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Abstract Background Antimicrobial resistance (AMR) is a significant global health concern, necessitating the monitoring of antimicrobial usage (AMU). However, there is a lack of consensus on the standardized collection and reporting of AMU data in the veterinary field. In Denmark, the Danish Cattle Database (DCDB) contains treatment information on animal level, which allows counting of number of treatments carried out, used daily doses (UDD). The Danish VetStat database (VetStat) contains information on veterinary medicinal prescriptions at farm level and uses fixed standard doses of each product to calculate number of daily treatments, animal daily doses (ADD). This study aimed to compare two different numerators, UDD and ADD, used to describe AMU on Danish cattle farms, and estimate their correlation. Results Routinely collected registry data from conventional dairy farms in Denmark for 2019 were used, including a total of 2,197 conventional dairy farms. The data from VetStat and the DCDB were aggregated and analysed, and treatment frequencies (TF) were calculated for both UDD and ADD, adjusting for farm size. Spearman correlation analysis and Bland–Altman plots were employed to assess the relationship and agreement between TF for ADD and UDD, respectively. The results showed a high correlation between TF for ADD and UDD for most prescription groups, i.e., groups used to categorise antibiotics based on target organs. An exception is found for the Udder prescription group, where a systematic underreporting of UDD compared to ADD was observed. This discrepancy may be due to combination treatments, and potential missing or grouped registrations in the DCDB. Conclusions Our UDD and ADD comparison yields valuable insights on farm-level AMU. We observe strong correlations between UDD and ADD, except for udder treatments, where some farms report only 1/3 UDD compared to ADD, indicating potential underreporting. Further investigations are needed to understand the factors contributing to these patterns and to ensure the accuracy and completeness of recorded information. Standardizing AMU data collection and reporting remains crucial to tackle the global challenge of AMR effectively.

Background: Musculoskeletal (MSK) conditions affect over 20.3 million people in the UK, presenting a substantial economic impact on health and social services. Physiotherapy can alleviate MSK conditions, especially if delivered in the acute or sub‐acute period. However, patients often present after significant waiting times. Objectives: Our analysis examined how waiting times and the number of treatments influenced physiotherapy outcomes for MSK conditions. Design: Retrospective analysis of the Data for Impact, Physio First dataset. Methods: Logistic regression models assessed the effects of symptom duration, treatment frequency, and other variables on pain, Patient‐Specific Functional Scores (PSFSs), and Goal Achievement (GA). Results: Analysis of 15,624 patient records showed that patients treated within two weeks of symptom onset were more likely to have favourable outcomes in pain (odds ratio [OR] = 2.01, 95% Confidence Interval [95% CI] = 1.65–2.45), PSFS (OR = 1.80, 95% CI = 1.55–2.08), and GA (OR = 1.74, 95% CI = 1.51–2.01) compared to those treated after longer durations. Receiving four or more treatment sessions significantly improved outcomes compared with only one session (pain: OR = 4.64, PSFS: OR = 5.72, GA: OR = 1.94, all p's < 0.001), with no additional benefits beyond four sessions. Younger age was associated with better outcomes (approximately OR = 0.99 per year age difference). Other findings included better outcomes in males and in those with fewer previous episodes of the condition. Conclusions: Shorter waiting times, a greater number of treatments, and younger patient age are associated with better physiotherapy outcomes for MSK conditions. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance (AMR) is a significant global health concern, necessitating the monitoring of antimicrobial usage (AMU). However, there is a lack of consensus on the standardized collection and reporting of AMU data in the veterinary field. In Denmark, the Danish Cattle Database (DCDB) contains treatment information on animal level, which allows counting of number of treatments carried out, used daily doses (UDD). The Danish VetStat database (VetStat) contains information on veterinary medicinal prescriptions at farm level and uses fixed standard doses of each product to calculate number of daily treatments, animal daily doses (ADD). This study aimed to compare two different numerators, UDD and ADD, used to describe AMU on Danish cattle farms, and estimate their correlation. Results: Routinely collected registry data from conventional dairy farms in Denmark for 2019 were used, including a total of 2,197 conventional dairy farms. The data from VetStat and the DCDB were aggregated and analysed, and treatment frequencies (TF) were calculated for both UDD and ADD, adjusting for farm size. Spearman correlation analysis and Bland–Altman plots were employed to assess the relationship and agreement between TF for ADD and UDD, respectively. The results showed a high correlation between TF for ADD and UDD for most prescription groups, i.e., groups used to categorise antibiotics based on target organs. An exception is found for the Udder prescription group, where a systematic underreporting of UDD compared to ADD was observed. This discrepancy may be due to combination treatments, and potential missing or grouped registrations in the DCDB. Conclusions: Our UDD and ADD comparison yields valuable insights on farm-level AMU. We observe strong correlations between UDD and ADD, except for udder treatments, where some farms report only 1/3 UDD compared to ADD, indicating potential underreporting. Further investigations are needed to understand the factors contributing to these patterns and to ensure the accuracy and completeness of recorded information. Standardizing AMU data collection and reporting remains crucial to tackle the global challenge of AMR effectively. [ABSTRACT FROM AUTHOR]

ABSTRACT: The use of veterinary drugs is of similar importance to that of human drugs in addressing health challenges. In this context, pharmaceuticals and their metabolites inevitably enter soil and water in unknown quantities. Therefore, this study collects and analyzes drug data from 2020 for 50 dairy farms located in Germany. The most frequently used substance group is antibiotics (40.13%), followed by antiphlogistics (18.86%), antiparasitics (13.09%), and hormones (9.29%). Treatment frequencies record the number of days per year on which an average animal on a farm was treated with a substance. The calculated values range from 0.94 to 21.69 d/yr and are distributed heterogeneously across farms. In this study, on average, a cow was treated on 6 d in 2020: 2.34 d with antibiotics, 1.07 d with antiphlogistics, 0.76 d with antiparasitics, and 0.41 d with hormones. In addition to individual farm management practices, other factors are related to treatment frequency. Farms with a veterinary care contract used more hormonal substances than farms without a care contract. In addition, higher milk yield coincides with more frequent treatments with antiphlogistic or hormonal substances. Other related factors include grazing, longevity, farm size, and use of a claw bath. Our study represents an important first step in describing the amounts and determinants of veterinary drugs used in livestock farming. Such insights on magnitudes and farm parameters are essential to estimate potential environmental effects and derive strategies to reduce veterinary drug use.

The use of veterinary drugs is of similar importance to that of human drugs in addressing health challenges. In this context, pharmaceuticals and their metabolites inevitably enter soil and water in unknown quantities. Therefore, this study collects and analyzes drug data from 2020 for 50 dairy farms located in Germany. The most frequently used substance group is antibiotics (40.13%), followed by antiphlogistics (18.86%), antiparasitics (13.09%), and hormones (9.29%). Treatment frequencies record the number of days per year on which an average animal on a farm was treated with a substance. The calculated values range from 0.94 to 21.69 d/yr and are distributed heterogeneously across farms. In this study, on average, a cow was treated on 6 d in 2020: 2.34 d with antibiotics, 1.07 d with antiphlogistics, 0.76 d with antiparasitics, and 0.41 d with hormones. In addition to individual farm management practices, other factors are related to treatment frequency. Farms with a veterinary care contract used more hormonal substances than farms without a care contract. In addition, higher milk yield coincides with more frequent treatments with antiphlogistic or hormonal substances. Other related factors include grazing, longevity, farm size, and use of a claw bath. Our study represents an important first step in describing the amounts and determinants of veterinary drugs used in livestock farming. Such insights on magnitudes and farm parameters are essential to estimate potential environmental effects and derive strategies to reduce veterinary drug use. [ABSTRACT FROM AUTHOR]

Antimicrobial usage in both human and veterinary medicine is considered one of the main drivers of antimicrobial resistance; its reduction poses a serious challenge. To analyse the associations between usage and resistance, data from monitoring systems and classification of all antimicrobial substances are crucial. In this analysis, we investigated longitudinal data collected between 2013 and 2020 within the Veterinary Consumption of Antibiotics project from pig farms in Germany, including all antimicrobial classes, but focusing on critically important antimicrobials: third- and fourth-generation cephalosporins, fluoroquinolones, macrolides, and polymyxins. Analysing the treatment frequency, we found that a reduction in antimicrobial use in all types of pig production has occurred over time, accompanied by a rising percentage of farms without any usage. The lists of the World Health Organisation, World Organisation for Animal Health, and European Medicine Agency classify different antimicrobial substances as critically important. The vast differences between the respective weighted treatment frequencies allocated to the antimicrobials of main interest reflect the huge impact of the three categorisation systems. We concluded that, with the aim of creating national treatment guidelines supporting veterinarians to make treatment decisions, the list of the European Medicine Agency is the most suitable. [ABSTRACT FROM AUTHOR]

The accumulation of protein-bound uremic toxins and medium-large molecule toxins in maintenance hemodialysis (MHD) patients is one of the causes of long-term dialysis-related complications. Hemoperfusion can remove these uremic toxins and reduce the complications of MHD patients. Upon a review of the Chinese and international literature, combined with practical experience of clinical diagnosis and treatment, the Shanghai Medical Association Society of Nephrology reached a consensus on the clinical applications of hemoperfusion in MHD patients. This consensus included four aspects: selection of appropriate patients, treatment frequency, treatment methods, and adverse reactions and precautions and provided guidelines for the rational and standardized treatment of hemoperfusion in MHD patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the predictors of annual treatment frequency in the second year of pro re nata (PRN) intravitreal ranibizumab (IVR) injections for diabetic macular edema (DME). Study design: A retrospective study. Methods: We reviewed 65 eyes of 60 patients with center-involved DME who received PRN IVR injections after 3 monthly loading doses. The central subfield thickness (CST) and qualitative findings were assessed on the spectral domain optical coherence tomography (SD-OCT) images. We then investigated whether the parameters at the baseline or at the 12-month visit were associated with treatment frequency in the second year. Results: The number of ranibizumab injections decreased from 6 (4–8) during the first year to 2 (0–3) during the second year (P <.001). The injection numbers during the first year (ρ = 0.259, P =.037) but not during the second year (ρ = 0.152, P =.226) were modestly related to the logarithm of the minimum angle of resolution (logMAR) improvement at 24 months. Multivariate analyses revealed that the CST (β = 0.336, P =.005) and hyperreflective walls in the foveal cystoid spaces (β = 0.273, P =.020) at baseline were associated with the number of IVR injections during the second year. The treatment frequency during the second year was also related to the CST (β = 0.266, P =.012), hyperreflective walls (β = 0.394, P =.002), and cumulative doses of ranibizumab injections (β = 0.294, P =.006) at the 12-month visit. Conclusions: The cumulative doses of ranibizumab injections, CST, and hyperreflective walls in the foveal cystoid spaces at the 12-month visit are designated predictors of the treatment frequency of ranibizumab injections during the second year in DME. [ABSTRACT FROM AUTHOR]

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that involves abnormal activation of immune response, affecting multiple organs, including joints, kidneys, lungs, skin, and the hematopoietic system, thereby impairing their normal function. Despite there being no cure for SLE, Mesenchymal Stem Cell (MSC) therapy offers hope for SLE patients because of its potent role in immunomodulation. Here, we report a case of a 65-year-old female battling with SLE for almost 30 years and on a treatment regimen consisting of several medications. Given the level of immunosuppression associated with conventional SLE treatments, the subject was initially enrolled as a participant in a study protocol designed to provide immune protection against COVID-19. The subject received multiple infusions of autologous Hope Biosciences adipose-derived MSCs (HB-adMSCs) which significantly improved her SLE symptoms and functionality that led the patient's physician to discontinue her Rituximab regime. Based on her response to HB-adMSC therapy, the subject was approved to receive a set of nine infusion treatments to specifically treat her SLE symptoms. Over the course of ∼ one year, the first six infusions were given on a monthly basis, while the remaining three were administered bimonthly - each with a dose of 200 million HB-adMSCs. Since the beginning of the treatment, the subject showed remarkable improvements in her SLE symptoms, as demonstrated by changes in her SF-36 questionnaire responses, Visual Analog Scale (VAS) scores, and C-Reactive Protein (CRP) measurements; however, worsening of the symptoms was noted later during treatment course (when the frequency of infusions changed to bimonthly). Although the shift in remission-relapse cycle is not fully understood, however, the data suggest that treatment frequency might be the key player. No serious adverse events occurred during the entire treatment period. Further research is needed to evaluate the results of this study.

Antimicrobial usage in both human and veterinary medicine is considered one of the main drivers of antimicrobial resistance; its reduction poses a serious challenge. To analyse the associations between usage and resistance, data from monitoring systems and classification of all antimicrobial substances are crucial. In this analysis, we investigated longitudinal data collected between 2013 and 2020 within the Veterinary Consumption of Antibiotics project from pig farms in Germany, including all antimicrobial classes, but focusing on critically important antimicrobials: third- and fourth-generation cephalosporins, fluoroquinolones, macrolides, and polymyxins. Analysing the treatment frequency, we found that a reduction in antimicrobial use in all types of pig production has occurred over time, accompanied by a rising percentage of farms without any usage. The lists of the World Health Organisation, World Organisation for Animal Health, and European Medicine Agency classify different antimicrobial substances as critically important. The vast differences between the respective weighted treatment frequencies allocated to the antimicrobials of main interest reflect the huge impact of the three categorisation systems. We concluded that, with the aim of creating national treatment guidelines supporting veterinarians to make treatment decisions, the list of the European Medicine Agency is the most suitable.

AIM: To investigate the effect of albuminuria on diabetic macular edema (DME) and the possible association between baseline urinary albumin excretion (UAE) and intravitreal conbercept (IVC) treatment frequency in DME patients. METHODS: In this hospital-based retrospective study, a total of 350 in-patients with type 2 diabetes mellitus were recruited and their clinical records were reviewed. Thereafter, 52 patients identified with severe non-proliferative diabetic retinopathy (NPDR) combined with albuminuria were divided into the microalbuminuria (UAE 30-300 mg/24h) and macroalbuminuria (UAE>300 mg/24h) groups, which were compared and analyzed by both independent sample t-test and Chi-square test. Correlations between the systemic variables and the central foveal thickness (CFT) were evaluated using Spearman’s correlation and linear regression analyses. Of the 52 patients with center-involved DME, 43 received an initial combined injection of conbercept (0.5 mg/0.05 mL) and triamcinolone acetonide (1 mg/0.05 mL), followed by an IVC injection, as needed. The relationship between baseline UAE and number of IVC injections during the first year of treatment was analyzed using Spearman’s partial correlation. RESULTS: Of 350 patients, a higher incidence of DME was observed in severe non-proliferative retinopathy (NPDR) patients than that observed in other groups. By dividing the 52 patients with severe NPDR into the micro- and macro-albuminuria subgroups, significant differences in CFT, systolic blood pressure, total cholesterol and serum creatinine levels, and UAE were revealed. Furthermore, a positive liner correlation between the UAE and CFT was found. Finally, the partial correlation coefficient adjusted for either the CFT or UAE indicated that both parameters directly correlated with the number of IVC injections administered during the 12mo of follow-up. CONCLUSION: Generally, macular edema occurred in patients with severe NPDR, for whom the UAE is an independent risk predictor of DME. The baseline UAE and CFT predicted the treatment frequency of IVC injections administered in the first year for eyes with DME.

Abstract Background This study aims to determine whether 3 sessions per week of acupuncture treatment is superior to 1 session per week of acupuncture treatment for symptomatic outcomes in knee osteoarthritis. Methods/design This is a two parallel-group, assessor-blinded, randomized controlled trial. Sixty patients with knee osteoarthritis (Kellgren–Lawrence grade II or III) will be recruited and randomly allocated to receive 24 or 8 sessions (group M or group L) of acupuncture treatment in a 1:1 ratio. Patients in group M will receive 3 sessions per week of acupuncture for 8 weeks. Patients in group L will receive acupuncture once per week for 8 weeks. The primary outcome is the response rate—the percentage of patients achieving a decrease ≥ 2 points on a numerical rating pain scale and a decrease ≥ 6 points in the Western Ontario and McMaster Universities Osteoarthritis Index function score at 8 weeks compared with baseline. Secondary outcomes include pain, function, overall effect, quality of life, and treatment credibility and expectancy. Discussion Three sessions per week of acupuncture treatment may be superior to 1 session per week of acupuncture treatment for symptomatic outcomes in knee osteoarthritis. Results of the study will be of great importance for the guidelines of clinical therapy. Trial registration Clinicaltrials.gov, NCT03359603. Registered on 1 December 2017.

In this work, antimicrobial usage data from 2,546 commercial broiler chicken flocks originating from 37 farms are presented. Antimicrobial usage data at the flock level were based on mandatory documentation of antibiotic treatments in livestock in Germany, collected retrospectively for the time period of 2013–2018. The data encompasses all antimicrobial treatments during the fattening period of each flock, starting with the placement of day-old chicks at the barn. The aim of this analysis was to investigate antibiotic usage patterns in broiler chicken flocks in Germany, temporal trends in treatment frequency, the proportions of different antimicrobial classes and the weights of the broiler chickens at the time of treatment. The median treatment frequency over all flocks was six, and veterinary medicinal products belonging to nine different antimicrobial classes were used. Overall, the most frequently used classes were aminoglycosides (25.6%) and lincosamides (25.6%), followed by polypeptides (21.4%) and beta-lactams (16.2%). Over the 6 years evaluated, a considerable increase in the relative usage of lincosamides and aminoglycosides was observed. Compared to the first year of data collection, the percentage of treatments with fluoroquinolones, macrolides and polypeptides decreased in consecutive years. The median age of the broiler chickens at the time of treatment was 5 days, which corresponded to a median body weight at the time of treatment of 111 g, with substantial differences among various antimicrobial classes. We showed that in Germany, the median weight of broiler chickens at the time of treatment was substantially lower than the standard weight of broilers of 1,000 g proposed by the European Surveillance of Veterinary Antimicrobial Consumption. The median weight at treatment is very much influenced by the frequency of age-specific diseases. As different antimicrobial classes are used to combat these diseases, variations in the weight at treatment may have a considerable impact on the estimated treatment indicators. Additionally, a decrease in the relative usage of the highest-priority critically important antimicrobials, such as fluoroquinolones, macrolides and polypeptides, was shown, which might be the consequence of increasing awareness of the antibiotic resistance situation as well as of antibiotic monitoring and benchmarking systems currently running in Germany.

Abstract Introduction To determine anatomical, functional, and intraocular pressure (IOP) responses to diabetic macular edema (DME) treatments pre- and post-0.2 µg/day fluocinolone acetonide (FAc) implant administration compared with baseline and the preceding 3 years. Methods This was a retrospective, chart review, cohort study in four U.S. centers. Patients received the 0.2 µg/day FAc implant for the treatment of DME in at least one eye before January 1, 2016. DME treatments administered up to 36 months pre-FAc implant and up to 24 months post-FAc implant were recorded, and treatment frequency was calculated. Visual acuity (VA) was assessed using a Snellen eye chart and converted to early treatment diabetic retinopathy study (ETDRS) letters, and central subfield thickness (CST) was measured using optical coherence tomography (OCT). Treatment frequency, mean VA, mean CST, percentage of patients with CST of ≤ 300 µm, mean IOP, IOP events, and IOP treatments pre- and post-FAc implant administration were measured. Positive and negative predictive values for the IOP response to prior steroid therapy were also determined. Results In total, 160 eyes of 130 patients were studied. VA was maintained at pre-FAc levels from baseline to month 24, despite a significant reduction in treatment frequency from one treatment every 2.9 months pre-FAc implant to one treatment every 14.3 months post-FAc implant. Patients with better baseline VA required fewer DME treatments post-FAc than did patients with worse baseline VA. The majority of patients did not require additional DME treatment during the post-FAc follow-up period. A significant reduction in CST and an increase in the percentage of patients with CST of ≤ 300 µm were seen up to month 21 post-FAc implant. Pre-FAc implant IOP was maintained during the post-FAc implant period; increased IOP with prior steroid therapy was found to be highly predictive of increased IOP post-FAc implant. Conclusion The results of this study confirm the positive safety and efficacy profile of the FAc implant and demonstrate for the first time the effectiveness of the U.S. label indication of FAc in reducing the incidence of post-treatment pressure elevation. The FAc implant significantly reduced treatment burden in the overall population without significantly increasing the risk of steroid-induced pressure elevation. Funding Alimera Sciences.

This 16-week randomised controlled trial (8-week treatment followed by 8-week follow-up) evaluated the symptomatic improvement in patients with knee osteoarthritis on 3 sessions per week of acupuncture (TSWA) compared to 1 session per week of acupuncture (OSWA). Sixty participants were randomised to either the TSWA or the OSWA group in a 1:1 ratio. The primary outcome was response rate, defined as the percentage of participants achieving ≥2 points decrease on the numerical rating scale (NRS) and ≥6 points decrease in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score at week 8 compared with baseline. Additional outcomes included response rates at weeks 4 and 16, NRS, WOMAC, Patient Global Assessment, 12-item Short Form Health Survey (SF-12), and treatment credibility and expectancy. No significant difference was seen in response rate between TSWA and OSWA groups at week 8 (64.7% vs 50.0%; difference, 14.7 percentage points [95% CI, -10.1 to 39.4 percentage points], P = 0.435). At weeks 4 and 16, the TSWA group had higher response rates than the OSWA group (week-4: difference, 44.7 percentage points [95% CI, 23.2-66.1 percentage points], P = 0.001; week-16: difference, 46.0 percentage points [95% CI, 24.4-67.6 percentage points], P < 0.001). Participants in the TSWA group experienced significantly greater improvements in NRS, WOMAC function, and Patient Global Assessment than those in the OSWA group. There were no significant between-group differences in WOMAC stiffness and SF-12. In summary, TSWA immediately improved knee pain and dysfunction compared with OSWA. In addition, the benefit of TSWA persists throughout follow-up. [ABSTRACT FROM AUTHOR]

Background: The evidence for different frequencies of acupuncture treatment in postprandial distress syndrome (PDS) is insufficient. This study determined whether 3 sessions per week of acupuncture treatment are superior to 1 session per week for symptomatic outcomes in PDS. Methods: This 16‐week randomized clinical pilot trial was conducted in an outpatient setting in China. Patients with PDS were randomly assigned to receive 3 sessions per week of acupuncture (group H) or 1 session per week of acupuncture (group L) for 4 weeks. The primary outcome was the complete elimination of core symptoms at week 4. Secondary outcomes included overall treatment efficacy, dyspepsia symptoms, quality of life, anxiety, and depression. Key Results: Sixty patients were randomized of whom 53 (88.3%) completed this trial. The complete elimination rate of core symptoms was 26.7% (95% CI 12.3%‐45.9%) in group H and 10.0% (95% CI 2.1%‐26.5%) in group L at week 4 (P =.095). There was a significant difference between H and group L at weeks 8, 12, and 16 (P =.038,.02, and.02). All secondary outcomes were better in group H at all time points. No serious adverse events occurred in either groups. Conclusions: This trial showed that acupuncture, at 3 sessions per week, tended to improve symptoms and the quality of life among patients with PDS as compared to once a week. Acupuncture treatment for 4 weeks was feasible and safe. A larger sample, multicenter, randomized controlled trial of acupuncture for PDS appears to be justified in the future. [ABSTRACT FROM AUTHOR]

It is well-established that antimicrobial use is a major factor for the development of antimicrobial resistance. To analyze the associations between antimicrobial resistance and usage of antimicrobial agents, data from monitoring and surveillance systems are crucial. Within the project VetCAb (Veterinary Consumption of Antibiotics), antibiotic usage data in German livestock is regularly collected and evaluated. Based on a cross-sectional study in 2011, the project was continued as the longitudinal study VetCAb-Sentinel with ongoing participant recruitment and data collection from 2013. The data collection is based on official German application and delivery forms (ADF), voluntarily provided by veterinarians and farmers. In this study the results of antibiotic usage data of dairy cows, dairy calves and beef cattle were described, using a semi-annual treatment frequency, and 95,944 ADF issued between 2011 and 2015 were analyzed. Results show that the median of the treatment frequency in dairy calf and beef cattle holdings slightly decreased from 0.4 to 0.3 and from 0.2 to 0 days, respectively, whereas the median in dairy cow holdings ranged between 1.9 and 2.3 during the observed period. Temporal changes and the effect of the factors “farm size” and “region” on the treatment frequency were investigated, using multiple linear mixed and logistic regression models. Generally, the factor “time” has a statistically significant impact on the treatment frequency in all production types. In addition, a temporal trend test over the first six half-years shows that an increasing linear trend can be stated in dairy cows and dairy calves (p = 0.017; p = 0.004, respectively). If the time-period is extended to all eight half-years under study, this turns into a quadratic effect (dairy cows: p = 0.006; dairy calves: p < 0.001). In dairy calves and beef cattle the factor “farm size” also has a statistically significant impact. The factor “region,” in contrast, shows no statistically significant impact at all. Compared to other livestock populations in Germany, the use of antimicrobials in dairy cows, dairy calves, and beef cattle appears to be low, but varies across several associated factors. Considering these effects, it is recommended that the size of dairy calf and beef cattle holdings is regularly considered in the evaluation of antimicrobial usage data over time.

Tackling the problem of rising antibiotic resistance requires valid and comparable data on the use of antimicrobial drugs in livestock. To date, no harmonized monitoring of antimicrobial usage in animals is available, and there is no system to assess usage data throughout Europe, thus hampering a direct comparison between different European countries. Most of the currently applied monitoring systems are based on sales data. Placement of sales data in relation to the population at risk requires overall assumptions about the weights of the animals treated and the doses applied. Only a few monitoring systems collect data in which the number of treated animals is reported exactly and does not need to be estimated. To evaluate the influence of different calculation methods on the standardizing procedure of antibiotic usage and benchmarking of farms, the treatment frequency for several farms (broiler, suckling piglets, and fattening pigs) was calculated in the following two different ways: first, based on the Used Daily Dose (TFUDD), and second, based on the Defined Daily Dose (TFDDD). To support this evaluation, consumption data from the Veterinary Consumption of Antibiotics Sentinel (VetCAb-S) project in Germany were used as example data. The results show discrepancies between both outcomes depending on the calculation method applied. In broiler holdings, the median values of TFDDD were 20.89% lower than the median values of TFUDD. In suckling piglets and fattening pig holdings, the median values of TFDDD were increased 77.14% and 16.33%, respectively, which may have serious implications for the benchmarking of farms. Furthermore, this finding reflects that the calculation procedure also has an impact on the comparison between populations. Therefore, UDD-based calculations should be preferred to run monitoring systems with a benchmark mission. If, in contrast, the DDD approach is chosen to compare antimicrobial usage between populations, additional considerations should be made to adjust for the addressed discrepancies.

Introduction: To determine anatomical, functional, and intraocular pressure (IOP) responses to diabetic macular edema (DME) treatments pre- and post-0.2 µg/day fluocinolone acetonide (FAc) implant administration compared with baseline and the preceding 3 years.Methods: This was a retrospective, chart review, cohort study in four U.S. centers. Patients received the 0.2 µg/day FAc implant for the treatment of DME in at least one eye before January 1, 2016. DME treatments administered up to 36 months pre-FAc implant and up to 24 months post-FAc implant were recorded, and treatment frequency was calculated. Visual acuity (VA) was assessed using a Snellen eye chart and converted to early treatment diabetic retinopathy study (ETDRS) letters, and central subfield thickness (CST) was measured using optical coherence tomography (OCT). Treatment frequency, mean VA, mean CST, percentage of patients with CST of ≤ 300 µm, mean IOP, IOP events, and IOP treatments pre- and post-FAc implant administration were measured. Positive and negative predictive values for the IOP response to prior steroid therapy were also determined.Results: In total, 160 eyes of 130 patients were studied. VA was maintained at pre-FAc levels from baseline to month 24, despite a significant reduction in treatment frequency from one treatment every 2.9 months pre-FAc implant to one treatment every 14.3 months post-FAc implant. Patients with better baseline VA required fewer DME treatments post-FAc than did patients with worse baseline VA. The majority of patients did not require additional DME treatment during the post-FAc follow-up period. A significant reduction in CST and an increase in the percentage of patients with CST of ≤ 300 µm were seen up to month 21 post-FAc implant. Pre-FAc implant IOP was maintained during the post-FAc implant period; increased IOP with prior steroid therapy was found to be highly predictive of increased IOP post-FAc implant.Conclusion: The results of this study confirm the positive safety and efficacy profile of the FAc implant and demonstrate for the first time the effectiveness of the U.S. label indication of FAc in reducing the incidence of post-treatment pressure elevation. The FAc implant significantly reduced treatment burden in the overall population without significantly increasing the risk of steroid-induced pressure elevation.Funding: Alimera Sciences. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effect of different frequency of acupoint thread-embedding on weight loss in subjects with overweight/obesity of spleen deficiency and dampness retention., Methods: A total of 126 subjects with overweight/obesity of spleen deficiency and dampness retention were randomized into a 2-week group(63 cases, 13 cases dropped out)and a 3-week group(63 cases, 11 cases dropped out, 1 case was eliminated). The two groups were treated with acupoint thread-embedding once every 2 weeks and once every 3 weeks respectively, Zhongwan(CV 12), Shuifen(CV 9), Qihai(CV 6), Guanyuan(CV 4) and bilateral Zhangmen(LR 13), Tianshu(ST 25), Liangmen(ST 21), Daheng(SP 15), Fujie(SP 14), Pishu(BL 20), Yinlingquan(SP 9)were selected. Four times were required in the two groups. Before and after treatment, follow-up after 2 months of treatment completion, the body mass index(BMI), body weight, waist circumference, hip circumference, waist-to-hip ratio, obesity degree, fat percentage(F%), skin fold thickness were observed in the two groups., Results: After treatment and in follow-up, the BMI, body weight, waist circumference, hip circumference, waist-to-hip ratio, obesity degree, F%, skin fold thickness in the two groups were decreased compared with those before treatment ( P <0.001, P <0.01), the changes of BMI, body weight, obesity degree, F%, skin fold thickness in the 2-week group were larger than those in the 3-week group( P <0.05, P <0.01, P <0.001)., Conclusions: The effect of acupoint thread-embedding once every 2 weeks on weight loss in subjects with overweight/obesity of spleen deficiency and dampness retention is superior to that once every 3 weeks.

In Canada, limited resources and increasing demand place pressure on the public healthcare system, something that is likely to increase. In this context, wait lists in outpatient physiotherapy departments (OPD) will get longer, system inefficiencies will arise, and frustrations and ethical concerns will be experienced by patients and staff. To better understand the perceptions of OPD staff regarding priority setting, treatment frequency, treatment duration, and wait list management strategies, we conducted an Interpretive Description study involving semi-structured interviews in three OPDs in Montreal. Participants discussed factors that influenced their decision making about who was prioritized to receive care, strategies that were used to respond to an imbalance between needs and resources in the OPDs and procedures to manage wait lists to help improve access to care. While clinical needs are central in approaches to prioritization, other non-clinical factors relating to the patient, the physiotherapist, and the institution also influence decisions. We examine these findings through the lens of complexity theory, providing insight into opportunities and obstacles for the implementation of management strategies in OPDs. These strategies will need to be carefully evaluated in order to create evidence-based guidelines for wait list management in other settings. [ABSTRACT FROM AUTHOR]

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Background: Targeted ultraviolet B (T-UVB) phototherapy in vitiligo is usually administered twice or thrice a week on non-consecutive days. It is difficult for many patients to adhere to this regimen, forcing them to discontinue treatment.Aim: The study aimed to compare the efficacy of twice-weekly and once-weekly targeted ultraviolet B phototherapy regimens in vitiligo.Methods: Sixty patients with non-segmental vitiligo on the face, neck or trunk were divided into two groups of 30 patients each. The patients in group A received targeted ultraviolet B twice weekly, while those in group B received targeted ultraviolet B once weekly. Repigmentation was monitored and graded as excellent (≥75% repigmentation), good (50-74% repigmentation) and poor (<50% repigmentation). The extent of repigmentation at each body site (primary outcome measure), the number of doses required for initiation of pigmentation, and the cumulative dose of targeted ultraviolet B administered was calculated and compared between both groups.Results: A total of 90 lesions (48 in the twice weeklygroup and 42 in the once weekly group) were treated on the face, neck and trunk. Excellent results were obtained in 62.5% (30/48) of lesions treated twice weekly, and 64.3% (27/42) in lesions treated once weekly. The mean number of doses required for initiation of pigmentation was 4.69 in the twice weekly group, and 4.35 in the once weekly group. The patients in the twice weekly group received a mean cumulative dose of 8.26 J/cm 2, while the once weekly group received 7.69 J/cm2. No statistically significant differences were observed between the two groups with respect to the outcome, with respect to the total repigmentation, the number of doses till onset of pigmentation, as well as the cumulative dose of targeted UVB.Conclusion: Once-weekly targeted ultraviolet B phototherapy appears to be as efficacious as the twice-weekly regimen in vitiligo. [ABSTRACT FROM AUTHOR]

Excess sludge biomass generation is one of the major problems in effluent treatment plants and it is an unavoidable byproduct generated due to the growth of microorganisms. Moreover, the treatment and disposal of excess sludge costs about 60% of the plant total operating cost. In this work it has been attempted to limit the excess biomass generation during effluent treatment itself, by applying mechanical stress on aerobic sludge biomass. The concept of maintenance metabolism has been implemented in this study to enhance the microbial maintenance requirements along with cell lysis for excess sludge reduction. The experiments have been carried out using identically sequenced continuous reactors with two different hydraulic retention times (HRT), two sludge treatment volumes and three treatment frequencies (TF). Mathematical expressions were deduced to estimate various parameters. Maximum excess sludge reduction of 47% was achieved with treatment frequency of 0.5 and sludge treatment volume of 40%. Further increase in TF resulted in the release of more suspended solids leading to deterioration of the treated effluent. Better COD removal efficiency was achieved with the HRT of 36 h. [ABSTRACT FROM AUTHOR]

Although switching from annual to biannual ivermectin treatment yields small additional health benefits, in the context of elimination goals its benefit is pronounced, increasing the feasibility of and shortening the time frames for reaching proposed operational thresholds for stopping treatment.Background. Recently, there has been a shift in onchocerciasis control policy, changing from prevention of morbidity toward elimination of infection. Switching from annual to biannual ivermectin distribution may accelerate progress toward the elimination goals. However, the settings where this strategy would be cost effective in Africa have not been described.Methods. An onchocerciasis transmission framework (EpiOncho) was coupled to a disease model in order to explore the impact on disability-adjusted life years averted, program cost, and program duration of biannual ivermectin treatment in different epidemiological and programmatic scenarios in African savannah.Results. While biannual treatment yields only small additional health gains, its benefit is pronounced in the context of the elimination goals, shortening the time frames for and increasing the feasibility of reaching the proposed operational thresholds for stopping treatment. In settings with high precontrol endemicity (and/or poor coverage and compliance), it may not be possible to reach such thresholds even within 50 years of annual ivermectin, requiring adoption of biannual treatment. Our projections highlight the crucial role played by coverage and compliance in achieving the elimination goals.Conclusions. Biannual ivermectin treatment improves the chances of reaching the 2020/2025 elimination goals, potentially generating programmatic cost savings in settings with high precontrol endemicity. However, its benefit and cost are highly sensitive to levels of systematic noncompliance and, in many settings, it will lead to an increase in costs. Furthermore, it may not always be feasible to implement biannual treatment, particularly in hard-to-reach populations. This highlights the continued need for a macrofilaricide. [ABSTRACT FROM AUTHOR]

High quantities of pesticides are applied on vineyards. For example, the average treatment frequency index (TFI) for French vineyards was 13.5 in 2016, whereas the average TFI for wheat (a major annual crop in France) was 4.9 in 2017. Reducing pesticide use is a key issue to improve viticulture sustainability. The aims of this study were (i) to analyse the evolution of pesticide use in vineyard farms voluntarily participating in a pesticide reduction programme, and (ii) to understand the options winegrowers used to reduce their pesticide use. We analysed data from the DEPHY farm network, including 244 cropping systems followed over 10 years and spread across 12 winegrowing regions. We used the TFI to assess the intensity of pesticide use. Mean pesticide use within the network decreased over the 10-year period and mostly concerned fungicide use. By analysing several indicators such as the number of treatments and the mean TFI per fungicide treatment, we were able to identify some of the management options mobilised for achieving this pesticide reduction. The use of biocontrol products and the reduction of sprayed doses were often associated with a low TFI. The analysis of yield evolution showed a significant mean reduction, although it was smaller than the TFI reduction. This raised the question of the impact of pesticide reduction on productivity. Further trade-off analyses are required in the future. • This study is based on 244 vineyards from a demonstration network. • Pesticide use declined by 32% over 10 years and varied by region. • Pesticide reduction was mainly based on substitution and efficiency. • Lower fungicide use was mainly achieved by adjusting treatment doses. • A decrease in vineyard productivity was also observed. [ABSTRACT FROM AUTHOR]

This study compared the effectiveness of a school-based treatment for expressive grammar in 5-year-olds with specific language impairment delivered in two different dose frequencies: eight sessions delivered daily over 8 consecutive school days or eight sessions delivered weekly over 8 consecutive weeks. Eighteen children received treatment daily and 13 children received treatment weekly. In both groups, treatment consisted of eight 1-hour sessions of small group activities in a classroom setting. Techniques included explicit instruction, focused stimulation, recasting, and imitation. Results were analysed at the group level and as a case series with each child as their own control in a single-subject design. The 8-weeks group showed significantly greater gain in test scores over the treatment period than in an equal time period prior to treatment, whereas the 8-days group did not (Cohen's d = 1.64 for 8-weeks group). Single-subject analyses indicated that 46% of children in the 8-week group and 17% of children in the 8-day group showed a significant treatment effect. It is concluded that expressive grammar treatment was most effective when dose frequency was weekly over 8 weeks rather than daily over 8 days for 5-year-old children with specific language impairment. [ABSTRACT FROM AUTHOR]

Summary: Introduction: When comparing satisfaction studies of medical and chiropractic back pain care, chiropractic care does better than medical care overall. Treatment length may be a contributing factor as may treatment frequency. There is no current literature that compares chiropractic styles and satisfaction, therefore inter-satisfaction differences between the various styles of chiropractic practice is not known. An understanding of these factors is a key part of increasing patient satisfaction and confidence. Methods: The study design was a cross sectional survey. A self-administered questionnaire was mailed out to a number of pre-recruited chiropractic clinics in varying locations in the UK. The questionnaires were completed anonymously by the patients in these clinics. Results: A total of 186/250 valid questionnaires were received, giving a response rate of 75%. Most respondents attended chiropractic clinics for the treatment of back pain. The results showed some clear and important opinions regarding treatment length and frequency. Overall satisfaction and quality of life scores were highest in clinics with treatments times over 20min. In addition clinics practising wellness care had lower satisfaction scores with higher frequency of care, than those with less frequent care sessions. Conclusion: The results would imply more emphasis is placed on patient choice for treatment frequency. This element, along with less frequency, may optimise satisfaction. The results of this study have shown that patient satisfaction is influenced by different chiropractic styles, but further studies are required to clarify a wider range of variables. [Copyright &y& Elsevier]

Treatment frequency is one of the key regulators determining the efficiency of and investment in controlling invasive plants. However, it is highly unlikely to find the optimal solution to the control of invasive plants through studying treatment frequency alone. In addition, the efficiency of controlling invasive plants is habitat-dependent. In this paper, clipping treatment was employed as the method to control invasive species Spartina alterniflora. We made an attempt to illustrate that clipping frequency can be reduced by considering the habitat properties and other relevant controlling regulators. Our full factorial test of combining clipping timing with considerations of clipping frequency and tidal regime showed that four-time clipping treatment started at florescence in high marsh or three-time clipping treatment started at florescence in low marsh was effective for controlling S. alterniflora. This implies that the control efficiency could be enhanced if treatment timing is optimized in relation to treatment frequency and habitat properties, which will lead to reduced management costs of controlling invasive species. [ABSTRACT FROM AUTHOR]

Background Context: Rehabilitation services using intensive exercise for the treatment of chronic spinal pain have traditionally been scheduled at a frequency of three times per week.Purpose: In an attempt to reduce the cost of rehabilitation services, this study was designed to determine whether treatment offered two times per week could produce similar outcomes when compared with an established three times per week spine therapy program.Study Design: Prospective cohort study.Patient Sample: Seventy-seven consecutive patients with chronic spinal pain were treated with aggressive spine rehabilitation either two or three times per week.Outcome Measures: Flexibility, trunk strength and lifting capacity were quantified before and after treatment. Pain visual analog scores and Oswestry disability scores were measured before and after treatment, as well as 12 months after treatment.Methods: A two times per week physical therapy program was developed to be identical in its treatment method to an established three times per week, group-oriented physical therapy program used for the treatment of chronic spinal pain. Patients with spinal pain who continued to work despite chronic pain complaints were allowed to choose between the two therapy programs based on availability of treatment slots and convenience. Treatment consisted of non-pain contingent quota-based exercises targeting identified physical impairments. Treatment sessions lasted for 2 hours and consisted of 30 minutes of stretching, 30 minutes of low-impact step aerobics class and 1 hour of exercise on strength and endurance equipment. Therapy occurred in groups consisting of a maximum of eight patients who were closely supervised by two therapists. Targeted treatment time was 6 weeks. At 12 months after treatment, subjects were surveyed by mailed questionnaires.Results: Seventy-seven patients with chronic spinal pain with a mean duration of symptoms of 32 months underwent treatment. Twenty-four subjects opted for the twice per week and 53 opted for the three times per week treatment. Seventy-one percent of subjects responded to the 12-month follow-up questionnaire. Physical and self-reported measures improved with both treatment frequencies. There were no differences in outcomes between treatment frequencies for measured flexibility, trunk strength, lifting capacity, pain intensity scores or Oswestry scores at the completion of treatment. At 12-month follow-up, no differences were noted between treatment frequencies for pain scores, Oswestry scores, patients' perceptions of adequacy of treatment, posttreatment exercise compliance or use of other treatments for their spinal problem. Total therapy visits were less in the two than three times per week groups (12 vs 15 visits).Conclusion: Similar outcomes were obtained from aggressive spine rehabilitation occurring two versus three times per week in patients presenting with moderate levels of chronic spinal pain. Reduction in physical therapy services and therefore cost did not adversely affect clinical outcomes in the treatment of this patient population. [ABSTRACT FROM AUTHOR]

The German Antibiotics Minimization Concept defines a farm-level benchmarking process based on half-yearly treatment frequencies that applies to six animal populations for fattening: calves (≤ 8 months), cattle (> 8 months), piglets (≤ 30 kg), pigs (> 30 kg), broiler chickens, and turkeys. The treatment frequency defined in the Minimization Concept takes into account the number of animals treated, the treatment duration, and the number of active antimicrobial ingredients, for each individual treatment, and is equivalent to a treatment frequency based on the used daily dose (UDD) and the actual weight of the animals at the time of treatment. With data from the German benchmarking system for the seven half-year periods from the second semester 2014 to the end of 2017, we compared UDD-based metrics of antimicrobial use (AMU) at the treatment and the farm level with metrics based on defined daily doses for animals (DDDvet) and standardized animal weights assumed at the time most likely for treatment. We show the extent to which DDDvet-based metrics would introduce errors into the measurement of AMU at the treatment level and consequently at the farm level. To that end, we introduce the average animal daily dose ratio, an aggregate measure that quantifies how choice of antimicrobial substances, deviations of used doses from recommended doses, of recommended doses from DDDvet values, and of treatment weights from standardized weights, affect a farm's AMU metrics. Our results show that in all animal populations considered benchmarking processes would become less successful at targeting high users. This would be especially true for broiler chickens and turkeys where the relative weight gain during fattening is the largest and overdosing appears to be common practice. Therefore, in AMU monitoring systems with the purpose of benchmarking farms UDD-based metrics are preferable to DDDvet-based metrics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Flor, Tenhagen and Käsbohrer.)

Objective: To observe the clinical efficacy of different treatment frequency of auricular bloodletting combined with auricular point sticking for acne vulgaris., Methods: A total of 90 patients with acne vulgaris were randomized into a treatment group 1 (30 cases, 2 cases dropped off), a treatment group 2 (30 cases, 4 cases dropped off) and a treatment group 3 (30 cases, 5 cases dropped off). Combination therapy of auricular bloodletting and auricular point sticking at Fei (CO 14 ), Shenmen (TF 4 ), Neifenmi (CO 18 ) and Shenshangxian (TG 2 p) were given once a week, twice a week and 3 times a week in the treatment group 1, the treatment group 2 and the treatment group 3 respectively, 4 weeks were as one course and totally 3 courses were required in the 3 groups. Before treatment and after 1, 2, 3 courses of treatment, the scores of global acne grading system (GAGS), skin lesion and quality of life-acne (QoL-Acne) were observed, the clinical efficacy was evaluated after 3 courses of treatment and the recurrence rate was evaluated in follow-up of 1 month after treatment in the 3 groups., Results: Compared before treatment, the scores of GAGS and skin lesion were decreased at each time point in the 3 groups ( P <0.05), the QoL-Acne scores were increased after 1 course of treatment in the treatment group 3 and after 2, 3 courses of treatment in the 3 groups ( P <0.05). There were no statistical differences in scores of GAGS, skin lesion and QoL-Acne among the 3 groups ( P >0.05). There were no statistical differences in effective rate and recurrence rate among the 3 groups ( P >0.05)., Conclusion: Different frequency of auricular bloodletting combined with auricular point sticking have similar efficacy in treating acne vulgaris, all can improve the skin lesion and quality of life in patients with acne vulgaris, and have a cumulative effect and good long-term curative effect.

The aim of this cross-sectional study was to characterise the usage of antibiotic and non-antibiotic drugs with a withdrawal period in German veal calves in more detail. In Germany, the documentation of the usage of veterinary medicinal products in food producing animals is mandatory. In the German monitoring system antibiotic use in calves under the age of eight months is recorded irrespective of the production type and only some basic measures (50 % and 75 % percentiles of the entire distributions of the treatment frequencies) are published regularly. Within this study 57 farms were included contributing data of 169 veal calf groups with a total of 91,196 individual calves. To assess the drug use the treatment frequency (TF) was calculated. Most treatments were applied in the first weeks after arrival at the farm against respiratory and gastrointestinal disorders, accounting for 65.2 % and 28.6 % of the TF, respectively. Antibiotics account for 91 % of the TF. The antibiotics used most frequently were tetracyclines (35.6 %), beta-lactams (21.9 %), macrolides (12.7 %), sulphonamides (6.0 %) and trimethoprimes (5.3 %). Tetracyclines and polypeptides were administered as group treatments in more than half of the recorded applications. The number of antibiotic group treatments decreased considerably from the first to the second half of the fattening period. Logistic regression analyses revealed no statistically significant association between TF and groups size or mortality. Nevertheless, the results indicate a negative associated between TF and mortality. Concerning non-antibiotics mainly iron compounds, arylpropionic acids, mucolytics and avermectines were applied, accounting for about 5 % of the total TF. The present study provides basic data on antibiotic and non-antibiotic use in German veal calf production. [ABSTRACT FROM AUTHOR]

In this work, antimicrobial usage data from 2,546 commercial broiler chicken flocks originating from 37 farms are presented. Antimicrobial usage data at the flock level were based on mandatory documentation of antibiotic treatments in livestock in Germany, collected retrospectively for the time period of 2013-2018. The data encompasses all antimicrobial treatments during the fattening period of each flock, starting with the placement of day-old chicks at the barn. The aim of this analysis was to investigate antibiotic usage patterns in broiler chicken flocks in Germany, temporal trends in treatment frequency, the proportions of different antimicrobial classes and the weights of the broiler chickens at the time of treatment. The median treatment frequency over all flocks was six, and veterinary medicinal products belonging to nine different antimicrobial classes were used. Overall, the most frequently used classes were aminoglycosides (25.6%) and lincosamides (25.6%), followed by polypeptides (21.4%) and beta-lactams (16.2%). Over the 6 years evaluated, a considerable increase in the relative usage of lincosamides and aminoglycosides was observed. Compared to the first year of data collection, the percentage of treatments with fluoroquinolones, macrolides and polypeptides decreased in consecutive years. The median age of the broiler chickens at the time of treatment was 5 days, which corresponded to a median body weight at the time of treatment of 111 g, with substantial differences among various antimicrobial classes. We showed that in Germany, the median weight of broiler chickens at the time of treatment was substantially lower than the standard weight of broilers of 1,000 g proposed by the European Surveillance of Veterinary Antimicrobial Consumption. The median weight at treatment is very much influenced by the frequency of age-specific diseases. As different antimicrobial classes are used to combat these diseases, variations in the weight at treatment may have a considerable impact on the estimated treatment indicators. Additionally, a decrease in the relative usage of the highest-priority critically important antimicrobials, such as fluoroquinolones, macrolides and polypeptides, was shown, which might be the consequence of increasing awareness of the antibiotic resistance situation as well as of antibiotic monitoring and benchmarking systems currently running in Germany., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Kasabova, Hartmann, Freise, Hommerich, Fischer, Wilms-Schulze-Kump, Rohn, Käsbohrer and Kreienbrock.)

Purpose: We evaluated the relationship between dosing frequency of intravitreal antivascular endothelial growth factor (anti-VEGF) agents and visual acuity (VA) outcomes over 2 years in eyes with macular edema (ME) secondary to central retinal vein occlusion (CRVO) in the US routine clinical practice setting., Methods: This retrospective analysis assessed electronic medical records of eyes with ME secondary to CRVO that received their first anti-VEGF injection January 1, 2012, to May 31, 2016, and were followed for 1 year or more in the US-based Vestrum Health Treatment and Outcomes database. Eyes were divided into 2 injection frequency subcohorts (≤6 or ≥7 injections/year)., Results: Overall, 851 (34.6%) of 2458 eyes with ME secondary to CRVO received 6 or fewer injections, and 1607 (65.4%) received 7 or more injections through 1 year. The mean number of injections in patients receiving 6 or fewer injections and 7 or more injections was 4.7 and 8.8, respectively, and baseline mean VA was 35 and 37 letters, respectively. At year 1, mean letter gain from baseline was less in eyes receiving 6 or fewer injections vs in those receiving 7 or more injections (7.0 vs 12.2, P < .001). Mean VA at year 2 was 50 letters in eyes receiving 6 or fewer injections (n = 50) and 55 letters in eyes receiving 7 or more injections (n = 157)., Conclusions: In routine clinical practice, more frequent dosing with anti-VEGF agents was associated with greater visual benefits in eyes with ME secondary to CRVO., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Yasha S. Modi is a consultant for Alimera, Allergan, Genentech, Novartis, and Zeiss. Lediana Goduni has nothing to disclose. Hadi Moini is a salaried employee of Regeneron Pharmaceuticals, Inc. Andrea Gibson was a salaried employee of Regeneron Pharmaceuticals, Inc, at the time that these analyses were undertaken. Nick Boucher is a salaried employee of Vestrum Health. Genevieve Lucas was a salaried employee of Vestrum Health at the time that these analyses were undertaken. Dilsher S. Dhoot is a consultant for Regeneron Pharmaceuticals, Inc, Genentech, Novartis, Bayer, Allergan, Alimera, Eyepoint Pharmaceuticals, Santen, Allegro, and Notal Vision., (© The Author(s) 2021.)

Purpose: This work evaluates dosing frequency with intravitreal antivascular endothelial growth factor (anti-VEGF) agents over 2 years and visual acuity (VA) outcomes in neovascular age-related macular degeneration (nAMD)., Methods: This retrospective analysis assesses electronic medical record data (Vestrum Health treatment and outcomes database) of newly diagnosed nAMD in patients who were initiated on intravitreal anti-VEGF treatment at US clinical sites. Eyes were divided into 2 injection frequency subcohorts (≤ 6 or > 6 injections/y); treatment frequency and change in mean VA (Early Treatment Diabetic Retinopathy Study letters) were evaluated., Results: Overall, 8127 of 213 824 eyes met inclusion criteria in year 1 and 4968 in year 2. During year 1, 77% of the eyes received more than 6 injections (n = 6287), the majority of which received injections at the same frequency during year 2. Mean VA gain from baseline at year 1 was lower in the ≤ 6 than > 6 injections/y subcohort (2.2 vs 6.5, P < .001). Decrease in mean VA from the end of year 1 to year 2 was significantly greater for eyes administered 6 or fewer injections in year 2 than those that received more frequent injections, irrespective of the frequency of injections in the first year., Conclusions: In routine clinical practice, most eyes with nAMD that completed at least 1 year of follow-up were treated with more than 6 injections of anti-VEGF agents during the first year of treatment, resulting in better VA gains than eyes treated less frequently during the same period., Competing Interests: The author(s) declare the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Andrew A. Moshfeghi has served as a consultant to Allegro, Allergan, Alimera, Graybug, Regeneron Pharmaceuticals, Inc, Genentech, Clearside, Bausch, EyePoint, and Novartis and as a speaker for Allergan. He has also received research support from Allegro, Novartis, Genentech, and Regeneron Pharmaceuticals, Inc and holds equity interest in Pr3vent, OptiSTENT, and Visunex. John D. Pitcher has served as a consultant to Allergan, Genentech, Novartis, Regeneron Pharmaceuticals, Inc, and REGENXBIO and as a speaker for Genentech, Novartis, and Regeneron Pharmaceuticals, Inc. He has also received research support from Alcon. Genevieve Lucas was a salaried employee of Vestrum Health at the time that these analyses were undertaken. Nick Boucher is a salaried employee of Vestrum Health. Namrata Saroj was a salaried employee of Regeneron Pharmaceuticals, Inc at the time that these analyses were undertaken and is currently a paid consultant for Regeneron Pharmaceuticals, Inc. Dr Saroj also serves as a consultant for Aerie, Allegro, Apellis, Adverum, and SamaCare and is an equity owner in Allegro, Pr3vent, and SamaCare., (© The Author(s) 2020.)

Purpose: We assessed the effect of treatment frequency with intravitreal antivascular endothelial growth factor (anti-VEGF) agents on visual acuity (VA) in diabetic macular edema (DME)., Methods: This retrospective analysis assessed electronic medical records of eyes newly diagnosed with DME and treated with an anti-VEGF agent at US clinics using the Vestrum Health (Naperville, Illinois) treatment and outcomes database. Eyes were divided into 2 injection frequency subcohorts (≤ 6 vs > 6 injections/y); treatment frequency and change in mean VA (Early Treatment Diabetic Retinopathy Study letters) were evaluated., Results: Among 155 240 eyes assessed, 3028 met inclusion criteria for analysis in year 1 and 1292 in year 2. During year 1 of treatment, 57% (n = 1725) received > 6 injections; most continued to receive the same injection frequency during year 2. Mean VA gain from baseline at year 1 was lower in the ≤ 6 than in the > 6 injections/year subcohort (3.7 vs 8.0 letters, respectively; P < .001). Mean VA change from the end of year 1 to year 2 for eyes receiving ≤ 6 injections in year 1 generally remained unchanged, irrespective of year 2 dosing frequency. In eyes that received > 6 injections in year 1, mean VA loss was significantly greater for eyes receiving less-frequent dosing in year 2 than in those maintained on > 6 injections., Conclusions: More than 50% of eyes with DME in routine clinical practice that completed at least 1 year of follow-up received > 6 injections of an anti-VEGF agent during the first year, resulting in better VA gains than eyes treated less frequently., Competing Interests: The author(s) declare the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: John D. Pitcher has served as a consultant for Allergan, Genentech, Novartis, Regeneron Pharmaceuticals, Inc, and REGENXBIO and as a speaker for Genentech, Novartis, and Regeneron Pharmaceuticals, Inc. He has also received research support from Alcon. Andrew A. Moshfeghi has served as a consultant for Allegro, Allergan, Alimera, Graybug, Regeneron Pharmaceuticals, Inc, Genentech, Clearside, Bausch, EyePoint, and Novartis and as a speaker for Allergan. He has also received research support from Allegro, Novartis, Genentech, and Regeneron Pharmaceuticals, Inc, and holds equity interest in Pr3vent, OptiSTENT, and Visunex. Genevieve Lucas was a salaried employee of Vestrum Health at the time these analyses were undertaken. Nick Boucher is a salaried employee of Vestrum Health. Hadi Moini is a salaried employee of Regeneron Pharmaceuticals, Inc. Namrata Saroj was a salaried employee of Regeneron Pharmaceuticals, Inc at the time these analyses were undertaken. Dr Saroj also serves as a consultant for Amgen, Allegro, Apellis, RegenXBio, iRenix, and SamaCare and is an equity owner in Allegro, Pr3vent, iRenix, Retina Technologies, and SamaCare., (© The Author(s) 2020.)