Associations between Corneal Nerve Structure and Function in a Veteran Population.

Background: We evaluate the relationship between corneal nerve structure and function in a veteran population. Methods: 83 veterans (mean age: 55 ± 5 years) seen at the Miami Veterans Affairs (VA) eye clinic were included in this study. Each individual filled out questionnaires to evaluate ocular symptoms (5-Item Dry Eye Questionnaire, DEQ5; Ocular Surface Disease Index, OSDI) and ocular pain (Numerical Rating Scale, NRS; Neuropathic Pain Symptom Inventory modified for the Eye, NPSI-Eye). The individuals also underwent an ocular surface examination that captured functional nerve tests including corneal sensation, corneal staining, and the Schirmer test for tear production. Corneal sub-basal nerve analysis was conducted using in vivo confocal microscopy (IVCM) images with corneal nerve density, length, area, width, and fractal dimension captured. IVCM and functional corneal metrics from the right eye were examined using correlational and linear regression analysis. Results: Most corneal structural metrics were not related to functional metrics, except for weak correlations between various IVCM metrics and tear production. In addition, corneal nerve fiber area was positively related to corneal sensation (r = 0.3, p = 0.01). On linear regression analyses, only the corneal fractal dimension remained significantly related to tear production (ß = -0.26, p = 0.02) and only the corneal nerve fiber area remained significantly related to corneal sensation (ß = 0.3, p = 0.01). Conclusions: Most corneal nerve structural metrics did not relate to functional metrics in our veteran population, apart from a few weak correlations between structural metrics and tear production. This suggests that using corneal nerve anatomy alone may be insufficient for predicting corneal function.

Associations between dry eye disease and sleep quality: a cross-sectional analysis.

BACKGROUND/AIMS: To investigate relationships between dry eye (DE) disease and sleep quality, with a focus on which aspects of sleep most closely relate to DE. METHODS: 141 veterans (mean age: 56±5) seen at the Miami Veterans Affairs eye clinic filled out questionnaires to quantify the severity of DE symptoms (5-Item Dry Eye Questionnaire (DEQ-5) and Ocular Surface Disease Index (OSDI)) and ocular pain (Numerical Rating Scale (NRS) and Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-E)). All individuals also underwent an ocular surface examination. Aspects of sleep quality were assessed using the Pittsburgh Sleep Quality Index (PSQI). DE metrics were examined by PSQI scores and subscores. RESULTS: Most participants (76%) reported mild or greater DE symptoms (DEQ-5 ≥6). Overall, ocular symptoms were more related to sleep metrics than signs. The strongest DE symptom association was between the OSDI and sleep disturbances (PSQI subscore 5, r=0.49, p<0.0005). For DE signs, ocular surface inflammation and meibum quality were related to subjective sleep quality (PSQI subscore 1, r=0.29, p=0.03, for both). On linear regression analyses, most ocular symptom questionnaires remained associated with sleep disturbances (PSQI subscore 5: NRS (r=0.52, p<0.0005), DEQ-5 (r=0.36, p<0.0005), and OSDI (r=0.31, p<0.0005)). For DE signs, ocular surface inflammation and meibum quality remained associated with subjective sleep quality (r=0.26, p=0.01; r=0.46, p<0.0005, respectively). CONCLUSION: DE symptom and ocular pain intensity were closely related to sleep metrics, most strongly to sleep disturbances. Relationships were weaker for DE signs, with subjective sleep quality relating to inflammation and meibum quality.

A prospective study on quality in endoscopic retrograde cholangiopancreatography (ERCP): trend in Italy from the REQUEST study.

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure with a relatively high rate of adverse events. Data on training of operators and fulfillment of quality indicators in Italy are scarce. The goal of this study was to assess the overall quality of ERCP in Italy compared to international standards. Patients and methods This was a prospective, observational study from different Italian centers performing ERCP. Operators answered a questionnaire, then recorded data on ERCPs over a 1-to 3-month period. Results Nineteen Italian centers participated in the study. The most common concern of operators about training was the lack of structured programs. Seven/19 centers routinely used conscious sedation for ERCP. Forty-one experienced operators and 21 trainees performed 766 ERCPs: a successful deep biliary cannulation in native-papilla patients was achieved in 95.1 % of cases; the post-ERCP pancreatitis (PEP) rate was 5.4 % in native-papilla patients; cholangitis rate was 1.0 %; bleeding and perforation occurred in 2.7 % and 0.4 % of the patients, respectively. Conclusions This study revealed that, overall, ERCP is performed in the participating Italian centers meeting good quality standards, but structured training and sedation practice are still subpar. The bleeding and perforation rate slightly exceeded the American Society of Gastrointestinal Endoscopy indicator targets but they are comparable to the reported rates from other international surveys.

The Effect of Portfolio-Based Education and Evaluation on Clinical Competence of Nursing Students: A Pretest-Posttest Quasiexperimental Crossover Study.

PURPOSE: Currently, revisions in education and evaluation in the nursing domain are necessary to increase the clinical competence of graduates. The aim of this study was to compare nursing students' clinical competence using the portfolio method with conventional education and evaluation methods in clinical education. METHODS: In this pretest-posttest quasiexperimental crossover study, all six-semester undergraduate nursing students of Ahvaz Jundishapur University of Medical Sciences were classified into four groups. They were selected based on the use of portfolio and conventional methods during their apprenticeship. Then, they were educated using conventional and portfolio methods. Their clinical competence was measured by a self-appraisal questionnaire. Data were statistically analyzed with independent and paired t-tests. RESULTS: There were significant differences between average scores of clinical competence in all three domains before and after study in portfolio-based education method (P=0.0001). Furthermore, the average difference in scores before and after internship between the two educational groups in all three domains - cognitive (P=0.002), affective (P=0.0001), and psychomotor - (P=0001) was significant. Similarly, there was a significant difference in total average scores of clinical competence between the two methods (P=0.0001). CONCLUSION: The results showed the effect of educational method on increasing the clinical competence of nursing students in a clinical unit. This new method can be used as a combination of education, evaluation and student-centered methods.

Comparison between needle-knife fistulotomy and standard cannulation in ERCP.

AIM: To compare the rates of success and complications of two different methods of access into the common bile duct (CBD). METHODS: Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied. In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy (group F); in the following 85 patients standard cannulation was performed through the Oddi sphincter (group S). Indications for the procedure were: choledocholithiasis, biliary obstruction, postoperative leak, sclerosing cholangitis, and Mirizzi's syndrome. RESULTS: Deep CBD cannulation was successful in 85/88 patients (96.5%) in group F vs 60/85 patients (70.6%) in group S (P < 0.0001). The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy. Fistulotomy was successful in 21/25 patients (84%). As for complications, hyperamilasemia occurred in 7 (7.9%) group F patients vs 7 (8.2%) group S patients (P = NS); mild pancreatitis in 1 (1.1%) group F patient vs 5 (5.8%) group S patients (P = NS); bleeding in 3 (3.4%) group F patients vs 3 (3.5%) group S patients (P = NS). CONCLUSION: Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation.

Femtosecond laser in situ keratomileusis versus conductive keratoplasty to obtain monovision in patients with emmetropic presbyopia.

PURPOSE: To compare visual outcomes, complications, and patient satisfaction after femtosecond laser in situ keratomileusis (LASIK) and conductive keratoplasty (CK). SETTING: Private laser clinics, Reading and Southampton, United Kingdom. METHODS: In this retrospective consecutive single-surgeon comparative study, presbyopic emmetropia was treated with femtosecond LASIK or CK to achieve monovision by targeting -1.50 diopters (D) of myopia in the nondominant eye after a successful monovision contact lens trial. The CK treatments were performed with a ViewPoint CK system using the light-touch technique. The femtosecond LASIK was performed using an IntraLase FS/FS30 and EC-5000 platform with OPDCAT wavefront treatment. RESULTS: The mean spherical equivalent 12 months postoperatively was -1.63 D +/- 0.68 (SD) in the femtosecond LASIK group and -0.97 +/- 0.82 D in the CK group (P<.001). The mean vector value of astigmatism at 12 months was 0.32 +/- 0.32 D and 1.00 +/- 0.75 D, respectively (P<.0001). The mean induced higher-order aberration (HOA) was 0.45 +/- 0.28 microm in the femtosecond LASIK group and 1.13 +/- 0.25 microm in the CK group (P<.0001). The retreatment rate was 3% after femtosecond LASIK and 50% after CK (P<.0001). On a questionnaire administered at 12 months, 20 patients (62.5%) in the femtosecond LASIK group and 11 patients (34.4%) in the CK group reported being satisfied (P = .02). CONCLUSIONS: In emmetropic presbyopic cases, femtosecond LASIK monovision provided stable correction with less induced astigmatism and HOA. Eyes with CK monovision had regression and induced astigmatism.

LCT-13910C>T polymorphism-associated lactose malabsorption and risk for colorectal cancer in Italy.

BACKGROUND: The activity of epithelial lactase (LCT) associates with a polymorphism 13910 bp upstream the LCT-encoding gene (LCT-13910C>T). The relationship between LCT-13910C>T polymorphism and risk for colorectal cancer is unclear. AIMS: We examined the relationship between the LCT-13910C>T polymorphism causing lactose intolerance and risk for colorectal cancer/polyps onset in the Italian population. PATIENTS AND METHODS: 793 subjects (306 with colorectal cancer, 176 with polyps and 311 controls) were genotyped for the LCT-13910C>T variant by TaqMan real time-PCR. RESULTS: Lactose malabsorption linked to the CC genotype did not associate with an increased risk for either colorectal cancer (OR=1.041; 95% CI=0.751-1.442; p=0.868) or polyps (OR=0.927; 95% CI=0.630-1.363; p=0.769). There was no association with colorectal cancer/polyps site. 60% of the subjects overall bore the CC genotype. CONCLUSION: In the Italian population the LCT-13910C>T polymorphism is not associated to the risk for colorectal cancer or polyps.