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Specific Techniques Compared to. Typical Components? Psychotherapy Incorporation and its Role throughout Ethical Training.
Results This study included 97 patients. Preoperative vs post-PRK 95% LoAs between Pentacam-AXL and IOLMaster 700 were as follows AvgK/Km, (-0.42, 0.08 diopter [D]) vs (-0.49, 0.18 D); Zonal-K2.5/Km, (-0.40, 0.32 D) vs (-0.57, 0.74 D); J0 (-0.33, 0.18 D) vs (-0.28, 0.35 D); J45 (-0.28, 0.23 D) vs (-0.24, 0.27 D); pupil pachymetry/CCT, (-18, 12 μm) vs (-2.6, 19.6 μm); apical pachymetry/CCT, (-17.4, 12.8 μm) vs (-1.7, 20.9 μm); ACD (-0.03, 0.13 mm) vs (-0.03, 0.13 mm); WTW (-0.68, 0.23 mm) vs (-0.63, 0.14 mm); and AL (-0.07, 0.01mm) vs (-0.07, 0.03 mm), respectively. Conclusions PRK showed a negative impact on inter-device agreement for CCT and corneal power measurements, whereas it did not have a significant effect on the agreement of devices for ACD, WTW, AL, and the J45 astigmatism vectoral component. For intraocular lens power measurement in post-PRK eyes, the 2 devices could be regarded as interchangeable for measuring AL and ACD, but not for keratometry readings.Purpose To compare the 18-month efficacy and safety of the Kahook Dual Blade goniotomy (KDB) in combination with cataract surgery (phaco-KDB) or as a standalone procedure (KDB). Setting Single surgeon practice. Design Retrospective review study. Methods One hundred sixteen eyes of 100 patients underwent KDB by a single well-experienced surgeon from May 2016-2018. A total of 93 and 23 eyes were in the phaco-KDB and KDB groups, respectively. Trichostatin A Main outcome measures were reduction in IOP and IOP-lowering medication as well as adverse events. Data were collected and analyzed using Welch's t-tests in R. Results 71% of eyes within the phaco-KDB group compared to 83% within the KDB group had moderate or severe glaucoma. At baseline, mean IOP was 16.5±5.0mm Hg (n=93) and 24.3±9.1 (n=23) in the phaco-KDB and KDB groups, respectively (p less then 0.05). The IOP decreased in both groups at 12 months (14.1±3.9 vs 16.9±7.6, p=0.24) and 18 months (14.4±3.7 vs 16.7±7.6, p=0.5). There was a statistically significant difference in the number of drops between the phaco-KDB and KDB groups at baseline (2.4±1.2 vs 2.9±1.0, p less then 0.05) persisting at 12 months (1.3±1.2 vs 2.6±1.2, p less then 0.05) and at 18 months (1.3±1.2 vs 3.3±1.2, p less then 0.05). Complications included transient hyphemas (n=20,17%) and IOP spike (n=20,17%). Seven eyes required additional glaucoma surgery, 5 of which were in the standalone group. Conclusions KDB is an effective and safe procedure for different glaucoma disease severity, whether combined with cataract surgery or as a standalone surgery. KDB is an alternative to consider prior to pursuing more invasive glaucoma surgeries.Purpose To compare the effectiveness of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPS) by resident surgeons. Setting Parkland Memorial Health and Hospital System, Dallas, Texas, U.S.A. Design Prospective randomized study. Methods All surgeries to be performed by PGY-3 & 4 residents from October 2015 through June 2017 were eligible for inclusion. Patients were required to complete a post-op day 1, week 1, month 1, and month 3 visit. Specular microscopy was performed preoperatively and post-operatively. Surgeries were filmed and each step timed and compared. Surgeon and patient surveys were filled out post-operatively. Results Of the 135 eyes of 96 subjects enrolled in the study, 64 eyes received FLACS and 71 eyes received CPS. There was no significant difference in best corrected visual acuity (BCVA), either preoperatively or at the postop day 1, week 1, month 1, or month 3 visits (P= 0.469, 0.539, 0.701, 0.777, and 0.777 respectively). Cumulated dissipated energy and irrigation fluid usage were not different between FLACS and CPS (P-values 0.521 and 0.368), nor was there a difference n the reduction of endothelial cell counts after surgery (P=0.881). Wound creation (P=0.014), cortical cleanup (P=0.009) and IOL implantation (P=0.031) were faster in the CPS group. Survey results indicated that the overall patient experience was similar for FLACS and CPS. Conclusion This first prospective randomized trial evaluating resident-performed FLACS shows that, in resident hands, FLACS provides similar results to CPS with regards to visual acuity, endothelial cell loss, operative time, patient satisfaction, and surgical complication rate.Purpose To analyze the difference between the behavior of semi-circular (balanced) and bent (mini) tips at 20 incremental torsional power settings. Setting Tsukazaki Hospital, Himeji, Japan. Design Experimental study. Methods Using an ultra-high-speed video camera HPV-X2, we recorded the two tips during torsional oscillation, comparing tip behavior at power settings from 5% to 100% by tracking points 1-5 (tip end; and at 1325, 2650, 3975, and 5035 μm from the tip end). Results Both tips increased their amplitude widths, drawing an S-curve at all points as the torsional power setting was increased, reaching their upper limits from 70% to 90% torsional power. At all 20 power settings, both tips showed significantly different amplitudes (All p less then 0.01), and the difference of the amplitude increased as the power setting increased. While at Point 1 and 3, the balanced tip amplitude was nearly 1.5 times larger than the mini tip amplitude, the amplitude difference was ≤10 μm at points 2 and 4. At point 5, the mini tip amplitude was at least three times more than the balanced tip amplitude. Conclusion The amplitude does not increase proportionally and varies markedly with the tip shape on reaching the upper limit, suggesting that a higher power setting may not contribute greatly to nuclear fragmentation. The balanced tip may cause greater damage to surrounding tissues if it is inserted at approximately 3 mm from the wound site. To obtain maximum shaft stability using the balanced tip, it is important to insert at least 5 mm.Background Procedure codes in the Danish National Patient Registry are used for administrative purposes and are a potentially valuable resource for epidemiologic research. To our knowledge, the validity of antineoplastic procedure codes has only been evaluated in one study. Methods We randomly extracted a sample of 420 patients in the Southern Region of Denmark with a diagnosis of colorectal cancer and an oncology contact during 2016-2018. Using the medical record as gold standard, we computed the positive predictive value (PPV) and sensitivity of antineoplastic procedure codes recorded in the Danish National Patient Registry. Results We identified 2,243 codes for antineoplastic treatments in the registry and 2,299 in the medical records. We confirmed that 213 of 214 patients with registered therapies in the Danish National Patient Registry received therapy, corresponding to a PPV of "any registration" of 1.00 (95% confidence interval [CI] = 0.97, 1.00). Considering single registrations, the overall PPV was 0.95 (95% CI = 0.94, 0.95), and the overall sensitivity was 0.90 (95% CI = 0.89, 0.91). Number of recorded treatments and treatments administered were strongly correlated. Considering the most frequent single antineoplastic regimens, PPV ranged from 0.90 (95% CI = 0.87, 0.92) for capecitabine to 0.98 (95% CI = 0.95, 1.00) for cetuximab, whereas sensitivity ranged from 0.81 (95% CI = 0.75, 0.87) for 5-fluorouracil and irinotecan (FOLFIRI) regimen to 0.97 (95% CI = 0.94, 0.99) for bevacizumab. Analysis per hospital showed the highest validity of registrations at the University Hospital. Conclusion The validity of antineoplastic procedure codes in the Danish National Patient Registry is generally high and thus usable for epidemiologic research.Background We investigated to what extent social inequalities in childhood obesity could be reduced by eliminating differences in screen media exposure. Methods We used longitudinal data from the UK-wide Millennium Cohort Study (n = 11,413). The study measured mother's educational level at child's age 5. We calculated screen media exposure as a combination of television viewing and computer use at ages 7 and 11. We derived obesity at age 14 from anthropometric measures. We estimated a counterfactual disparity measure of the unmediated association between mother's education and obesity by fitting an inverse probability-weighted marginal structural model, adjusting for mediator-outcome confounders. Results Compared with children of mothers with a university degree, children of mothers with education to age 16 were 1.9 (95% confidence interval [CI] = 1.5, 2.3) times as likely to be obese. Those whose mothers had no qualifications were 2.0 (95% CI = 1.5, 2.5) times as likely to be obese. Compared with mothers with university qualifications, the estimated counterfactual disparity in obesity at age 14, if educational differences in screen media exposure at age 7 and 11 were eliminated, was 1.8 (95% CI = 1.4, 2.2) for mothers with education to age 16 and 1.8 (95% CI = 1.4, 2.4) for mothers with no qualifications on the risk ratio scale. Hence, relative inequalities in childhood obesity would reduce by 13% (95% CI = 1%, 26%) and 17% (95% CI = 1%, 33%). Estimated reductions on the risk difference scale (absolute inequalities) were of similar magnitude. Conclusions Our findings are consistent with the hypothesis that social inequalities in screen media exposure contribute substantially to social inequalities in childhood obesity.Background In some time-to-event analyses, it is unclear whether loss to follow up should be treated as a censoring event or competing event. Such ambiguity is particularly common in HIV research that uses routinely collected clinical data to report the timing of key milestones along the HIV care continuum. In this setting, loss to follow up may be viewed as a censoring event, under the assumption that patients who are "lost" from a study clinic immediately enroll in care elsewhere, or a competing event, under the assumption that people "lost" are out of care all together. Methods We illustrate an approach to address this ambiguity when estimating the 2-year risk of antiretroviral treatment initiation among 19,506 people living with HIV who enrolled in the IeDEA Central Africa cohort between 2006 and 2017, along with published estimates from tracing studies in Africa. We also assessed the finite sample properties of the proposed approach using simulation experiments. Results The estimated 2-year risk of treatment initiation was 69% if patients were censored at loss to follow up or 59% if losses to follow up were treated as competing events. Using the proposed approach, we estimated that the 2-year risk of antiretroviral therapy initiation was 62% (95% confidence interval 61, 62). The proposed approach had little bias and appropriate confidence interval coverage under scenarios examined in the simulation experiments. Conclusions The proposed approach relaxes the assumptions inherent in treating loss to follow up as a censoring or competing event in clinical HIV cohort studies.Background In the context of declining levels of participation, understanding differences between participants and non-participants in health surveys is increasingly important for reliable measurement of health-related behaviors and their social differentials. This study compared participants and non-participants of the Finnish Health 2000 survey, and participants and a representative sample of the target population, in terms of alcohol-related harms (hospitalizations and deaths) and all-cause mortality. Methods We individually linked 6,127 survey participants and 1,040 non-participants, aged 30-79, and a register-based population sample (n = 496,079) to 12 years of subsequent administrative hospital discharge and mortality data. We estimated age-standardized rates and rate ratios for each outcome for non-participants and the population sample relative to participants with and without sampling weights by sex and educational attainment. Results Harms and mortality were higher in non-participants, relative to participants for both men (rate ratios = 1.
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