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.
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-1β, 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.
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-1β (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.
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.
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.
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.
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.
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.
Abstract Femtosecond laser–assisted cataract surgery (FLACS) putatively offers several advantages over conventional phacoemulsification. We review the current status of FLACS and discuss the ...evolution of femtosecond lasers in cataract surgery and the currently available femtosecond laser platforms. We summarize the outcomes of FLACS for corneal wound creation, limbal relaxing incisions, capsulotomy, and lens fragmentation. We discuss surgical planning, preoperative considerations, clinical experiences including the learning curve and postoperative outcomes with FLACS, and also the cost effectiveness of FLACS. We present the intraoperative complications and management of challenging cases where FLACS offers an advantage and also speculate on the future directions with FLACS. Further advancements in laser technology to refine its efficacy, advancement in intraocular lens design to harness the potential benefits of FLACS, and a reduction in cost are needed to establish a clear superiority over conventional phacoemulsification.
To compare the effect of femtosecond laser-assisted cataract surgery on effective phacoemulsification time (EPT) with standard cataract surgery.
This prospective clinical trial evaluated the ...feasibility of using a femtosecond laser system (Catalys Precision Laser System, OptiMedica) to perform capsulotomy and lens fragmentation in the treatment of patients with senile cataract. Patients were evaluated preoperatively with the Lens Opacities Classification System III (LOCS III). Fifty-two patients underwent standard cataract surgery and 57 patients underwent femtosecond laser-assisted cataract surgery in December 2011. Both groups underwent phacoemulsification using pulsed ultrasound energy and EPT was evaluated.
Preoperative LOCS III grades were 3.4±0.9 in the femtosecond laser-assisted cataract surgery group and 3.1±0.9 in the standard group. In the femtosecond laser-assisted cataract surgery group, mean laser treatment time was 54.9 seconds and EPT was 0.16±0.21 seconds compared to 4.07±3.14 seconds in the standard group.
The use of the femtosecond laser-assisted system in cataract surgery led to a lower EPT compared to the standard procedure.
To quantify changes in endothelial cell counts and corneal thickness measurements in patients having standard phacoemulsification compared with femtosecond laser-assisted cataract removal.
Ruhr ...University Eye Clinic, Bochum, Germany.
Prospective randomized intraindividual cohort study.
One eye of each patient had standard phacoemulsification (control group) and the other eye had femtosecond laser-assisted phacoemulsification (study group), both with intraocular lens implantation. Pulsed ultrasound energy was used for phacoemulsification. Noncontact endothelial cell microscopy and corneal pachymetry were performed preoperatively and 1 day, 3 to 4 days, 7 to 10 days, 50 to 60 days, and 90 to 100 days postoperatively.
The mean endothelial cell loss was 7.9% ± 7.8% (SD) 1 week postoperatively and 8.1% ± 8.1% 3 months postoperatively in the study group and 12.1% ± 7.3% and 13.7% ± 8.4%, respectively, in the control group. The mean relative change in corneal thickness from the preoperative values was -0.0% ± 1.9% at 1 day, 2.8% ± 1.8% at 1 week, and 3.3% ± 1.7% at 3 months in the study group and -0.9% ± 2.3%, 2.4% ± 1.5%, and 3.2% ± 1.4%, respectively, in the control group.
The femtosecond laser did not add to the endothelial damage caused by cataract surgery and might be beneficial in eyes with low preoperative endothelial cell values (eg, cornea guttata cases).
To investigate the intraocular prostaglandin concentrations after femtosecond laser treatment and the potential relationship to miosis.
Aqueous humor was collected from patients after femtosecond ...laser pretreatment and at the beginning of routine cataract surgery. The total prostaglandin and the prostaglandin E2 concentrations were measured in two independent studies using an enzyme-linked immunoassay.
A significantly higher level of prostaglandins was noted in the aqueous humor of patients immediately after femtosecond laser treatment. This could be confirmed in two studies consisting of independent patient populations (study I: control = 17.3 ± 4.0 pg/mL n = 22, femtosecond laser femto = 182.1 ± 38.1 pg/mL n = 22, P = .0001, and study II: control = 17.5 ± 1.4 pg/mL n = 37, femto: 377.1 ± 83.6 pg/ mL n = 35, P = .00004). A significant increase of prostaglandin E2 was noted in two measurements (study III: control = 4.5 ± 1.9 pg/mL n = 13, femto: 19.2 ± 2.5 pg/mL n = 20, P = .0002, and study IV: control = 11.3 ± 1.6 pg/mL n = 35, femto: 60.3 ± 16.1 pg/mL n = 36, P = .004). No correlation was noted between age or cataract density and prostaglandin/prostaglandin E2 level or between corneal incision, suction time, or laser time in the femto groups and prostaglandin/prostaglandin E2 level.
Prostaglandins rise immediately after femtosecond laser treatment. Future patients should perhaps be treated with non-steroidal anti-inflammatory drugs to maintain mydriasis before undergoing femto-second laser treatment for cataract surgery.
To evaluate intraocular pressure (IOP) during femtosecond laser-assisted cataract surgery using a fluid-filled interface.
Ruhr University Eye Clinic, Bochum, Germany.
Prospective clinical trial.
The ...absolute IOP was measured with a modified Schiotz tonometer before and after laser-assisted cataract surgery with and without a fluid-filled interface (Liquid Optics interface, Catalys Precision Laser System).
The study evaluated 100 eyes. Tonometry and laser cataract surgery were completed successfully in all eyes. The mean preoperative IOP was 15.6 mm Hg ± 2.5 (SD). Upon application of the suction ring and vacuum, the mean IOP rose to 25.9 ± 5.0 mm Hg and remained nearly constant after the laser procedure (27.6 ± 5.5 mm Hg). After removal of the suction ring, the mean IOP was 19.1 ± 4.4 mm Hg. The IOP 1 hour after surgery was not significantly higher than the preoperative values.
The results indicate a minor increase in IOP using the fluid-filled interface. This is in strong contrast to substantially higher values reported in the literature with flat and curved applanating contact interfaces.
Objective: This study explored healthcare workers' experiences of transitioning infusions of natalizumab from hospital to a patient-centred model of home care.
Background: Hospital in the home is one ...of the fastest growing healthcare delivery models. In Australia, intravenous infusions are rarely available at home for chronic disease patients, such as those with multiple sclerosis. A recent trial of natalizumab infusions at home for patients with multiple sclerosis required both the hospital and hospital in the home staff to consider the logistics of how this transition could be achieved safely.
Study design and methods: This was a qualitative study using an exploratory-descriptive approach. Twelve participants from two main groups of healthcare workers participated in delivering natalizumab infusions during the six-month trial period and were subsequently interviewed about their experience. Participants were recruited from a hospital ambulatory care day unit and a Home Infusion Team from a private provider of home nursing care located in South Australia. The data was analysed thematically.
Results: Three main themes were identified from the interviews: 'preparing for change', 'focussing on the patient', and 'enhancing professional support and relationships'. These findings demonstrated the importance of understanding healthcare workers' experiences of transitioning to a patient-centred model of care, from hospital to home infusion of natalizumab.
Discussion: Flexibility and good management of logistics is necessary to maintain the standards of the health services, which highlights the need for training and professional support to facilitate quality home care. This may enhance workers' sense of professional confidence and trust and reduce stress when delivering the home model of care.
Conclusion: Healthcare workers and patients worked to support one another, not only therapeutically but also logistically within collegial relationship and interdependent communications. Being flexible, communicating clearly and being willing to work together within the team, especially between the hospital in the home staff and the hospital staff, was demonstrated to be an important factor for the safe delivery of infusions at home. Managing the logistics of delivering a flexible and safe home therapy service was an important part of this model of care.
Implications for research, policy, and practice: The results of this study will be used to inform healthcare teams about the key logistical components that are important for healthcare services, when considering transitioning to a home-based model of care for treating people with relapsing-remitting multiple sclerosis.
What is already known about the topic?
- Although outpatient infusion programs are often hospital based, they may be run by regional health authorities or private organisations, such as a hospital in the home service.
- Healthcare workers delivering a hospital in the home service require advanced knowledge and skill in order to deliver quality care.
What this paper adds:
- The development of a comprehensive logistical process, which has the patient at the centre of the model of care, enabled natalizumab to be delivered safely in the community by healthcare workers.
- Being flexible, communicating clearly and being willing to work together within the team, especially between the hospital in the home staff and the hospital staff, was demonstrated to be an important factor for the safe delivery of infusions at home
Femtosecond laser-assisted cataract surgery in infants Dick, H Burkhard; Schultz, Tim
Journal of cataract & refractive surgery/Journal of cataract and refractive surgery,
05/2013, Letnik:
39, Številka:
5
Journal Article
Recenzirano
Odprti dostop
We describe a technique for performing cataract surgery with a femtosecond laser in infants. Anterior capsulotomy and lens division are performed by the laser. A fluid-filled interface makes it ...possible to re-dock the laser to the eye for posterior capsulotomy after the eye has been opened for lens aspiration without complications. The integrated 3-dimensional optical coherence tomography also visualizes the posterior capsule, allowing a centered central posterior capsulotomy followed by mechanical anterior vitrectomy. The anterior and the posterior capsule disks are removed without capsule tears. The technique has been performed in 4 infants (ages 2, 4, 7, and 9 months) with congenital cataract. It can enhance the quality of pediatric cataract surgery.
To describe a new two-step femtosecond laser-assisted technique for intumescent white cataracts.
In 6 eyes with intumescent white cataracts, a laser-assisted mini-capsulotomy was performed first to ...release the intralenticular pressure. In the next step, the fluid milky lens material was removed from the anterior chamber before the eyes were re-docked to the laser system and a second larger anterior capsulotomy (4.5-mm diameter) was performed. Finally, the cataractous lens material was removed followed by intraocular lens implantation in the capsular bag.
In all cases, the laser system was able to identify and cut the anterior capsule without complications. Small residual tissue bridges were recognized after laser-assisted mini-capsulotomy in 2 eyes and solved with the dimple-down maneuver. The second, larger capsulotomy demonstrated satisfactory quality and a 360° overlap on the intraocular lens' optic was achieved in all cases.
This novel technique for intumescent white cataracts using a two-step laser-assisted mini-capsulotomy has the potential to avoid complications.
