Does the gamification aspect of an online focal ambient visual acuity stimulation therapeutic game for treating amblyopia in children improve adherence? (Preprint)

2021 ◽  
Author(s):  
Catheline Bocqué ◽  
Jingyun Wang ◽  
Annekatrin Rickmann ◽  
Henrike Julich-Haertel ◽  
Uwe Kaempf ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Standard Treatment ◽  
Patient Adherence ◽  
Therapy Group ◽  
Tablet Computer ◽  
Old Patients ◽  
Occlusion Therapy ◽  
Therapeutic Game ◽  
Golden Standard ◽  
Recorded Data

BACKGROUND The golden standard treatment for amblyopia is patching the better eye. Visual acuity improvement of the amblyopic eye is significantly impacted by adherence of the patching therapy. It is known that the overall adherence is rather low. OBJECTIVE This retrospective study evaluated whether an updated version of attention binding digital therapeutic games based on the principle of focal ambient visual acuity stimulation (FAVAS) would result in an improved patient adherence in 4- to 16-year-old patients with amblyopia. METHODS We analyzed pseudonymised electronically recorded data from patients treated with occlusion therapy and FAVAS therapeutic games. One group used an older (2015) and the other group the newer version (2020) that provided more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the amount of minutes using the therapeutic games as monitored in the automatized logbook versus prescribed minutes of using the games. RESULTS Children in Group 2015 (n=138) spent on average 2009.3±1372.1 (36 to 5472) minutes using FAVAS; children in Group 2020 (n=129) spent on average 2695.5±1526.8 (37.5 to 5672) minutes using the improved therapy. Group 2020 spent on average 686.2 more minutes on FAVAS than Group 2015 (t=3.87, P<.001). Although patient adherence was very variable, compared to the 57%±34% in Group 2015, it significantly improved up to 78%±46% in Group 2020 (t=4.3, P<.001). CONCLUSIONS FAVAS 2020 with an improved gamification aspect as well as tablet computer functionality increased adherence significantly compared to the earlier version FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support adherence to amblyopia treatment. CLINICALTRIAL DRKS00017633

scholarly journals Objective adherence to an online FAVAS therapeutic game for treating amblyopia in children

2021 ◽  
Author(s):  
Catheline Bocqué ◽  
Jingyun Wang ◽  
Annekatrin Rickmann ◽  
Henrike Julich-Haertel ◽  
Uwe Kaempf ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retrospective Study ◽  
Patient Adherence ◽  
Tablet Computer ◽  
Old Patients ◽  
Occlusion Therapy ◽  
Therapeutic Game ◽  
Recorded Data

ABSTRACTAimThis retrospective study was to evaluate whether an updated version of attention binding digital therapeutic games based on the principle of Focal Ambient Visual Acuity Stimulation (FAVAS) would result in an improved patient adherence of patching in 4- to 12-year-old patients with amblyopia.MethodsWe analyzed pseudonymised electronically recorded data from patients treated with two different versions of attention binding digital therapeutic games in 2015 and 2020. Two groups of children treated with occlusion therapy and attention binding digital therapeutic games, divided in treatment version, were compared. Patients in Group 2015 used the old version of therapeutic games without tablet computer functionality, while Group 2020 used more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the amount of minutes using the therapeutic games as monitored in the automatized logbook versus prescribed minutes of using the games.ResultsChildren in Group 2015 spent on average 2009.3±1372.1 (36 to 5472) minutes using FAVAS; children in Group 2020 spent on average 2695.5±1526.8 (37.5 to 5672) minutes using the improved therapy. Meaning, Group 2020 spent 686.2 more minutes on FAVAS than Group 2015 (t=3.87, P<0.001). Although patient adherence was very variable, it significantly improved up to 78% ± 46% in Group 2020 compared to the 57% ± 34% in Group 2015 (t=4.3, P<0.001).ConclusionFAVAS 2020 with an improved gamification aspect as well as tablet computer functionality increased adherence significantly compared to the earlier version FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support patching amblyopia treatment.

scholarly journals Cataract Surgery in Very Old Patients: A Case-Control Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4658
Author(s):  
Hanan Nussinovitch ◽  
Erez Tsumi ◽  
Raimo Tuuminen ◽  
Boris Malyugin ◽  
Yotam Lior ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Case Control Study ◽  
Surgical Techniques ◽  
Case Control ◽  
Dissipated Energy ◽  
Old Patients ◽  
Very Old ◽  
Very Old Patients ◽  
Control Study

Advancements in surgical techniques and increased life expectancy have made cataract surgery more common among very old patients. However, surgical outcomes seem impaired in patients older than 90 years, especially with ocular comorbidities. A retrospective case-control study of 53 eyes of 53 very old patients (mean 92.6 ± 3.0) and 140 eyes of 140 matched patients (mean 75.2 ± 7.6) was undertaken. Groups were matched in terms of gender and systemic and ocular comorbidities. In very old patients, higher phacoemulsification energy (cumulative dissipated energy [CDE], 25.0 ± 22.4 vs. 16.1 ± 10.7, p = 0.01) and rate of intraoperative floppy iris syndrome (IFIS, 9.4% vs. 1.4%, p = 0.02) were observed compared to controls. Uncorrected (UCVA) and best-corrected distance visual acuity (BCVA) gains were significantly poorer among the very old patients than among the control at postoperative day 30 (0.20 ± 0.70 vs. 0.56 ± 0.61 logMAR, p < 0.001 and 0.27 ± 0.64 vs. 0.55 ± 0.62 logMAR, p = 0.006, respectively). Even after including CDE and IFIS as covariates, age remained an independent factor for poor visual gain at 30 days (p < 0.001). Cataract surgery in very old patients may demand more experienced surgeons due to higher nuclear density and the rates of IFIS. Expectations in visual acuity gains should be aligned with the patient’s age.

scholarly journals Association Between Occlusion Therapy and Optotype Visual Acuity in Children Using Data From the Infant Aphakia Treatment Study

2016 ◽  
Vol 134 (8) ◽  
pp. 863 ◽  
Author(s):  
Carolyn Drews-Botsch ◽  
Marianne Celano ◽  
George Cotsonis ◽  
E. Eugenie Hartmann ◽  
Scott R. Lambert ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Occlusion Therapy ◽  
Using Data

scholarly journals Natural Course and Prognostic Factors of Ethambutol Toxic Optic Neuropathy

2020 ◽  
Author(s):  
Ye Ji Kim ◽  
Soo Hyun Lim ◽  
Ungsoo Kim
Keyword(s):  
Visual Acuity ◽  
Prognostic Factors ◽  
Optic Neuropathy ◽  
Natural Course ◽  
Systemic Diseases ◽  
Old Patients ◽  
Toxic Optic Neuropathy ◽  
Initial Visual Acuity ◽  
Risk Patients ◽  
Recovery Group

Abstract Background: To investigate the natural course and prognostic factors of ethambutol toxic optic neuropathy (ETON).Methods: Medical charts of 87 patients diagnosed with ETON were reviewed retrospectively, and the visual acuity and history of ethambutol medication were analyzed. Based on the final visual acuity, patients were divided into two groups: recovery and no-recovery groups. We investigated the prognostic factors, including the sex, age, duration of medication, initial visual acuity, and systemic diseases (diabetes mellitus, hypertension, renal disorders, etc.). Results: In this study, 37 men and 50 women, with ages ranging from 22 to 91 years, were included. Although a poor initial visual acuity was noted in the old patients, a short duration of medication had a weak negative correlation with the initial visual acuity. Follow-up of over 1 year could be performed for 28 out of 87 patients, including nine men and 19 women, with a mean age of 70.0 ± 8.2 years. Ten eyes of seven (25%) patients, including three men and four women, did not recover vision after discontinuation of ethambutol. Patients were significantly older in the no-recovery group than in the recovery group (73.9 ± 8.3 and 68.7 ± 8.1 years, respectively). The poor initial visual acuity and presence of systemic diseases affected the prognosis of ETON. Conclusion: Three-fourth of patients with ETON had visual recovery after discontinuation of ethambutol. High-risk patients with poor prognostic factors, including old age, presence of systemic diseases, and poor initial visual acuity, should be screened in early stages of ETON.

scholarly journals Factors influencing occlusion therapy in refractive amblyopia

2019 ◽  
Vol 5 (1) ◽  
pp. 15-21
Author(s):  
Niharika K Shetty ◽  
◽  
Indireddy Prathyusha ◽  
Keyword(s):  
Visual Acuity ◽  
Refractive Error ◽  
Vision Loss ◽  
Anterior Segment ◽  
Influential Factor ◽  
Adaptation Period ◽  
Health Care Centre ◽  
Factors Affecting ◽  
Occlusion Therapy ◽  
Myopic Astigmatism

Introduction: Amblyopia is an of important cause of preventable blindness and early detection with timely rehabilitation can prevent blindness in childhood age. It also carries a higher risk of vision loss in fellow eye. The most common method of treatment to recover the monocular function involves patching the good eye in an effort to reinforce the amblyopic eye to improve. In our study we evaluated the factors affecting occlusion therapy in amblyopia patients in terms of age, gender, amount of refractive error and the time period of occlusion as the influential factor in rehabilitation of amblyopia. Methods: In this observational study, all patients between 3 years to 25 years who attended the ophthalmic OPD at Sri Siddhartha Medical College, a tertiary health care centre for ocular evaluation and diagnosed with amblyopia were included in the study. The patients were evaluated for Visual acuity on Snellens visual acuity chart and then subjected to Refractive error evaluation on Unique RK 800 Autorefractometer. Anterior segment was evaluated on Slit lamp and Fundus examination was done on Direct and indirect ophthalmoscope. Post refraction and Post treatment visual acuity was evaluated for the patients on Snellens visual acuity chart. Results: Total of 42 patients were studied out of which 16 were males and 26 were females. All patients were between 3- 35 years of age, with maximum patients 20 (47. 6%) in the age group of 6 to 15 years. 21 patients (50%) were having a baseline visual acuity in the range of 3 meter finger counting to 6/36. The commonest refractive error was astigmatism 23(54.8%) amongst whom compound myopic astigmatism was commonest in 9 patients (21.4%). In our study the post correction visual acuity improvement was 6/24 to 6/6 which was found in maximum patients 31 (73.8%), which further improved in the post occlusion visual acuity in 35 patients (83.3%) from 6/24 to 6/6. Conclusion: In this study we found myopic astigmatism as the commonest refractive error in anisometropic amblyopias. Though we found a female preponderance, the gender association was not found significant in the visual recovery or the treatment response. A good improvement following occlusion treatment as well as refractive adaptation period

scholarly journals Cost-Effectiveness of Adding SGLT2 Inhibitors to Standard Treatment for Heart Failure With Reduced Ejection Fraction Patients in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Yaohui Jiang ◽  
Rujie Zheng ◽  
Haiqiang Sang
Keyword(s):  
Heart Failure ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Ejection Fraction ◽  
Standard Treatment ◽  
Cost Effective ◽  
Old Patients ◽  
Reduced Ejection Fraction ◽  
Diabetes Status ◽  
Life Years

Objective: To evaluate the economics and effectiveness of adding dapagliflozin or empagliflozin to the standard treatment for heart failure (HF) for patients with reduced ejection fraction (HFrEF) in China.Methods: A Markov model was developed to project the clinical and economic outcomes of adding dapagliflozin or empagliflozin to the standard treatment for 66-year-old patients with HFrEF. A cost-utility analysis was performed based mostly on data from the empagliflozin outcome trial in patients with chronic heart failure and a reduced ejection fraction (EMPEROR-Reduced) study and the dapagliflozin and prevention of adverse outcomes in heart failure (DAPA-HF) trial. The primary outcomes were measured via total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER).Results: In China, compared to the standard treatment, although adding dapagliflozin to the standard treatment in the treatment of HFrEF was more expensive ($4,870.68 vs. $3,596.25), it was more cost-effective (3.87 QALYs vs. 3.64 QALYs), resulting in an ICER of $5,541.00 per QALY. Similarly, adding empagliflozin was more expensive ($5,021.93 vs. $4,118.86) but more cost-effective (3.66 QALYs vs. 3.53 QALYs), resulting in an ICER of $6,946.69 per QALY. A sensitivity analysis demonstrated the robustness of the model in identifying cardiovascular death as a significant driver of cost-effectiveness. A probabilistic sensitivity analysis indicated that when the willingness-to-pay was $11,008.07 per QALY, the probability of the addition of dapagliflozin or empagliflozin being cost-effective was 70.5 and 55.2%, respectively. A scenario analysis showed that the cost of hospitalization, diabetes status, and time horizon had a greater impact on ICER.Conclusion: Compared with standard treatments with or without empagliflozin, adding dapagliflozin to the standard treatment in the treatment of HFrEF in China was extremely cost-effective.

scholarly journals Proportion of Non-Compliance and Factors Affecting It in Children Undergoing Occlusion Therapy for Amblyopia

2020 ◽  
Vol 7 (48) ◽  
pp. 2879-2884
Author(s):  
Pravitha M. Kumar ◽  
Naina Jabeen Hyder ◽  
Shaji A ◽  
Sunil M.S ◽  
Pappa P
Keyword(s):  
Visual Acuity ◽  
Negative Impact ◽  
Visual Outcome ◽  
Learning Ability ◽  
Final Visual Acuity ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Occlusion Therapy ◽  
Study Results

BACKGROUND The term amblyopia literally means dullness of vision. It is defined as unilateral or bilateral reduction of visual acuity due to pattern vision deprivation or abnormal binocular interaction for which no ocular causes can be detected by ocular examination and can be reversed by therapeutic measures. The study was undertaken to estimate the proportion of non-compliance and factors affecting it in children undergoing occlusion therapy for amblyopia. METHODS The study was designed as a hospital based cross sectional study. Children aged 5 - 12 years undergoing occlusion therapy for amblyopia due to strabismus, anisometropia or both, who had been prescribed occlusion for a period of minimum 3 months were included in the study. Children with developmental or neurological disorders and other ocular conditions causing visual impairment, whose parents were not willing to participate in the study or follow up, and uncooperative children were also excluded from the study. RESULTS 52.5 % were non-compliant to occlusion therapy, 31.1 % were partially compliant and only 16.4 % were compliant. 38.5 % had final visual acuity in the range of 6 / 60 - 6 / 24 and 6 / 18 – 6 / 12, 20 % had 6 / 9 - 6 / 6. Different variables were assessed against compliance to check for any association. Significant association was found between compliance to occlusion and socioeconomic status (p = .006), visual acuity at presentation (p = .026), type of amblyopia (p = .038) and final visual acuity (p < .01) and association with educational status were found to be borderline (p = .059). CONCLUSIONS Occlusion therapy for amblyopia is a long drawn process which needs strict compliance and regular follow up. Compliance is a major factor affecting final visual outcome. Poor compliance leads to unsuccessful amblyopia therapy which in turn can have negative impact on child’s learning ability and psychosocial wellbeing. For this reason it is critical that care givers leave the clinic with clear knowledge of how and why patching is being recommended and its importance in improving child’s vision. KEYWORDS Amblyopia, Occlusion, Compliance

scholarly journals The Effect of Black Tea (Camellia sinensis (L) Kuntze) on Pediatrics With Acute Nonbacterial Diarrhea

2016 ◽  
Vol 22 (1) ◽  
pp. 114-119 ◽  
Author(s):  
Sareh Doustfatemeh ◽  
Mohammad Hadi Imanieh ◽  
Abdolali Mohagheghzade ◽  
Mohammad M. Zarshenas ◽  
Zahra Torkamani ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Intervention Group ◽  
Black Tea ◽  
Control Group ◽  
Old Patients ◽  
Significant Difference ◽  
The Mean ◽  
And Control ◽  
Single Blind

We aimed to evaluate the antidiarrheal effect of black tea in pediatric patients with acute nonbacterial diarrhea. This single-blind randomized clinical trial study was performed on 2 to 12-year-old patients, with acceptable criteria for acute nonbacterial diarrhea in Shiraz, Iran. In total, 120 patients took part in this study. Blocked randomization method was used to allocate them into 2 groups of intervention (black tea tablet + standard treatment) and control group (standard treatment; 60 patients in each). Frequency of defecation, volume, and consistency of stool were registered on arrival and 24 hours later. We used χ2 test, t test, and Mann-Whitney U test. After a 24-hour follow-up, the proportion of patients with formed stool was higher in the intervention group when compared with the control group ( P < .001). There was a significant difference between the mean number of defecations per 24 hours in both groups, after treatment ( P < .001). We found a possible antidiarrheal effect of black tea.

Idraparinux versus standard therapy in the treatment of deep venous thrombosis in cancer patients: A subgroup analysis of the Van Gogh DVT trial

2010 ◽  
Vol 104 (07) ◽  
pp. 86-91 ◽  
Author(s):  
Alexander Cohen ◽  
Bruce Davidson ◽  
Herve Decousus ◽  
Alexander Gallus ◽  
Michael Gent ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Cancer Patients ◽  
Standard Therapy ◽  
Standard Treatment ◽  
Therapy Group ◽  
Vitamin K Antagonists ◽  
Hazard Ratio ◽  
Standard Therapy Group ◽  
Van Gogh

SummaryStandard treatment with heparin followed by vitamin K antagonists is frequently complicated by bleeding and recurrent venous thromboembolism (VTE) in cancer patients with VTE. To compare the efficacy, safety and overall survival of long-term idraparinux treatment to standard therapy in cancer patients we conducted a post-hoc analysis in the subgroup of non-active and active cancer patients included in the Van Gogh DVT clinical trial. The cancer patients with deep venous thrombosis (DVT) and without pulmonary embolism (PE) were randomised to standard treatment or a once-weekly subcutaneous injection of idraparinux (2.5 mg), a synthetic pentasaccharide. 421 cancer patients were included. A total of 220 patients received idraparinux and 201 were allocated to standard therapy for three months (8%) or six months (92%). A recurrent VTE was observed during the first six months in 2.5% (n=5) of the idraparinux recipients compared to 6.4% (n=12) in the standard therapy group (hazard ratio 0.39, 95% confidence interval [CI]; 0.14–1.11). The rate of bleeding was comparable (odds ratio 0.89, 95% CI; 0.50–1.59). The outcomes were similar at three months after randomisation in all patients. Of the idraparinux recipients, 22.7% (n=50) died during the study period compared to 48 patients (23.9%) in the standard treatment group (hazard ratio 0.99, 95% CI; 0.66–1.48). In conclusion, no significant safety or survival differences were observed between cancer patients with DVT treated with idraparinux for six months compared to standard therapy. Fewer recurrent VTEs were observed in the idraparinux group; however, this was not statistically significant and also because of study limitations this should be interpreted with caution.

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