Bleb vessel density as a predictive factor for surgical revisions after Preserflo Microshunt implantation.

PURPOSE: Bleb failure is a common complication after glaucoma filtration surgery. Different bleb classification schemes incorporating filtration bleb vascularization have been proposed, but the reported correlation with intraocular pressure (IOP) has been variable, possibly because of subjective vascularization grading. The purpose of the present study was to evaluate bleb vascularization after Preserflo Microshunt (PM) implantation using anterior segment OCT-angiography (AS-OCTA) as a biomarker for bleb failure. METHODS: Twenty-three eyes of twenty-three patients underwent PM implantation. Up to 12 months after surgery PM scleral passage-centred AS-OCTA measurements (PLEX Elite 9000) for bleb-vessel density (BVD) determination were performed and IOP as well as necessity for surgical revisions (needling and open revision) were documented. After multi-step image analysis (region of interest definition, artefact removal, binarization, BVD calculation), the predictive value of early postoperative BVD for surgical revisions was assessed using logistic regression modelling. RESULTS: Baseline IOP (23.57 ± 7.75 mmHg) decreased significantly to 8.30 ± 2.12, 9.17 ± 2.33 and 11.70 ± 4.40 mmHg after 1, 2 and 4 week(s), and 13.48 ± 5.83, 11.87 ± 4.49, 12.30 ± 6.65, 11.87 ± 3.11 and 13.05 ± 4.12 mmHg after 2, 3, 6, 9 and 12 month(s), respectively (p < 0.001). Nine patients (39%) needed surgical revisions after a median time of 2 months. Bleb vessel densities at 2 and 4 weeks were significantly associated with future surgical revisions upon logistic regression analysis (2 W/4 W likelihood-ratio test p-value: 0.0244/0.0098; 2 W/4 W area under the receiver operating characteristics curve: 0.796/0.909). CONCLUSION: Filtration bleb vessel density can be determined using AS-OCTA in the early postoperative period and is predictive for bleb failure after PM implantation.

Asymmetry in body composition parameters of the upper and lower extremity among healthy Austrian women.

Humans typically have bilateral symmetry, however, deviations from perfect symmetry can be observed. In the case of the upper extremities, mostly a right-biased asymmetry in the length or strength of the bones, but also lean body mass was reported. Regarding the lower extremities, the asymmetry patterns are weaker. The aim of this study is to analyze directional and cross-asymmetry in body composition parameters among healthy non-athletic women. In particular, it is hypothesized that body composition asymmetry patterns of the limbs change with increasing age. 584 Austrian women aged between 16 and 83 years were enrolled in the study. Data collection took place between 1995 and 2000 at the Menox outpatient department for the treatment of climacteric symptoms in Vienna. Bone mineral density (BMD), bone mineral content (BMC), lean mass, and fat mass was determined using dual-energy-x-ray absorptiometry (DEXA). Signed asymmetry was calculated for each body composition parameter of the upper and lower limbs. Right-sided symmetry dominated for lean mass, BMC, and BMD in the upper extremity. Asymmetry in the lower limbs was not as strong as in the arms, but a right-sided asymmetry was still observable. Fat mass showed the strong right-sided asymmetry of all measurements for the lower extremities in the whole sample. Contra lateral asymmetry of the extremities could be found in 37-45% of the sample for lean mass, BMD, and BMC. For fat mass, almost half of the sample displayed cross asymmetry. Significant associations between asymmetry patterns and age were observable for the fat mass of the upper extremities only. Participants younger than 30 years showed a significant left-sided asymmetry for fat mass in the upper extremities. However, this pattern changed around the age of 30 and shifted to a slight right-sided asymmetry. In general, the body composition of the upper and lower limbs showed distinct asymmetry patterns.

Assessing patient experience with patient safety in primary care: development and validation of the ASK-ME-questionnaire.

OBJECTIVE: To develop and test the validity and reliability of a tool measuring patient experiences with patient safety in ambulatory care that is suitable for routine use in general practitioner and specialist practices. DESIGN: Instrument development was based on a literature review, a 3-round Delphi survey with a multidisciplinary expert panel and cognitive interviews with patients. The instrument was piloted in 22 practices using a cross-sectional survey. Exploratory (EFA) and confirmatory factor analysis (CFA) were performed to test construct validity. Internal consistency and the ability of the questionnaire to differentiate between selected subgroups and at the level of individual practices was examined. SETTING: General practitioner and specialist practices. PARTICIPANTS: Patients aged >18 years seeking care in ambulatory care practices between February and June 2020. RESULTS: The final ASK-ME-questionnaire consisted of 22 items covering 5 theoretical dimensions. A total of 3042 patients (71.1%) completed the questionnaire. Median item non-response rate was 4.2% (IQR 3.4%-4.7%). EFA yielded 3 factors comprising 14 items explaining 64.8% of the variance representing contributing factors to patient safety incidents. CFA confirmed the factorial structure suggested by EFA. The model fit the data satisfactorily (comparative fit index=0.92, root mean square error of approximation=0.08, standardised root mean square residual=0.08). Internal consistency values ranged from 0.7 to 0.9. Discriminant validity was supported by significant differences between patients of different age and differences in self-reported health status. The factors distinguished well between practices. CONCLUSION: The ASK-ME-questionnaire showed good psychometric properties. It is suitable for routine use in patient safety measurement and improvement systems in ambulatory care. Further research is required to adequately assess number and type of experienced events in routine measurements.