The validity of telemedicine-based screening for retinopathy of prematurity in the Premature Eye Rescue Program in Hungary

2019 ◽  
pp. 1357633X1988011 ◽  
Author(s):  
Erika Maka ◽  
Gábor Kovács ◽  
László Imre ◽  
Clare Gilbert ◽  
Miklós Szabó ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Nurse Practitioners ◽  
Retinopathy Of Prematurity ◽  
Digital Imaging ◽  
Lower Sensitivity ◽  
Second Phase ◽  
Neonatal Transport ◽  
Group A ◽  
Group B ◽  
Rop Screening

Purpose To assess the validity of wide-field digital imaging (WFDI) and telemedicine-based screening compared with examination by binocular indirect ophthalmoscopy (BIO) and to present some of the results from the first five years of telemedicine-based screening in the Premature Eye Rescue Program in Hungary. Methods We performed a retrospective analysis in two periods that aimed to assess (a) the validity of retinal digital imaging and (b) routine bedside screening. The validity was assessed in two neonatal intensive care units (NICUs), one in the First Department of Paediatrics and the other in the Second Department of Obstetrics and Gynaecology, Semmelweis University. The telemedicine-based WFDI (WFDI-TM) screening program was introduced in two phases. In the first phase (from 30 November 2009 to 8 August 2010), BIO and WFDI were performed by the same paediatric ophthalmologist (Group A). In the second phase (from 9 August 2010 to 29 March 2011), BIO was performed by the paediatric ophthalmologist, while retinal images were captured by a trained neonatal transport nurse practitioner (Group B). BIO screening was the reference method as a gold standard in both phases. Results During the validity assessment period 634 examinations were performed in 153 preterm infants. Overall, 76 babies were screened in Group A and 80 were screened in Group B. We found lower sensitivity and specificity in cases of any ROP (sensitivity 86%, specificity 99%) compared with those of treatment-requiring retinopathy of prematurity (TR-ROP) (both sensitivity and specificity 100%). In the Premature Eye Rescue Program between 1April 2011 and 31 March 2016, we used WFDI in 3035 infants (4589 procedures). Over this five-year period, 100 (9.6%) infants were treated by laser, and no child who received care in any of the Semmelweis University NICUs became blind from ROP. Conclusions (a) WFDI-TM ROP screening is a useful and efficient approach, although it cannot completely replace BIO; (b) no ROP-related blindness developed among the screened preterm babies; and (c) WFDI-TM ROP screening can be implemented in the logistics of a neonatal emergency and ambulance team infrastructure with neonatal transport nurse practitioners as ‘photographers’.

scholarly journals Evaluation of Plasma Amino Acid Levels in Preterm Infants and Their Potential Correlation with Retinopathy of Prematurity

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yasin Ozcan ◽  
Gumus Huseyin ◽  
Kenan Sonmez
Keyword(s):  
Amino Acids ◽  
Aspartic Acid ◽  
Preterm Infants ◽  
Retinopathy Of Prematurity ◽  
Glutamine Supplementation ◽  
Controlled Study ◽  
Serum Concentrations ◽  
Group A ◽  
The Mean ◽  
Group B

Aim. The aim of this study is to ascertain whether the level of circulating amino acids (aa) is associated with retinopathy of prematurity (ROP). Methods. This is a randomized controlled study of 55 infants born at gestational age (GA) ≤32 weeks or birth weight (BW) ≤1500 grams. Serum samples were obtained from two groups: Group A comprised of 26 preterm infants with ROP and Group B comprised of 29 preterm infants without ROP. Plasma aa levels were analyzed using liquid chromatography with tandem mass spectrometry (LC-MS/MS). Correlation test and multivariate regression analysis were used to evaluate the relationship between plasma aa levels and variables. Results. The mean serum arginine and glutamine levels were significantly higher, but the mean lysine and aspartic acid levels were significantly lower in Group A, compared to Group B ( p = 0.04 , p = 0.002 , p = 0.029 , and p = 0.002 , respectively). In multivariate analysis, the mean arginine and lysine levels were significantly associated with the stage of the disease ( p = 0.03 and p = 0.01 , respectively). No significant differences were determined between the groups in terms of alanine, asparagine, valine, leucine, phenylalanine, tyrosine, serine, proline, citrulline, cysteine, ornithine, tryptophan, methionine, threonine, taurine, and isoleucine amino acids ( p > 0.05 , respectively). Conclusions. These results indicate a significant association between high arginine and glutamine, with low lysine and aspartic acid serum concentrations with ROP. Due to higher serum concentrations in ROP, extra arginine-glutamine supplementation in hyperoxic conditions may be unfavorable through pathways involving reactive oxygen, particularly in patients with ROP.

scholarly journals Evolving Trends in Teaching: Narration and Imagination vs Video Footages

2014 ◽  
Vol 9 (1) ◽  
pp. 81-91
Author(s):  
Urooj Fatima
Keyword(s):  
Mode Of Delivery ◽  
Choice Test ◽  
Academic Learning ◽  
Second Phase ◽  
Two Phase ◽  
Mean Values ◽  
Video Footage ◽  
Group A ◽  
Group B ◽  
The Impact

The research discussed in this paper aims to study the impact of video footages on the academic performance of students. Video footages are usually inserted into video lectures — in addition to the verbal narration of any examples by the teachers — to explain and simplify concepts. Similarly, in conventional classrooms, teachers verbally narrate examples to clarify concepts — but, in this case, students have to rely on their imagination and previous exposure to similar situations to develop an understanding of the concepts. A two-phase experiment was designed to compare these two teaching methods. A sample of 70 participants was drawn from non-psychology students in the Virtual University of Pakistan; and two groups, Group A and Group B, each with 35 participants, were formed through random assignment of the students. In the first phase of the experiment, members of Group A were taught through a 24-minute video lecture on psychology, which had four chunks of video footage in it. After the lecture, the students' academic learning was measured through a multiple-choice test with 27 items, which was developed by incorporating an equal number of questions on three levels of Bloom's taxonomy (viz. understanding, comprehension and application). The item levels were decided after agreement by three examiners who had at least three years of experience of developing such questions. In the second phase, a lecture with similar content was taught to Group B. The only difference was in the mode of delivery: in this case, the content was conveyed verbally and no video footages were used. The same test of students' learning was employed to get the scores of Group B. In addition, a qualitative study, involving data gathered through participants' feedback on the performance of the learning facilitators and weaknesses in both teaching modes was collected in order to explore the participants' perceptions and experiences of the phenomenon being studied. The results indicated that the two groups were significantly different in terms of academic achievement. The mean values suggested that those who were taught through video footages showed a higher level of academic learning than those who received a traditional verbal narration lecture. In addition, the students reported that the video footages and examples facilitated their learning, and helped them to remain focused and motivated in class. The findings have broad implications for teachers, content developers, academic policy-makers and producers involved in the production of academic content.

scholarly journals Assessment of Appropriateness of Antimicrobial Therapy in Resource-Constrained Settings: Development and Piloting of a Novel Tool—AmRAT

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 200
Author(s):  
Ashish Kumar Kakkar ◽  
Nusrat Shafiq ◽  
Neeru Sahni ◽  
Ritin Mohindra ◽  
Navjot Kaur ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Educational Background ◽  
Audit And Feedback ◽  
Consensus Algorithm ◽  
World Health ◽  
Resource Constrained ◽  
Antimicrobial Prescribing ◽  
Percent Agreement ◽  
Group A ◽  
Group B

Inappropriate antimicrobial prescribing is considered to be the leading cause of high burden of antimicrobial resistance (AMR) in resource-constrained lower- and middle-income countries. Under its global action plan, the World Health Organization has envisaged tackling the AMR threat through promotion of rational antibiotic use among prescribers. Given the lack of consensus definitions and other associated challenges, we sought to devise and validate an Antimicrobial Rationality Assessment Tool—AmRAT—for standardizing the assessment of appropriateness of antimicrobial prescribing. A consensus algorithm was developed by a multidisciplinary team consisting of intensivists, internal medicine practitioners, clinical pharmacologists, and infectious disease experts. The tool was piloted by 10 raters belonging to three groups of antimicrobial stewardship (AMS) personnel: Master of Pharmacology (M.Sc.) (n = 3, group A), Doctor of Medicine (MD) residents (n = 3, group B), and DM residents in clinical pharmacology (n = 4, group C) using retrospective patient data from 30 audit and feedback forms collected as part of an existing AMS program. Percentage agreement and the kappa (κ) coefficients were used to measure inter-rater agreements amongst themselves and with expert opinion. Sensitivity and specificity estimates were analyzed comparing their assessments against the gold standard. For the overall assessment of rationality, the mean percent agreement with experts was 76.7% for group A, 68.9% for group B, and 77.5% for group C. The kappa values indicated moderate agreement for all raters in group A (κ 0.47–0.57), and fair to moderate in group B (κ 0.22–0.46) as well as group C (κ 0.37–0.60). Sensitivity and specificity for the same were 80% and 68.6%, respectively. Though evaluated by raters with diverse educational background and variable AMS experience in this pilot study, our tool demonstrated high percent agreement and good sensitivity and specificity, assuring confidence in its utility for assessing appropriateness of antimicrobial prescriptions in resource-constrained healthcare environments.

scholarly journals The immune response does not prevent homologous Porcine epidemic diarrhoea virus reinfection five months after the initial challenge.

2021 ◽  
Author(s):  
Ivan Díaz ◽  
Joan Pujols ◽  
Esmeralda Cano ◽  
Marti Cortey ◽  
Núria Navarro ◽  
...  
Keyword(s):  
Immune Response ◽  
Clinical Signs ◽  
Second Phase ◽  
Post Inoculation ◽  
Viral Shedding ◽  
Porcine Epidemic Diarrhoea Virus ◽  
Diarrhoea Virus ◽  
Group A ◽  
Ifn Γ ◽  
Group B

The aim of the present study was to evaluate the duration of protective immunity against Porcine epidemic diarrheoa virus (PEDV). To that, a two phases study was performed. In the first phase, 75 four-week-old pigs (group A) were orally inoculated (0 days post-inoculation; dpi) with a European PEDV G1b strain and 14 were kept as controls (group B). The second phase started five month later (154 dpi), when animals in group A were homologous challenged and animals in group B were challenged for first time. Clinical signs, viral shedding and immune responses were evaluated after each inoculation, including the determination of antibodies (ELISA and viral neutralisation test, IgA and IgG ELISPOTs using peripheral blood mononuclear cells and lymph node cells) and the frequency of interferon-gamma (IFN-γ) secreting cells. During the first phase, loose stools/liquid faeces were observed in all group A animals. Faecal shedding of PEDV occurred mostly during the first 14 days but, in some animals, persisted until 42 dpi. All inoculated animals seroconverted for specific-PEDV IgG and IgA, and for neutralizing antibodies (NA). At 154 dpi, 77% of pigs were still positive for NA. After that, the homologous challenge resulted in a booster for IgG, IgA, NA, as well as specific-PEDV IgG, IgA and IFN-γ secreting cells. In spite of that, PEDV was detected in faeces of all pigs from group A, indicating that the immune response did not prevent reinfection although the duration of the viral shedding and the total load of virus shed was significantly lower for previously challenged pigs (p<0.05). Taken together, the results indicated that, potentially, maintenance of PEDV infection within an endemic farm may occur by transmission to and from previously infected animals and also indicates that sterilising immunity is shorter than the productive life of pigs.

scholarly journals The Effects of Valerian on Sleep Quality, Depression, and State Anxiety in Hemodialysis Patients: A Randomized, Double-blind, Crossover Clinical Trial

2021 ◽  
Vol 36 (2) ◽  
pp. e255-e255
Author(s):  
Mohammad Reza Tammadon ◽  
Monir Nobahar ◽  
Zaynab Hydarinia-Naieni ◽  
Abbasali Ebrahimian ◽  
Raheb Ghorbani ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Sleep Quality ◽  
State Anxiety ◽  
Pittsburgh Sleep Quality Index ◽  
Anxiety And Depression ◽  
Second Phase ◽  
Double Blind ◽  
Group A ◽  
The Mean ◽  
Group B

Objectives: Our study sought to determine the effects of valerian on sleep quality, depression, and state anxiety in hemodialysis (HD) patients. Methods: This randomized, double-blind, placebo-controlled, crossover clinical trial was conducted on 39 patients undergoing HD allocated into a valerian and placebo group. In the first phase of the study, group A (n = 19) received valerian and group B (n = 20) received a placebo one hour before sleep every night for a total of one month. Sleep quality, state anxiety, and depression were assessed in the patients at the beginning and end of the intervention using the Pittsburgh Sleep Quality Index, the Spielberger State-Trait Anxiety Inventory, and Beck Depression Inventory. In the second phase, the two groups’ treatment regimen was swapped. After a one-month washout period, the same process was repeated on the crossover groups (i.e., group A received placebo and group B received valerian). Results: In the first phase, the mean sleep quality, depression, and state anxiety scores showed significant reductions in both groups, but the reduction was significantly higher in group A compared to group B (7.6 vs. 3.2, p < 0.001; 6.5 vs. 2.3, p = 0.013; 14.6 vs. 7.3, p = 0.003, respectively). In the second phase, the mean sleep disorder, depression, and state anxiety scores showed significant reductions in both groups, but the reduction was significantly lower in group A compared to group B (1.4 vs. 4.6, p < 0.001; 1.2 vs. 3.8, p = 0.002; 1.5 vs. 6.2, p < 0.001, respectively). Conclusions: Valerian significantly improved sleep quality, the symptoms of state anxiety, and depression in HD patients.

Survival on Chronic Peritoneal Dialysis: Have Results Improved in the 1990s?

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 410-413 ◽  
Author(s):  
Ana Rodríguez-Carmona ◽  
Teresa García Falcon ◽  
Miguel pérez Fontán ◽  
Pablo Bouza ◽  
Magdalena Adeva ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Patient Survival ◽  
Time Lapse ◽  
The Other ◽  
Second Phase ◽  
Chronic Peritoneal Dialysis ◽  
Technique Survival ◽  
Group A ◽  
Group B

One hundred and seventy patients were treated with home peritoneal dialysis (PD) in our unit between 1986 and 1994. During this time lapse, several technical improvements were included in our practice. Among others there were: Swan neck permanent catheters, Y-systems, and automated home PD (APD). We reviewed our experience, to assess if these improvements had any impact on patient and technique survival, comparing patients who started PD between 1986 and 1989 (group A), with those who started PD between 1990 and 1994 (group B). Both groups had a comparable basal comorbidity, except for a higher proportion of elderly patients in group B (mean age 48 vs 58 years, p < 0.01). The incidence of peritonitis was lower in group B, while there were no differences in the rates of catheter-related infection or hospital admission. Also, there were no significant differences in patient or technique survival. The increasing presence of elderly patients in our PD unit was, apparently, determinant for the evolution of patient survival. On the other side, technical improvements had a marginal impact on technique survival. A good general PD survival in both groups, with few patients changing to hemodialysis (HD), may explain the lack of significant differences. In addition, peritonitis and inadequate PD/ultrafiltration (UF) were replaced by abdominal surgical events and social reasons as the main causes for PD failure in the second phase of the study.

scholarly journals Biosynthetic cellulose induces the formation of a neoduramater following pre-natal correction of meningomyelocele in fetal sheep

2007 ◽  
Vol 22 (3) ◽  
pp. 174-181 ◽  
Author(s):  
Rita de Cássia Sanchez e Oliveira ◽  
Paulo Roberto Valente ◽  
Rogério C. Abou-Jamra ◽  
Andrezza Araújo ◽  
Paulo Hilário Saldiva ◽  
...  
Keyword(s):  
Dura Mater ◽  
Neural Tissue ◽  
In Utero ◽  
Control Group ◽  
Second Phase ◽  
Corrective Surgery ◽  
Fetal Sheep ◽  
Group A ◽  
Group B ◽  
Experimental Group

PURPOSE: The aim of this study was to compare the effectiveness of two dura-mater substitutes, namely human acellular dermal matrix (HADM) and biosynthetic cellulose (BC), in repairing, in utero, surgically-induced meningomyelocele (MMC) in fetal sheep. METHODS: A neural tube defect was created at 74-77 days gestation in 36 fetal sheep. They were divided into 3 groups, the control group that did not receive pre-natal corrective surgery, and the other two groups that received corrective surgery using HADM (Group A) or BC (Group B). Both materials were used as a dura-mater substitutes between the neural tissue and the sutured skin. Correction was performed at gestation day 100 and the fetuses were maintained in utero until term. Sheep were sacrificed on gestation day 140. The fetal spine was submitted to macro and microscopic analysis. At microscopy, adherence of the material to the skin and neural tissue was analyzed. RESULTS: In the initial phase (pilot), experimentally-induced MMC was performed on 11 fetuses and 4 survived (37%). In the second phase (study), 25 fetuses received surgery and 17 survived (68%). In the study group, 6 fetuses did not undergo repair (control group), 11 cases were submitted to corrective surgery (experimental group) and one fetal loss occurred. Of the surviving cases in the experimental group, 4 constituted Group A and 6 in Group B. Macroscopically, skin and underlying tissues where easily displaced from the BC in all cases it was used; in contrast, HADM adhered to these tissues. To compare the adherence, 4 cases from Group A and 4 in Group B were studied. We observed adherence, host cell migration and vessel proliferation into the HADM all sections from Group A and this aspect was not present in any cases in Group B (p < 0.05). In Group B, we also observed that a new fibroblast layer formed around the BC thus protecting the medulla and constituting a "neoduramater". CONCLUSION: The use of BC seems to be more adequate as a dura-mater substitute to cover the damaged neural tissue than HADM. It seems promising for use in the in utero correction of MMC because to does not adhere to neural tissue of superficial and deep layers ("tethered spinal cord"). Thus, BC minimizes the mechanical and chemical intrauterine damage to the spinal medulla.

scholarly journals Effect of Margin Design and Processing Steps on Marginal Adaptation of Captek Restorations

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Amy Shih ◽  
Robert Flinton ◽  
Jayalakshmi Vaidyanathan ◽  
Tritala Vaidyanathan
Keyword(s):  
Digital Imaging ◽  
Marginal Adaptation ◽  
Marginal Gap ◽  
Porcelain Firing ◽  
Acceptable Range ◽  
Group A ◽  
Group B ◽  
Stage 1 ◽  
Group D ◽  
Processing Steps

This study examined the effect of four margin designs on marginal adaptation of Captek crowns during selected processing steps. Twenty-four Captek crowns were fabricated, six each of four margin designs: shoulder (Group A), chamfer (Group B), chamfer with bevel (Group C), and shoulder with bevel (Group D). Marginal discrepancies between crowns and matching dies were measured at selected points for each sample at the coping stage (Stage 1), following porcelain application (Stage 2) and cementation (Stage 3). Digital imaging methods were used to measure marginal gap. The results indicate decreasing trend of margin gap as a function of margin design in the order A>B>C>D. Between processing steps, the trend was in the order Stage 3 < Stage 1 < Stage 2. Porcelain firing had no significant effect on marginal adaptation, but cementation decreased the marginal gap. Generally, the margin gap in Captek restorations were in all cases less than the reported acceptable range of margin gaps for ceramometal restorations. These results are clinically favorable outcomes and may be associated with the ductility and burnishability of matrix phase in Captek metal coping margins.

Validation of the postnatal growth and retinopathy of prematurity screening criteria: A retrospective Italian analysis

2021 ◽  
pp. 112067212110113
Author(s):  
Samuele Caruggi ◽  
Matteo Scaramuzzi ◽  
Maria Grazia Calevo ◽  
Enrico Priolo ◽  
Lorenza Sposetti ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Sensitivity And Specificity ◽  
Retinopathy Of Prematurity ◽  
Postnatal Growth ◽  
Detection Sensitivity ◽  
Screening Criteria ◽  
Screening Protocol ◽  
Type 1 Rop ◽  
Rop Screening

Purpose: Retinopathy of prematurity (ROP) is the leading cause of childhood blindness. The aim of our study is to validate the new screening criteria elaborated by the Postnatal Growth and Retinopathy of Prematurity (G-ROP) study group in a monocentric cohort of Italian preterm infants. Methods: We retrospectively applied the G-ROP screening criteria to a cohort of preterm infants born between May 2015 and July 2020 with known birth weight, gestational age, serial weight measurement, and known ROP outcome. Primary outcomes were sensitivity and specificity of ROP detection, especially of treatment requiring ROP. Secondary outcomes were reduction of ophthalmologic examinations and of infants requiring screening. Results: We retrospectively evaluated 595 children and 475 were included in our study. Of them, 119 developed any type ROP, 39 developed type 1 ROP, and 28 underwent treatment. G-ROP criteria predicted 39 of 39 cases of type 1 ROP (100% sensitivity and specificity). Sensitivity and specificity for detection of treated ROP were 100%. Considering any type ROP detection, sensitivity was 87.4% and specificity was 100%. Our analysis showed that screening could be avoided in 50% of patients, resulting in a 29% reduction of the number of examinations. Conclusions: Our study validates the new G-ROP screening protocol in a monocentric cohort of premature infants. We demonstrate that all Type 1 ROP and requiring treatment ROP could be found even with a reduction of eye examinations.

Identification of treatment-warranted retinopathy of prematurity by neonatal nurse specialist

2021 ◽  
pp. fetalneonatal-2021-322266
Author(s):  
Janette Ravelo ◽  
Gillian Adams ◽  
Shahid Husain
Keyword(s):  
Sensitivity And Specificity ◽  
Retinopathy Of Prematurity ◽  
Imaging System ◽  
Nurse Specialist ◽  
Wide Field ◽  
Gestation Age ◽  
Screening Services ◽  
The Mean ◽  
Agreement Study ◽  
Rop Screening

ObjectiveTo determine the accuracy in the identification of infants with treatment-warranted retinopathy of prematurity (ROP) by a trained and experienced ROP neonatal nurse specialist compared with skilled ophthalmologists.MethodsA single-centre, prospective, blinded, agreement study was performed on a cohort of infants undergoing ROP screening. An experienced ROP neonatal nurse specialist obtained retinal images using a wide field digital retinal imaging system (WFDRI) on 127 infants and identified those with treatment-warranted ROP. This interpretation was compared with the interpretation of the same images by skilled ophthalmologists. The accuracy of the ROP nurse specialist’s interpretation was assessed for sensitivity and specificity compared with the gold standard interpretation by the ophthalmologists.ResultsThe ROP nurse specialist performed 345 ROP screens on both eyes of 127 infants. The mean (SD) gestation age (weeks) and birth weight (g) of the infants screened was 26.8 (2.8) and 929 (327), respectively. The nurse specialist correctly identified all 8 infants with treatment-warranted ROP and 118/119 infants without. The sensitivity and specificity (95% CI) of ROP screening episodes were 100% (63% to 100%) and 99.7% (98.4% to 100.0%), respectively.ConclusionA trained and experienced ROP neonatal nurse specialist can correctly identify infants with treatment-warranted ROP using WFDRI. Further work is required to examine the generalisability of this finding and its impact on ROP screening services.

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