Improving Access to Specialist Eye Care for Indigenous Australians via Telehealth: An Observational Cohort Study.

Background: Indigenous people are often neglected in eye health research and service delivery programs, despite having a greater burden of vision loss, most of which is avoidable. The objective of this work was to improve access to specialist eye care for Indigenous Australians living in rural and remote areas, by providing direct access to expert diagnostic services based in metropolitan areas through a tele-ophthalmology system. Methods: Over a four-year study period, 13 remote communities in Queensland and the Northern Territory were identified that had limited or no access to eye screening services. Relationships with health service providers in the communities were established to codesign a sustainable model of service delivery and referral pathways to ensure that patients identified with eye issues received appropriate treatment. Results: Over the course of the study, screening records from 378 patients were uploaded to a web-based telehealth system and diagnosed by ophthalmologists. From these examinations, 64 new cases of diabetic retinopathy (DR) were identified (including 2 cases of proliferative DR and 4 cases of severe nonproliferative DR), and diabetic macular edema was noted in 18 patients. The majority of participants screened had no eye problems, which enables the removal of these patients from the queues of overwhelmed specialist lists, improving service efficiency. The study also demonstrates capacity building of healthcare workers to perform eye screening and improved patient health awareness where the retinal cameras were used as an educational tool. Conclusions: A valuable screening service has been established in the target areas, where access to ophthalmic services has been improved for residents of the study screening locations. Routine eye examination (instead of opportunistic eye examination) is feasible for early detection of some eye diseases for remote and rural patients.

Assessment of orthodontic treatment efficacy of Clarity Aligners using the Peer Assessment Rating index and the American Board of Orthodontics Cast-Radiograph Evaluation.

INTRODUCTION: 3M Oral Care Solutions (St Paul, Minn) has recently introduced Clarity Aligners into the market. This cohort study evaluated the orthodontic treatment efficacy of this clear aligner system using the Peer Assessment Rating (PAR) index and the American Board of Orthodontics Cast-Radiograph Evaluation (CR-Eval). METHODS: Pretreatment and posttreatment dental models of 87 subjects who had undergone orthodontic treatment using Clarity Aligners in both arches to align their teeth to a target setup were independently evaluated by 4 examiners using the PAR index and the American Board of Orthodontics CR-Eval. Changes in CR-Eval and PAR scores from pretreatment to posttreatment were calculated, with PAR score reductions also expressed as percentages. RESULTS: Treatment with Clarity Aligners reduced the CR-Eval scores from 39.05 ± 14.98 to 30.34 ± 8.76, resulting in a statistically significant difference of 8.76 ± 11.45 between pretreatment and posttreatment scores. Similarly, aligner treatment reduced the weighted PAR scores from 13.40 ± 9.26 to 5.80 ± 4.84, resulting in a statistically significant difference of 7.50 ± 7.56 between pretreatment and posttreatment scores. The overall median PAR reduction was 53%, with 94% of the subjects having reduced PAR scores after treatment. Seventy-eight percent of subjects had >30% PAR reduction, 57% had >50% PAR reduction, and 33% had >70% PAR reduction. CONCLUSIONS: The results suggest that Clarity Aligners may be an effective treatment modality in mild to moderate malocclusions.

Medical Adhesive-Related Skin Injury Prevalence Among Adult Acute Care Patients: A Single-Center Observational Study.

PURPOSE: The purpose of this study was to measure the daily prevalence of adhesive product use and related skin injuries in adult patients in a non-intensive care unit setting. DESIGN: Prospective, descriptive study. SUBJECTS AND SETTING: The study sample consisted of patients cared for on 2 inpatient care units in a university-based acute care facility in the Midwestern United States. One was a 30-bed medical/surgical unit and the second was a 35-bed cardiac/telemetry unit. Their median age was 58 years; the average daily proportion of males and females was 56% and 42%, respectively. METHODS: Medical adhesive-related skin injury (MARSI) prevalence was calculated using 3 methods: (1) the proportion of subjects who had any MARSI injury (subject prevalence), (2) the prevalence of MARSI by injury type and severity (severity prevalence), and (3) the proportion of medical adhesive products that had any associated MARSI (product prevalence). RESULTS: The daily subject prevalence of any MARSI injury ranged from 3.4% to 25.0% with a mean and median of 13.0% and 12.7%, respectively. The severity prevalence of MARSI injury ranged from 8 to 149 per 1000 product-days with a mean and median of 63 and 56 MARSIs per 1000 product-days, respectively. The median (range) product prevalence among all adhesive products varied from a high of 70 injuries per 1000 product-days for surgical closure to a low of 0 injuries per 1000 product-days for peripheral intravenous line dressing. CONCLUSIONS: Medical adhesive-related skin injury is a prevalent event in the acute care setting. Preventing skin injury has the potential to reduce complications, increase patient satisfaction, and improve clinical outcomes.

A comparison of the in vitro moisture vapour transmission rate and in vivo fluid-handling capacity of six adhesive foam dressings to a newly reformulated adhesive foam dressing.

This study compared moisture vapour transmission rate (MVTR) and wear time or fluid-handling capacities of six adhesive foam dressings to a reformulated control dressing. Standardised in vitro MVTR methodology and a previously published in vivo artificial wound model (AWM) were used. Mean inverted MVTR for the reformulated dressing was 12 750 g/m(2) /24 hours and was significantly higher than four of the six comparator dressings (P < 0·0001), which ranged from 830 to 11 360 g/m(2) /24 hours. Mean upright MVTR for the reformulated dressing was 980 g/m(2) /24 hours and was significantly different than all of the comparator dressings (P < 0·0001), which ranged from 80 to 1620 g/m(2) /24 hours (three higher/three lower). The reformulated dressing median wear time ranged from 6·1 to >7·0 days, compared with 1·0 to 3·5 days for the comparator dressings (P = 0·0012 to P < 0·0001). The median fluid volume handled ranged from 78·0 to >87 ml compared with 13·0 to 44·5 ml for the comparator dressings (P = 0·0007 to P < 0·001). Interestingly, inverted MVTR did not correspond well to the AWM. These results suggest that marked differences exist between the dressings in terms of both MVTR and wear time or fluid-handling capacity. Furthermore, high inverted MVTR does not necessarily predict longer wear time or fluid-handling capacities of absorbent dressings.

Nitric oxide levels in wound fluid may reflect the healing trajectory.

We analyzed nitric oxide metabolites (nitrate and nitrite, NOx) and other biomarkers in human wound fluids and correlated these markers with wound healing status (progressing or worsening) based on patient's wound history. Samples were collected pre- and postcleansing from patients with wounds of various etiologies and analyzed for NOx, matrix metalloproteinase activity, and elastase activity. A laboratory method was developed to analyze NOx which can detect at least 5 µM in samples as small as 10 µL. A nitrate-free sample collection device was identified to match the sensitivity of this new assay (most "nitrate-free" products tested contained nitrate levels higher than this detection limit when extracted in such a small volume). The correlation between pre- and postcleansing biomarker values, and the diagnostic potential of the biomarkers to wound progress were analyzed. Fifty wounds provided samples that were suitable for NOx analysis. The pre- and postcleansing values for NOx showed good correlation (r = 0.72); the correlation was not very strong for matrix metalloproteinase and elastase. Data analysis showed that NOx represents the best metabolite to discriminate between worsening and progressing wounds, and suggested that a two cut point diagnostic test using NOx is better than a single cut point test to identify progressing from worsening wounds.

Assessing the Prevalence of Trachoma: Lessons from Community Screening with Laboratory Testing in Australia's Torres Strait Islands.

PURPOSE: We undertook a screening program between 2016 and 2019 to determine if trachoma was endemic in the Torres Strait Islands of Queensland, Australia. METHODS: Eleven screening surveys assessing trachoma prevalence were undertaken in seven communities using the World Health Organization (WHO) simplified grading tool. Additionally, an ophthalmologist performed a detailed clinical assessment including examination for Herbert's pits and corneal pannus and, where clinically indicated, collection of conjunctival specimens to investigate the presence of Chlamydia trachomatis nucleic acid. RESULTS: Prevalence of trachomatous inflammation-follicular (TF) in children aged 5-9 years for the aggregated first survey across all communities was 6% (17/284). No child had trachomatous inflammation-intense, trachomatous scarring, corneal pannus, or Herbert's pits. Of the 66 times any child was tested for C. trachomatis by polymerase chain reaction (PCR), the result was negative. No cicatricial trachoma was identified amongst the adults (n = 186) who were opportunistically offered examination. CONCLUSION: Whilst TF was present, the lack of intense inflammatory thickening in any child examined, the lack of end-stage trachomatous disease, and the lack of ocular C. trachomatis detection by PCR indicate trachoma is not endemic in the Torres Strait Islands, and no ongoing public health intervention is required. These findings add to a growing body of evidence suggesting that use of the WHO simplified grading tool alone in the peri-elimination setting may overestimate the community burden of trachoma.

A randomised controlled 8-week crossover clinical evaluation of the 3M Coban 2 Layer Compression System versus Profore to evaluate the product performance in patients with venous leg ulcers.

This study compared a two-layer (Coban 2 Layer) and a four-layer (Profore) compression bandage system in venous leg ulcer patients. Participants (n = 81) were enrolled into an 8-week, randomised, open-label, ten-centre, crossover clinical trial. The primary endpoint was bandage slippage measured at each dressing change. Secondary endpoints included wound healing, health-related quality of life (HRQoL) and patient preference. Mean slippage estimated from a mixed analysis of variance model (697 visits) was 2.48 cm for the two-layer system and 4.17 cm for the four-layer system (P < 0.001). There were no significant differences in percent of wounds that healed (Fisher's exact test, P = 0.30), in wound area reduction (Wilcoxon rank-sum test, P = 0.88) or in linear healing rate (Wilcoxon rank-sum test, P = 0.94). The HRQoL Physical Symptoms and Daily Living scores were significantly higher with the two-layer system (pooled two-sample t-test, P < 0.05). Patients had a strong preference for the two-layer system (72%) than the four-layer system (22%), with 6% having no preference. In conclusion, the two-layer system exhibited significantly less bandage slippage than the four-layer system. While less bandage slippage did not appear to impact wound healing, there was indication that it may have influenced patient preference in favour of the two-layer system and potentially impacted patients' HRQoL.

Catheter securement systems: comparison of two investigational devices to a sutureless securement device, a securement dressing, and sutures in a pig model.

BACKGROUND: Catheter securement is critical for the success of infusion therapy and to prevent complications. Our purpose was to compare the strength of catheter securement achieved with two investigational adhesive securement devices to two securement products and also to sutures using an in vivo animal model. METHODS: Twenty-five live pigs were prepared for aseptic abdominal surgery. Four central venous catheters were inserted per animal into the epigastric veins and secured with four of the five securement systems studied, following a balanced incomplete randomized block design. A peak axial pull force test method was used to measure the force required to dislodge the catheter 1 cm from the insertion site and/or cause failure of the device and/or dressing. This pull test was done 10 min after device application, per constraints of the animal model. Comparison analysis was carried out using a mixed effects model with pig, sample, and sample location as factors. Non-inferiority testing was carried out using 95 % confidence intervals with a margin of 4.52 N or 1 lb (454 g). Tukey's method was used to adjust for multiple pairwise comparisons. RESULTS: Results showed that the two investigational devices displayed the highest mean peak axial pull forces (40-41 N) and were significantly better than sutures (28 N, p < 0.0001) and the securement dressing (17 N, p < 0.0001) and non-inferior to the securement device (37 N) in this test. The securement device required a higher mean peak axial pull force than sutures (p = 0.0007) and the securement dressing (p < 0.0001) for failure to occur. Finally, there was also a statistical difference between sutures and the securement dressing, with sutures requiring a higher mean peak axial pull force for catheter dislodgement than the securement dressing (p < 0.0001). CONCLUSION: The two investigational devices appear to be a promising alternative for catheter securement, superior to sutures and the securement dressing, and non-inferior to the securement device.

Dietary intake and food sources of whole grains among US children and adolescents: data from the 1994-1996 Continuing Survey of Food Intakes by Individuals.

OBJECTIVE: This study characterizes whole grain consumption among a nationally representative sample of US children and adolescents. DESIGN: Data used in this study were collected as part of the 1994-1996 US Department of Agriculture Continuing Survey of Food Intakes by Individuals (CSFII). SUBJECTS/SETTING: CSFII was designed to obtain a nationally representative sample of noninstitutionalized persons of all ages residing in the United States. Analyses reported in this article are limited to participants aged 2 to 18 years with two days of dietary recall data (n=4,802). Foods reported in the survey were quantified in servings as defined by the Food Guide Pyramid using the US Department of Agriculture Pyramid Servings Database, which contains reference data for each food reported in CSFII in servings per 100 g for 30 Pyramid food groups, including whole grain and total grain. STATISTICAL ANALYSES: Means, frequencies, and logistic regression analyses were conducted as appropriate. RESULTS: Average whole grain intake ranged from 0.8 servings per day for preschool-aged children to 1.0 servings per day for adolescents. Ready-to-eat cereals, corn and other chips, and yeast breads were found to be the major food sources of whole grains accounting for 30.9%, 21.7%, and 18.1% of whole grain intake respectively among those aged two to 18 years. APPLICATIONS/CONCLUSIONS: Given the apparent low level of whole grain intake among most children and adolescents in the United States, interventions are needed to increase intake of whole-grain foods.

Suppression of regrowth of normal skin flora under chlorhexidine gluconate dressings applied to chlorhexidine gluconate-prepped skin.

BACKGROUND: Catheter colonization and bloodstream infection during the first week after insertion of a central venous catheter have been shown to result from the patient's own skin flora. METHODS: The backs of 32 healthy subjects were prepped with a 2% chlorhexidine gluconate (CHG)/70% isopropyl alcohol antiseptic. Three dressings, 2 of which contained CHG, were placed on the prepped skin in a randomized design. Samples of aerobic bacteria were collected using the cup scrub method. Skin under the dressings was sampled by quadrant on days 1, 4, and 7. Relative suppression of regrowth was compared using an adjusted paired t test. RESULTS: Mean log counts were 3.2 log(10) colony-forming units (CFU)/cm(2) before antisepsis and 0.4 after antisepsis. Mean log counts obtained on days 1, 4, and 7 were 0.4, 0.3, and 0.5 log(10) CFU/cm(2) for the CHG gel; 0.4, 0.4, and 0.9 log(10) CFU/cm(2) for the CHG disk; and 0.9, 1.2, and 1.5 log(10) CFU/cm(2) for the Control, respectively. CONCLUSION: Skin flora was not completely eradicated during antisepsis, and bacterial regrowth occurred postantisepsis. The use of CHG dressings helped sustain a reduced bacterial count on the skin. The continuously releasing CHG gel maintained suppression to a greater extent than the CHG disk at 7 days (P = .01).

A new in vivo test method to compare wound dressing fluid handling characteristics and wear time.

A refined in vivo artificial wound model utilizing artificial wound fluid (AWF) was developed to overcome important limitations such as adhesive-skin interactions, movement, pressure, shear, and varying environmental conditions in in vitro models. Using this model, a study with primary endpoints of wear time and fluid handling capacity was conducted to compare two foam dressings: a high performance (HPF) dressing and an adhesive dressing (AAF). A 10-cm(2) artificial wound bed, created using a nonstick absorbent pad, was applied to the lower back of 24 healthy volunteers and the tip of a 23-gauge catheter was inserted into the pad to administer AWF. The pad and catheter were secured in place with paper tape and covered with the test dressings. This model and 1.0-mL AWF infusions every 12 hours was used to simulate highly exudating wounds. The HPF dressing absorbed 75% more fluid before failure and remained intact for a median of 6.1 days compared to 3.5 days for the AAF dressing (P <0.001, Cox proportional hazard model). Comparisons between dressing outcomes using this model and previously published in vitro results suggest the model may be valid and reliable. Studies to ascertain the ability of this model to predict clinical dressing performance and research to compare other wound outcomes that affect dressing change frequency and cost (eg, healing) are needed.

A randomized controlled trial to compare the complications of 2 peripheral intravenous catheter-stabilization systems.

An open-label, prospective, randomized, noninferiority study was conducted at a large academic, Magnet-designated, Level I trauma center to compare the peripheral intravenous catheter securement-related complication rates of 2 different stabilization systems. The control stabilization system included the StatLock device with a nonwinged catheter, and the investigational stabilization system included a closed catheter system with a specially designed Tegaderm dressing. Data from 302 subjects indicated that the investigational stabilization system was noninferior or similar to the control stabilization system with respect to the overall securement-related complications. The cost of the investigational stabilization system was approximately 75% of the cost for the control stabilization system.

Sequential gene profiling of basal cell carcinomas treated with imiquimod in a placebo-controlled study defines the requirements for tissue rejection.

BACKGROUND: Imiquimod is a Toll-like receptor-7 agonist capable of inducing complete clearance of basal cell carcinoma (BCC) and other cutaneous malignancies. We hypothesized that the characterization of the early transcriptional events induced by imiquimod may provide insights about immunological events preceding acute tissue and/or tumor rejection. RESULTS: We report a paired analysis of adjacent punch biopsies obtained pre- and post-treatment from 36 patients with BCC subjected to local application of imiquimod (n = 22) or vehicle cream (n = 14) in a blinded, randomized protocol. Four treatments were assessed (q12 applications for 2 or 4 days, or q24 hours for 4 or 8 days). RNA was amplified and hybridized to 17.5 K cDNA arrays. All treatment schedules similarly affected the transcriptional profile of BCC; however, the q12 x 4 days regimen, associated with highest effectiveness, induced the most changes, with 637 genes unequivocally stimulated by imiquimod. A minority of transcripts (98 genes) confirmed previous reports of interferon-alpha involvement. The remaining 539 genes portrayed additional immunological functions predominantly involving the activation of cellular innate and adaptive immune-effector mechanisms. Importantly, these effector signatures recapitulate previous observations of tissue rejection in the context of cancer immunotherapy, acute allograft rejection and autoimmunity. CONCLUSION: This study, based on a powerful and reproducible model of cancer eradication by innate immune mechanisms, provides the first insights in humans into the early transcriptional events associated with immune rejection. This model is likely representative of constant immunological pathways through which innate and adaptive immune responses combine to induce tissue destruction.