Comparison of toric intraocular lens alignment between femtosecond laser-assisted capsular marking and digital marking.

PURPOSE: To compare the accuracy of toric intraocular lens (IOL) alignment between femtosecond laser-assisted capsular marking and digital marking. SETTING: Ruhr University Eye Clinic, Bochum, Germany. DESIGN: Prospective clinical trial. METHODS: In this study, 28 eyes of 23 patients, who underwent femtosecond laser-assisted cataract surgery with implantation of a toric IOL, were included. Intraoperatively, both femtosecond laser-assisted capsular marking and digital marking were applied simultaneously and compared in every case. The toric IOL was aligned to the capsular markings. Postoperatively, the axis of the capsular markings and toric IOL alignment was examined. Visual acuity and refractive outcomes were evaluated. RESULTS: Both alignment methods were performed without intraoperative complications in all cases. 25 eyes were included in the final analysis. Misalignment was significantly lower with femtosecond laser-assisted capsular marking than with digital marking (1.71 ± 1.25 degrees vs 2.64 ± 1.70 degrees, P = .016). Deviation from the target axis of the toric IOL was 1.62 ± 1.24 degrees 4 to 6 weeks postoperatively. Postoperative uncorrected distance visual acuity was 0.14 ± 0.13 logMAR, and residual astigmatism was 0.3 ± 0.23 diopter (D) with an astigmatism ≤0.5 D in 93% of eyes. CONCLUSIONS: Both methods showed excellent results for the alignment of toric IOLs. However, femtosecond laser-assisted capsular marking was significantly more precise than digital marking and showed good refractive results. In addition, capsular marking offers the possibility to avoid parallax error and evaluating postoperative IOL rotation.

Development of a telemedicine group educational program for patients with heart failure: A delphi study.

Aims: Evidence regarding the most effective and feasible videoconferencing group educational program for patients with heart failure is still equivocal. This study aimed to reach consensus about the structure, acceptability, and feasibility of videoconferencing for people with heart failure in Jordan that improves access to healthcare and clinical outcomes. Methods: There were two Delphi survey studies of three rounds each. Delphi one survey involved 32 healthcare staff, experienced in heart failure clinical practice and telehealth, to obtain a consensus of opinion on a proposed group videoconferencing program for patients with heart failure. Delphi two involved seven staff of the information technology center, experienced in videoconferencing and using supporting applications, to obtain their consensus on the current capabilities of the healthcare system and patients about information technology. Descriptive statistics were used for each item to determine whether consensus was achieved or not. Items that received 80% disagreement or 80% agreement of participants were not presented for re-rating in the third round, while the items that scored varying degrees of agreement were presented for experts for re-rating. Results: In Delphi one a group of items reached consensus regarding structure, factors influencing, and effectiveness of the videoconferencing program. In Delphi two, the findings indicated that videoconferencing modality is applicable and feasible in Jordan. Conclusion: This is the first study that addresses the equivocal evidence for the design and implementation of heart failure videoconferencing programs. The framework of the current proposed program can be utilized as a guideline to test or develop a future videoconference program.

Increased Angiopoietin-1 and -2 levels in human vitreous are associated with proliferative diabetic retinopathy.

BACKGROUND: Diabetic retinopathy is a frequent complication of diabetes mellitus and a leading cause of blindness in adults. The objective of this study was to elucidate the diabetic retinopathy pathophysiology in more detail by comparing protein alterations in human vitreous of different diabetic retinopathy stages. METHODS: Vitreous samples were obtained from 116 patients undergoing pars plana vitrectomy. Quantitative immunoassays were performed of angiogenic factors (VEGF-A, PIGF, Angiopoietin-1, Angiopoietin-2, Galectin-1) as well as cytokines (IL-1ß, IL-8, IFN-γ, TNF-α, CCL3) in samples from control patients (patients who don't suffer from diabetes; n = 58) as well as diabetes mellitus patients without retinopathy (n = 25), non-proliferative diabetic retinopathy (n = 12), and proliferative diabetic retinopathy patients (n = 21). In addition, correlation analysis of protein levels in vitreous samples and fasting glucose values of these patients as well as correlation analyses of protein levels and VEGF-A were performed. RESULTS: We detected up-regulated levels of VEGF-A (p = 0.001), PIGF (p<0.001), Angiopoietin-1 (p = 0.005), Angiopoietin-2 (p<0.001), IL-1ß (p = 0.012), and IL-8 (p = 0.018) in proliferative diabetic retinopathy samples. Interestingly, we found a strong positive correlation between Angiopoietin-2 and VEGF-A levels as well as a positive correlation between Angiopoietin-1 and VEGF-A. CONCLUSION: This indicated that further angiogenic factors, besides VEGF, but also pro-inflammatory cytokines are involved in disease progression and development of proliferative diabetic retinopathy. In contrast, factors other than angiogenic factors seem to play a crucial role in non-proliferative diabetic retinopathy development. A detailed breakdown of the pathophysiology contributes to future detection and treatment of the disease.

Comparison of experiences of nursing staff and patients before and after move to 100% single-bed room hospital in Australia: mixed methods.

BACKGROUND: There is sufficient and consistent international evidence of issues reported by nurses working in single-bed room environments, requiring a design that is not only comfortable for patients but meets nurses working needs. This paper presents a comparison of nursing staff and patients experience prior to a move to 100% single-bed room hospital in 2016 (Stage 1) and actual experiences after the move in 2021 (Stage 2) in South Australia. METHOD: Mixed method case study design. Survey sample of forty-two nursing staff; twelve patient interviews of their experiences of current environment and; thirteen nursing staff interviews of their experiences delivering nursing care in 100% single bed-room environment. RESULTS: Nurses and patients highlighted single-bed rooms contributed to patients' privacy, confidentiality, dignity and comfort. As anticipated in Stage 1, nurses in Stage 2 reported lack of patient and staff visibility. This impacted workload, workflow and concern for patient safety. CONCLUSION: Patient and nursing staff experiences are interdependent, and implications of single-bed room accommodation are complicated. Future impacts on the health system will continue to affect hospital design, which must consider nurses working needs and patient safety and comfort.

Identifying Feasible Heart Failure Interventions Suitable for the Jordan Healthcare system: A Delphi Study.

Interventions and strategies should align with the context and capacity of the health system. Identifying the most feasible and appropriate heart failure interventions in Jordan will improve heart failure management and clinical outcomes. Therefore, this study aimed to derive consensus from clinicians (using the Delphi method) regarding the most feasible and appropriate heart failure interventions in Jordan. A two-round Delphi study involving seven clinicians and policy makers were conducted. The Delphi results found consensus for the feasibility of the educational materials, follow up phone call, cardiac rehabilitation, group session, and training courses for staff. The components that were not feasible were: multidisciplinary team, individual session, and telemonitoring devices. The present study demonstrates the importance of utilizing interventions tailored to patients' characteristics and aligned with the capacity of healthcare system.

Predictors of Effective Self-care Interventions Among Jordanians With Heart Failure.

Jordanians are more at risk for heart failure now than in years prior. However, there are few studies addressing heart failure self-care in Jordanians. Identifying predictors that promote heart failure self-care among Jordanian patients is crucial in providing comprehensive care. This study aimed to identify predictors of self-care behaviors among Jordanians with heart failure. A cross-sectional study with a convenience sample of 300 Jordanian patients was performed in an educational hospital in the north of Jordan. Differences in the level of self-care between selected sociodemographic and clinical variables were identified using univariate statistics, and multiple regression was used to adjust estimates for covariates. The predictors of self-care were insomnia (p ≤ .001) and marital status (p = .018). Identifying factors influencing self-care can assist with addressing the causes of insomnia to ensure effective treatment, providing patients with social support, and eventually promoting heart failure self-care.

A Mixed-Methods Systematic Review of the Effectiveness and Experiences of Quality Improvement Interventions in Radiology.

OBJECTIVE: This study aimed to compile and synthesize evidence regarding the effectiveness of quality improvement interventions in radiology and the experiences and perspectives of staff and patients. METHODS: Databases searched for both published and unpublished studies were as follows: EMBASE, MEDLINE, CINAHL, Joanna Briggs Institute, Cochrane Central Register of Controlled Trials, PsycINFO, Scopus, Web of Science, Mednar, Trove, Google Gray, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative studies of patients undergoing radiological examinations and/or medical imaging health care professionals; a broad range of quality improvement interventions including introduction of health information technology, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; context of radiological setting; a broad range of outcomes including patient safety; and a result-based convergent synthesis design. RESULTS: Eighteen studies were selected from 4846 identified by a systematic literature search. Five groups of interventions were identified: health information technology (n = 6), training and education (n = 6), immediate and critical reporting (n = 3), safety programs (n = 2), and the introduction of mobile radiography (n = 1), with demonstrated improvements in outcomes, such as improved operational and workflow efficiency, report turnaround time, and teamwork and communication. CONCLUSIONS: The findings were constrained by the limited range of interventions and outcome measures. Further research should be conducted with study designs that might produce findings that are more generalizable, examine the other dimensions of quality, and address the issues of cost and risk versus benefit.

Using an implementation science approach to build leader facilitation capability in healthcare: a novel approach for enhancing action learning set facilitation.

PURPOSE: The study describes the implementation of a novel strategy, entitled the Action Learning Set Facilitation Model, to develop internal facilitation capability to lead change. The Model incorporated the Novice-Experienced-Expert pathway, a facilitation development approach underpinning the integrated-Promoting Action on Research Implementation in Health Services Implementation Framework, with action learning methodology. DESIGN/METHODOLOGY/APPROACH: A mixed-methods descriptive approach reports the results of 22 interviews, 182 Action Learning Sets and 159 post program survey data sets to explore facilitator experiences, strengths and potential application of the Model. FINDINGS: At program completion, five novice (of 174) and one experienced (of 27) facilitator transitioned to the next facilitation level. The three groups of facilitators described positive change in confidence and facilitation skill, and experience of action learning sets. Inconsistencies between self-report competence and observed practice amongst novices was reported. Novices had decreasing exposure to the Model due to factors related to ongoing organisational change. Internal facilitators were considered trusted and credible facilitators. RESEARCH LIMITATIONS/IMPLICATIONS: There are practical and resource implications in investing in internal facilitation capability, noting proposed and real benefits of similar development programs may be compromised during, or as a consequence of organisational change. Further research describing application of the facilitation model, strategies to enhance multisystemic support for programs and evaluation support are suggested. PRACTICAL IMPLICATIONS: The Action Learning Set Facilitation Model offers promise in developing internal facilitation capability supporting change in organisations. Critical success factors include building broad scale internal capability, stable leadership and longitudinal support to embed practice. ORIGINALITY/VALUE: This is the first application of the facilitation component of the integrated-Promoting Action on Research Implementation in Health Services implementation framework embedded to action learning sets as an implementation science strategy for leader development supporting organisational change.

Epi-Bowman keratectomy versus alcohol-assisted photorefractive keratectomy: wound healing and complications.

PURPOSE: In Epi-Bowman Keratectomy™ (EBK), a new dynamic multi-blade single-use device (Epi-Clear™, Orca Surgical, Israel) is utilized to remove the epithelium by sweeping movements across the corneal surface. Epithelial cells are discarded. Alcohol or other chemical agents are not utilized. We wanted to compare clinical results of Epi-Clear photorefractive kertectomy (PRK) to alcohol-assisted PRK. STUDY DESIGN: Retrospective, comparative study. METHODS: Consecutive case series: Adult patients seeking laser vision correction of myopia or myopic astigmatism without ocular diseases or prior surgery were included. The Epi-Clear PRK group comprised 50 consecutive eyes of 27 patients and the PRK group 50 eyes of 25 patients. RESULTS: No intraoperative complications occurred. Epi-Clear PRK: At day 1, day 4, and 3 months, uncorrected distance visual acuity (UDVA) was 0.41/0.47/0.93 (decimal scale); epithelial defect diameter was 4.7/0.2/0 (mm); pain level was 3.8/0.3/0 (visual analogue scale, 0-10), respectively. At 3 months, efficacy index was 0.86 and spherical aberrations were unchanged. Three eyes (6%) showed (presumably sterile) infiltrates. PRK: At day 1, day 4, and 3 months, UDVA was 0.56/0.46/1.15; epithelial defect diameter was 6.3/0.2/0 (mm); pain level was 5.0/0.3/0, respectively. At 3 months, efficacy index was 1.1 and spherical aberrations were unchanged. CONCLUSION: The new method of epithelial debridement with Epi-Clear before laser ablation seems to offer fast epithelial removal without nicking Bowman's layer (as observed with the laser microscope). However, we found significantly inferior results of Epi-Clear PRK compared to alcohol-assisted PRK. Furthermore, after Epi-Clear PRK corneal infiltrates as a new type of postoperative complication were observed.

Best evidence for advance care planning in older adults with dementia and their families: an umbrella review protocol.

OBJECTIVE: The objective of this review is to summarize current best evidence for advance care planning in older adults with dementia and their families. INTRODUCTION: Contemporary end-of-life care cannot be fully achieved without high quality advance care planning practice, which facilitates the expression of patient preferences for treatment if they lose the capacity to decide or communicate their wishes. However, advance care planning for people experiencing dementia can be highly complex and requires additional knowledge and skills. Improving advance care planning for this vulnerable patient group is an urgent matter. INCLUSION CRITERIA: The review will include systematic reviews of quantitative, qualitative, and mixed-method studies examining advance care planning for older adults with dementia and their families, published from 2000. METHODS: Published and unpublished reviews will be identified from searches of the major international databases and relevant databases for gray literature, respectively. Two independent reviewers will conduct screening, critical appraisal, and data extraction for included studies. The extracted data will include specific details about the study characteristics (e.g. setting/context, participants, and the intervention/phenomena of interest), quantitative results (including heterogeneity), and qualitative findings relevant to the review. Results of systematic reviews will be presented in tabular format and accompanied by narrative synthesis. Qualitative results will include the overall synthesis of findings. Overlap of original research studies of any design across multiple systematic reviews will be clearly identified.

Ab externo device for the treatment of glaucoma: direct flow from the anterior chamber to the ocular surface.

A new microinvasive glaucoma surgery device, the Beacon Aqueous Microshunt (BAM), drains aqueous humor directly from the anterior chamber to the surface of the eye vs draining to enclosed spaces within the eye, where outflow resistance, including the episcleral venous pressure, might limit drainage effectiveness. The BAM has a 0.030 mm × 0.048 mm channel and provides a fixed resistance. For implantation, a 1.40 mm wide transcorneal incision into the anterior chamber was created with a posterolimbal outer placement under topical anesthesia. The surgery was easy to execute and had a flat learning curve. Preliminary and early experience have shown success with lowering intraocular pressure immediately postoperatively. In conclusion, the BAM offers a promising minimally invasive surgical procedure.

Visual performance comparison of 2 extended depth-of-focus intraocular lenses.

PURPOSE: To compare the visual acuity and satisfaction outcomes of 2 different concepts of extended depth-of-focus intraocular lenses (EDOF IOLs). SETTING: University Eye Hospital Bochum, Germany. DESIGN: Prospective randomized comparative clinical trial. METHODS: Patients undergoing cataract surgery with the implantation of 2 different concept EDOF IOLs. In the first group (IC-8 Group), a monofocal 1-piece Tecnis Z B00 IOL (Johnson & Johnson Vision Care, Inc.) was implanted in the dominant eye, and an IC-8 IOL (AcuFocus) was implanted in the nondominant eye. In the second group (Symfony Group), a Tecnis Symfony IOL (Johnson & Johnson Vision Care, Inc.) was implanted in both eyes. The target refraction of the dominant eye was emmetropia and slight myopia (mini-monovision, -0.75 diopters) in the nondominant eye. Visual and refractive outcomes and patient satisfaction rates were evaluated 3 months postoperatively. RESULTS: This study comprised 76 eyes of 38 patients. No intraoperative or postoperative complications occurred in either group. Target refraction was reached in both groups without statistically significant differences. The uncorrected distance visual acuity (UDVA, photopic and mesopic light conditions) was excellent in both groups with statistically significantly better results in the IC-8 goup (logarithm of the minimum angle of resolution; IC-8 Group (0.1 ± 0.07 logarithm of the minimum angle of resolution [logMAR]; Symfony Group 0.07 ± 0.1 logMAR, P value .02 [photopic]; IC-8 group 0.12 ± 0.09 logMAR, Symfony group 0.22 ± 0.1 logMAR, P value < .01 [mesopic]). Binocular uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA) were also good in both groups without statistically significant differences (UIVA: IC-8 Group, 0.01 ± 0.07 logMAR, Symfony Group 0.01 ± 0.08 logMAR, P value .35; UNVA: IC-8 Group 0.14 ± 0.11, Symfony Group 0.09 ± 0.08, P value .14). Subjective satisfaction was high in both groups. CONCLUSIONS: Both EDOF IOLs provided a very good UDVA with superior results in the IC-8 Group, and a good UIVA and UNVA under photopic light conditions. Subjective patient satisfaction was higher in the IC-8 Group.

Long-term follow-up and clinical evaluation of the light-adjustable intraocular lens implanted after cataract removal: 7-year results.

PURPOSE: To determine the long-term safety and effectiveness of a light-adjustable intraocular lens (LAL) over a period that is longer than reported in the literature at the time of the study. SETTING: University Eye Hospital, Bochum, Germany. DESIGN: Noninterventional observation. METHODS: In 445 patients, cataract surgery with LAL implantation was performed between April 2008 and December 2012. It was possible to contact 171 of these patients or their relatives through letter or telephone; 61 patients (103 eyes) agreed to participate in the long-term study and were examined. RESULTS: The mean time between the lock-in (final light treatment) and long-term visit was 7.2 years; 61 patients were included and examined. Corrected and uncorrected distance visual acuity was and remained good (n = 93). The refractive outcome was stable with minimal deviation. There were no significant changes in corneal thickness. In 2 patients, there were slight opacities of the IOL material without impact on visual acuity. Other eye diseases were within the normal range of the patients' age. CONCLUSION: Seven years after implantation and refractive adjustment, eyes with an LAL had stable refraction, good visual acuity, and no IOL-associated pathologies. The findings suggest that LAL technology is a safe and efficient method to achieve good visual results without long-term complications.

The practicability and relevance of developing a yoga intervention for mental health consumers: A qualitative study.

The aim of the study was to understand the perspectives of mental health consumers, staff, and yoga teachers on the characteristics of a yoga-based intervention to be developed for consumers with a long-term mental health condition, in addition to anxiety and/or depression. Two focus groups were held with mental health consumers (n = 8), two focus groups with mental health staff (n = 13) from a metropolitan community mental health setting, and five one-on-one interviews with yoga teachers. Participants were asked about the feasibility and appropriateness of a range of yoga practice features to be tested as a newly developed yoga-based intervention. Thematic analysis was used to identify themes. Findings included the following consumer themes: Mental health understanding and experience of teachers and participants is important, Creating a safe space and Yoga practice elements. Staff themes included Mental health understanding and experience of teachers is important, Environmental design, and Yoga practice elements. Yoga teacher themes included Environmental design and Yoga practice elements. Mental health understanding and experience of the yoga teacher, and trauma-informed care were consistently emphasized by consumers and staff. Teachers focused less on specific mental health considerations, which may be reflective of a broader knowledge gap. Recommendations regarding yoga practice elements, including pre-information, regular and consistent practice, modifications, breathwork, mindfulness and guided practice, and environmental design features, were consistent with current trauma-informed yoga research. Findings will be used to guide the development of a yoga-based intervention for consumers with a long-term mental health condition, in addition to anxiety and/or depression.

Women's experiences with enhanced recovery after elective caesarean section with next day discharge: A qualitative study.

BACKGROUND: A maternity service in Australia recently implemented an 'Enhanced recovery after Elective Caesarean' pathway, which includes antenatal preparation and facilitates an active role in postnatal recovery such as encouraging mobility and early cessation of fasting. The pathway includes next day discharge for women and their babies after elective caesarean section and safely transitions maternity care from hospital to home with community midwifery care. While enhanced recovery has been implemented in a number of surgical procedures to reduce hospital stay and to improve patient outcomes it has only been considered for elective caesarean sections in more recent years. Given this, enhanced recovery is not well established or researched in obstetric contexts. Furthermore, women's experiences with reduced hospital stays post-caesarean, particularly next day discharge, is limited. A qualitative explorative descriptive study of women's experiences with the pathway and the associated early transition home will help to inform clinical practice and the research evidence base. METHODS: Eleven interviews were conducted with women who had experienced the pathway and next day discharge. Thematic analysis was conducted. FINDINGS: Three major themes and twelve sub-themes emerged from the data. Major themes identified were women's general experience of an enhanced recovery pathway, their experiences following arrival at home and support at home. All women interviewed were satisfied with the pathway and home recovery. However, there are a number of aspects of care that are essential to a positive experience. This includes excellent support from social networks, healthcare staff and home midwifery care; well managed pain relief; and adequate and timely information, including reassurance that they or their baby could remain in hospital if required. CONCLUSION: This study takes a woman-centred perspective adding to both literature and practice.

Small incision lenticule extraction for the correction of high myopia.

PURPOSE: Excimer laser-based refractive procedures can have less predictable results when used for correcting high myopia than when used for moderate myopia. Small incision lenticule extraction might overcome this weakness. However, small incision lenticule extraction is only Food and Drug Administration approved for use in myopic eyes up to -8 D with astigmatism of -3 D or less. We report outcomes of small incision lenticule extraction in highly and moderately myopic eyes and compare these to modern laser-assisted in situ keratomileusis. METHODS: Retrospective, observational consecutive case series. Inclusion criteria: attempted myopic spherical correction ⩾-8 or-3 to -7.75 D with astigmatism ⩽-3 D, and corrected distance visual acuity of 1.0 (decimal scale) or better. RESULTS: A total of 62 highly myopic and 407 moderately myopic eyes were included. At 3 months postoperatively, the highly myopic eyes had a mean spherical equivalent refraction of -0.28 ± 0.41 D (range: -1.13 to +0.75 D). Mean uncorrected distance visual acuity was 1.0. Mean efficacy index was 0.84. Mean safety index was 1.03. Uncorrected distance visual acuity same or better than corrected distance visual acuity: 61%. Astigmatism was ⩽0.5 D in 90% and ⩽1 D in 100%. The results in the moderately myopic eyes were comparable. CONCLUSION: We found equally good visual and refractive outcomes after small incision lenticule extraction for the correction of high and of moderate myopia combined with an astigmatic correction of up to 3 D, respectively.

Clinical outcomes of small incision lenticule extraction versus advanced surface ablation in low myopia.

PURPOSE: To compare the visual and refractive outcomes of small incision lenticule extraction and advanced surface ablation for low myopia or myopic astigmatism. METHODS: Retrospective, observational case series of our first 50 consecutive small incision lenticule extraction patients compared to refraction-matched 50 advanced surface ablation treatments with attempted spherical equivalent correction ⩽-3.5 D, astigmatism ⩽-1.5 D, and corrected distance visual acuity of 1.0 (decimal scale) or better. Only one eye per patient was included. RESULTS: Small incision lenticule extraction: mean attempted spherical equivalent correction was -2.80 ± 0.63 D. Uncorrected distance visual acuity was 0.85 and 1.0 at days 1 and 5, respectively. At 3 months, mean spherical equivalent refraction was 0.02 ± 0.32 D (range: -0.5 to +0.75 D), mean cylinder was -0.24 ± 0.21 D (range: 0 to -0.75 D), mean uncorrected distance visual acuity was 1.27, mean efficacy index was 0.96, and mean safety index was 1.05. Uncorrected distance visual acuity was same or better than corrected distance visual acuity in 96%, astigmatism ⩽0.5 D in 98% and ⩽1 D in 100% of eyes, respectively. Advanced surface ablation: mean attempted spherical equivalent correction was -2.75 ± 0.5 D. Uncorrected distance visual acuity was 0.72 and 0.61 at days 1 and 5, respectively. At 3 months, mean spherical equivalent refraction was 0.22 ± 0.32 D, mean cylinder was -0.27 ± 0.27 D, mean uncorrected distance visual acuity was 1.21, mean efficacy index was 1.03, and mean safety index was 1.08. CONCLUSION: Small incision lenticule extraction for low myopia was found to be safe and effective with outcomes at 3 months similar to those obtained with advanced surface ablation while offering a quicker visual recovery.