scholarly journals Auditing service delivery in glaucoma clinics using visual field records: a feasibility study

2019 ◽  
Vol 4 (1) ◽  
pp. e000352
Author(s):  
Stephen R Kelly ◽  
Susan R Bryan ◽  
John M Sparrow ◽  
David P Crabb
Keyword(s):  
Visual Field ◽  
Service Delivery ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Large Scale ◽  
Health Service Delivery ◽  
Mean Deviation ◽  
Normal Limits ◽  
Field Analyser

ObjectiveThis study aimed to demonstrate that large-scale visual field (VF) data can be extracted from electronic medical records (EMRs) and to assess the feasibility of calculating metrics from these data that could be used to audit aspects of service delivery of glaucoma care.Method and analysisHumphrey visual field analyser (HFA) data were extracted from Medisoft EMRs from five regionally different clinics in England in November 2015, resulting in 602 439 records from 73 994 people. Target patients were defined as people in glaucoma clinics with measurable and sustained VF loss in at least one eye (HFA mean deviation (MD) outside normal limits ≥2 VFs). Metrics for VF reliability, stage of VF loss at presentation, speed of MD loss, predicted loss of sight years (bilateral VF impairment) and frequency of VFs were calculated.ResultsOne-third of people (34.8%) in the EMRs had measurable and repeatable VF loss and were subject to analyses (n=25 760 patients). Median (IQR) age and presenting MD in these patients were 71 (61, 78) years and −6 (–10, –4) dB, respectively. In 19 264 patients with >4 years follow-up, median (IQR) MD loss was −0.2 (−0.8, 0.3) dB/year and median (IQR) intervals between VF examinations was 11 (8, 16) months. Metrics predicting loss of sight years and reliability of examinations varied between centres (p<0.001).ConclusionThis study illustrates the feasibility of assessing aspects of health service delivery in glaucoma clinics through analysis of VF databases. Proposed metrics could be useful for blindness prevention from glaucoma in secondary care centres.

Relationship between mean follow-up intraocular pressure, rates of visual field progression and current target intraocular pressure guidelines

2020 ◽  
pp. bjophthalmol-2020-317406
Author(s):  
Bruna Melchior ◽  
Carlos Gustavo De Moraes ◽  
Jayter S Paula ◽  
George A Cioffi ◽  
Christopher A Girkin ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Visual Field ◽  
Treatment Guidelines ◽  
Evaluation Study ◽  
Mean Deviation ◽  
Racial Groups ◽  
Current Guideline ◽  
Registration Number ◽  
The Mean

AimsTo investigate if eyes presenting intraocular pressure (IOP) within the limits of current guideline-driven target IOP indeed experience slow rates of glaucomatous visual field (VF) progression.MethodsA total of 8598 24-2 VF tests from 603 eyes from the African Descent and Glaucoma Evaluation Study with manifest glaucoma were included. The sample was split into three groups based on baseline VF mean deviation (MD): G1 (better than −5.0 dB), G2 (−5.0 to −10 dB) and G3 (worse than −10 dB). We investigated the relationship between existing target IOP guidelines and rates of MD progression in these groups.ResultsFor stable eyes, the medians and IQR of the mean follow-up IOP were G1=15.0 mmHg (IQR: 13.1 to 17.7), G2=13.2 mmHg (IQR: 11.6 to 14.3) and G3=11.9 mmHg (IQR: 10.1 to 13.8) (p<0.01). When considering the mean follow-up IOP within the limits proposed by current guidelines, the median MD slopes were: −0.20 dB/y (IQR: −0.43 to −0.02) for G1<21 mmHg, −0.19 dB/y (IQR: −0.51 to −0.01) for G2<18 mmHg and −0.15 dB/y (IQR: −0.47 to 0.05) for G3<15 mmHg (p=0.63). There were no significant differences between racial groups.ConclusionIn a sample of patients with manifest glaucoma, despite substantial variability between eyes, adherence to treatment guidelines helped slow the rates of global VF progression at various stages of disease.Trial registration numberclinicaltrials.gov Identifier: NCT00221923.

Comparing the usefulness of a new algorithm to measure visual field using the variational Bayes linear regression in glaucoma patients, in comparison to the Swedish interactive thresholding algorithm

2021 ◽  
pp. bjophthalmol-2020-318304
Author(s):  
Hiroshi Murata ◽  
Ryo Asaoka ◽  
Yuri Fujino ◽  
Masato Matsuura ◽  
Kazunori Hirasawa ◽  
...  
Keyword(s):  
Visual Field ◽  
Linear Regression ◽  
Open Angle Glaucoma ◽  
Variational Bayes ◽  
Mean Deviation ◽  
Test Duration ◽  
Field Analyser ◽  
Measurement Duration ◽  
Measurement Algorithm ◽  
Thresholding Algorithm

Background/aimsWe previously reported that the visual field (VF) prediction model using the variational Bayes linear regression (VBLR) is useful for accurately predicting VF progression in glaucoma (Invest Ophthalmol Vis Sci. 2014, 2018). We constructed a VF measurement algorithm using VBLR, and the purpose of this study was to investigate its usefulness.Method122 eyes of 73 patients with open-angle glaucoma were included in the current study. VF measurement was performed using the currently proposed VBLR programme with AP-7700 perimetry (KOWA). VF measurements were also conducted using the Swedish interactive thresholding algorithm (SITA) standard programme with Humphrey field analyser. VF measurements were performed using the 24–2 test grid. Visual sensitivities, test–retest reproducibility and measurement duration were compared between the two algorithms.ResultMean mean deviation (MD) values with SITA standard were −7.9 and −8.7 dB (first and second measurements), whereas those with VBLR-VF were −8.2 and −8.0 dB, respectively. There were no significant differences across these values. The correlation coefficient of MD values between the 2 algorithms was 0.97 or 0.98. Test–retest reproducibility did not differ between the two algorithms. Mean measurement duration with SITA standard was 6 min and 02 s or 6 min and 00 s (first or second measurement), whereas a significantly shorter duration was associated with VBLR-VF (5 min and 23 s or 5 min and 30 s).ConclusionVBLR-VF reduced test duration while maintaining the same accuracy as the SITA-standard.

Microcannula Utilization for Injectable Facial Fillers: Standard of Care?

2018 ◽  
Vol 35 (4) ◽  
pp. 189-197 ◽  
Author(s):  
Kian Karimi ◽  
Chester F. Griffiths ◽  
Alex Reivitis ◽  
Austin Davis-Hunter ◽  
Elizabeth Zhang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Standard Of Care ◽  
Dermal Filler ◽  
Popular Method ◽  
Patient Reported ◽  
Clinical Series ◽  
Filler Injections

The microcannula technique has become an increasingly popular method for injecting cosmetic fillers. Previous studies have illustrated that the microcannula technique allows filler to be injected with less pain, swelling, and essentially no bruising. This study is a retrospective clinical series examining 247 patients who have undergone dermal filler injections using the microcannula technique from 2011 to 2016 with a single injector, Kian Karimi. The purpose of this study is to assess the frequency of adverse events associated with injections such as bruising and swelling. All 666 recorded patient visits from 2011 to 2016 were analyzed using electronic medical records based on the criteria that the patients had cosmetic filler using the microcannula technique by the surgeon investigator. Of the 666 filler treatments using the microcannula technique, 3 treatments (0.5%) produced adverse events on the day of service, and 32 treatments (4.8%) produced adverse events at 2-week follow-up. In total, 5.4% of treatments produced adverse events. At the 2-week follow-up, 5.7% of treatments using the 25-gauge microcannula produced adverse events ( P = .830); 3.9% of treatments using the 27-gauge microcannula produced adverse events ( P = .612]). Only 3 patients were treated with the 30-gauge microcannula, and 1 patient reported adverse events on the day of service. None of the treatments using the 30-gauge microcannula produced adverse events at the 2-week follow-up ( P = .160). The data support that the microcannula technique is a safe and effective alternative to hypodermic needles for the injection of dermal filler to minimize common adverse events.

scholarly journals Midterm Safety of Carbon Dioxide Insufflation of the Knee During Arthroscopic Cartilage–Based Procedures

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110354
Author(s):  
Judson L. Penton ◽  
Travis R. Flick ◽  
Felix H. Savoie ◽  
Wendell M. Heard ◽  
William F. Sherman
Keyword(s):  
Carbon Dioxide ◽  
Clinical Outcomes ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Knee Arthroscopy ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Systemic Complications ◽  
Allograft Transplantation

Background: When compared with fluid arthroscopy, carbon dioxide (CO2) insufflation offers an increased scope of view and a more natural-appearing joint cavity, and it eliminates floating debris that may obscure the surgeon’s view. Despite the advantages of CO2 insufflation during knee arthroscopy and no reported cases of air emboli, the technique is not widely used because of concerns of hematogenous gas leakage and a lack of case series demonstrating safety. Purpose/Hypothesis: To investigate the safety profile of CO2 insufflation during arthroscopic osteochondral allograft transplantation of the knee and report the midterm clinical outcomes using this technique. We hypothesized that patients undergoing CO2 insufflation of the knee joint would have minimal systemic complications, allowing arthroscopic cartilage work in a dry field. Study Design: Case series; level of evidence, 4. Methods: A retrospective chart review was performed of electronic medical records for patients who underwent arthroscopic osteochondral allograft transplantation of the knee with the use of CO2 insufflation. Included were patients aged 18 to 65 years who underwent knee arthroscopy with CO2 insufflation from January 1, 2015, to January 1, 2021, and who had a minimum follow-up of 24 months. All procedures were performed by a single, fellowship-trained and board-certified sports medicine surgeon. The patients’ electronic medical records were reviewed in their entirety for relevant demographic and clinical outcomes. Results: We evaluated 27 patients (14 women and 13 men) with a mean age of 38 and a mean follow-up of 39.2 months. CO2 insufflation was used in 100% of cases during the placement of the osteochondral allograft. None of the patients sustained any systemic complications, including signs or symptoms of gas embolism or persistent subcutaneous emphysema. Conclusion: The results of this case series suggest CO2 insufflation during knee arthroscopy can be performed safely with minimal systemic complications and provide an alternative environment for treating osteochondral defects requiring a dry field in the knee.

Predicting chronic pain after major traumatic injury

2019 ◽  
Vol 19 (3) ◽  
pp. 453-464 ◽  
Author(s):  
Elisabeth B. Powelson ◽  
Brianna Mills ◽  
William Henderson-Drager ◽  
Millie Boyd ◽  
Monica S. Vavilala ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Traumatic Injury ◽  
Opioid Use ◽  
Post Injury ◽  
Regional Analgesia ◽  
Final Model ◽  
Opioid Medications

Abstract Background and aims Chronic pain after traumatic injury and surgery is highly prevalent, and associated with substantial psychosocial co-morbidities and prolonged opioid use. It is currently unclear whether predicting chronic post-injury pain is possible. If so, it is unclear if predicting chronic post-injury pain requires a comprehensive set of variables or can be achieved only with data available from the electronic medical records. In this prospective study, we examined models to predict pain at the site of injury 3–6 months after hospital discharge among adult patients after major traumatic injury requiring surgery. Two models were developed: one with a comprehensive set of predictors and one based only on variables available in the electronic medical records. Methods We examined pre-injury and post-injury clinical variables, and clinical management of pain. Patients were interviewed to assess chronic pain, defined as the presence of pain at the site of injury. Prediction models were developed using forward stepwise regression, using follow-up surveys at 3–6 months. Potential predictors identified a priori were: age; sex; presence of pre-existing chronic pain; intensity of post-operative pain at 6 h; in-hospital opioid consumption; injury severity score (ISS); location of trauma, defined as body region; use of regional analgesia intra- and/or post-operatively; pre-trauma PROMIS Depression, Physical Function, and Anxiety scores; in-hospital Widespread Pain Index and Symptom Severity Score; and number of post-operative non-opioid medications. After the final model was developed, a reduced model, based only on variables available in the electronic medical record was run to understand the “value add” of variables taken from study-specific instruments. Results Of 173 patients who completed the baseline interview, 112 completed the follow-up within 3–6 months. The prevalence of chronic pain was 66%. Opioid use increased from 16% pre-injury to 28% at 3–6 months. The final model included six variables, from an initial set of 24 potential predictors. The apparent area under the ROC curve (AUROC) of 0.78 for predicting pain 3–6 months was optimism-corrected to 0.73. The reduced final model, using only data available from the electronic health records, included post-surgical pain score at 6 h, presence of a head injury, use of regional analgesia, and the number of post-operative non-opioid medications used for pain relief. This reduced model had an apparent AUROC of 0.76, optimism-corrected to 0.72. Conclusions Pain 3–6 months after trauma and surgery is highly prevalent and associated with an increase in opioid use. Chronic pain at the site of injury at 3–6 months after trauma and surgery may be predicted during hospitalization by using routinely collected clinical data. Implications If our model is validated in other populations, it would provide a tool that can be easily implemented by any provider with access to medical records. Patients at risk of developing chronic pain could be selected for studies on preventive strategies, thereby concentrating the interventions to patients who are most likely to transition to chronic pain.

scholarly journals Classification and Statistical Trend Analysis in Detecting Glaucomatous Visual Field Progression

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Cristiana Valente ◽  
Elisa D’Alessandro ◽  
Michele Iester
Keyword(s):  
Statistical Analysis ◽  
Standard Deviation ◽  
Visual Field ◽  
Trend Analysis ◽  
Open Angle Glaucoma ◽  
Mean Deviation ◽  
Threshold Strategy ◽  
Visual Field Progression ◽  
The Mean

Aim. To evaluate the agreement between different methods in detection of glaucomatous visual field progression using two classification-based methods and four statistical approaches based on trend analysis. Methods. This is a retrospective and longitudinal study. Twenty Caucasian patients (mean age 73.8 ± 13.43 years) with open-angle glaucoma were recruited in the study. Each visual field was assessed by Humphrey Field Analyzer, program SITA standard 30-2 or 24-2 (Carl Zeiss Meditec, Inc., Dublin, CA). Full threshold strategy was also accepted for baseline tests. Progression was analyzed by using Hodapp–Parrish–Anderson classification and the Advanced Glaucoma Intervention Study visual field defect score. For the statistical analysis, linear regression (r2) was calculated for mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI), and when it was significant, each series of visual field was considered progressive. We also used Progressor to look for a significant progression of each visual field series. The agreement between methods, based on statistical analysis and classification, was evaluated using a weighted kappa statistic. Results. Thirty-eight visual field series were analyzed. The mean follow-up time was 6.2 ± 1.53 years (mean ± standard deviation). At baseline, the mean MD was −7.34 ± 7.18 dB; at the end of the follow-up, the mean MD was −9.25 ± 8.65 dB; this difference was statistically significant (p<0.001). The agreement to detect progression was fair between all methods based on statistical analysis and classification except for PSD r2. A substantial agreement (κ = 0.698 ± 0.126) was found between MD r2 and VFI r2. With the use of all the statistical analysis, there was a better time-saving. Conclusions. The best agreement to detect progression was found between MD r2 and VFI r2. VFI r2 showed the best agreement with all the other methods. GPA2 can help ophthalmologists to detect glaucoma progression and to help in treatment decisions. PSD r2 was the worse method to detect progression.

Optical Coherent Tomography Predicts Long-Term Visual Outcome of Pituitary Adenoma Surgery: New Perspectives From a 5-Year Follow-up Study

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 106-112 ◽  
Author(s):  
Young Soo Chung ◽  
Minkyun Na ◽  
Jihwan Yoo ◽  
Woohyun Kim ◽  
In-Ho Jung ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Visual Field ◽  
Assessment Tool ◽  
Visual Fields ◽  
Visual Field Defects ◽  
Mean Deviation ◽  
Rnfl Thickness ◽  
Long Term Follow Up

Abstract BACKGROUND Compressive optic neuropathy is the most common indication for transsphenoidal surgery for pituitary adenomas. Optical coherence tomography (OCT) is a useful visual assessment tool for predicting postoperative visual field recovery. OBJECTIVE To analyze visual parameters and their association based on long-term follow-up. METHODS Only pituitary adenoma patients with abnormal visual field defects were selected. A total of 188 eyes from 113 patients assessed by visual field index (VFI) and 262 eyes from 155 patients assessed by mean deviation (MD) were enrolled in this study. Postoperative VFI, MD, and retinal nerve fiber layer (RNFL) thickness were evaluated and followed up. After classifying the patients into normal (&gt;5%) and thin (&lt;5%) RNFL groups, we investigated whether preoperative RNFL could predict visual field outcomes. We also observed how RNFL changes after surgery on a long-term basis. RESULTS Both preoperative VFI and MD had a linear proportional relationship with preoperative RNFL thickness. Sustained improvement of the visual field was observed after surgery in both groups, and the degree of improvement over time in each group was similar. RNFL thickness continued to decrease until 36 mo after surgery (80.2 ± 13.3 μm to 66.6 ± 11.9 μm) while visual field continued to improve (VFI, 61.8 ± 24.5 to 84.3 ± 15.4; MD, −12.9 ± 7.3 dB to −6.3 ± 5.9 dB). CONCLUSION Patients with thin preoperative RNFL may experience visual recovery similar to those with normal preoperative RNFL; however, the probability of normalized visual fields was not comparable. RNFL thickness showed a strong correlation with preoperative visual field defect. Long-term follow-up observation revealed a discrepancy between anatomic and functional recovery.

scholarly journals Information Extraction from Electronic Medical Records Using Multitask Recurrent Neural Network with Contextual Word Embedding

2019 ◽  
Vol 9 (18) ◽  
pp. 3658 ◽  
Author(s):  
Jianliang Yang ◽  
Yuenan Liu ◽  
Minghui Qian ◽  
Chenghua Guan ◽  
Xiangfei Yuan
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Large Scale ◽  
Short Term Memory ◽  
Conditional Random Field ◽  
Named Entity Recognition ◽  
Recognition Task ◽  
Entity Recognition ◽  
Language Models ◽  
Named Entity

Clinical named entity recognition is an essential task for humans to analyze large-scale electronic medical records efficiently. Traditional rule-based solutions need considerable human effort to build rules and dictionaries; machine learning-based solutions need laborious feature engineering. For the moment, deep learning solutions like Long Short-term Memory with Conditional Random Field (LSTM–CRF) achieved considerable performance in many datasets. In this paper, we developed a multitask attention-based bidirectional LSTM–CRF (Att-biLSTM–CRF) model with pretrained Embeddings from Language Models (ELMo) in order to achieve better performance. In the multitask system, an additional task named entity discovery was designed to enhance the model’s perception of unknown entities. Experiments were conducted on the 2010 Informatics for Integrating Biology & the Bedside/Veterans Affairs (I2B2/VA) dataset. Experimental results show that our model outperforms the state-of-the-art solution both on the single model and ensemble model. Our work proposes an approach to improve the recall in the clinical named entity recognition task based on the multitask mechanism.

scholarly journals Efficacy of 27-Gauge Vitrectomy with Internal Limiting Membrane Peeling for Epiretinal Membrane in Glaucoma Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Masaaki Yoshida ◽  
Hiroshi Kunikata ◽  
Shiho Kunimatsu-Sanuki ◽  
Toru Nakazawa
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Epiretinal Membrane ◽  
Internal Limiting Membrane ◽  
Threshold Sensitivity ◽  
Mean Deviation ◽  
Normal Test ◽  
Microincision Vitrectomy Surgery ◽  
Test Points

Purpose. To evaluate the efficacy of epiretinal membrane (ERM) surgery for patients with ERM and glaucoma. Methods. We reviewed the medical records of 20 consecutive ERM patients with glaucoma, who underwent 27-gauge microincision vitrectomy surgery (27GMIVS) with internal limiting membrane (ILM) peeling. The preoperative and 6-month postoperative visual field was tested with the Humphrey Field Analyzer (HFA) 24-2 program. Changes in threshold sensitivity in the HFA test points were analyzed point-by-point, with points classified into groups based on sensitivity as abnormal (less than 5th percentile in pattern deviation) or normal (all other points) and based on location as central (12 central points) or peripheral (all other points) with a linear mixed-effects model. Results. Visual acuity and mean deviation improved postoperatively (P<0.001 for both) in all patients. Threshold sensitivity in central or peripheral points that were abnormal preoperatively improved postoperatively (P=0.006 or P<0.001, respectively). Threshold sensitivity also improved in the central normal test points (P=0.03), but not in the peripheral normal points (P=0.12). Conclusion. Visual acuity improved, and there was no visual field progression, after ERM surgery in glaucomatous eyes during a 6-month postoperative follow-up, suggesting that ERM and ILM removal using 27GMIVS may be effective even in glaucomatous eyes.

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