Vision-related Quality of Life after Bilateral Implantation of Monofocal and Multifocal Intraocular Lenses

Purpose: To evaluate vision-related quality of life in two sets of patients after routine cataract surgery implanting with traditional versus multifocal intraocular lens (IOLs). Methods: In a cross-sectional prospective study, 58 and 33 candidates for cataract surgery were divided into traditional (Acrysof SN60WF, Alcon Laboratories, Inc) and multifocal IOL (AcrySof IQ PanOptix IOL TFNT00, Alcon Laboratories, Inc.) groups, respectively. The primary outcome was VFQ-25 scores. The secondary outcomes were making comparisons between the two IOL types in the near vision and the driving items. Results: The mean patients’ age in traditional and multifocal IOL groups was 60.85 ± 7.40 (55% female) and 59.85 ± 8.95 (36% female) years, respectively. The mean VFQ-25 total scores in traditional and multifocal IOL groups before and after surgery were 63.69 ± 4.95 and 72.15 ± 9.66, and 98.08 ± 0.70 and 95.70 ± 1.30, respectively (P = 0.001 & 0.001). The mean scores of night driving in traditional and multifocal IOL groups were 38.79 ± 20.50 and 44.35 ± 21.12 (P = 0.1) before surgery which improved to 97.41 ± 7.68 and 56.45 ± 11.12 after surgery, respectively (P = 0.001). The mean scores of near vision in traditional and multifocal IOL groups were 46.83 ± 10.56 and 50.53 ± 8.58 (P = 0.2) before surgery which improved to 89.94 ± 4.87 and 100.00 ± 0.00 after surgery, respectively (P = 0.001). Conclusion: Vision-related quality of life after cataract surgery with either type of traditional or multifocal (PanOptix) IOLs improved to an excellent level. Traditional IOLs provided more satisfaction in nighttime driving while multifocal IOLs provided increased satisfaction in near and intermediate vision

Fourier Analysis of Keratometric Data in Epithelium Removal versus Epithelial Disruption Corneal Cross-linking

Purpose: To compare epithelium-removal and epithelium-disruption corneal crosslinking (CXL) methods in Fourier analysis of keratometric data and clinical outcomes. Methods: In this double-masked randomized clinical trial, each eye of 34 patients with bilateral keratoconus was randomly allocated to either the epithelium-removal or epithelium-disruption CXL treatment groups. Ocular examination, refraction, uncorrected and best spectacle-corrected visual acuity (UCVA and BSCVA, respectively) measurements, and Pentacam imaging (keratometry, pachymetry, and Fourier analysis) were performed at baseline and at six-month follow-up period. Results: Patients’ mean age was 23.3 ± 3.6 years. The preoperative thickness of the thinnest point was 459.20 ± 37.40 μm and 455.80 ± 32.70 μm in the epithelium removal and epithelial-disruption CXL groups, respectively (P = ?). The corresponding figures were 433.50 ± 33.50 μm and 451.90 ± 39.70 μm, respectively, six months after the treatment (P = 0.0001). The irregularity component was 0.030 ± 0.016 μm in the epithelium-removal group and 0.028 ± 0.011 μm in the epithelium-disruption group preoperatively (P = ?). This measurement was 0.031 ± 0.016 μm and 0.024 ± 0.009 μm, respectively at month 6 (P = 0.04). The epithelium-disruption CXL group had better results in terms of the thickness of the thinnest point and the irregularity component as compared to the epithelium-removal group. The two study groups were comparable in spherical equivalent, mean keratometry, UCVA, BSCVA, or other Fourier analysis components (spherical R min, spherical eccentricity, central, peripheral regular astigmatism, and maximum decentration) (P > 0.05). Conclusion: This study shows that epithelium-disruption CXL is superior to epithelium removal CXL regarding the short-term changes in pachymetry and corneal irregularity. Other evaluated parameters were comparable between the two techniques within the six-month follow-up period

The Assessment of Acupuncture and Exercise Therapy in Patients with Carpal Tunnel Syndrome: Randomized Clinical Trial

Background: The efficacy of acupuncture and exercise therapy in the treatment of carpal tunnel syndrome (CTS) has been investigated in limited studies with controversial results. The purpose of this study was to compare the short-term efficacy of acupuncture and exercise therapy in patients with mild to moderate CTS.Materials and Methods: This study was a randomized controlled clinical trial study conducted on 60 patients (55 women) with mild to moderate CTS referring to Imam Hossein Hospital in Tehran in 2017. The patients were randomly divided in to 3 equal groups; groupa1: only night splint was used for 6 weeks (control), group2: splint with tendon and nerve gliding exercises (2 times a day for 6 weeks) were applied, group3: splint and electroacupuncture was performed for 12 sessions (2 sessions/week). The score on the Boston Carpal Tunnel Questionnaire (BCTQ) for Functional Status and Symptom Severity (BCTQ FUNCT and SYMPT) and visual analog scale (VAS) score were evaluated at baseline and after the treatment.Results: At the final follow up, significant improvements in all parameters of quality of life and VAS were found in third groups (p<0.05). Acupuncture affected the score on the BCTQ FUNCT and SYMPT, the VAS score more than exercise therapy. In addition, the efficacy of splint alone was less than intervention groups in all parameters.Conclusion: Acupuncture with splint has a high effect on reducing pain and improving the quality of life in patients with mild to moderate CTS and could be adopted in the management of these patients.

Vision-related Quality of Life After Bilateral Implantation of Monofocal and Multifocal Intraocular Lenses

Purpose: To evaluate vision-related quality of life in two sets of patients after routine Cataract surgery implanting with traditional versus multifocal intraocular lens (IOLs). Methods: In a cross-sectional prospective study, 58 and 33 candidates for Cataract surgery were divided into traditional (Acrysof SN60WF, Alcon Laboratories, Inc) and multifocal IOL (AcrySof IQ PanOptix IOL TFNT00, Alcon Laboratories, Inc.) groups, respectively. The primary outcome was VFQ-25 scores. The secondary outcomes were making comparisons between the two IOL types in the near vision and the driving items. Results: The mean patients' age in traditional and multifocal IOL groups was 60.85 ± 7.40 (55% female) and 59.85 ± 8.95 (36% female) years, respectively. The mean VFQ-25 total scores in traditional and multifocal IOL groups before and after surgery were 63.69 ± 4.95 and 72.15 ± 9.66, and 98.08 ± 0.70 and 95.70 ± 1.30, respectively (P = 0.001 & 0.001). The mean scores of night driving in traditional and multifocal IOL groups were 38.79 ± 20.50 and 44.35 ± 21.12 (P = 0.1) before surgery which improved to 97.41 ± 7.68 and 56.45 ± 11.12 after surgery, respectively (P = 0.001). The mean scores of near vision in traditional and multifocal IOL groups were 46.83 ± 10.56 and 50.53 ± 8.58 (P = 0.2) before surgery which improved to 89.94 ± 4.87 and 100.00 ± 0.00 after surgery, respectively (P = 0.001). Conclusion: Vision-related quality of life after Cataract surgery with either type of traditional or multifocal (PanOptix) IOLs improved to an excellent level. Traditional IOLs provided more satisfaction in nighttime driving while multifocal IOLs provided increased satisfaction in near and intermediate vision

Fourier Analysis of Keratometric Data in Epithelium Removal Versus Epithelial Disruption Corneal Cross-linking

Purpose: To compare epithelium-removal and epithelium-disruption corneal crosslinking (CXL) methods in Fourier analysis of keratometric data and clinical outcomes. Methods: In this double-masked randomized clinical trial, each eye of 34 patients with bilateral keratoconus was randomly allocated to either the epithelium-removal or epithelium-disruption CXL treatment groups. Ocular examination, refraction, uncorrected and best spectacle-corrected visual acuity (UCVA and BSCVA, respectively) measurements, and Pentacam imaging (keratometry, pachymetry, and Fourier analysis) were performed at baseline and at six-month follow-up period. Results: Patients' mean age was 23.3 ± 3.6 years. The preoperative thickness of the thinnest point was 459.20 ± 37.40 μm and 455.80 ± 32.70 μm in the epithelium removal and epithelial-disruption CXL groups, respectively (P = ?). The corresponding figures were 433.50 ± 33.50 μm and 451.90 ± 39.70 μm, respectively, six months after the treatment (P = 0.0001). The irregularity component was 0.030 ± 0.016 μm in the epithelium-removal group and 0.028 ± 0.011 μm in the epithelium-disruption group preoperatively (P = ?). This measurement was 0.031 ± 0.016 μm and 0.024 ± 0.009 μm, respectively at month 6 (P = 0.04). The epithelium-disruption CXL group had better results in terms of the thickness of the thinnest point and the irregularity component as compared to the epithelium-removal group. The two study groups were comparable in spherical equivalent, mean keratometry, UCVA, BSCVA, or other Fourier analysis components (spherical R min, spherical eccentricity, central, peripheral regular astigmatism, and maximum decentration) (P > 0.05). Conclusion: This study shows that epithelium-disruption CXL is superior to epithelium removal CXL regarding the short-term changes in pachymetry and corneal irregularity. Other evaluated parameters were comparable between the two techniques within the six-month follow-up period

Quality assessment of emergency wards in Khorramabad public hospitals based on EFQM model

Background: Based on recommendation of management development and organizational change center of the ministry of health. EFQM model is the most appropriate model to deploy in country`s hospitals. In this study we assess quality of emergency wards in khorramabad hospitals based on EFQM model and compare it with results of annual evaluation of the ministry of health. Materials and Methods: this descriptive, cross-sectional study was carried out in 2009. Emergency wards of khorramabad hospitals were our study population which were selected using census method. Data collection tool was questionnaire of EFQM model which was filled out by researchers in studied wards. RADAR logic used for scoring and EFQM consensus process used for agreement. The data were analyzed through descriptive statistics, SPSS and EFQM softwares. Results: Scores of studied wards (Social security, Shahid Madani,Shohaday-e Ashayer and Asali hospitals) were 216,108.1,129.9,72.1 respectively. The mean score in EFQM criteria were: leadership 12.3%, policy and strategy 7.1%, staff 11.8%, partnerships and resources 13.8%, processes 20.8%, customers results 8.3%, staff results 12.5% society results 9.5%, key performance results 18.8%. Conclusion: Findings show that quality of studied wards is less than the model standards and other similar studies considerably. From view point of the researcher the existing gap with external studies is logical and in comparison with internal studies is irrational. The studied wards acquired the most score in process criterion and the least score in policy and strategy criterion. Also ,findings shows a negative relation between results of assessment based on EFQM model and current evaluation system of the ministry of health, so it is suggested that the current system should be revised fundamenally