40 research outputs found
Tips, Tricks, and Guides in Descemet Membrane Endothelial Keratoplasty Learning Curve
Publisher Copyright: © 2021 Davide Borroni et al.Lamellar keratoplasty is fast becoming the most popular form of corneal transplantation. The adoption of Descemet membrane endothelial keratoplasty (DMEK) in the management of Fuchs endothelial dystrophy and pseudophakic bullous keratopathy is partly responsible for this shift in the paradigm of management of corneal pathology. The learning curve of DMEK, however, has been proven to be much steeper than previous endothelial keratoplasty procedures. To ease the procedure, experts have proposed multiple innovative techniques from tissue preparation to graft unfolding to aid the more novice surgeon. Here, we collate and share tips and tricks from our collective experiences to support the learning curve and outcomes in DMEK for both the novice and more experienced corneal transplant surgeons.publishersversionPeer reviewe
Evaluation of pseudoephedrine pharmacy sales before and after mandatory recording requirements in Western Australia: a case study
Background: A community pharmacy real-time electronic recording program, ProjectSTOP, enables Australian community pharmacists to verify pseudoephedrine requests. In Western Australia the program was available for voluntary use from April 2007 and became mandatory November 2010. This case study explores the effectiveness of the program by reviewing the total requests for pseudoephedrine products, and the proportion of requests which were classified as ‘denied sales’ before and after mandatory implementation. Seasonal and annual trends in these measures are also evaluated. Methods: ProjectSTOP data recordings for Western Australia pharmacies between 1 December 2007 and 28 February 2014 were analysed. Data included a de-identified pharmacy number and date of each pseudoephedrine product request. The total number of requests and sale classification (allowed, denied, safety, or not recorded) were calculated for each month/pharmacy. The potential influence of mandatory reporting using ProjectSTOP was investigated using a Regression Discontinuity Design. Correlations between sales from the same pharmacy were taken into account by classifying the pharmacy number as a random effect. The main effects of year (continuous variable), and season (categorical variable) were also included in the model. Results: There was a small but steady decline in the total requests for pseudoephedrine per month per 100,000 population (per pharmacy) from the time of mandatory reporting. The number of denied sales showed a steady increase up until mandatory reporting, after which it showed a significant decline over time. Total sales were heavily influenced by season, as expected (highest in winter, least in summer). The seasonal pattern was less pronounced for denied sales, which were highest in winter and similar across other seasons. The pattern over time for safety sales was similar to that for denied sales, with a clear change occurring around the time of mandatory reporting. Conclusion: Results indicate a decrease in pseudoephedrine product requests in Western Australia community pharmacies. Findings suggest ProjectSTOP has been successful in addressing suspicious sales and potential diversion however ongoing data review is recommended
Endometrial cancer
Endometrial cancer is the most common gynecological
malignancy in well-developed countries.
Biologically and clinicopathologically,
endometrial carcinomas are divided into two
types: type 1 or estrogen-dependent carcinomas
and type 2 or estrogen-independent carcinomas.
Type 1 cancers correspond mainly to endometrioid
carcinomas and account for approximately
90 % of endometrial cancers, whereas
type 2 cancers correspond to the majority of the
other histopathological subtypes.
The vast majority of endometrial cancers
present as abnormal vaginal bleedings in
postmenopausal women. Therefore, 75 % of
cancers are diagnosed at an early stage, which
makes the overall prognosis favorable.
The first diagnostic step to evaluate women
with an abnormal vaginal bleeding is the measurement
of the endometrial thickness with
transvaginal ultrasound. If endometrial thickening
or heterogeneity is confirmed, a biopsy
should be performed to establish a definite
histopathological diagnosis.
Magnetic resonance imaging is not considered
in the International Federation of Gynaecology
and Obstetrics staging system. Nonetheless it
plays a relevant role in the preoperative staging of
endometrial carcinoma, helping to define the best
therapeutic management. Moreover, it is important
in the diagnosis of treatment complications,
in the surveillance of therapy response, and in the
assessment of recurrent disease.info:eu-repo/semantics/publishedVersio
Tips, Tricks, and Guides in Descemet Membrane Endothelial Keratoplasty Learning Curve
Lamellar keratoplasty is fast becoming the most popular form of corneal transplantation. The adoption of Descemet membrane endothelial keratoplasty (DMEK) in the management of Fuchs endothelial dystrophy and pseudophakic bullous keratopathy is partly responsible for this shift in the paradigm of management of corneal pathology. The learning curve of DMEK, however, has been proven to be much steeper than previous endothelial keratoplasty procedures. To ease the procedure, experts have proposed multiple innovative techniques from tissue preparation to graft unfolding to aid the more novice surgeon. Here, we collate and share tips and tricks from our collective experiences to support the learning curve and outcomes in DMEK for both the novice and more experienced corneal transplant surgeons
Clinical validation of the automated characterization of cone size and center in keratoconic corneas
PURPOSE: To evaluate an automated method for detecting the cone shape characteristics and to assess the cornea specialists' subjective variability of these measures using different maps. METHODS: Topographic images of the anterior and posterior surface of each eye were presented to 12 clinicians in two different types of map: Tangential curvature and relative elevation to the best-fit sphere. They were asked to mark the cone center and its boundaries in the two maps without knowing that they belonged to the same patient. The results between the maps were compared to assess the subjective variability dependent on the map type and the automated method was compared against both estimations to assess its accuracy. RESULTS: Considering the results of anterior and posterior surfaces, there was low agreement between the cone center estimations using different types of maps for 10 of the 12 cases (P .05). There was high variability, up to 55%, among clinicians' estimations of the cone area. The results of the automated method were within the range of the expert's estimations. CONCLUSIONS: An objective, mathematically derived method of determining morphological dimensions of the cone was consistent with clinicians' evaluations. Although there was high variability among the experts' subjective estimates, which were highly influenced by the type of map, the objective method provided a reliable evaluation of the keratoconus shape independent of maps or color scale