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BACKGROUND: Acquired neonatal intestinal diseases have an array of overlapping presentations and are often labeled under the dichotomous classification of necrotizing enterocolitis (which is poorly defined) or spontaneous intestinal perforation, hindering more precise diagnosis and research. The objective of this study was to take a fresh look at neonatal intestinal disease classification using unsupervised machine learning. METHODS: Patients admitted to the University of Florida Shands Neonatal Intensive Care Unit January 2013-September 2019 diagnosed with an intestinal injury, or had imaging findings of portal venous gas, pneumatosis, abdominal free air, or had an abdominal drain placed or exploratory laparotomy during admission were included. Congenital gastroschisis, omphalocele, intestinal atresia, malrotation were excluded. Data was collected via retrospective chart review with subsequent hierarchal, unsupervised clustering analysis. RESULTS: Five clusters of intestinal injury were identified: Cluster 1 deemed the "Low Mortality" cluster, Cluster 2 deemed the "Mature with Inflammation" cluster, Cluster 3 deemed the "Immature with High Mortality" cluster, Cluster 4 deemed the "Late Injury at Full Feeds" cluster, and Cluster 5 deemed the "Late Injury with High Rate of Intestinal Necrosis" cluster. CONCLUSION: Unsupervised machine learning can be used to cluster acquired neonatal intestinal injuries. Future study with larger multicenter datasets is needed to further refine and classify types of intestinal diseases. IMPACT: Unsupervised machine learning can be used to cluster types of acquired neonatal intestinal injury. Five major clusters of acquired neonatal intestinal injury are described, each with unique features. The clusters herein described deserve future, multicenter study to determine more specific early biomarkers and tailored therapeutic interventions to improve outcomes of often devastating neonatal acquired intestinal injuries.
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Enteropatias , Aprendizado de Máquina não Supervisionado , Humanos , Recém-Nascido , Estudos Retrospectivos , Feminino , Masculino , Unidades de Terapia Intensiva Neonatal , Enterocolite Necrosante/diagnóstico , Análise por Conglomerados , Doenças do Recém-NascidoRESUMO
BACKGROUND: Retrospective cohort study of 561 adult patients undergoing secondary intraocular lens (IOL) implantation by vitreoretinal surgeons at a single institution from April 2015 to December 2020. METHODS: Patient historical factors, intraoperative/postoperative complications, and outcomes of IOL type (anterior chamber IOL versus scleral sutured IOL versus scleral fixated IOL versus. sulcus) were assessed. Primary outcomes were rates of postoperative retinal tears and rhegmatogenous retinal detachment. Secondary outcomes were rates of intraoperative endolaser, intraoperative retinal tear, and further IOL surgery. RESULTS: The incidence of intraoperative retinal tears was 7.3% and not significantly different between techniques. Rates of intraoperative endolaser use were 17.5% among all techniques and not significantly different between techniques. Rates of postoperative retinal tear were low (0%-2.7%). Rates of postoperative rhegmatogenous retinal detachment were not significantly different between techniques (anterior chamber IOL 9/198 [4.5%], SFIOL 1/54 [1.9%], scleral sutured IOL 14/274 [5.1%], sulcus 2/35 [5.7%], total 26/561 [4.6%], P = 0.79). Rates of repeat IOL surgery trended higher in sulcus lenses (anterior chamber IOL 5/198 [2.5%], SFIOL 4/54 [7.4%], scleral sutured IOL 16/274 [5.8%], sulcus 5/35 [14.3%], total 30/561 [5.3%], P = 0.12). CONCLUSION: Intraoperative endolaser use and intraoperative retinal tear are not uncommon in secondary IOL surgery and underscore the importance of careful vitreoretinal management among these patients.
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Implante de Lente Intraocular , Complicações Pós-Operatórias , Descolamento Retiniano , Acuidade Visual , Vitrectomia , Humanos , Vitrectomia/métodos , Vitrectomia/efeitos adversos , Estudos Retrospectivos , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Feminino , Masculino , Idoso , Descolamento Retiniano/cirurgia , Complicações Pós-Operatórias/epidemiologia , Pessoa de Meia-Idade , Perfurações Retinianas/cirurgia , Seguimentos , Complicações Intraoperatórias , Incidência , Reoperação , Lentes Intraoculares/efeitos adversosRESUMO
PURPOSE: To describe the prevalence, management, and outcomes of rhegmatogenous retinal detachment (RRD) after incisional glaucoma filtering surgery. METHODS: All patients with a history of trabeculectomy or glaucoma drainage device surgery who were subsequently diagnosed with an RRD from January 1, 2016, to January 1, 2021, at the Wills Eye Hospital were identified. RESULTS: Forty-six eyes met the inclusion criteria. The mean age was 60.7 ± 19.6 years, and 15 patients (32.6%) were female. Of all eyes, 34 (73.9%) were diagnosed with primary open-angle glaucoma. The mean time from most recent incisional glaucoma surgery to RRD diagnosis was 1,133 ± 1,644 days. There were 19 eyes (41.3%) with preoperative proliferative vitreoretinopathy (9 eyes [19.6%] with Grade C proliferative vitreoretinopathy) and 35 eyes (76.1%) had macula-off RRD at the time of presentation. At RRD presentation, 4 eyes (8.7%) had concomitant endophthalmitis, 5 (10.9%) had concurrent choroidal detachment, and 2 (4.7%) had concurrent vitreous hemorrhage. Primary vitrectomy was performed in most (91.3%) cases. Silicone oil tamponade was often required (71.1%). The single surgery success rate was 65.2% (30 of 46). The mean preoperative logarithm of the minimum angle of resolution visual acuity was 1.72 ± 0.78 (Snellen acuity 20/1,050), and the mean final postoperative logarithm of the minimum angle of resolution was 1.59 ± 0.89 (20/778, P = 0.2853). Of glaucoma surgeries performed, the 5-year prevalence of RRD was 0.71% (26 of 3,664, 95% Poisson confidence interval 0.48%-1.04%). CONCLUSION: The 5-year prevalence of RRDs after trabeculectomy or glaucoma drainage device was 0.71%. Most patients presented with macula-involving detachments, often with proliferative vitreoretinopathy. Anatomical and visual outcomes were poor.
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Implantes para Drenagem de Glaucoma , Glaucoma de Ângulo Aberto , Descolamento Retiniano , Trabeculectomia , Vitreorretinopatia Proliferativa , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , Descolamento Retiniano/epidemiologia , Descolamento Retiniano/cirurgia , Descolamento Retiniano/diagnóstico , Vitreorretinopatia Proliferativa/cirurgia , Óleos de Silicone , Prevalência , Estudos Retrospectivos , Vitrectomia , Resultado do TratamentoRESUMO
PURPOSE: To report factors affecting the retinal redetachment rate after silicone oil removal (SOR) following rhegmatogenous retinal detachment (RRD) repair. METHODS: Retrospective cohort study from December 1, 2014, to March 1, 2020, of 205 consecutive patients treated for RRD with silicone oil (SO) tamponade and subsequent SOR with at least 6-month follow-up. Primary outcome measure was the rate of retinal redetachment after SOR. RESULTS: The retinal redetachment rate after SOR was 18.5%. Preoperative macula and lens status, proliferative vitreoretinopathy, previous retinectomy, retinal detachment size, concomitant phacoemulsification, previous scleral buckling, and endolaser during SOR did not affect the redetachment rate after SOR. Previous SO exchange was associated with increased redetachment (OR 2.53, 95% CI [1.11-5.80], P = 0.0278). Twelve months of SO tamponade had lower redetachment rates compared with 3 months (OR 0.25, 95% CI [0.04-0.09], P = 0.048). Shorter SO tamponade (3 vs. 12 months) had better final visual outcomes after SOR (0.80 ± 0.61 vs. 1.41 ± 0.66, P < 0.0001). CONCLUSION: No preoperative or intraoperative factors in this analysis influenced the risk of redetachment after SOR except duration of SO tamponade and previous SO exchange. Although longer SO tamponade duration may be associated with lower rates of redetachment, visual outcomes may be worse.
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Descolamento Retiniano , Óleos de Silicone , Humanos , Recidiva , Descolamento Retiniano/etiologia , Estudos Retrospectivos , Óleos de Silicone/efeitos adversos , Resultado do Tratamento , Acuidade Visual , Vitrectomia/efeitos adversosRESUMO
BACKGROUND: Paradoxical adipose hyperplasia (PAH), a rare side effect of CoolSculpting (cryolipolysis), is characterized by fatty enlargement of the treatment area occurring months after the procedure. OBJECTIVES: The purpose of this study was to report a retrospective case series of patients diagnosed with PAH at the authors' institution, increase the collective understanding of this complication and subsequent management, and raise the question of who should ethically perform cryolipolysis. METHODS: All participants diagnosed with PAH by a plastic surgeon at a large academic medical center were identified. Demographic information, medical history, procedure details, time to PAH diagnosis, and corrective surgical intervention details were collected. Mean duration of time from cryolipolysis treatment to diagnosis of PAH was calculated, along with other descriptive statistics. A scoping review of all PAH literature published in PubMed, Embase, and Web of Science was also conducted. RESULTS: Four patients diagnosed with PAH after cryolipolysis were identified for inclusion in this study. The calculated incidence of PAH at our center was 0.67%. All patients requested therapy for PAH and subsequently underwent either liposuction, abdominoplasty, or both. The mean duration of in-person follow-up time after final surgical treatment of PAH was 13.8â +â 19.8 months (range, 2.8-43.5). Fortunately, no patients showed signs of PAH recurrence, and 3 out of 4 patients did not show signs of residual deformity. CONCLUSIONS: Findings from this patient cohort and scoping review provide evidence that although revisions may be required, conventional body contouring methods, not in the armamentarium of non-plastic surgeon practitioners, effectively alleviated PAH.
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Lipectomia , Gordura Subcutânea , Humanos , Gordura Subcutânea/patologia , Hiperplasia/etiologia , Estudos Retrospectivos , Lipectomia/efeitos adversos , Lipectomia/métodos , Adiposidade , Obesidade/cirurgiaRESUMO
A new health threat in the form of a new variant of Covid-19 called Omicron has emerged globally in this holiday season. This new variant has been declared a variant of concern (VOC) by the World Health Organization and experts are expecting another wave of the pandemic. A lot still unknown about this variant and researchers worldwide are conducting studies to find the nature and characteristics of this mutated strain. Cases have begun to rise dramatically around the world and many countries have already imposed travel restrictions again to prevent disease transmission. It is being speculated that this particular variant has got tendency of immune escape and therefore can even infect fully vaccinated individuals. Vaccination and adhering to Covid-19 guidelines and protocols can curtail the spread of the virus. The present paper focuses on what is currently known about this variant, antigen diagnostic tests, importance of getting fully vaccinated and having booster dose etc. If we want to emerge from this pandemic, countries should practice vaccine equality and solidarity for the good of mankind.
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COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Pandemias/prevenção & controle , SARS-CoV-2 , Estações do AnoRESUMO
The second wave of the COVID-19 pandemic has affected India significantly with country reporting more than 400,000 cases in the month of May 2021 and health system almost collapsing. This was attributed to the new mutant strain also called as the 'Delta Strain' which led to high surge of cases across the country. As the country was stabilising over this situation, another imminent threat in the form of Covid Associated Mucormycosis (CAM) challenged the already burdened health system of India. Also called as 'Black Fungus,' cases of CAM began to rise rapidly in the last week of May 2021 with multiple states reporting steady rise in the number of cases. Based on the published literature, India contributed to approximately 71% of global cases of CAM from December 2019 to start of April 2021, with majority of the cases occurring during the second wave. The present paper focuses on the epidemic of CAM during the second wave in India highlighting the causes, symptoms and various treatment modalities that have been adopted to cure the disease. Also, spotlight has also been thrown on some other nations where cases of CAM have begun to emerge. Some key recommendations are also mentioned which can prove vital towards disease prevention.
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COVID-19/epidemiologia , Antifúngicos/uso terapêutico , COVID-19/complicações , Diabetes Mellitus/epidemiologia , Epidemias , Fungos , Humanos , Índia/epidemiologia , Mucormicose/complicações , Mucormicose/tratamento farmacológico , Mucormicose/epidemiologia , Pandemias , SARS-CoV-2RESUMO
PURPOSE OF REVIEW: The COVID-19 pandemic has posed an unprecedented challenge to the healthcare community. To reduce disease transmission, national regulatory agencies temporarily recommended curtailment of all nonurgent office visits and elective surgeries in March 2020, including vitreoretinal outpatient care in the USA. The effect of these guidelines on utilization of vitreoretinal care has not been explored to date. RECENT FINDINGS: Retinal outpatient visits, new patient visits, intravitreal antivascular endothelial growth factor injections and in-office multimodal retinal imaging has seen a significant decline in utilization in the early phase of the pandemic. Intravitreal injections were performed at a comparatively higher rate than office visits. Utilization appeared to steadily increase in April 2020. Telemedicine visits, enabled by new national legislation for all areas of medicine, have been adopted to a modest degree by the retina community. SUMMARY: In-office retinal care declined in response to the COVID-19 pandemic and national regulatory guidelines limiting nonurgent care. These trends in practice patterns and care utilization may be of interest to vitreoretinal providers and all ophthalmologists at large.
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Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Doenças Retinianas , Corpo Vítreo/patologia , Assistência Ambulatorial/estatística & dados numéricos , COVID-19 , Bases de Dados Factuais , Atenção à Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Doenças Retinianas/diagnóstico , Doenças Retinianas/terapia , SARS-CoV-2 , Telemedicina/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
PURPOSE: To report the 1-year clinical outcomes of combined pars plana vitrectomy and ab externo scleral fixation of an intraocular lens using Gore-Tex suture. METHODS: Retrospective, interventional case series. Outcome measures were change in visual acuity and occurrence of intraoperative and postoperative complications with minimum follow-up of 1 year. RESULTS: Eighty-four eyes of 83 patients were identified. The mean best available visual acuity improved from 20/782 preoperatively to 20/65 postoperatively (P < 0.001). The mean follow-up was 598 ± 183 days (median 533 days, range 365-1,323 days). There were no intraoperative complications noted. A Bausch & Lomb Akreos AO60 intraocular lens was implanted in 77 eyes and an Alcon CZ70BD in 7 eyes. Postoperative complications included transient vitreous hemorrhage in six eyes (7.1%), cystoid macular edema in four eyes (4.8%), ocular hypertension in three eyes (3.6%), hyphema in two eyes (2.4%), and transient corneal edema in two eyes (2.4%). There were no cases of postoperative endophthalmitis, suture erosion/breakage, hypotony, retinal detachment, suprachoroidal hemorrhage, choroidal detachment, uveitis-glaucoma-hyphema syndrome, or persistent postoperative inflammation during the follow-up period. CONCLUSION: Combined pars plana vitrectomy and ab externo scleral fixation of an intraocular lens with Gore-Tex suture was well tolerated at a minimum of 1-year follow-up. No suture-related complications were encountered.
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Implante de Lente Intraocular/métodos , Lentes Intraoculares , Politetrafluoretileno , Esclera/cirurgia , Técnicas de Sutura/instrumentação , Vitrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Refração Ocular , Estudos Retrospectivos , Suturas , Fatores de Tempo , Acuidade Visual , Adulto JovemAssuntos
Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma de Ângulo Aberto/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias , Infecções Estafilocócicas/microbiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológicoAssuntos
Angiofluoresceinografia/métodos , Edema Macular/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Vasculite Retiniana/diagnóstico , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Criança , Diagnóstico Diferencial , Fundo de Olho , Humanos , Edema Macular/complicações , Masculino , Oclusão da Artéria Retiniana/complicações , Vasculite Retiniana/complicaçõesRESUMO
After the eradication of smallpox (SPX), a new zoonotic threat that can trigger outbreaks has emerged. It may be fatal during the COVID19 outbreak. Humanity continues to be threatened due to re-emergence of the outbreaks. In most cases, new emerging viral agents originate from nonhuman hosts with zoonotic origins. Recent outbreaks of zoonotic infectious diseases with the potential to cause epidemics and pandemics continue to pose a major threat to the health security of entire regions, continents, and the world at large. Around five decades backthat Monkeypox (MPX) was reported for the first time in the Democratic Republic of the Congo (DRC) and was then confined to Central Africa only. Over the time, it has spread to other regions of Africa as well as outside Africa. As of August 2022, 40398 infections have been confirmed in almost 68 countries that have never reported MPX before. The majority of infections have been reported in Europe and Southeast Asia. On 23rd August 2022, MPX was declared a public health emergency of international concern, a step below declaring any disease as a pandemic. The article discusses the recent history of MPX outbreaks, as well as the evolving clinical manifestations of the disease, and the possible causes of the increase in cases, including the cessation of SPX vaccinations.
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COVID-19 , Mpox , Varíola , Animais , Humanos , Mpox/epidemiologia , COVID-19/epidemiologia , Zoonoses/epidemiologia , Zoonoses/prevenção & controle , Saúde PúblicaRESUMO
Inflammatory bowel disease (IBD) commonly requires immunosuppressive treatments to induce and maintain durable remission. Janus kinase inhibitors (JAKis) are a novel group of orally administered, small molecule drugs that work by attenuating multiple cytokine signalling pathways to mediate dysregulated immune responses involved in the pathogenesis of IBD. Tofacitinib, filgotinib and upadacitinib have demonstrated efficacy against placebo and are licensed for the treatment of moderate to severe ulcerative colitis; upadacitinib is the only JAKi also currently approved for the treatment of Crohn's disease. Safety concerns stratified by age have led to class-wide regulatory restrictions for JAKi use across all inflammatory diseases. It is important for gastroenterologists managing patients with IBD to be aware of the key pivotal trial outcomes, to identify appropriate patients in whom to commence a JAKi, and to understand the safety considerations and ways to mitigate these risks in the patients they treat. This review provides a contemporaneous overview of this emerging therapeutic class and provides a practical guide for healthcare practitioners for initiating and monitoring JAKi in IBD.
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Cerebellar strokes have high morbidity and mortality due to bleeding or edema, leading to increased pressure in the posterior fossa. This retrospective cohort study analyzed three outcomes following a cerebellar stroke: in-hospital mortality, length of hospital stay, and total hospitalization costs. It uses data from the National Inpatient Sample (NIS) and aims to identify the predictors of outcomes in cerebellar stroke patients, including 464,324 patients, 18 years of age and older, hospitalized between 2010 and 2015 in US hospitals with cerebellar strokes. In our study, for every decade age increased beyond 59 years, there was a significant increase in mortality; those aged 80+ years had 5.65 odds of mortality (95% CI: 5.32-6.00; P < 0.0001). Significant differences in patient characteristics were observed between patients who survived to discharge and those who did not, including older age (77.4 vs. 70.3 years; P < 0.0001), female sex (58% vs. 52%; P < 0.0001), and being transferred from another healthcare facility (17% vs. 10%; P < 0.0001). Patients admitted directly rather than through the emergency department were more likely to die (29% vs. 16%; P < 0.0001). The mortality rate was lower for blacks (OR: 0.75; P < 0.0001), Hispanics (OR: 0.91; P = 0.005), and Asians (OR: 0.89; P = 0.03), as compared to the white population, for females in comparison to males, and geographically, in all other areas (Midwest, South, and West) in contrast to the Northeast. Cerebellar stroke incidence and high mortality were seen in the traditional stroke belt. Mortality is also affected by the severity of the disease and increases with the Charlson Comorbidity Index (CCI), All Patient Refined Diagnosis Related Groups (APR-DRG) scores, and indirectly by place of receiving care, length of stay (LOS), cost of stay, type of insurance, and emergency department admissions. LOS increased with age, in males in the Northeast, and was less in whites compared to other races. Trend analysis showed a decrease in LOS and costs from 2010 to 2015. Increased costs were seen in non-whites, males, higher household income based on zip code, being covered under Medicaid, transfers, CCI ≥ 5, and discharges in the western US. Median household income based on the patient's zip code was well-balanced between those who lived and those who died (P = 0.091). However, payers were not evenly distributed between the two groups (P < 0.0001 for the overall comparison). A higher proportion of discharges associated with in-hospital mortality were covered under Medicare (70% vs. 65% in the died vs. lived groups, respectively). Fewer discharges were associated with death if they were covered by commercial insurance or paid for out-of-pocket (15% vs. 19% for commercial insurance and 3% vs. 5% for out-of-pocket). In-hospital mortality was associated with a longer length of hospital stay (5.6 days vs. 4.5 days; P < 0.0001) and higher costs ($16,815 vs. $11,859; P < 0.0001). Variables that were significantly associated with lower total costs were older age, having commercial insurance, paying out-of-pocket or other payers, not being admitted through the emergency department, having a lower comorbidity index (CCI = 1-2), and being discharged from a hospital that was small- or medium-sized, located in the Midwest or South, and/or was non-teaching (rural or urban).
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BACKGROUND AND OBJECTIVE: This study aimed to report retinal displacement incidence following rhegmatogenous retinal detachment (RRD) repair with pars plana vitrectomy (PPV), scleral buckle (SB), or combined SB/PPV. PATIENTS AND METHODS: A single-center, case series using Optos fundus autofluorescence (FAF) images was performed after RRD repair between April 2020 and February 2022. Retinal displacement was identified by imprinted retinal vessels on FAF imaging. RESULTS: One hundred ninety-four eyes were included. Ninety-seven (50.0%) eyes underwent PPV, 46 (23.7%) underwent SB, and 51 (26.3%) underwent SB/PPV. A total of 25/194 eyes (12.9%) had retinal vessel imprinting on FAF imaging consistent with retinal displacement. The SB/PPV group (9/51, 17.6%) and the PPV group (15/97, 15.5%) had significantly higher displacement rates when compared to the SB group (1/46, 2.2%; P = 0.017, P = 0.021, respectively). CONCLUSIONS: Retinal displacement after RRD repair is more prevalent after PPV. There was a low rate of displacement with SB. Retinal displacement was not associated with a visual acuity difference. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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OBJECTIVES: To fill access gaps for adolescents, addressing sexual and reproductive health (SRH) is recommended in nontraditional settings. In previous improvement work, we increased documentation of sexual history to >80% of adolescents hospitalized on our pediatric hospital medicine (PHM) service. This study assessed adolescents' perception of SRH conversations with hospital providers and the extent to which they were helpful. METHODS: Postdischarge survey of patients 13 to 17 years discharged from the PHM service at an academic children's hospital between August 2019 and March 2020. Survey items included demographics; whether confidential discussion of sexual health topics such as contraception, sexually transmitted infection (STI), and sexual orientation occurred; perceptions of these discussions, and sexual history. RESULTS: Eighty-three patients enrolled and 44 (53%) completed the survey after discharge. A total of 68% of respondents were female and median age was 15 years (interquartile range 14-16). A total of 77% reported discussing SRH privately with a PHM provider. A total of 18% recalled discussing condoms, and 63% rated the discussion helpful. A total of 27% of females reported discussing birth control, and 40% rated it helpful. A total of 57% recalled discussing sexual orientation, and 40% rated it helpful. None reported discussions of STI testing with PHM. Of the 23% who were sexually active, none reported being given condoms. CONCLUSIONS: Analysis of adolescent patient experiences identified opportunities for continued improvement in the content and quality of SRH discussions, specifically regarding offering STI testing, condom distribution, and sexual orientation conversations. Our work highlights the importance of incorporating patient-reported data into improvement work to ensure providers are addressing targeted gaps in adolescent care.
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Assistência ao Convalescente , Infecções Sexualmente Transmissíveis , Adolescente , Feminino , Humanos , Masculino , Atenção à Saúde , Alta do Paciente , Saúde Reprodutiva , Comportamento Sexual , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/prevenção & controleRESUMO
PURPOSE: To describe a rare case of silicone oil emulsification which occurred only three months postoperatively. We discuss the implications for postoperative counseling. METHODS: Retrospective chart review of a single patient. RESULTS: 39-year-old female who presented with a right eye macula-on retinal detachment which was repaired with scleral buckle, vitrectomy, and silicone oil tamponade. Her course was complicated by extensive silicone oil emulsification within 3 months postoperatively, most likely due to shear forces induced by her daily CrossFit exercise regimen. CONCLUSION: Typical postoperative precautions after a retinal detachment repair include no heavy lifting or strenuous activity for one week. These restrictions may need to be more stringent and long-term for patients with silicone oil to prevent early emulsification.
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OBJECTIVE: To examine the trends in first and last authorship of women within clinical retina research over the last 25 years. DESIGN: Cross-sectional study. PARTICIPANTS: First and last author names were retrieved from original articles published between January 1, 1995, and January 1, 2021, in the American Journal of Ophthalmology, JAMA Ophthalmology (Archives of Ophthalmology), Ophthalmology, and Retina. METHODS: The medical subject heading major term "retina" was used in PubMed to filter publications specific to the field of retina. Publications by single authors and collaborative study groups and those classified as comments, letters, and editorials were excluded. First and last author names were obtained, and Gender API was used to assign sex. Names were crosschecked with the American Society of Retina Specialists (ASRS) directory for United States-based authors. MAIN OUTCOME MEASURES: The proportion of male and female first and last authors throughout the study period and the association between first and last authorship gender were assessed. RESULTS: A total of 4142 articles were included. The percentage of women in first and last authorship positions significantly increased from 23% to 37.7% and 14.2% to 24.6%, respectively, over 25 years (P < 0.001 and P < 0.001, respectively). When the last authors were women, 32.5% of the first authors were women, and when the last authors were men, 27.1% of the first authors were women (P = 0.002). Based on the ASRS 2020 directory, 17% of practicing retina specialists in the United States were women in 2020. For publications in 2020, 28.2% of the first authors and 22.3% of the last authors of retina publications from the United States were women (P < 0.001 and P < 0.001, respectively). CONCLUSIONS: Although a disparity in authorship persists in the subspecialties of ophthalmology, this data suggest that retina is a field where the gap is improving. Mentorship by senior female authors is associated with a higher proportion of female first authors.
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Autoria , Oftalmologia , Humanos , Masculino , Feminino , Estados Unidos , Estudos Transversais , Bibliometria , PubMedRESUMO
INTRODUCTION: As refugees adjust to a new country, their health care can take a toll. Refugees may have difficulty navigating a new health care system and experience low health self-efficacy. Another potential contributor is inadequate medical trainee curriculum addressing refugee health. METHODS: We devised simulated clinic experiences called mock medical visits. Surveys were utilized before and after the mock medical visits to assess the Health Self-Efficacy Scale for refugees and the Personal Report of Intercultural Communication Apprehension for trainees. RESULTS: Health Self-Efficacy Scale scores increased from 13.67 to 15.47 (P = 0.08, n = 15). Personal Report of Intercultural Communication Apprehension scores decreased from 27.1 to 25.4 (P = 0.40, n = 10). DISCUSSION: While our study did not reach statistical significance, the overall trends suggest mock medical visits can be a valuable tool to increase health self-efficacy in refugee community members and decrease intercultural communication apprehension in medical trainees.