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1.
Aust J Gen Pract ; 50(8): 595-602, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34333570

RESUMO

BACKGROUND AND OBJECTIVES: Home visits may change patients' healthcare resource utilisation, including hospital admission, medications, outpatient and emergency room visits. The aim of the present study was to report changes in healthcare resource utilisation after the provision of home healthcare services. METHOD: This was a multicentre follow-up study. Data on health and functional statuses were collected during home visits. Electronic medical records of 12 medical institutions were retrieved (outpatient visits, emergency care use, hospital admissions and prescription medications). The researchers analysed healthcare utilisation and medications before and after enrolment. RESULTS: There were 246 participants. The mean age was 85.5 years (52% men). There was an increase in annual outpatient visits and a decrease in hospital admission days after enrolment (13.7-15.3 visits/year and 17.5-15 days/year, respectively). The number of medical institutions visited increased, but specialties and doctors visited decreased. Oral medications also increased (3.3-4.3 types). DISCUSSION: Home visits help decrease days of hospital admission, but not medications or outpatient or emergency room visits.


Assuntos
Visita Domiciliar , Aceitação pelo Paciente de Cuidados de Saúde , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Serviços de Saúde , Hospitalização , Humanos , Masculino
2.
Exp Eye Res ; 206: 108539, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33741324

RESUMO

Oxidative stress-related ocular surface epithelial damage can be initiated by ambient oxygen, UV radiation, and chemical burns. The oxidative damage to cornea can lead to inflammation and even vision loss. Lingzhi (Ganoderma lucidum) is a Chinese herbal drug and has been shown to prevent chronic diseases in clinical practices and has been proven to possess anti-oxidative and anti-inflammatory properties. In the study, we prepared poly (lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) as a sustained drug release system of Lingzhi (LZH) to improve bioavailability. The particle size of developed NPs containing LZH (LZH-NPs) was ~184 nm with narrow size distribution. The results of cellular uptake revealed that using NPs as a drug delivery system could significantly increases the intracellular retention time. The results of the cell viability and chemiluminescence assay revealed that 5 µg/ml of LZH-NPs might be the threshold concentration for cultivation of corneal epithelial cells. After treating LZH-NPs in oxidative damaged cells, the results showed that the inflammation-related gene expression and DNA fragmentation level were both significantly decreased. Post-treatment of LZH-NPs in damaged corneal epithelial cells could increase the cell survival rate. In the rabbit corneal alkali burn model, topical instillation of LZH-NPs could promote corneal wound healing and decrease the inflammation. These results suggest that LZH-NPs may have the potential to treat ocular surface diseases caused by oxidative stress.


Assuntos
Queimaduras Químicas/terapia , Lesões da Córnea/terapia , Medicamentos de Ervas Chinesas/administração & dosagem , Epitélio Corneano/efeitos dos fármacos , Queimaduras Oculares/terapia , Estresse Oxidativo/efeitos dos fármacos , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/administração & dosagem , Animais , Materiais Biocompatíveis/administração & dosagem , Queimaduras Químicas/metabolismo , Queimaduras Químicas/patologia , Sobrevivência Celular , Lesões da Córnea/metabolismo , Lesões da Córnea/patologia , Preparações de Ação Retardada , Epitélio Corneano/metabolismo , Epitélio Corneano/patologia , Queimaduras Oculares/metabolismo , Queimaduras Oculares/patologia , Nanopartículas/administração & dosagem , Coelhos , Reishi
3.
J Med Internet Res ; 22(12): e22703, 2020 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-33259324

RESUMO

BACKGROUND: Telehealth is a recommended method for monitoring the progression of nonsevere infections in patients with COVID-19. However, telehealth has not been widely implemented to monitor SARS-CoV-2 infection in quarantined individuals. Moreover, studies on the cost-effectiveness of quarantine measures during the COVID-19 pandemic are scarce. OBJECTIVE: In this cohort study, we aimed to use telehealth to monitor COVID-19 infections in 217 quarantined Taiwanese travelers and to analyze the cost-effectiveness of the quarantine program. METHODS: Travelers were quarantined for 14 days at the Taiwan Yangmingshan quarantine center and monitored until they were discharged. The travelers' clinical symptoms were evaluated twice daily. A multidisciplinary medical team used the telehealth system to provide timely assistance for ill travelers. The cost of the mandatory quarantine was calculated according to data from the Ministry of Health and Welfare of Taiwan. RESULTS: All 217 quarantined travelers tested negative for SARS-CoV-2 upon admission to the quarantine center. During the quarantine, 28/217 travelers (12.9%) became ill and were evaluated via telehealth. Three travelers with fever were hospitalized after telehealth assessment, and subsequent tests for COVID-19 were negative for all three patients. The total cost incurred during the quarantine was US $193,938, which equated to US $894 per individual. CONCLUSIONS: Telehealth is an effective instrument for monitoring COVID-19 infection in quarantined travelers and could help provide timely disease management for people who are ill. It is imperative to screen and quarantine international travelers for SARS-CoV-2 infection to reduce the nationwide spread of COVID-19.


Assuntos
COVID-19/economia , COVID-19/terapia , Quarentena/métodos , Telemedicina/métodos , Telemedicina/estatística & dados numéricos , Adulto , COVID-19/diagnóstico , COVID-19/epidemiologia , Estudos de Coortes , Análise Custo-Benefício , Feminino , Humanos , Masculino , SARS-CoV-2/isolamento & purificação , Taiwan/epidemiologia , Telemedicina/economia
4.
J Pain Symptom Manage ; 60(6): 1136-1143, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32619671

RESUMO

CONTEXT: Patients who died of cancers and those who died of noncancer diseases may receive different end-of-life care. OBJECTIVES: This study aimed to evaluate the trends of utilization of palliative care and aggressive end-of-life care for patients who died of cancers and those who died of noncancer diseases in hospitals. METHODS: The medical records of patients who died in a public hospital because of cancer or other diseases were reviewed. The proportion of those who received palliative care, admitted to intensive care unit (ICU) within 30 days of death, died in ICU, and received cardiopulmonary resuscitation (CPR) within three days of death in 2013-2014, 2015-2016, and 2017-2018, respectively, was investigated. Multivariate logistic regression was applied to evaluate the independent effects of various factors on the risk of receiving aggressive end-of-life care. RESULTS: Significant trends of increase in receiving palliative care were found. The proportion of patients who died of noncancer diseases and received palliative care was lower than that of those who died of cancers. Palliative care was associated with a reduced risk of ICU admission within 30 days of death (adjusted odds ratio [AOR] 0.361), death in ICU (AOR 0.208), and receiving CPR within three days of death (AOR 0.057). Patients who died of noncancer diseases had a higher risk of ICU admission within 30 days of death (AOR 5.016), death in ICU (AOR 5.086), and receiving CPR within three days of death (AOR 3.274). CONCLUSION: Utilization of palliative care is increasing. Patients who died of noncancer diseases received less palliative care but more aggressive end-of-life care than those who died of cancers.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Neoplasias , Assistência Terminal , Hospitais , Humanos , Neoplasias/terapia , Cuidados Paliativos , Estudos Retrospectivos
6.
J Formos Med Assoc ; 119(11): 1650-1657, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31948731

RESUMO

BACKGROUND/PURPOSE: Reactivation of herpes viruses poses threat to corneal graft survival. This study evaluated the presence of herpes simplex virus type 1 (HSV-1), HSV type 2 (HSV-2), and cytomegalovirus (CMV) DNA in recipient corneas and the aqueous humor of patients undergoing penetrating keratoplasty (PKP), and the impact on graft survival. METHODS: This retrospective study reviewed 90 eyes of 71 patients underwent PKP between 2008 and 2016. Cornea and aqueous humor samples were sent for polymerase chain reaction (PCR) testing for viral DNA. The main outcomes were PCR results and graft survival. RESULTS: Recipient corneas tested positive for HSV-1 in 47 eyes (52.2%), for HSV-2 in 24 eyes (26.7%), and for CMV in seven eyes (7.8%). Aqueous humor tested positive for HSV-1 in 44 eyes (48.9%), for HSV-2 in 25 eyes (27.8%), and for CMV in eight eyes (8.9%). The presence of aqueous HSV-1 DNA was associated with higher risk of graft failure (p = 0.005), whereas corneal HSV-1 DNA was not. The presence of HSV-2 DNA had no significant impact on graft survival. Aqueous CMV DNA was associated with higher risk of graft failure in univariate model, but not in multivariate model. CONCLUSION: There were high positive rates of HSV-1, HSV-2, and CMV DNA in recipient corneas and aqueous humor at the time of PKP, even among patients not suspected of latent viral infection. The presence of aqueous HSV-1 DNA was associated with higher risk of graft failure.


Assuntos
Sobrevivência de Enxerto , Ceratoplastia Penetrante , Humor Aquoso , Córnea , DNA Viral , Humanos , Estudos Retrospectivos
7.
Am J Hosp Palliat Care ; 37(6): 474-480, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31749385

RESUMO

BACKGROUND: In recent decades, issues related to end-of-life care and advance care planning (ACP) have attracted popular attention. Advance care planning has been broadly discussed as one of the potential solutions to protect a patient's rights, autonomy, and dignity at the end of life. To better understand publishing on this topic, we conducted this study to demonstrate the worldwide research productivity, trends, and citations of ACP in the past 3 decades by bibliometric analysis. METHODS: Articles published on ACP were retrieved from the Web of Science Core Collection database, and the subject terms included "advance directive," or "advance care planning." RESULTS: Overall, 2126 publications on ACP were retrieved until January 22, 2019. North America, Western Europe, and Australia were the most productive regions. The top 15 countries published 95.9% of the total number of articles. The United States accounted for approximately three-fifths (61.0%) of all publications. When adjusted for population size, Australia had the highest number of articles per million persons (6.64), followed by the Netherlands (6.14) and Belgium (4.61). The most productive authors were Sudore (n = 37), Deliens (n = 29), and Green (n = 24). CONCLUSIONS: The current study revealed that research in terms of publications on ACP has rapidly increased over the past 3 decades. Developed countries, especially the United States, were more concerned with the ACP research field than developing countries were.


Assuntos
Planejamento Antecipado de Cuidados/estatística & dados numéricos , Bibliometria , Publicações Periódicas como Assunto/estatística & dados numéricos , Humanos
8.
Tohoku J Exp Med ; 249(3): 213-221, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31776299

RESUMO

Myopia is the most common refractive disorder in Eastern Asia. The development of myopia is associated with the cooperation of various ocular tissues. Exosomes in the aqueous humor (AH) have been implicated to modulate intracellular communications by transferring exosomal miRNAs and proteins between cells. These exosomal miRNAs and proteins are likely involved in the pathogenesis of various eye diseases. In this study, we aimed to explore human exosomal miRNA profiles and their roles in myopia development. AH samples were collected from 16 patients (8 myopia and 8 control) undergoing routine cataract surgeries. Exosomes were isolated from AH of each individual using the ExoQuick solution. The numbers and sizes of exosomes were not significantly different between the myopia and control groups. The individual exosomes of the same group were pooled to purify RNA. Unexpectedly, the myopia group contained 2.78-fold total RNA amount than that in the control group. Thereafter, miRNA profiles were analyzed using the OpenArray system. We thus found 15 myopia-specific miRNAs and four myopia-absent miRNAs. By using bioinformatics analysis, we identified six well-known myopia-associated genes that are potential targets of five myopia-specific miRNAs (has-miR-582-3p, has-miR-17-5p, has-miR-885-3p, has-miR-19b-3p, and has-miR-450b-5p). These genes are cholinergic receptor muscarinic 2 (CHRM2), cyclic nucleotide-gated channel beta 3 (CNGB3), vascular endothelial growth factor A (VEGFA), adenosine A2a receptor (ADORA2A), insulin-like growth factor 1 (IGF1), and lumican (LUM). Moreover, CHRM2 may be a target of myopia-absent miRNA (has-miR-378a-5p). In conclusion, we show the expression profiles of AH-derived exosomal miRNAs and their potential roles in myopia development.


Assuntos
Humor Aquoso/metabolismo , Exossomos/genética , Perfilação da Expressão Gênica , MicroRNAs/genética , Miopia/genética , Idoso , Sequência de Bases , Estudos de Casos e Controles , Feminino , Regulação da Expressão Gênica , Humanos , Masculino , MicroRNAs/metabolismo , Pessoa de Meia-Idade
10.
J Chin Med Assoc ; 82(4): 282-288, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30893267

RESUMO

BACKGROUND: Elderly people are susceptible to develop multiple chronic diseases and are thus likely to utilize the emergency department (ED). Access to health care and health outcomes may differ between rural and urban areas. This study aims to compare the frequency and outcome of geriatric ED utilization between urban and rural areas. METHODS: This population-based study obtained information from the health insurance database. The frequency and outcome of ED utilization in 2013 were compared among people aged ≥65 years living in urban and rural areas. The independent effect of various characteristics on the frequency and outcome of ED utilization was evaluated using multivariate logistic regression analysis. RESULTS: Of the 6695 people living in urban areas, 1879 (28.07%) utilized the ED and accounted for 3859 ED visits. Meanwhile, 908 (29.75%) of the 3052 people living in rural areas utilized the ED and accounted for 1820 ED visits. No difference in the prevalence of ED utilization was found between the urban and rural areas. Urbanization did not affect the risk of frequent ED utilization among ED users. People living in rural areas had an increased risk of ED visits with a high acuity (adjusted odds ratio: 1.40, 95% CI: 1.12-1.75). Urbanization did not affect the risk of hospitalization or immediate death after ED visits. CONCLUSION: The frequency of ED utilization showed no urban-rural difference. Elderly people living in rural areas had an increased risk of visiting the ED with a high acuity.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Serviços de Saúde Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos
11.
Theranostics ; 9(1): 232-245, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30662564

RESUMO

Artificial intelligence (AI) based on convolutional neural networks (CNNs) has a great potential to enhance medical workflow and improve health care quality. Of particular interest is practical implementation of such AI-based software as a cloud-based tool aimed for telemedicine, the practice of providing medical care from a distance using electronic interfaces. Methods: In this study, we used a dataset of labeled 35,900 optical coherence tomography (OCT) images obtained from age-related macular degeneration (AMD) patients and used them to train three types of CNNs to perform AMD diagnosis. Results: Here, we present an AI- and cloud-based telemedicine interaction tool for diagnosis and proposed treatment of AMD. Through deep learning process based on the analysis of preprocessed optical coherence tomography (OCT) imaging data, our AI-based system achieved the same image discrimination rate as that of retinal specialists in our hospital. The AI platform's detection accuracy was generally higher than 90% and was significantly superior (p < 0.001) to that of medical students (69.4% and 68.9%) and equal (p = 0.99) to that of retinal specialists (92.73% and 91.90%). Furthermore, it provided appropriate treatment recommendations comparable to those of retinal specialists. Conclusions: We therefore developed a website for realistic cloud computing based on this AI platform, available at https://www.ym.edu.tw/~AI-OCT/. Patients can upload their OCT images to the website to verify whether they have AMD and require treatment. Using an AI-based cloud service represents a real solution for medical imaging diagnostics and telemedicine.


Assuntos
Inteligência Artificial , Tomada de Decisões , Testes Diagnósticos de Rotina/métodos , Processamento de Imagem Assistida por Computador/métodos , Degeneração Macular/diagnóstico , Tomografia de Coerência Óptica/métodos , Humanos , Software , Telemedicina/métodos
12.
Acta Ophthalmol ; 97(2): e290-e295, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30259675

RESUMO

PURPOSE: Retina vein occlusion (RVO) is a visual-threatening retinal disease that causes irreversible impaired quality of life. The contribution of oxidative stress behind clinical course of RVO was rarely investigated. The study aimed to measure the serum oxidative biomarker in patients with RVO to investigate further physical response. METHODS: We measured the serum levels of malondialdehyde (MDA), 8-hydroxy-2-deoxyguanosine (8OHdG), Sirutin 1 (SIRT1), peroxisome proliferator- activated receptor gamma (PPAR-r), Peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), orkhead box protein O1 (FOXO1), orkhead box protein O3 (FOXO3), catalase, (SOD) and hydrogen peroxide (H2 O2 ) among 19 patients with cataract as control group and 36 patients with RVO, respectively. RESULTS: The mean MDA, 8OHdG and hydrogen peroxide in the serum were significantly higher in patients with RVO compared with the results in control group subjects. Whereas SIRT1, PPAR-r, PGC-1, FOXO1, FOXO3, catalase and SOD levels in serum were significantly decreased in patients with RVO compared with control group. CONCLUSION: We demonstrated that the serum level of MDA, 8OHdG and hydrogen peroxide is increased in patients with RVO. Among these, the elevation of MDA, 8OHdG and hydrogen peroxide suggests the increasing of serum oxidative stress in RVO patients. All enzymes related reactive oxygen species scavenge were decreased. Thus, focal RVO may increase systemic oxidative stress within serum.


Assuntos
Catalase/sangue , Desoxiguanosina/análogos & derivados , Peróxido de Hidrogênio/sangue , Malondialdeído/sangue , Estresse Oxidativo , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/sangue , Oclusão da Veia Retiniana/sangue , 8-Hidroxi-2'-Desoxiguanosina , Idoso , Biomarcadores/sangue , Desoxiguanosina/sangue , Feminino , Humanos , Masculino , Prognóstico , Espécies Reativas de Oxigênio/sangue
13.
Asia Pac J Ophthalmol (Phila) ; 8(3): 206-210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30421588

RESUMO

PURPOSE: To report the clinical course and treatment response in a cohort of patients with neuromyelitis optica spectrum disorder (NMOSD) from a single referral center in Taiwan. DESIGN: Case series. METHODS: All NMOSD patients who received treatment and follow-up checks at National Taiwan University Hospital for at least 2 years between January 2008 and December 2016 were recruited. Demographic data and detailed characteristics of clinical course including acute episodes, maintenance therapies, and visual outcome were collected. Patients were examined every 6 months and during each episode of relapse. RESULTS: A total of 96 patients were identified; of them, 68 (70.8%) had optic neuritis. Optic neuritis was the initial presentation of NMOSD in 44 patients. Among the patients with optic neuritis, 32.4% had recurrent optic neuritis within 1 year from the first episode. Compared with the group without optic neuritis, the group with optic neuritis had a younger age of presentation (34.4 ± 15.9 vs 42.4 ± 14.8 years, P = 0.02) and a higher 1-year recurrence rate (64.7% vs 17.9%, P < 0.001). Among the patients with optic neuritis, 51.5% had a final visual acuity of worse than 20/200. Multiple regression analysis showed that the presence of aquaporin-4-IgG antibodies and poor initial visual acuity were the risk factors for worse visual outcome. CONCLUSIONS: In this study, patients with optic neuritis were younger and had a higher 1-year recurrence rate. Despite using steroid therapy during the acute phase and immunosuppressive agents as long-term treatment, visual prognosis was poor. Aquaporin-4-IgG antibodies and initial visual acuity were associated with final visual outcome.


Assuntos
Imunossupressores/uso terapêutico , Metilprednisolona/administração & dosagem , Neuromielite Óptica/terapia , Plasmaferese/métodos , Acuidade Visual , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Anti-Idiotípicos/imunologia , Aquaporina 4/imunologia , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Imunoglobulina G/imunologia , Injeções Intravenosas , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuromielite Óptica/diagnóstico , Neuromielite Óptica/imunologia , Nervo Óptico/patologia , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento , Adulto Jovem
14.
J Clin Med ; 7(12)2018 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-30477203

RESUMO

PURPOSE: Artificial neural networks (ANNs) are one type of artificial intelligence. Here, we use an ANN-based machine learning algorithm to automatically predict visual outcomes after ranibizumab treatment in diabetic macular edema. METHODS: Patient data were used to optimize ANNs for regression calculation. The target was established as the final visual acuity at 52, 78, or 104 weeks. The input baseline variables were sex, age, diabetes type or condition, systemic diseases, eye status and treatment time tables. Three groups were randomly devised to build, test and demonstrate the accuracy of the algorithms. RESULTS: At 52, 78 and 104 weeks, 512, 483 and 464 eyes were included, respectively. For the training group, testing group and validation group, the respective correlation coefficients were 0.75, 0.77 and 0.70 (52 weeks); 0.79, 0.80 and 0.55 (78 weeks); and 0.83, 0.47 and 0.81 (104 weeks), while the mean standard errors of final visual acuity were 6.50, 6.11 and 6.40 (52 weeks); 5.91, 5.83 and 7.59; (78 weeks); and 5.39, 8.70 and 6.81 (104 weeks). CONCLUSIONS: Machine learning had good correlation coefficients for predicating prognosis with ranibizumab with just baseline characteristics. These models could be the useful clinical tools for prediction of success of the treatments.

15.
Taiwan J Ophthalmol ; 8(2): 67-73, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30038884

RESUMO

Myasthenia gravis (MG) is an autoimmune disease involving the neuromuscular junction. Autoantibodies to the acetylcholine receptor or, less frequently, to muscle-specific kinase, attack against the postsynaptic junctional proteins, resulting in fluctuating and variable weakness of muscles. Extraocular, levator palpebrae superioris, and orbicularis oculi muscles are particularly susceptible. The majority of patients with MG present with purely ocular symptoms including ptosis and diplopia initially. About half of these patients progress to generalized disease within 2 years. The prevalence of MG in Taiwan is 140 per million with male to female ratio of 0.7. The incidence rate is higher in the elderly. Several immune-related diseases such as lymphoid malignancy, diabetes, and thyroid diseases are associated with MG in the national population-based studies in Taiwan. Ice pack test, rest test, Tensilon/neostigmine test, circulating antibody measurement, and electrophysiological studies are useful diagnostic tools with variable sensitivity and specificity. For the patients with ocular MG, acetylcholinesterase inhibitors are usually the first-line treatment. Corticosteroids and immunosuppressant could provide better disease control and may reduce the risk of conversion to generalized form although there is still some controversy. A thymectomy is also beneficial for ocular MG, especially in refractory cases. The correction of ptosis and strabismus surgery could improve the visual outcome but should be performed only in stable disease.

17.
Taiwan J Ophthalmol ; 7(3): 160-163, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29034156

RESUMO

Compared with conventional penetrating keratoplasty, Descemet's stripping automated endothelial keratoplasty (DSAEK) more effectively maintain global integrity and rapid vision rehabilitation with less ocular surface disorders in patients with endothelial dysfunction. Here, we report a case of a 76-year-old woman who experienced opacification of a hydrophilic intraocular lens (IOL) approximately 10 months after DSAEK. The patient with no history of systemic disease developed pseudophakic bullous keratopathy in the right eye 2 years after undergoing cataract surgery. The best-corrected visual acuity (BCVA) of the right eye was Snellen 0.01 when presented to our hospital. DSAEK was arranged and performed smoothly. However, the graft detached over the upper part of the cornea on postoperative day 1. Thus, rebubbling was performed immediately. After the procedure, the graft was well attached, and the cornea became clear gradually. The BCVA returned to Snellen 0.6. However, progressive opacification over the anterior surface of the IOL was observed 10 months postoperatively. Vision deteriorated to 0.5 with various refractive errors during 2-year follow-up. IOL exchange may be considered if the vision is getting worse. IOL opacification may result from a direct contact between the IOL surface and exogenous air, particularly in a hydrophilic IOL, and can be a rare but significant complication after DSAEK. Clinicians planning to perform DSAEK should consider the composition of the IOL, the amount of intracameral air, duration of air filling, and high intraocular pressure.

18.
Taiwan J Ophthalmol ; 7(3): 149-154, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29034154

RESUMO

BACKGROUND/PURPOSE: Topical atropine treatment is generally accepted to retard the progression of myopia, but it is associated with side effects such as photophobia and elevation of intraocular pressure (IOP). IOP measurements in children are challenging. The traditional applanation tonometry by direct contact with the cornea will require patient's cooperation. The rebound tonometer, using a dynamic electromechanical method for measuring IOP, shows good correlation with traditional tonometry. The purpose of this study is to evaluate the IOP of myopic children under atropine treatment using rebound tonometer and to compare the characteristics between rebound tonometry and applanation tonometry. METHODS: This study is a prospective study measuring IOP by rebound tonometer in myopic children under regular low-dose atropine treatment. We recruited children with refraction error showing myopia over -0.5 D with 0.15%, 0.3%, or 0.5% atropine eye drops use every night or every other night for myopia control. Children with treatment duration of atropine <1 month were excluded from the study. IOP measurements were performed by applanation tonometer (Tono-Pen XL, Reichert) and rebound tonometer (ICARE). The reliability of rebound tonometer was analyzed with percentage. Comparison of IOP between rebound tonometer and applanation tonometry was presented. RESULTS: The rebound tonometry was well tolerated by all participants and caused no complaints, discomfort, or adverse events. Totally 42 myopic eyes of 42 subjects were included in the study. The average age of these participants was 10 years old, range from 5 to 16. Median = 10 years old. The average IOP of the right eye by rebound tonometer was 17.4 ± 3 mmHg, and 17.1 ± 3 mmHg by applanation tonometry. Nearly 19%, 33%, and 24% of difference of IOP readings between rebound tonometer and Tono-Pen applanation are within 0 mmHg, 1 mmHg, and 1-2 mmHg, respectively. CONCLUSIONS: Rebound tonometry has good correlation with applanation tonometry and 76.1% of differences between two tonometers are <2 mmHg. The advantage of drop-free rebound tonometry has made it easier to obtain IOP readings in myopia children under atropine treatment.

19.
Medicine (Baltimore) ; 96(41): e8210, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29019887

RESUMO

Awareness of factors affecting the place of death could improve communication between healthcare providers and patients and their families regarding patient preferences and the feasibility of dying in the preferred place.This study aimed to evaluate factors predicting home death among home palliative care recipients.This is a population-based study using a national representative sample retrieved from the National Health Insurance Research Database. Subjects receiving home palliative care, from 2010 to 2012, were analyzed to evaluate the association between a home death and various characteristics related to illness, individual, and health care utilization. A multiple-logistic regression model was used to assess the independent effect of various characteristics on the likelihood of a home death.The overall rate of a home death for home palliative care recipients was 43.6%. Age; gender; urbanization of the area where the patients lived; illness; the total number of home visits by all health care professionals; the number of home visits by nurses; utilization of nasogastric tube, endotracheal tube, or indwelling urinary catheter; the number of emergency department visits; and admission to intensive care unit in previous 1 year were not significantly associated with the risk of a home death. Physician home visits increased the likelihood of a home death. Compared with subjects without physician home visits (31.4%) those with 1 physician home visit (53.0%, adjusted odds ratio [AOR]: 3.23, 95% confidence interval [CI]: 1.93-5.42) and those with ≥2 physician home visits (43.9%, AOR: 2.23, 95% CI: 1.06-4.70) had higher likelihood of a home death. Compared with subjects with hospitalization 0 to 6 times in previous 1 year, those with hospitalization ≥7 times in previous 1 year (AOR: 0.57, 95% CI: 0.34-0.95) had lower likelihood of a home death.Among home palliative care recipients, physician home visits increased the likelihood of a home death. Hospitalizations ≥7 times in previous 1 year decreased the likelihood of a home death.


Assuntos
Esclerose Amiotrófica Lateral , Serviços de Assistência Domiciliar/organização & administração , Neoplasias , Cuidados Paliativos , Assistência Terminal , Doente Terminal/psicologia , Idoso , Idoso de 80 Anos ou mais , Esclerose Amiotrófica Lateral/mortalidade , Esclerose Amiotrófica Lateral/psicologia , Esclerose Amiotrófica Lateral/terapia , Feminino , Visita Domiciliar/estatística & dados numéricos , Humanos , Masculino , Mortalidade , Neoplasias/mortalidade , Neoplasias/psicologia , Neoplasias/terapia , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Cuidados Paliativos/estatística & dados numéricos , Preferência do Paciente , Relações Médico-Paciente , Características de Residência , Medição de Risco/métodos , Serviços de Saúde Rural/organização & administração , Assistência Terminal/métodos , Assistência Terminal/psicologia
20.
Br J Ophthalmol ; 101(12): 1611-1617, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28315834

RESUMO

PURPOSE: To evaluate the 1-year progression of myopia and associated risk factors in second-grade primary school children. METHODS: The myopia investigation study in Taipei provided semiannual visual acuity testing and cycloplegic refraction for all second-grade primary school children (mean age: 7.49 years) in Taipei who provided parental consent. A questionnaire was distributed to the participants' parents before the first and third examinations. We evaluated 1-year follow-up data for children noted to have myopia on the first examination. Multinomial logistic regression models were applied to assess risk factors associated with myopia progression. Myopia progression was categorised, based on the change in spherical equivalent (ΔSE) over 1 year, as slow (ΔSE>-0.5 dioptres (D)), moderate (-1.0 D<ΔSE≤-0.5 D) or fast (ΔSE≤-1.0 D). Of the 4214 myopic children, data were analysed for 3256 (77.3%) who completed the 1-year follow-up evaluation. RESULTS: The baseline SE was -1.43±1.1 D. The average ΔSE was -0.42±0.85 D, with 46.96%, 28.50% and 24.54% of the study subjects showing slow, moderate and fast myopia progression, respectively. When compared with slow myopia progression, fast myopia progression was associated with a greater myopic SE at baseline (OR: 0.67, 95% CI: 0.61 to 0.72) and a shorter eye-object distance when doing near work (OR: 1.45, 95% CI: 1.18 to 1.78). More outdoor activity time and self-reported cycloplegic treatment were not associated with slow myopia progression. CONCLUSIONS: Children with fast annual myopia progression were more myopic at baseline and had a shorter reading distance. Our study results highlight the importance of having children keep a proper reading distance.


Assuntos
Agnosia , Miopia Degenerativa/epidemiologia , Vigilância da População , Refração Ocular/fisiologia , Medição de Risco/métodos , Instituições Acadêmicas , Criança , Feminino , Humanos , Incidência , Masculino , Miopia Degenerativa/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Testes Visuais
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