for aggressive anticoagulation. In this article, we describe the rapid guidance process for the development of an anticoagulation protocol for COVID-19. Preliminary evidence was collected from multidisciplinary experts within our institution to inform the first protocol draft. After implementation, we rapidly acquired data to inform a revision, with subsequent modifications based on higher quality data. The description of this process can inform other health systems when faced with a similar crisis characterized by high patient volumes, poor clinical outcomes, lack of proven effective therapies, and rapid flow of information from multiple sources of variable credibility.

Comparing outcome measures in health care is a relatively common practice. Reports are designed to compare hospital infection rates in an accurate and fair manner. The current methodology used by New York State (NYS) has some limitations and flaws. This research provides a methodology that overcomes these limitations and flaws.

The methodology is a replication study using data from NYS and includes the use of the binomial and Poisson distribution to calculate upper tail (UTP) and lower tail probabilities (LTP). The UTP is used to screen for poor performers, and the LTP is used to screen for good performers.

The results we obtained using the tail probability method compared with NYS's confidence interval approach are similar across all health care-associated infection (HAI) categories but have the benefit of allowing for the analysis of any hospital regardless of the number of procedures, number of central line-days, or number of patient-days. In addition, we provide an evaluation of a hospital's performreduction of HAIs are a priority for health care institutions. While the results are similar to those reported by NYS, this approach can be used more comprehensively and can be interpreted more easily by administrators and practitioners. Health care administrators and clinicians may find the information useful to address infection rates. Hospitals consistently performing well may be used as a benchmark.

Electronic health record (EHR)-based clinical decision support tools can improve the use of evidence-based clinical guidelines for preeclampsia management that can reduce maternal mortality and morbidity. see more No study has investigated the organizational capabilities that enable hospitals to use EHR-based decision support tools to manage preeclampsia.

To examine the association of organizational capabilities and hospital adoption of EHR-based decision support tools for preeclampsia management.

Cross-sectional analyses of hospitals providing obstetric care in 2017. In total, 739 hospitals responded to the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS) and were linked to the 2017 American Hospital Association (AHA) Annual Survey Database and the Area Health Resources File (AHRF). A total of 425 hospitals providing obstetric care across 49 states were included in the analysis. The main outcome was whether a hospital adopted EHR-based clinical decision support tools for preeclampsia maR were also more likely to adopt the tools by 9.3 percentage points, but the difference was not statistically significant (95% CI, - 1.3 to 19.9). Hospitals with more processes to aid dissemination of best patient care practices were also more likely to adopt EHR-based decision-support tools for preeclampsia (0.4 percentage points; 95% CI, 0.1 to 0.6, for every 1-unit increase in dissemination processes; P < .01).

Standardized EHRs and policies to disseminate evidence are foundational hospital capabilities that can help advance the use of EHR-based decision support tools for preeclampsia management in the approximately one-third of US hospitals that still do not use them.

Standardized EHRs and policies to disseminate evidence are foundational hospital capabilities that can help advance the use of EHR-based decision support tools for preeclampsia management in the approximately one-third of US hospitals that still do not use them.

The prevalence of depression and insomnia in the military are substantial. Several transcranial magnetic stimulation (TMS) studies have used self-report sleep data as secondary research outcomes; however, there are limited studies using the gold standard of polysomnography (PSG) to ascertain actual sleep changes. Here, we provide data from a pilot and feasibility study using PSG to measure sleep changes after repetitive TMS.

Thirty-eight active duty service members (ADSM) were consented, of which 20 completed the study. The ADSM who met study criteria where sent for an initial PSG and completed baseline self-report measures. They then completed a standard course of TMS, and self-report measures were completed every fifth session. After TMS completion, ADSM underwent final PSG.

Comparison of baseline and postintervention PSG sleep parameters highlight that total rapid eye movement sleep improved after a course of TMS, regardless of improvements in depression. Total sleep time also improved, but only in t been shown to decrease REM, whereas our study found an increase in REM. Overall, this study helps further our understanding of TMS effects on sleep and presents new questions for potential larger follow-on studies.