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Measuring the impact of chronic cough on voice quality can be difficult and challenging in daily practice. Evidence about its potential effects on diagnostic tools used in voice evaluation is lacking. We hypothesized that the presence of chronic cough plays a role in patients' perception of dysphonia severity, leading to a mismatch between the subjective, objective, and perceptual evaluations.A retrospective chart review involving patients with a diagnosis of dysphonia and a complete speech voice evaluation was performed. A total of 311 patients were stratified into two different groups according to the presence of chronic cough. A total of 151 patients were assigned to the dysphonia and chronic cough group, while 160 patients were assigned to the dysphonia only group. During the initial evaluation, patients completed the Voice Handicap Index (VHI)-30, Glottal Function Index (GFI), and Reflux Symptoms Index (RSI). Voice evaluation also included aerodynamic/acoustic measures and the application of the GRBAS scale by a speech-language specialist. A paired t test and a linear regression analysis were used to compare subjective, perceptual, and aerodynamic/acoustic measures in both groups.The mean VHI-30 and GFI were elevated in both groups but significantly lower among patients with dysphonia and chronic cough when compared to patients with dysphonia only (P= 0.01). Additionally, a significantly higher RSI was found among patients with dysphonia and chronic cough (P0.01). No difference in aerodynamic/acoustic measures was found between groups (P0.05). Our linear regression model demonstrated a significant effect of the presence of chronic cough on the VHI-30, RSI, and GFI questionnaires (P0.05). Our model also found that the VHI-30 is a significant predictor for the (G), (B), (A), and (S) components of the GRBAS scale (P0.05).The presence of chronic cough has a significant impact on the different patient-reported outcome measures, including VHI-30, RSI, and GFI. The use of VHI-30 as a predictor for the GRBAS scale reinforces the importance of subjective and perceptual assessment among patients with voice disorders and establishes a new area for exploration.

International Dermatology Outcome Measures and the American Academy of Dermatology recently agreed on a physician-reported global severity measure to demonstrate quality of care in inflammatory dermatoses.Because patient-reported outcome measures are also important, we aimed to achieve consensus on 1 of these measures for clinical practice.Patients and providers participated in a consensus-building study involving a modified-Delphi technique. Voting was focused on identifying a minimal set of assessments for clinical practice, patient global assessments (PtGAs), Skindex instruments, and final instrument selection for quality improvement.Among 53 stakeholders,70% agreed that identification of patient goals, assessment of treatment harm, and assessment of the adequacy of treatment response were the minimal assessments needed for clinical practice. The most preferred PtGA was a 5-point PtGA (scale 0-4; 0 = clear, 4 = severe) having an optional check-box for worst ever. A new metric to assess change since treatment initiation, which we called a trajectory measure, was proposed. Stakeholders preferred Skindex instruments over PtGAs and a trajectory measure for clinical practice.A small number of patients and caregivers were involved and a consensus was not reached on all items.PtGAs as standalone measures do not adequately capture the patient's assessment of disease severity or the effect of care. The combination of a PtGA with a Skindex instrument or another measure of health-related quality of life might provide a more comprehensive evaluation of patients in clinical practice.

Diabetes mellitus (DM) is thought to be associated with poor outcomes in cervicofacial infections (CFI), yet little is known about the prevalence of DM in these cases. Stress hyperglycaemia (SHG), a normal physiological response to inflammation, is distinct from DM, though they overlap and may be conflated. We aimed to establish the prevalence of DM and SHG in CFI, and to determine the effect of each on severity of disease and outcome measures. The Maxillofacial Surgery Trainee Research Collaborative (MTReC) carried out an audit of all patients with CFI admitted to 25 hospitals between May and October 2017. To the best of our knowledge this created the largest prospective database on CFI, with information collected on presentation, source of infection, biological data, and outcomes. We recorded 1002 admissions, of which 78 (7.8%) had DM. Random blood glucose was measured on admission in 401 patients (40%), of which 45 (11%) displayed SHG. Patients diagnosed with DM were more likely to have infections arising from a salivary source (13% vs 4%, p0.00), more returns to theatre (9% vs 2%, p0.00), and a longer hospital stay (median (range) 2 (0-34) vs 1 (0-139) day, p=0.01) than non-DM patients. In contrast, patients with SHG had more severe disease (multiple fascial spaces involved in 59% vs 19%, p=0.01, and systemic inflammatory response syndrome present in 66% vs 45% p=0.03), but did not have significantly more returns to theatre (2% vs 3%, p=0.91) or longer stays in hospital (median (range) 1 (0-63) vs 1 (0-6), p=0.55) than normoglycaemic patients. The prevalence of DM in our cohort was only marginally higher than in the general population, despite previous retrospective case reviews suggesting a significantly higher prevalence. SHG was not associated with poor outcomes in our cohort, but is likely to be associated with a small increased risk of subsequent diagnosis of DM, which can be quantified using a calculator tool. On discharge, it is important to give appropriate advice about diet, lifestyle, exercise, and weight loss to all patients with CFI.

Objective To correlate the histopathologic results of conjunctival specimens with clinical findings in patients with conjunctivochalasis and report the results of the paste-pinch-cut technique for management. Design Retrospective chart review. Methods SETTING: Single tertiary ophthalmological centre (Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.). Methods Twenty-five patients (32 eyes) with clinically significant conjunctivochalasis. All patients were referred for clinically significant dry eye without previous diagnosis of chalasis. Sixteen patients had an underlying inflammatory systemic condition. Intervention or Observation Procedure(s): Patients underwent surgery with paste-pinch-cut technique. Subjective dry eye symptoms and ocular surface staining scores (corneal and conjunctival staining using fluorescein and lissamine green respectively) were assessed at every visit. Main outcome measures Change in patient symptoms and ocular surface staining scores and histopathologic findings in conjunctival specimens. Results After surgery, significant improvement was achieved in dry-eye symptoms as well as both corneal and conjunctival staining scores in 29 eyes on reduced topical therapy. Only 3 eyes had persisting conjunctival lissamine staining. Light microscopic examination disclosed mild to moderate lymphoplasmocytic inflammation of the conjunctivae with areas of epithelial goblet cell loss, squamous metaplasia, stromal edema, and fibrosis. Conclusion Conjunctivochalasis appears to be associated with significant inflammation in the setting of dry eye and underlying inflammatory systemic conditions. Although topical anti-inflammatory treatment could be attempted in the initial management, surgical excision should be considered in the absence of clinical response.

Background The use of a minimal individualized effective pneumatic tourniquet pressure is recommended to avoid pressure related complications in extremity surgery. The aim of this study was to investigate the efficacy of arterial occlusion pressure estimation-based tourniquet pressure settings in upper limb surgery. Methods Hundred and fifteen patients undergoing upper limb surgeries were enrolled in the present study. Arterial occlusion pressure estimation formula was used and a safety margin of 20 mmHg was added to arterial occlusion pressure in the tourniquet pressure setting. Primary and secondary endpoints were the amount of tourniquet pressure and its effectiveness respectively. Other outcome measures included the tourniquet pressure setting time and tourniquet related complications. Surgical team unaware of the tourniquet pressure assessed the bloodless surgical field. Results The mean initial and maximal tourniquet pressures were 171.5 ± 13.7 and 175.5 ± 13.2 mmHg, respectively. The effectiveness of the tourniquet was rated as “excellent” and “good” in the initial and middle stages, and at the end of the surgery of the procedure in 97.3%, 99.1%, and 100% of cases respectively. The mean tourniquet pressure setting time was 29.0 ± 3.7 s. No tourniquet related complications were observed. Conclusions Arterial occlusion pressure estimation-based tourniquet pressure setting is a practical and effective method, which allows using lower tourniquet pressures than previously used in the literature for upper extremity surgery.

OBJECTIVE To determine if repeat Muller's muscle conjunctival resection (MMCR) is a viable approach in the treatment of recurrent or residual eyelid ptosis. METHODS A retrospective review of patients who underwent repeat MMCR was performed using external photos obtained preoperatively, postoperatively, and at last follow-up. The marginal reflex distances (MRD1 and MRD2), brow position (BP), and tarsal platform show (TPS) were evaluated with digital image analysis. The change in upper eyelid height (MRD1) and TPS following repeat ptosis repair were the outcome measures. RESULTS Repeat MMCR was performed on 12 eyelids of 11 patients. Mean MRD1 elevation after initial MMCR was 1.6 mm (standard deviation [SD] = 1.0mm, p < 0.00001). Mean decrease in TPS was 1.9 mm (p = 0.04). There was no significant change in MRD2 (p = 0.36) or BP (p = 0.33) with initial MMCR. Mean interval between procedures was 12.8 months (range 2.3-48.0) and follow-up after repeat MMCR was 2.3 months. Total average follow-up after initial MMCR was 15.1 months. Mean elevation in MRD1 after repeat MMCR was 1.0 mm (SD = 0.8 mm, p < 0.002). Mean decrease in TPS was 1.0 mm (p = 0.03). There was no difference in MRD2 (p = 0.90) or BP (p = 0.53). There were no complications of repeat MMCR noted clinically or spontaneously reported, including no entropion, fornix foreshortening, or development of dry eye signs or symptoms. CONCLUSION Repeat MMCR significantly improves recurrent or residual ptosis after initial MMCR without significant adverse consequences. The degree of elevation with repeat MMCR was diminished when compared with initial MMCR.

Objective To assess the effects of adding a neurodynamic intervention into a multimodal management approach in individuals with multiple sclerosis (MS) with upper extremity pain symptoms. Design Randomized clinical trial. Setting Tertiary hospital center. Participants Thirty-two individuals with MS were randomly assigned to multimodal usual care alone (n = 16) or multimodal usual care plus neurodynamic intervention (n = 16). Interventions Both groups received 5 sessions of multimodal usual care of 30 minutes duration, twice per week. Subjects allocated to the neurodynamic group also received bilateral neurodynamic slider interventions targeting the upper extremity nerve trunks. Outcome measures Pressure pain thresholds (PPTs) at the radial, median and ulnar nerve trunks, second metacarpal and tibialis anterior, pain intensity in the upper extremity (NPRS, 0-10), light touch detection threshold (von Frey hairs) and manual dexterity (nine-hole peg test) were assessed before and after the intervention. Results Subjects receiving the neurodynamic interventions experienced larger improvements in PPTs at all locations (moderate effect size, between-groups differences from 89.5 kPa to 186.5 kPa), a higher decrease in pain intensity at rest (large effect, difference 1.7, 95%CI 0.4 to 3.0) and improvements in sensitivity to light touch (moderate effect, difference -0.7, 95%CI -1.3 to -0.1) and in manual dexterity (large effect, difference 7.7, 95%CI 4.0 to 11.4 seconds) than those that did not receive the neurodynamic intervention. Conclusions The inclusion of neural mobilization into a multimodal management approach resulted in reduction of pressure sensitivity, greater reduction in pain and improvement in sensitivity to light touch and manual dexterity in MS. Further studies are necessary to confirm these findings at longer term follow-ups.

Objective To evaluate test-retest reliability and related measurement properties of items developed to assess best, worst, and average prosthetic socket comfort. Design Methodological research to assess test-retest reliability of four individual socket comfort survey items. Socket comfort items were included in a self-report paper survey, which was administered to participants 2-3 days apart. Setting General community. Participants A minimum convenience sample of 63 participants was targeted for this study; 72 lower limb prosthesis users (>1-year post-amputation) completed the survey and were included in the final dataset. Interventions Not applicable. Main Outcome Measure The Expanded Socket Comfort Score (ESCS) was adapted from the original Socket Comfort Score (SCS). The original SCS is a single-item self-report instrument developed to assess a lower limb prosthesis user's current socket comfort. Three additional items were designed to assess the user's best, worst, and average socket comfort over the previous seven days. Results Best, worst, and average socket comfort items demonstrated better reliability, as indicated by higher intra-class correlation coefficients. As such, these items also exhibited lower measurement error and smaller minimal detectable change values than the item that measured current socket comfort. However, test-retest coefficients for all four items were below the level desired for evaluation of within-individual changes of socket comfort. Conclusions Items that assess best, worst, and average comfort provide a more stable measurement of socket fit than the existing SCS instrument. While administration of all four items may provide more comprehensive assessment of a lower limb prosthesis user's socket fit, administrators should expect variations in scores over time due to the variable nature of the underlying construct over time. Future research should examine whether a multi-item socket comfort scale provides an improved overall assessment of socket fit.

OBJECTIVE This study aimed to assess the health-related QoL (HR-QoL) of patients with hereditary hemorrhagic telangiectasia (HHT), with emphasis on the role/social aspects, and validate the Japanese version of the epistaxis severity score (ESS) in these patients. METHODS The Japanese version of the ESS was created through forward and reverse translation, and consultation with the original author. A validation analysis was performed by comparing ESS severity with the invasiveness of previous treatments for epistaxis and assessing the correlation between the ESS and HR-QoL. Medical history forms, ESS questionnaires, and the Medical Outcomes Study Short Form 36 (SF-36) were distributed to participants with HHT in August 2020. The relation between the ESS and summary scores of SF-36 was assessed by performing analysis of variance and Spearman's correlation. RESULTS In total, 73 participants were included in this study. The average ESS was 5.02; there were mild (32.9%), moderate (45.2%), and severe (21.9%) epistaxis groups. Patients with higher ESS received a significantly more invasive treatment (Fisher's exact test, p

Purpose To evaluate the effect of one full year of the coronavirus disease 2019 (COVID-19) pandemic on clinical presentation of acute, primary rhegmatogenous retinal detachment (RRD). Design Single-center, retrospective observational cohort study. Methods Patients were divided into two cohorts; consecutive patients treated for primary RRD during the COVID-19 pandemic (March 9, 2020 to March 7, 2021; pandemic cohort) and patients treated during the corresponding time in previous year (March 11, 2019 to March 8, 2020; control cohort). Main outcome measures Proportion of patients presenting with macula-involving (mac-off) or macula-sparring (mac-on) RRD. Results 952 patients in the pandemic cohort and 872 patients in the control cohort were included. Demographic factors were similar. Compared to the control cohort, significantly greater number of pandemic cohort patients presented with mac-off RRDs ([60.92%] pandemic, [48.17%] control, P = 0.0001) and primary proliferative vitreoretinopathy (PVR; [15.53%] pandemic, [6.9%] control, P = 0.0001). Pandemic cohort patients (10.81%) had significantly higher rates of lost to follow-up compared to control cohort (4.43%; P = 0.0001). Patients new to our clinic demonstrated significant increase in mac-off RRDs in the pandemic cohort (65.35%) compared to control cohort (50.40%; P = 0.0001). Pandemic cohort patients showed worse median final best-corrected visual acuity (BCVA; 0.30 logarithm of the minimum angle of resolution [logMAR]) compared to control cohort (0.18 logMAR; P = 0.0001). Conclusions Patients with primary RRD during the first year of the COVID-19 pandemic were more likely to have mac-off disease, present with primary PVR, be lost to follow-up, and have worse final BCVA outcomes.

Objective This study examines sex differences in social inferencing deficits after traumatic brain injury (TBI), and examines the odds of males and females being impaired while controlling for potential confounders. Design Cross-sectional survey. Setting Outpatient.USA and a University in Canada. Participants One hundred five participants with TBI (60 males, 45 females) and 105 healthy controls (HC; 57 males, 48 females). Interventions Not applicable. Main Outcome Measures The Awareness of Social Inference Test (TASIT), which includes 1) Emotional Evaluation Test (EET), 2) Social Inference-Minimal (SI-M) test, and 3) Social Inference-Enriched (SI-E) test. Results Within the HC sample, males and females performed similarly on all three TASIT subtests. Within the TBI group, males had significantly lower scores than females on EET (P = 0.03), SI-M (P=0.01) and SI-E (P=0.04). Using impairment cutoffs derived from the HC sample, significantly more males with TBI (30%) were impaired on the EET than females(16.7%); impairment was similar between males and females on SI-M and SI-E. When adjusting for executive functioning and education, the odds of being impaired on the EET did not significantly differ for males and females (OR = 0.47; 95% CI: 0.16 - 1.40; P = 0.18). Conclusions While more males with TBI have emotion perception deficits than females, the difference appears to be driven by education and executive functioning. Research is needed in larger samples with more definitive norms to better understand social inferencing impairments in males and females with TBI, and translation to interpersonal behaviors.

Objective To assess the priorities and decisions of gay and bisexual men (GBM) pursuing fatherhood. Design Cross-sectional study. Setting Internet-based survey. Patients GBM who were interested in pursuing or had previously pursued family building options. Interventions None. Main Outcome Measures This study aimed to assess the attitudes of respondents regarding: 1) mode of achieving parenthood and the relative importance of a genetic link to offspring; 2) the relative importance of factors considered when selecting an oocyte donor (OD); and 3) the relative importance of factors associated with selecting a gestational carrier (GC). Access to care and financial considerations were also analyzed. Results The majority (68.2%) of the 110 respondents desired parenthood via OD and GC. This was consistent with 53.2% of respondents reporting that a genetic link to a child was ‘extremely important’ or ‘important.’ Most couples (86.6%) desired to use sperm from both partners. 40.5% of respondents reported that a twin gestation would be the most ideal pregnancy outcome. Medical history was considered the most important factor when selecting an OD (83.5%) while pregnancy history was considered the most important selection criterion for a GC (86.2%). 89.1% of respondents reported the fertility services they desired were available to them, although 33.0% reported they would have to travel to another state for care. Conclusion Understanding the circumstances of GBM pursuing fatherhood allows for individualized care. Since many respondents desired twin pregnancies, it is important to counsel patients regarding risks of multiple gestation and to determine the motivations for this preference.

PURPOSE To evaluate the quality, reliability, and popularity of videos relating to glaucoma on YouTube. DESIGN Retrospective, cross-sectional study of YouTube videos about glaucoma. PARTICIPANTS One hundred YouTube videos were analyzed for this study. METHODS An online YouTube search for glaucoma videos was conducted simulating a user search using the keywords glaucoma, high eye pressure, and high intraocular pressure. The first 100 videos were analyzed, and each video was evaluated by 2 independent reviewers using the modified DISCERN (scale, 1-5), Journal of the American Medical Association (JAMA; scale, 0-4), and Global Quality (GQ; scale, 1-5) criteria to assess quality and reliability. Videos were categorized further into 3 groups depending on the source of their upload. Group 1 comprised videos uploaded by academic or government institutions, group 2 comprised videos uploaded by private medical practices, and group 3 comprised videos uploaded by independent users. MAIN OUTCOME MEASURES Modified DISCERN, JAMA, and GQ scores for quality and reliability of information and video power index (VPI) for video popularity. RESULTS No substantial difference in scoring was observed between the 2 independent reviewers. The overall mean ± standard error (SE) scores were modified DISCERN score, 3.81 ± 0.06; JAMA score, 2.93 ± 0.07; and GQ score, 3.98 ± 0.06. The overall mean ± SE VPI score was 9.9 ± 2.9. Significant positive correlations were found between video popularity and quality of information for all 3 criteria (P < 0.05). The videos in groups 1 and 2 showed higher modified DISCERN scores than those in group 3, but did not score higher with either the JAMA or GQ criteria. Videos in group 3 were the most popular when compared with videos in groups 1 or 2 (P < 0.01). CONCLUSIONS Overall, many of the videos had adequate quality and reliability scores. No difference was found among groups 1 through 3 for 2 of the 3 criteria used, suggesting a similar quality of information provided among academic, private, and independent sources.

To survey practice patterns designed to increase access to infertility care and evaluate the exposure of obstetrics and gynecology residents to infertility care for the underserved.Cross-sectional.Reproductive endocrinology and infertility (REI) practices associated with Accreditation Council for Graduate Medical Education-accredited obstetrics and gynecology residency training programs.None.Questionnaire survey.Presence of clinical programs designed to improve access to REI care, resident involvement in such programs, and perceived barriers to expanding access to care.Clinical initiatives to expand access included discounted infertility services (38%, n = 30), utilization of a low-cost in vitro fertilization (IVF) program (28%, n = 22), and utilization of a resident- and/or fellow-staffed clinic to provide infertility care (39%, n = 31). The most commonly discounted infertility services were IVF (73%, n = 22), clinical consultation (70%, n = 21), and intrauterine insemination (53%, n = 16). The provision of discounted prices was correlated with the increasing practice size (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.23-4.24) and number of assisted reproductive technology cycles performed annually (OR, 3.65; 95% CI, 1.48-9.02). Academic REI practices (OR, 3.6; 95% CI, 0.98-13.25) were more likely to have a low-cost IVF program. Less than half of obstetrics and gynecology residency programs (39%, n = 31) had an associated REI clinic in which obstetrics and gynecology residents provide direct infertility care to the medically underserved. Frequency and services offered in trainee clinics varied. Multiple barriers to expanding access to care were reported.Reproductive endocrinology and infertility practices associated with obstetrics and gynecology residency programs utilize a diverse range of approaches to provide infertility care to the underserved in the backdrop of considerable challenges and barriers, but significant gaps persist.

To determine the differences in neurologic recovery in persons with initial cervical American Spinal Cord Injury Association Impairment Scale (AIS) grades A and B over time.Retrospective analysis of data from people with traumatic cervical spinal cord injury (SCI) enrolled in the National Spinal Cord Injury Model Systems (SCIMS) database from 2011-2019.SCIMS centers.Individuals (N=187) with traumatic cervical (C1-C7 motor level) SCI admitted with initial AIS grade A and B injuries within 30 days of injury, age 16 years or older, upper extremity motor score (UEMS) ≤20 on both sides, and complete neurologic data at admission and follow-up between 6 months and 2 years.Not applicable.Conversion in AIS grades, UEMS and lower extremity motor scores (LEMS), and sensory scores.Mean time to initial and follow-up examinations were 16.1±7.3 days and 377.5±93.4 days, respectively. Conversion from an initial cervical AIS grades A and B to motor incomplete status was 13.4% and 50.0%, respectively. The mean UEMS change for people with initial AIS grades A and B did not differ (7.8±6.5 and 8.8±6.1; P=.307), but people with AIS grade B experienced significantly higher means of LEMS change (2.3±7.4 and 8.8±13.9 (P≤.001). The increased rate of conversion to motor incomplete status from initial AIS grade B appears to be the primary driving factor of increased overall motor recovery. Individuals with initial AIS grade B had greater improvement in sensory scores.While UEMS recovery is similar in persons with initial AIS grades A and B, the rate of conversion to motor incomplete status, LEMS, and sensory recovery are significantly different. This information is important for clinical as well as research considerations.

PURPOSE To perform a systematic review comparing outcomes of segmental versus circumferential arthroscopic labral reconstruction as a treatment for symptomatic irreparable or unsalvageable acetabular labral pathology. METHODS A systematic review was conducted according to PRISMA guidelines using defined inclusion and exclusion criteria. The study groups were divided into segmental and circumferential labral reconstructions. Studies with

Psychiatric sequelae of traumatic brain injury (TBI) can cause significant and often chronic impairment in functioning and quality of life; however, their phenomenological and mechanistic complexities continue to present significant treatment challenges. The clinical presentation is often an amalgam of syndromes and co-occurring symptoms that require a highly nuanced and systematic approach to treatment. Although few randomized controlled trials have tested treatments for psychiatric problems after TBI and the synthesis of results continues to be compromised by the heterogeneity of study populations, small samples, and differing inclusion criteria and outcome measures, an increasing body of literature supports evidence-based treatment strategies. We provide a narrative review of pharmacological, psychoeducational/behavioral, and neuromodulation treatments for psychiatric conditions in adults with TBI and discuss known or postulated mechanisms of action for these treatment approaches. Where data are available, we focus on randomized controlled trials and large case series in which a psychiatric condition provides both a selection criterion and a primary or secondary outcome. We conclude by proposing directions for future research, particularly the need for novel neuropharmacological, behavioral, and neurophysiological studies and pragmatic trials of multicomponent and adaptive models that will increase understanding of the mechanisms underlying post-TBI psychiatric disorders and accelerate dissemination and implementation of effective person-centered care.

To describe trends in the glaucoma fellowship match results, glaucoma applicant characteristics, and applicant characteristics associated with matching.Retrospective study.Ophthalmology fellowship applicants participating in the San Francisco (SF) Match between 2010 and 2017.De-identified, individual applicant data provided by the San Francisco (SF) Match were used to describe glaucoma fellowship match trends and applicant characteristics between 2010 and 2017. Publicly available, conglomerate SF Match data were used to determine trends in the number of programs participating in the glaucoma fellowship match, as well as the number of positions offered and filled from 2014 to 2019. All trends analyses were performed using linear regression models on log-transformed response variables. Summary statistics for applicants who matched in glaucoma were compared with those who did not match. A multivariable logistic regression model was used to evaluate factors associated with matching in glaucoma fellowship.Fellowship match status (matched in glaucoma vs. did not match in any ophthalmology subspecialty).From 2010 to 2019, the number of matched glaucoma fellowship applicants increased from 54 to 77 (mean 3.3% per year, P = 0.001), and the proportion of applicants to any ophthalmology fellowship who matched in glaucoma increased from 13% to 15.5% (mean, 3% per year; P = 0.041). Compared with applicants who did not match in any specialty between 2010 and 2017, matched glaucoma applicants were more likely to have graduated from a top 10 residency program (10.7% vs. 4.5%, P0.001), U.S. medical school (93.1% vs. 39.1%, P0.001), or U.S. residency program (95.0% vs. 42.2%, P0.001), and complete more interviews (9 vs. 1, P 0.001). After controlling for potential covariates, factors associated with increased odds of matching in glaucoma included graduating from a U.S. residency program (odds ratio [OR], 9.91; 95% confidence interval [CI], 5.45-18.03), applying to fewer programs (OR, 0.91; 95% CI, 0.88-0.93), and completing a greater number of interviews (OR, 1.49; CI, 1.39-1.60). United States Medical Licensing Examination (USMLE) Step scores were not associated with matching in glaucoma.The number of applicants who matched in glaucoma fellowship increased from 2010 to 2019. Factors associated with matching in glaucoma were graduating from a U.S. residency program and completing more interviews.

PURPOSE To evaluate outcomes of botulinum toxin (BTX) injection of the inferior oblique (IO) muscle. DESIGN Retrospective case series. METHODS Setting: Single center, ophthalmology department at Boston Children's Hospital. STUDY POPULATION All patients treated with IO muscle injection of BTX (onabotulinumtoxinA) between 2010 and 2020. OBSERVATION PROCEDURE Sensorimotor evaluations at short-term (

Purpose (1) To compare the efficacy of continued and stopping treatment for 0.05%, 0.025%, and 0.01% atropine during the third year. (2) To evaluate the efficacy of continued treatment over 3 years. (3) To investigate the rebound phenomenon and its determinants after cessation of treatment. Design A randomized, double-masked extended trial. Participants A total of 350 of 438 children aged 4 to 12 years originally recruited into the Low-Concentration Atropine for Myopia Progression (LAMP) study. Methods At the beginning of the third year, children in each group were randomized at a 1:1 ratio to continued treatment and washout subgroups. Cycloplegic spherical equivalent (SE) refraction and axial length (AL) were measured at 4-month intervals. Main Outcome Measures Changes in SE and AL between groups. Results A total of 326 children completed 3 years of follow-up. During the third year, SE progression and AL elongation were faster in the washout subgroups than in the continued treatment groups across all concentrations: –0.68 ± 0.49 diopters (D) versus –0.28 ± 0.42 D (P Conclusions During the third year, continued atropine treatment achieved a better effect across all concentrations compared with the washout regimen. 0.05% atropine remained the optimal concentration over 3 years in Chinese children. The differences in rebound effects were clinically small across all 3 studied atropine concentrations. Stopping treatment at an older age and lower concentration are associated with a smaller rebound.

Objectives We examined the association between birthweight and objectively measured hearing loss in older men and women. Study design 893 community-dwelling participants aged 50+ years with pure-tone audiometry data and self-reported birthweight were included for cross-sectional analysis. Participants were asked how much they weighed at birth either in pounds and ounces or in kilograms and grams. Main outcome measures The pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz (PTA0.5-4kHz) >25 dB HL in the better ear established the presence of hearing loss. Results Around 31.9% and 50.0% of participants who self-reported low ( 4.5 kg), respectively, had hearing loss. The odds of experiencing any level of hearing loss (>25 dB HL) after multivariate adjustment was: OR 2.00 (95% CI 1.13-3.56) for low birthweight and OR 2.43 (95% CI 1.23-4.82) for high birthweight, compared with participants in the reference group who self-reported normal birthweight (3.1-4.0 kg). Additionally, participants with high birthweight had 2.4-fold greater odds of having mild hearing loss (25-40 dB HL), while participants with low birthweight had 2.6-fold greater odds of moderate to severe hearing loss. Conclusions We observed an independent U-shaped association between birthweight and age-related hearing loss, that is, persons born with low or high birthweight had a greater likelihood of experiencing any level of hearing loss in older age. These findings provide further evidence to address an important gap in the literature regarding the influence of foetal growth on the auditory system in later life.

Purpose To calculate costs required to prevent center-involved diabetic macular edema (CI-DME) or proliferative diabetic retinopathy (PDR), and to improve the diabetic retinopathy severity score (DRSS) with intravitreal anti-VEGF injections as reported for aflibercept in two randomized control trials. Design Cost-effectiveness analysis modeling based on published data Subjects None Methods Results from PANORAMA and the Diabetic Retinopathy Clinical Research Network ( DRCR.net ) Protocol W were analyzed. Parameters collected included DRSS score, risk reduction of PDR, risk reduction of CI-DME, and number of treatments required. Costs were modeled based on 2020 Medicare reimbursement data practice settings of hospital-based facility and non-facility. Main Outcome Measure Cost to prevent case of PDR and CI-DME, and to improve DRSS stage Results Over 2 years in Protocol W, the cost required to prevent 1 case of PDR was $83,000 ($72,400) in the facility (non-facility) setting; in PANORAMA, the corresponding 2 year costs were $89,400 ($75,000) for the 2Q16 arm, and $91,200 ($89,900) for the 2Q8PRN arm. To prevent 1 case of CI-DME with vision loss in Protocol W, the cost was $154,000 ($133,000). For all CI-DME, with and without vision loss; in PANORAMA, the costs to prevent a case were $70,900 ($59,500) for the 2Q16 arm, and $90,000 ($88,800) for the 2Q8PRN arm. In Protocol W, the overall accumulated total for cost /DRSS unit change at the 2 year point for facility (non-facility) setting was $2700 ($2400)/DRSS. In the first year alone, it was $2100 ($1800)/DRSS and in the second year alone, $6100 ($5300)/DRSS. Conclusion There is a considerable cost associated with the prevention of PDR and CI-DME with intravitreal aflibercept injections. A price per unit of change in diabetic retinopathy severity score is a new parameter which might serve as a benchmark in future utility analyses that could be used to bring perspective to cost-utility considerations.

Objective To determine if hearing loss is associated with increased risk of frailty in later life. Study design Cross-sectional study of a community sample of 4,004 men aged 70 years and above living in the metropolitan region of Perth, Western Australia. Data were retrieved from the Health in Men Study (HIMS) and the Western Australian Data Linkage System (WADLS). Frailty was assessed using the FRAIL scale and the Frailty Index. Hearing loss was defined by self-report or by diagnosis recorded in the WADLS. We also collected demographic, lifestyle and social support information. Main outcome measures Frailty was assessed using the FRAIL scale and the Frailty Index. Results The prevalence of frailty in the sample population was 16.1% and 25.4% when assessed using the FRAIL scale and the Frailty Index respectively. After adjusting for participant demographic, lifestyle and social factors, hearing loss was significantly associated with the prevalence of frailty when diagnosed by either measure (FRAIL scale: odds ratio [OR] 1.59, 95 CI% 1.32 to 1.91; Frailty Index: OR 1.76, 95 CI% 1.50 to 2.05). The proportion of men with hearing loss increased with increasing severity of frailty. Conclusion Hearing loss is associated with increased prevalence of frailty in older men when assessed using the FRAIL scale and the Frailty Index. Future longitudinal studies using objective measures of hearing will be helpful in determining if this association is likely to be causal.

Study Objective The aim of the study was to examine the effect of heavy menstrual bleeding (HMB) and dysmenorrhea on daily activity and quality of life (QoL) in young women engaged in demanding activities. Design Cross-sectional study. Participants A total of 422 Israeli women soldiers in combat and non-combat roles. Interventions Participants were asked to provide consent and to complete study questionnaires. Main Outcome Measures A pictorial bleeding assessment chart (PBAC), visual analog scale (VAS), verbal multidimensional scoring system for assessment of dysmenorrhea, and approved Hebrew-translated age-appropriate Pediatric Quality of Life Inventory (PedsQL). Results HMB (PBAC >100) and severe HMB (PBAC >185) were demonstrated in 181 (50%) and 96 (26%) participants, respectively. A high PBAC score was recorded in 20% who answered “no” or “unknown” in the questionnaire on having HMB. Mild, moderate, and severe dysmenorrhea were demonstrated in 80 (21.5%), 115 (31%), and 142 (38%) participants, respectively. The prevalence of HMB and dysmenorrhea was similar in soldiers in combat and non-combat roles. Diagnosis of HMB was related to the lower fitness-for-service score, history of bleeding, and dysmenorrhea. Daily activity and QoL were both affected by the severity of HMB and dysmenorrhea. Conclusion Underdiagnosis of HMB and dysmenorrhea results from a combination of unawareness from the women's side and inattention from the system. In an era of female empowerment, each woman should be at the optimal physiological and psychological level to start her career; thus, addressing the menstrual burden and providing effective treatment is needed in the military scenario and other settings with demanding activities.

Objective To determine if a cytoplasmic diameter of ≥130 μm can help identify human giant oocytes (GOs) in clinical practice and confirm the presence of genetic abnormalities in GOs by assessing the spindle length and centromere numbers. Design Case–control study Setting Private in vitro fertilization clinic Patient(s) The subjects were females aged 20–49 years who underwent oocyte retrieval following ovarian stimulation from January 2014 to December 2020. Intervention(s) None Main Outcome Measure(s) Oocyte diameter was measured; immunofluorescent staining was performed to assess the spindle diameter and centromere numbers. Results Among the oocytes examined, 0.22% (561/254,337) had a diameter of ≥130 μm. The mean diameter range in the normal-sized metaphase II (MII) oocytes (MII group) was 103.0–119.0 μm and 132.3–175.9 μm in the GO group. Spindle size could be measured in 6 GOs with one spindle (GO1), 10 GOs with 2 spindles (GO2) and 16 MII groups. The equatorial plane and pole-to-pole distance in the GO1 were significantly longer than GO2 and MII groups. A median of 86 centromeres in GOs with one spindle and 42 in each spindle for GOs with 2 spindles was observed among 11 GO1s and 5 GO2s. Conclusions This study is the first to define GOs as oocytes with a diameter of ≥130 μm and is a large-scale study surveying the incidence of GO. It is also the first study to analyze and elucidate the relationship between spindle numbers within the cytoplasm of GOs and spindle size and centromeres.

BACKGROUND Many patient-reported outcome measures (PROMs) have been used to follow clavicle fractures, providing an objective means to track outcomes. However, lack of standardization of PROM usage makes cross-study comparison difficult. Therefore, we reviewed articles on clavicle fractures from 11 of the most influential orthopedic journals to assess trends in PROM usage over time and based on geographic location. METHODS A focused systematic review of 11 of the most influential orthopedic journals was performed using PubMed. All articles published between 1981 and 2020 with greater than 9 patients reporting clinical outcomes of clavicle fractures were included. For each article, patient demographics, treatment modality, geographic location, and outcome measures used were recorded. Temporal trends were identified using the Cochran-Armitage test for trend and linear regression. Pearson chi-square and Kruskal-Wallis tests were used to compare between journals, geographic location, study type, and fracture classification. RESULTS From the initial literature search of 623 articles, 151 studies reporting on 15,853 primary clavicle fractures were included. Fractures of the middle one-third of the clavicle were most studied in the included literature (71%). Seventeen different PROMs were used, with an average of 1.6 outcome measures per study, and there was a significant increase in the number of PROMs used per article over time (P < .001). The Constant-Murley score was the most-reported outcome measure (44%) followed by the Disabilities of the Arm, Shoulder, and Hand score (27%), visual analog scale for pain (23%), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES; 14%). There was a significant difference between the measures used based on geography (P = .002), the most notable being that North American authors use the ASES score more frequently. CONCLUSIONS The use of PROMs in studies evaluating clavicle fracture treatment outcomes has increased over time, with recent studies reporting more PROMs than older studies, and there are notable differences in usage of the various scores based on geography and journal. Although there is no consensus on the most reliable PROM for assessing clavicle fractures, we recommend the use of at least 2 of the commonly reported PROMs in future studies to facilitate cross-study comparisons.

BACKGROUND: National recommendations allow for the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women ≥ 70 years-old with early-stage, hormone-receptor positive invasive breast cancer, but these therapies remain common. Previous work demonstrates an individual’s maximizing-minimizing (MM) trait—an inherent preference for more or less medical care—may influence the preference for low-value care. MATERIALS AND METHODS: We recruited an equal number of women ≥ 70 years who were maximizers, minimizers, or neutral based on a validated measure between September-November 2020. Participants were presented a hypothetical breast cancer diagnosis before randomization to one of three follow-up messages: maximizer-tailored, minimizer-tailored, or neutral. Tailored messaging aimed to redirect maximizers and minimizers towards declining SLNB and radiotherapy. The main outcome measure was predicted probability of choosing SLNB or radiotherapy. RESULTS: The final analytical sample (n=1600) was 515 maximizers (32%), 535 neutral (33%) and 550 (34%) minimizers. Higher maximizing tendency positively correlated with electing both SLNB and radiotherapy on logistic regression (p

The impact of depression on post-menopausal women is an important public health issue but remains largely unknown. The purpose of this study was to identify the prevalence of post-menopausal depression in Greece and outline the profile of the women it affects.A sample of post-menopausal women completed an anonymous, self-administered, web-based survey which included the Beck Depression Inventory-ΙΙ (BDI-II) and questions regarding socio-demographic data.The dependent variable of interest was a BDI-II score ≥ 20 (the cut-off for moderate depression according to the BDI).Overall, 502 post-menopausal women participated in the study. The median BDI-II score was 13 (range 0-50); 136 (27.1%) of the women scored ≥ 20 and were considered screen-positive for depression. According to the multivariate logistic regression model, age 55 years (OR: 1.621; 95% CI: 1.036-2.535), not working (OR: 1.580; 95% CI: 1.013-2.465), smoking (OR: 1.656; 95% CI: 1.081-2.536) and history of depression (OR: 1.650; 95% CI: 1.045-2.604) were independently associated with post-menopausal depression. Subgroup analyses revealed that current smokers (OR: 2.514; 95% CI: 1.485-4.256) had higher odds of moderate depression, while obesity (OR: 2.455; 95% CI: 1.206-4.996), absence of healthcare insurance (OR: 4.413; 95% CI: 1.970-9.887) and a history of depression (OR: 2.253; 95% CI: 1.212-4.190) were identified as independent risk factors for severe post-menopausal depression.More than one out of four post-menopausal women were screen-positive for symptoms indicative of depression, while a personal history of depression, age 55 years, smoking and current working status were independent predictors of its emergence.

Background There are three patient reported outcome measure instruments (PROMs) that have adequate content validity for breast reconstruction, BREAST-Q, BRECON-31 and EORTC QLQ-BRECON-23, and they all have been robustly validated. The aim of this study was to systematically review scores giving meaning to validated PROMs for breast reconstruction after mastectomy and discuss methods to enable interpretation of them. Methods A systematic review was performed according to the recommendations of PRISMA. Prospero CRD42021255874. Included articles had to meet criteria defined in a SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). The included studies were critically appraised using the GRADE approach. Results Three articles were finally included in the review: two studies on scores for healthy controls and one on minimally important differences (MIDs), both of BREAST-Q. All of the studies were performed in North America. Only MIDs based on statistical characteristics, and not on what constitutes a relevant change for the patient, exist. The risk of bias was evaluated as very high and moderate, respectively, of inconsistencies as low, of indirectness as high, of imprecisions as low, and of publication bias as probably low. Conclusions The overall certainty of evidence for scores giving meaning to PROMs for breast reconstruction is low (GRADE ƟƟОО). More studies are needed to establish relevant healthy control scores and what constitutes a relevant clinical difference for patient-reported outcome measures for breast reconstruction after mastectomy. Clinical implications of the findings and suggestions for further research are suggested in the article., Highlights • Patient reported outcome measurements have to be clinically interpretable to make sense. • Three articles on scores giving meaning to PROMs for breast reconstruction post-mastectomy exist. • More studies are needed to establish relevant controls and clinical differences in scores. • Clinical implications and suggestions for further research are discussed.

Background Bariatric surgery outcomes in elderly patients have been shown to be safe, but with a higher rate of adverse outcomes compared with nonelderly patients. The impact of race on bariatric surgery outcomes continues to be explored, with recent studies showing higher rates of adverse outcomes in black patients. Perioperative outcomes in racial cohorts of elderly bariatric patients are largely unexplored. Objective The goal of this study was to compare outcomes between elderly non-Hispanic black (NHB) and non-Hispanic white (NHW) bariatric surgery patients to determine whether outcomes are mediated by race. Setting Academic hospital. Methods Patients who had a primary Roux-en-Y (RYGB) and sleeve gastrectomy (SG) in the period 2015-2018 and were at least 65 years of age were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Data File (MBSAQIP PUF). Selected cases were stratified by race. Outcomes were compared between matched racial cohorts. Multivariate regression analyses were performed to determine whether race independently predicted morbidity. Results From 2015 to 2018, 29,394 elderly NHW (90.8%) and NHB (9.2%) patients underwent an RYGB or SG. At baseline, NHB elderly patients had a higher burden of co-morbid conditions, resulting in higher rates of overall (7.7% versus 6.4%, P = .009) and bariatric-related (5.4% versus 4.1%, P = .001) morbidity. All outcome measures were similar between propensity-score-matched racial elderly bariatric patient cohorts. On regression analysis, NHB race remained independently correlated with morbidity (odds ratio [OR] 1.3, 95% CI 1.08-1.47, P = .003). Conclusion RYGB and SG are safe in elderly patient cohorts, with no differences in adverse outcomes between NHB and NHW patients, accounting for confounding factors. While race does not appear to impact outcomes in the elderly cohorts, NHB race may play a role in access.

Objectives To examine the longitudinal association between participation in social activities and healthy lifestyle behaviours. Study design This 2-year follow-up study used data from 6168 older adults (73.5 ± 5.3 years; 49% men). We studied participation in five types of social activities at baseline: participation in volunteer, sports, hobbies, senior clubs, and neighbourhood-association groups. Main outcome measures The healthy lifestyle behaviours were physical activity (time spent walking: ≥150 min/week; or less), eating habits (dietary variety score: ≥4 points; or less), and intellectual activity (subcomponents of the Tokyo Metropolitan Institute of Gerontology Index of Competence: 4 points; or less). Results In the follow-up survey, 19% of participants were physically inactive, 53% had unfavourable eating habits, and 34% had diminished intellectual activity. Multilevel modified Poisson regression analysis showed that participation in sports groups was associated with a lower relative risk (RR) of physical inactivity (RR=0.82 [0.72, 0.93]) and unfavourable eating habits (RR=0.95 [0.90, 1.00]). Participation in hobby groups reduced the RR of unfavourable eating habits (RR=0.93 [0.90, 0.97]) and diminished intellectual activity (RR=0.90 [0.85, 0.96]). Participation in volunteering was associated with a lower RR of diminished intellectual activity (RR=0.84 [0.75, 0.95]). Relative to non-participation, participating in two or more social activities was associated with a 9% (95% CI: 0.83, 1.00) lower RR for physical inactivity, a 12% (95% CI: 0.82, 0.95) lower RR for unfavourable eating habits, and a 17% (95% CI: 0.77, 0.89) lower RR for diminished intellectual activity. Conclusions Both the nature and the number of social activities determine the longitudinal effects of social participation on healthy lifestyle behaviours.

OBJECTIVE To identify the impact of child involvement in vegetable preparation on vegetable preference and attitudes toward eating vegetables. DESIGN Pre-post mixed-methods. SETTING Food and Farming Camp at a nonprofit urban farm in Sunnyvale, California. PARTICIPANTS Camp participants aged 8-10 years (n = 34 girls, n = 12 boys), and aged 11-14 years (n = 19 girls, n = 4 boys). INTERVENTIONS Involvement in vegetable preparation through harvesting, cutting, cooking, and seasoning before consumption. Interviews identified camper perception of vegetable preference and involvement in preparation. MAIN OUTCOME MEASURES Change in vegetable preference from baseline with and without involvement in vegetable preparation. Attitudes toward involvement in vegetable preparation. ANALYSIS Adjustment of preferences to baseline followed by tests of hypotheses to identify differences with involvement. Thematic, qualitative coding to identify prevalent themes within interview responses. RESULTS Younger campers preferred vegetables they prepared (P < 0.05), except for carrots. Campers were more likely to choose vegetables they prepared (P < 0.05). Campers of both age groups were curious to try their vegetable creations and described feelings of pride and responsibility related to preparing vegetables. CONCLUSIONS AND IMPLICATIONS Involvement with food preparation, in particular in a garden-based setting, may provide an accessible method to improve child vegetable preference.

Background Although Foot and Ankle Outcome Score (FAOS) is a widely used patient-reported outcome measure (PROM) for foot and ankle conditions, research on its longitudinal validity is still needed. Minimal important change (MIC) values for the FAOS were determined using predictive modeling. Methods Overall, 134 patients that underwent operative treatment for foot and ankle conditions were included. An anchor based predictive logistic modeling method was used for estimating the MIC values for the FAOS subscales after surgery. Results Mean score changes in the improved and the unimproved groups were 17.7 and 0.43 points for Pain, 3.9 and −3.3 points for Symptoms, 21.3 and 1.8 points for Activities and daily living (ADL), 8.7 and −2.8 points for Sport, and 12.5 and −3.3 points for quality of life subscale, respectively. MIC was successfully determined to four out of five subgroups as follows: Pain 9.5 (94% CI −6.4 to 24.6); ADL 11.7 (95% CI −19.6 to 46.6); Sport (95% CI −10.4 to 15.4); QoL 5.0 (95% CI −2.6 to 12.9). The Symptoms subgroup presented with low MIC of 0.3 (95% CI −11.7 to 13.4) fitting to the measurement error. Conclusion ADL, Sports, Pain, and QoL subscales of the FAOS presented logical MIC values. The MIC can be further evaluated for specific conditions.

Objectives To characterize the utilization trends associated with the Aarogyasri health insurance scheme in Andhra Pradesh, India. Methods This is a retrospective cross-sectional study including participants enrolled in the Aarogyasri health insurance scheme, with recorded claims pertaining to inpatient care from quarter 3, 2014 through quarter 2, 2018. The main outcome measure, was annual utilization by service category, trended to characterize changes in the mean claim amount and the median length of stay. Mortality by service category was also trended. Mann-Kendall correlation was used to evaluate trends. Additionally, interdistrict migration for care in 2014 versus 2018 was examined to evaluate changes in access to care. Results The distribution of claims by caste significantly shifted over time, with members of backward castes and scheduled tribes filing more claims, and members of other castes and scheduled castes filing fewer claims. The median age of patients significantly increased, rising from 44.0 years in 2014 to 46.0 years in 2018. The nominal mean claim amount in 2018 was 105.4% of the 2014 average, but the 2018 real mean claim amount was 90.3% of the 2014 average. The median length of stay significantly decreased from 5 to 4 days. Mortality rates after procedures significantly decreased from 2.4% to 2.1%. Interdistrict migration to access care remained high among beneficiaries from the districts YSR Kadapa and West Godaveri in 2014 and 2018. Conclusions Over time, the value delivered by Aarogyasri improved. More patients received care at lower real per claim cost, with a concurrent decline in mortality.

Summary Objectives (1) To describe factors influencing the content, timing, and intensity of pre- and postoperative voice therapy for patients undergoing phonosurgery for benign vocal fold lesions. (2) To understand experts’ rationale for decisions made. (3) To critically analyze factors influencing intervention in relation to the wider literature in order to contribute to the development of a complex intervention. Design Qualitative interview study. Setting Multidisciplinary voice clinics in England. Participants Ten expert voice therapists with a mean of 22 years experience. Main outcome measures Participants were asked to describe factors influencing their current practice and views on optimum treatment for patients undergoing phonosurgery for benign vocal fold lesions. Data were analyzed using the Framework Method of thematic analysis. Results Factors influencing intervention related to four key themes. Pathophysiological, Patient, Therapist, and Service factors influenced the content, timing, and duration of the voice therapy provided. Consensus on core elements included delivering indirect and direct therapy preoperatively to manage underlying causative factors and address patient expectations. Postoperative intervention focused on indirect therapy to facilitate wound healing and direct therapy to improve vibratory characteristics of the vocal fold. Elements of therapy were highly individualized within participants according to the four themes above, but similarity between participants on broad parameters of intervention was high. Conclusions Expert voice therapists use direct and indirect methods pre- and postoperatively to treat patients with benign vocal fold lesions. Optimizing wound healing and mobilization of the epithelium postoperatively are concerns for expert voice therapists which distinguish postoperative patients from other dysphonic patients. This study provides an insight into the factors influencing clinician's intervention provision which can contribute to the development of an optimal pre- and postoperative voice therapy intervention. Further research to refine and test the effectiveness of an intervention is now required.

Background Yoga is among the most commonly studied complementary therapies for managing climacteric symptoms. However, it is unclear whether yoga practices in premenopause can affect the occurrence of symptoms when women reach menopause. Objective To assess climacteric symptoms and quality of life in regular yoga practitioners and to determine whether yoga practices before menopause may avoid or mitigate climacteric-related symptoms. Design This study of 108 women between 40 and 65 years old included 28 women who started to practice yoga in premenopause and had already practiced for at least five years, and as controls 30 physical activity practitioners (PA) who had practiced for at least five years, and 50 sedentary women. Main outcome measures Climacteric symptoms were evaluated with the Kupperman Menopausal Index (KMI) and the Women's Health Questionnaire (WHQ). Moreover, we measured the quality of life with the WHQ. Results The KMI showed that 39.3% of yoga practitioners had no menopausal symptoms, and none reported severe symptoms. The WHQ indicated a few symptoms and a good quality of life for yoga practitioners (3.56; 3.35–3.80). In addition, we found that the yoga group had significantly less moderate and severe symptoms (p = 0.002) compared with the sedentary group. We also observed that yoga practitioners had less vasomotor symptoms and memory/concentration disorders than PA practitioners (p = 0.010 and p = 0.047) and sedentary women (p = 0.001 and p = 0.001) and also used fewer drugs than the PA (p Conclusions Yoga practitioners who started to practice in premenopause had satisfactory results on the frequency and intensity of climacteric symptoms and quality of life. Although further research is required to support our findings, we conclude that yoga practice may represent an efficient non-pharmacological approach to manage and prevent climacteric symptoms.

Objectives To analyze and compare the experience of climacteric symptoms and their associations with sociodemographic and health-related characteristics in two cohorts of Finnish women aged 52–56 years, born ten years apart and not now or previously on menopausal hormone therapy (MHT). Study design Nationwide population-based time-trend study with a large number of participants (n = 1986 + 1988). Main outcome measures The experience of climacteric symptoms was assessed by 12 commonly used menopause-related symptoms. Results Women aged 52–56 experienced more moderate or severe symptoms and fewer mild symptoms in 2010 than in 2000. Being unemployed or inactive was associated with more severe symptoms (P = 0.007), but employment status had no effect on the relative odds estimates. Conclusions The influence of the birth cohort and time-period effects as well as work-related factors on the experience of climacteric symptoms in women not now or previously on MHT needs further research, particularly since the change in the experience of symptoms found in this study occurred within only ten years.

Objective The Outcome Measures in Rheumatology (OMERACT) is a research organization focused on improving health care outcomes for patients with autoimmune and musculoskeletal diseases. The Connective Tissue Disease-Interstitial Lung Disease (CTD-ILD) Working Group on Lung Physiology is a group within OMERACT charged with identifying outcome measures that should be implemented in studies of patients with CTD-ILD. The OMERACT Filter 2.1 is an evidence-based algorithm used to identify outcome measures that are truthful, feasible, and able to discriminate between groups of interest. Our objective was to summate evidence (published literature, key opinion leader input, patient perspectives) that would influence the CTD-ILD Working Group's vote to accept or reject the use of two measures of lung physiology, the forced vital capacity (FVC) and the diffusion capacity of carbon monoxide (DLco) for use in randomized controlled trials (RTCs) and longitudinal observational studies (LOSs) involving patients with systemic sclerosis associated ILD (SSc-ILD). Methods Patient Research Partners (those afflicted with SSc-ILD) and the CTD-ILD Working Group on Lung Physiology were polled to assess their opinion on the FVC and DLco in terms of feasibility; the CTD-ILD Working Group was also queried on these instruments’ face and content validity. We then conducted a systematic literature review to identify articles in the SSc-ILD population that assessed the following measurement properties of FVC and DLco: (1) construct validity, (2) test-retest reliability, (3) longitudinal construct validity, (4) clinical trial discrimination/sensitivity to detect change in clinical trials, and (5) thresholds of meaning. Results were summarized in a Summary of Measurement Properties (SOMP) table for each instrument. OMERACT CTD-ILD Working Group members discussed and voted on the strength of evidence supporting these two instruments and voted to endorse, provisionally endorse, or not endorse either instrument. Results Forty Patient Research Partners reported these two measures are feasible (are not an unnecessary burden or represent an infeasible longitudinal assessment of their disease). A majority of the 18 CTD-ILD Working Group members voted that both the FVC and DLco are feasible and have face and content validity. The systematic literature review returned 1,447 non-duplicated articles, of which 177 met eligibility for full text review. Forty-eight studies (13 RCTs, 35 LOSs) were included in the qualitative analysis. The FVC SOMP table revealed high quality, consistent data with evidence of good performance for all five measurement properties, suggesting requisite published evidence to proceed with endorsement. The DLco SOMP table showed a lack of data to support test-retest reliability and inadequate evidence to support clinical trial discrimination. There was unanimous agreement (15 [100%]) among voting CTD-ILD Working Group members to endorse the FVC as an instrument for lung physiology in RCTs and LOSs in SSc-ILD. Based on currently available evidence, DLco did not meet the OMERACT criteria and is not recommended for use in RCTs to represent lung physiology of SSc-ILD. The OMERACT Technical Advisory Group agreed with these decisions. Conclusion The OMERACT Filter 2.1 was successfully applied to the domain of lung physiology in patients with SSc-ILD. The FVC was endorsed for use in RCTs and LOSs based on the Working Group's vote; DLco was not endorsed.

Web-based patient engagement portals are increasing in popularity after total hip and knee arthroplasty (THA and TKA). The literature is mixed regarding patient utilization of these modalities and potential clinical benefit. We sought to determine which demographic factors are associated with increased platform participation and to quantify the impact of a web-based patient portal on patient-reported outcome measures (PROMs).We performed a retrospective analysis of consecutive primary THA (n = 554) and TKA (n = 485) at a single academic institution with minimum follow-up of 12 months. Patients were divided into those who opted-in and those who opted-out of portal use. Global health and joint-specific PROMs were collected preoperatively and postoperatively. Linear mixed effects modeling, bivariate analysis, and logistic regression were utilized.Of the 1039 included patients, 60.6% (336) THA and 62.7% (304) TKA patients enrolled in the portal. Those who opted-in were younger (P.001, P.003), had higher body mass index (P = .024, P = .011), and had a higher household income (P.001, P.001) in THA and TKA cohorts, respectively. Portal participation in the TKA but not the THA cohort was associated with significant improvement in physical function (P = .017) and joint-specific function (P = .045). For THA patients who opted-in, increased portal logins were associated with more rapid improvement and higher functional scores (P = .013).There is an inherent difference between patients who opt-in to and those who opt-out of web-based portals. Added resources and support provided by portals may translate to improved PROMs for TKA patients but not THA patients.

PURPOSE: We describe the large-scale self-initiated recruitment of patients to a self-monitoring initiative for macular pathologic features during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: Observational study with retrospective analysis. PARTICIPANTS: A total of 2272 patients from the Singapore National Eye Centre (SNEC) whose visits were rescheduled over lockdown (April 13-June 1, 2020) were offered participation in a self-monitoring initiative administered by SNEC with the Alleye application (Switzerland) as the testing instrument. METHODS: This was an observational study with retrospective analysis. Demographics and characteristics were compared between those who signed up and those who did not. Similar comparisons were made between patients who complied with the initiative versus those who did not. Outcomes were tracked for 6 months starting from the commencement of lockdown. MAIN OUTCOME MEASURES: Participation and compliance rates and characteristics of patients who were more likely to participate and comply with the initiative. RESULTS: Seven hundred thirty-two patients (32%) participated in this self-monitoring initiative. Those who participated were younger (62 years of age vs. 68 years of age; P < 0.001), men, and living with family. Patients not receiving treatment and those with poorer vision in the worse-seeing eye were more likely to participate. When grouped according to diagnosis, the proportion who participated was highest for diabetic macular edema (52%), nonneovascular age-related macular degeneration (AMD; 42%), diabetic retinopathy (35%), retinal vein occlusions (18%), and neovascular AMD (15%; P < 0.001). Testing compliance rate was 43% (315/732). Patients who complied with the initiative were older, were receiving treatment, and had poorer vision in the worse-seeing eye. Trigger events occurred in 33 patients, with 5 patients having clinically verified disease progression (1.6%). CONCLUSIONS: We provide clinical data on characteristics of patients with stable retinal diseases who were offered, participated in, and complied with a self-monitoring program. The lower participation rate compared with standardized clinical studies reflects the difficulties in implementation for such initiatives in clinical settings. Despite this, self-monitoring continues to show promise in relieving clinic resources, suggesting the feasibility of scaling such programs beyond the COVID-19 pandemic.

Purpose To compare patient preferences for eyeglasses prescribed using a low-cost, portable wavefront autorefractor versus standard subjective refraction (SR). Design Randomized, cross-over clinical trial. Participants Patients aged 18 to 40 years presenting with refractive errors (REs) to a tertiary eye hospital in Southern India. Methods Participants underwent SR followed by autorefraction (AR) using the monocular version of the QuickSee device (PlenOptika Inc). An independent optician, masked to the refraction approach, prepared eyeglasses based on each refraction approach. Participants (masked to refraction source) were randomly assigned to use SR- or AR-based eyeglasses first, followed by the other pair, for 1 week each. At the end of each week, participants had their vision checked and were interviewed about their experience with the eyeglasses. Main Outcome Measures Patients preferring eyeglasses were chosen using AR and SR. Results The 400 participants enrolled between March 26, 2018, and August 2, 2019, had a mean (standard deviation) age of 28.4 (6.6) years, and 68.8% were women. There was a strong correlation between spherical equivalents using SR and AR (r = 0.97, P 0.05 for all). Conclusions We observed a strong agreement between the prescriptions from SR and AR, and eyeglasses prescribed using SR and AR were equally preferred by patients. Wider use of prescribing based on AR alone in resource-limited settings is supported by these findings.

We sought to evaluate the impact of thoracoscopic repair on perioperative outcomes in infants with esophageal atresia and tracheoesophageal fistula (EA/TEF).The American College of Surgeons National Surgical Quality Improvement Program pediatric database from 2014 to 2018 was queried for all neonates who underwent operative repair of EA/TEF. Operative approach based on intention to treat was correlated with perioperative outcomes, including 30-day postoperative adverse events, in logistic regression models.Among 855 neonates, initial thoracoscopic repair was performed in 133 (15.6%) cases. Seventy (53%) of these cases were converted to open. Those who underwent thoracoscopic repair were more likely to be full-term (p = 0.03) when compared to those in the open repair group. There were no significant differences in perioperative outcome measures based on surgical approach except for operative time (thoracoscopic: 217 min vs. open: 180 min, p0.001). A major cardiac comorbidity (OR 1.6, 95% CI 1.2-2.1; p = 0.003) and preoperative ventilator requirement (OR 1.4, 95% CI 1.0-1.9; p = 0.034) were the only risk factors associated with adverse events.Thoracoscopic neonatal repair of EA/TEF continues to be used sparingly, is associated with high conversion rates, and has similar perioperative outcomes when compared to open repair.III.

Purpose To investigate the association between smartphone use and refractive error in teenagers using the Myopia app. Design Cross-sectional population-based study. Participants A total of 525 teenagers 12 to 16 years of age from 6 secondary schools and from the birth cohort study Generation R participated. Methods A smartphone application (Myopia app; Innovattic) was designed to measure smartphone use and face-to-screen distance objectively and to pose questions about outdoor exposure. Participants underwent cycloplegic refractive error and ocular biometry measurements. Mean daily smartphone use was calculated in hours per day and continuous use as the number of episodes of 20 minutes on screen without breaks. Linear mixed models were conducted with smartphone use, continuous use, and face-to-screen distance as determinants and spherical equivalent of refraction (SER) and axial length-to-corneal radius (AL:CR) ratio as outcome measures stratified by median outdoor exposure. Main Outcome Measures Spherical equivalent of refraction in diopters and AL:CR ratio. Results The teenagers on average were 13.7 ± 0.85 years of age, and myopia prevalence was 18.9%. During school days, total smartphone use on average was 3.71 ± 1.70 hours/day and was associated only borderline significantly with AL:CR ratio (β = 0.008; 95% confidence interval [CI], –0.001 to 0.017) and not with SER. Continuous use on average was 6.42 ± 4.36 episodes of 20-minute use without breaks per day and was associated significantly with SER and AL:CR ratio (β = –0.07 [95% CI, –0.13 to –0.01] and β = 0.004 [95% CI, 0.001–0.008], respectively). When stratifying for outdoor exposure, continuous use remained significant only for teenagers with low exposure (β = –0.10 [95% CI, –0.20 to –0.01] and β = 0.007 [95% CI, 0.001–0.013] for SER and AL:CR ratio, respectively). Smartphone use during weekends was not associated significantly with SER and AL:CR ratio, nor was face-to-screen distance. Conclusions Dutch teenagers spent almost 4 hours per day on their smartphones. Episodes of 20 minutes of continuous use were associated with more myopic refractive errors, particularly in those with low outdoor exposure. This study suggested that frequent breaks should become a recommendation for smartphone use in teenagers. Future large longitudinal studies will allow more detailed information on safe screen use in youth.

Objective To develop and evaluate the reliability of a 24-hour movement behavior questionnaire for physical activity, sedentary behavior, and sleep for youth in South Korea. Design Mixed-methods study using literature review, expert panels, pilot tests, and test-retest reliability. Setting Seoul and Gyeongg-do, South Korea. Participants A convenience sample of middle and high school students for a pilot test (n = 120) and reliability testing (n = 147). Main Outcome Measures The reliability of a 24-hour movement behavior questionnaire. Analysis Cohen's kappa, Spearman, and intraclass correlation coefficients for test-retest reliability testing. Results The questionnaire consisted of 19 questions in 5 categories: general information, sleep and nap, active transportation-related activity, school life, and free-time activities. The 24-hour movement behavior questionnaire achieved moderate reliability for all sleep, physical activity, and sedentary (r = 0.79, 0.61, 0.56). The amount of sleep, physical activity, and sedentary behavior indicated moderate-to-good rest-retest reliability, with intraclass correlation coefficients ranging from 0.54 to 0.79 (P Conclusions and Implications The 24-hour movement behavior questionnaire was reliable for measuring sleep, physical activity, and sedentary behavior in Korean adolescents aged 13–17 years. The development of this questionnaire could facilitate more accurate and useful measurements of adolescent's activities and lifestyles in South Korea.

Clinical outcome measures are important in both the conduct of clinical research and evaluation of knee surgery in every day clinical practice. A wide variety of validated outcome scores are available in the literature. The objective of this study was to investigate if there is a difference between clinician-completed and patient-completed outcome scores in detecting improvement following anterior cruciate ligament (ACL) reconstruction.Fifty patients with ACL rupture were prospectively evaluated using nine clinical outcome measures. Five clinician-completed knee scores included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score and Tapper and Hoover Meniscal Grading Score. Four patient-completed knee scores included IKDC Subjective Knee Score, Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), Short Form-12 Item Health Survey (SF-12) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Thirty-four of the 50 patients underwent an ACL reconstruction and were reassessed with all nine outcome scores upon their follow-up review 3 months post-operatively.A significant longitudinal improvement was observed of all five clinician-completed knee scores including Tegner (3.3-4.1 (p = 0.006)), Lysholm (71.7-85.3 (p 0.001)), Cincinnati (62.6-75.9 (p 0.001)), IKDC Objective (Abnormal to Nearly Normal (p = 0.001)) and Tapper and Hoover (Fair to Good (p 0.001)). However, none of the four patient-completed knee scores revealed a statistically significant improvement post-operatively.Results of clinician-completed scores were found to be inconsistent with those of patient-completed instruments. It's important to consider the mode of administering outcome measures either for research or clinical practice as it can have a significant influence on the end results. The use of both a clinician-completed and a patient-completed instrument maybe the more prudent approach to assessing and quantifying ACL injuries and the outcome post-operatively. Ultimately, better methods of objectively evaluating surgical interventions of the knee are required.

Summary Objective To evaluate the response of polypoidal choroidal vasculopathy (PCV) in eyes treated with intravitreal bevacizumab (BVZ) and untreated fellow eyes in black Africans. Methods We studied 22 eyes (12 patients) divided into 12 treated and 10 untreated eyes from January 2017 to January 2020. Treated eyes received 1 monthly injection of BVZ 2.5 mg for 3 months, with optional additional injections depending on the patient's course. Both groups of eyes were evaluated at presentation and then at 3, 6, 9, and 12 months after treatment. Outcome measures were visual acuity (VA) and ophthalmoscopic and OCT findings. Results The mean age of the patients was 66.3 ± 5.6 years. In treated eyes, VA remained stable from 0.10 ± 0.12 at baseline to 0.20 ± 0.30 at month 12, P = 0.84. VA was stable in 83.3% and improved in 16.7% of eyes. On OCT, 41.7% of eyes showed decreased and another 41.7% disappearance of subretinal fluid (SRF) at 12 months. Pigment epithelial detachment (PED) height decreased in 9 eyes (75.0%) but remained unchanged in 3 eyes (25%). In untreated eyes, no difference was observed between the baseline (0.53 ± 0.42) and 12-month VA (0.58 ± 0.40), P = 0.82. VA improved in 2 eyes, decreased in one eye, and remained unchanged in 7 eyes. OCT lesions remained stable in 6 eyes. The PED enlarged in one eye but remained stable in 3 other eyes. Conclusion Intravitreal injection of BVZ 2.5 mg led to stabilization of VA, resorption of SRF, and reduction in the size of the PED in the majority of eyes with PCV but was ineffective on the polyps. The one-year prognosis in untreated eyes with PCV was favorable and marked by functional and structural stability.

Objective To examine how adverse childhood experiences (ACEs) relate to healthy weight behaviors in children. Methods We examined data from the 2016 National Survey of Children's Health. ACE scores were calculated from 6 measures of household dysfunction. Outcome measures included 5 healthy weight behaviors. Logistic regression models assessed associations between ACEs and healthy weight behaviors controlling for sociodemographic variables. Results Children 6 to 17 years of age (n = 32,528) with 0 ACEs had increased odds of: watching 2 hours or less of television daily (6–12 years: odds ratio [OR] 1.46; 95% confidence interval [CI], 1.20–1.80, 13–17 years: OR 1.64; 95% CI, 1.39–1.94), using electronics for 2 hours or less daily (6–12 years: OR 1.44; 95% CI, 1.15–1.80, 13–17 years: OR 1.86; 95% CI, 1.60–2.16), sharing 4 or more family meals per week (6–12 years: OR 1.39; 95% CI, 1.17–1.66, 13–17 years: OR 1.68; 95% CI, 1.44–1.95), and getting adequate age-specific sleep (6–12 years: OR 1.50; 95% CI, 1.26–1.79, 13–17 years: OR 1.31; 95% CI, 1.11–1.55) when compared to children with one or more ACEs. Children 13 to 17 years of age with 0 ACEs had increased odds of exercising for 60 minutes daily (OR 1.27; 95% CI, 1.02–1.58) when compared to children with one or more ACEs. There was an overall gradient dose pattern; the odds of engaging in a healthy weight behavior decreased as the number of ACEs increased, with mixed significance levels. Conclusions In children, ACE exposure is associated with decreased healthy weight behaviors and behavior counseling alone may be insufficient. Trauma-informed care to address intra-familial adversity may be necessary.

Background The items of the Patient Health Questionnaire-9 (PHQ-9) represent the criterion symptoms for DSM-IV major depression. This study evaluated the extent to which the PHQ-9 functions as a patient-reported outcome measure (PROM) specific to patients with major depressive disorder. Method Data were from the Veterans Outcome Assessment survey for 8848 patients beginning treatment in VA general mental health clinics, including 5754, re-surveyed after 3 months. The PHQ-9’s performance as a PROM was evaluated by comparing rank order correlations between both initial scores and improvements over 3 months between the PHQ-9 and several transdiagnostic PROMs across a range of diagnoses and comorbidities. Performance of PHQ-9-related patient-reported outcome-based performance measures (PROM-PM) were evaluated by comparing rates of response and remission across patient groups. Results Correlations between the PHQ-9 and transdiagnostic measures were significant and comparable in magnitude across a range of diagnoses and for cases with depression with or without comorbidities. Rates of response and remission were comparable across most patient groups. Limitations Limitations include use of clinical diagnoses as recorded in health records, and the relatively short time between assessments. Conclusions In these settings, the PHQ-9 functions more as a general measure of symptoms or distress than as a disease-specific scale. This supports its use as a PROM for patients beyond those with major depression, including those with related diagnoses and those with comorbidities, and use of related PROM-PMs in clinical settings where diagnoses may not be precise and comorbidities may be common.

Objective Examine the association between the timing of sugar-sweetened beverages (SSBs) and 100% juice introduction with subsequent diet quality at age 3 years. Design Secondary analysis of a publicly available, national longitudinal dataset. Participants A total of 2,218 children from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Main Outcome Measure Dietary intakes were assessed using a 24-hour dietary recall completed by caregivers of children aged 3 years. Diet quality was assessed using the Healthy Eating Index Score-2015 (HEI-2015). Analysis Linear regression was used to assess the relationship between the timing of introduction to 100% juice and SSBs with HEI-2015. Adjustments were made for child- and maternal-related factors. Results Delayed introduction of SSBs during the first 2 years of life was associated with an increased HEI-2015 score. In adjusted analyses, for every 1-month delay in the introduction, there was a 0.09-point increase (95% confidence interval, 0.04–0.13) in the HEI-2015 score at 3 years. Conclusions and Implications Earlier introduction to SSBs may be associated with subsequent lower diet quality in WIC participants. This association may be driven by total fruit, whole grains, and added sugars HEI component scores. Further research is needed to support changes to existing WIC nutrition practices regarding SSBs and 100% juice.

Made available in DSpace on 2022-05-01T09:31:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-11-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objectives: To compare trunk muscle endurance among females and males with and without patellofemoral pain (PFP), and to investigate the correlations between trunk muscle endurance and performance of the single leg hop test (SLHT) and forward step-down test (FSDT). Design: Cross-sectional. Setting: Laboratory-based study. Participants: 110 females and 38 males with PFP, 61 females and 31males without PFP. Main outcome measures: Anterior and lateral trunk muscle endurance were assessed with the prone and bilateral side-bridge tests, respectively. Performance during the SLHT and FSDT was also assessed. Results: Lower anterior and lateral trunk muscle endurance were identified in females (p