Frequency, comprehension and attitudes of physicians towards abbreviations in the medical record.

AIMS: Abbreviations are common in the medical record. Their inappropriate use may ultimately lead to patient harm, yet little is known regarding the extent of their use and their comprehension. Our aim was to assess the extent of their use, their comprehension and physicians' attitudes towards them, using ophthalmology consults in a tertiary hospital as a model. METHODS: We first mapped the frequency with which English abbreviations were used in the departments' computerised databases. We then used the most frequently used abbreviations as part of a cross-sectional survey designed to assess the attitudes of non-ophthalmologist physicians towards the abbreviations and their comprehension of them. Finally, we tested whether an online lecture would improve comprehension. RESULTS: 4375 records were screened, and 235 physicians responded to the survey. Only 42.5% knew at least 10% of the abbreviations, and no one knew them all. Ninety-two per cent of respondents admitted to searching online for the meanings of abbreviations, and 59.1% believe abbreviations should be prohibited in medical records. A short online lecture improved the number of respondents answering correctly at least 50% of the time from 1.2% to 42% (P<0.001). CONCLUSIONS: Abbreviations are common in medical records and are frequently misinterpreted. Online teaching is a valuable tool for physician education. The majority of respondents believed that misinterpreting abbreviations could negatively impact patient care, and that the use of abbreviations should be prohibited in medical records. Due to low rates of comprehension and negative attitudes towards abbreviations in medical communications, we believe their use should be discouraged.

Peak Occurrence of Retinal Detachment following Cataract Surgery: A Systematic Review and Pooled Analysis with Internal Validation.

INTRODUCTION: Timing of retinal detachment (RD) following cataract surgery is of importance for both diagnostic and prognostic factors. However, results on RD onset-time following cataract surgery have been conflicting. METHOD: A systematic pooled analysis of the literature regarding timing of retinal detachment following cataract surgery. Outcomes were verified against an independent dataset. RESULTS: Twenty-one studies, reporting on rates of RD in 3,352,094 eyes of 2,458,561 patients, met our inclusion criteria and were included in the analysis. The mean pooled time to RD following surgery was 23.12 months (95% CI: 17.79-28.45 months) with high heterogeneity between studies (I 2=100%, P < 0.00001). Meta-analytic pooling for the risk of retinal detachment revealed a risk of 1.167% (95% CI: 0.900 to 1.468, I 2=99.50%, P < 0.0001). A retrospective chart review identified 54 pseudophakic RD cases (mean age 65.5, 59.3% males). The 95% confidence interval for the mean time to RD was 3.1-6.75 years. CONCLUSIONS: The interval between cataract surgery and RD in a pooled analysis revealed a mean time of approximately 1.5-2.3 years. However, there was high variability between studies. Validation based on our local results showed similar yet slightly longer time frames. Timing of pseudophakic retinal detachment might direct appropriate follow-up, assisting in earlier detection.

Glycemic Control and Quality of Life Following Cataract Surgery in Patients with Type 2 Diabetes and without Maculopathy.

OBJECTIVE: To assess whether cataract removal surgery will improve glycemic control and quality of life in patients with diabetes. METHODS: A prospective longitudinal study of 28 patients with type 2 diabetes and without diabetic retinopathy scheduled for cataract removal surgery. During the 4 months of follow-up, measurements of glycated hemoglobin (HbA1c) were obtained and assessment of quality of life was performed using two questionnaires: The EuroQoL 5-Dimension (EQ-5D®) and the Multidimensional Diabetes Questionnaire (MDQ). RESULTS: HbA1c values decreased by approximately 0.45% following surgery (7.24% to 6.78%, P = 0.009). Younger patients reduced HbA1c significantly more than older patients (0.73% vs. 0.03%, respectively, P = 0.043). Younger age also correlated with better visual acuity improvement (R = -0.44, P = 0.02). Poor glycemic control prior to surgery correlated with better HbA1c reductions, with a 42% chance for reduction of at least 0.5% HbA1c in patients with preoperative HbA1c values of 7.5% and a 72% chance for reduction in patients with preoperative HbA1c values of 8.5%. Quality of life was improved by 14% following surgery, as noted in the MDQ results (33.9-38.7, P = 0.034) only. CONCLUSIONS: Cataract removal surgery may positively influence glycemic control and quality of life in type 2 diabetic patients without maculopathy. Younger patients achieved superior improvement in visual and glycemic outcomes. The results of this study highlight the need for frequent inquiry regarding eyesight deterioration in patients with diabetes.

Treatment of retinal artery occlusion using transluminal Nd:YAG laser: a systematic review and meta-analysis.

AIMS: To review clinical experience, efficacy, and safety of transluminal Nd:YAG laser embolectomy/embolysis (TYE) for retinal artery occlusion. METHODS:  Electronic databases were searched for all published clinical studies and case-reports reporting on TYE in central (CRAO) or branch (BRAO) retinal artery occlusion. Individual patient data was evaluated in a weighted pooled analysis. RESULTS: Sixty-one cases were reported, 47 with BRAO and 14 with CRAO. Visual acuity (VA) at onset averaged 20/252 (1.1 LogMAR) and improved following the procedure to 20/47 (0.37 LogMAR) at first follow-up (avg. 6 days, P < 0.001) and to 20/30 (0.18 LogMAR) at last reported follow-up (avg. 1.1 years, P = 0.02). Patients with worse VA (<20/200) improved further (12 vs. three lines, P < 0.001). VA was not improved when using higher pulse energies (≥ 2.4 mJ) which were associated with more vitrectomies. In a weighted analysis vitreous/sub-retinal hemorrhage was estimated to occur in 54% of cases and required vitrectomy in 18% of cases. CONCLUSIONS: TYE was followed by significant visual improvement in the vast majority of cases, including CRAO, and was frequently associated with vitreous hemorrhage. Patients with poor visual acuity appear to benefit further and higher pulse energies may be detrimental. Lack of randomization and intrinsic biases prevent any definite conclusions regarding the benefits and further research is warranted.

Photoreceptor Integrity Predicts Response to Anti-VEGF Treatment.

PURPOSE: Assessing changes in foveal photoreceptor microstructure (FPM) following intravitreal anti-VEGF treatment may serve as a prognostic marker in patients with macular edema (ME). METHODS: Sixteen eyes belonging to newly diagnosed patients with ME were included in this prospective longitudinal study. FPM integrity was evaluated at baseline and at the end of a series of anti-VEGF injections. RESULTS: Treatment led to a significant improvement in mean visual acuity (VA) and central macular thickness. A larger FPM defect was associated with lower VA, both before and after treatment. Patients with larger FPM defects at baseline had smaller VA improvements, and the improvement in FPM integrity was associated with VA improvement (every 100-µm FPM recovery contributed to a gain of 0.04 logMAR). CONCLUSIONS: Recovery of FPM after anti-VEGF treatment was significantly associated with a VA improvement. Direct measurement of photoreceptor integrity might provide an additional tool for the assessment of retinal function and treatment response in patients newly diagnosed with ME.

Modifiable factors in the management of glaucoma: a systematic review of current evidence.

PURPOSE: Primary open angle glaucoma is a chronic optic neuropathy affecting millions of people worldwide and represents a major public health issue. Environmental factors, behaviors, and diet are intimately related to patient health and may play a role in the pathogenesis and progression of glaucoma. This study aims to review the literature, focusing on the last three years, regarding modifiable lifestyle interventions in the management of primary open angle glaucoma. METHODS: Electronic databases were searched for studies published between January 2013 and July 2016 on the topic of lifestyle interventions in primary open angle glaucoma. RESULTS: Sleeping with the head elevated and avoiding the worst eye-dependent side during sleep may slightly lower intraocular pressure and reduce visual field loss. Some food supplements and moderate aerobic exercise may also reduce intraocular pressure up to 2.0 and 3.0 mmHg, respectively. Frequency of coffee intake may be associated with disease progression. Potential negative effects are associated with weight-lifting and yoga exercises. CONCLUSIONS: Certain lifestyle habits could influence glaucoma progression, yet no specific interventions are currently supported by robust evidence. Awareness of the possible influences of certain habits should help guide clinical advice and is important to help patients avoid adverse outcomes and take an active role in the management of their disease.

Ipsilateral hemodialysis access after axillary dissection for breast cancer.

Breast cancer survivors who have had axillary lymph node dissection (ALND) and who later develop end-stage renal failure may eventually require hemodialysis access. If veins available for access in the contralateral arm have been exhausted, especially after chemotherapy, the ipsilateral arm will have to be considered for access construction. There are no evidence-based guidelines for lymphedema prevention, but there are sweeping recommendations to avoid physical injury to the ipsilateral limb, including needle puncture, after ALND with or without radiotherapy. Three studies have shown little or no effect of hand surgery in producing or exacerbating lymphedema after ALND. Dialysis access guidelines recommend the use of autogenous accesses over synthetic grafts whenever possible. Three patients after ALND were referred for hemodialysis access construction in our center. Pre-operative duplex ultrasound confirmed that patent veins appropriate for autogenous access construction were only present in the ipsilateral arm. Autogenous arteriovenous fistulas were constructed in the ipsilateral arm in the three patients. All the three entered our access surveillance program and were regularly examined. All had more than 20 lymph nodes removed. One had axillary radiotherapy and anthracycline-based chemotherapy, one had anthracycline-based chemotherapy without axillary radiotherapy and one had neither treatment. The access was established 4-10 years after ALND. No patient developed significant lymphedema at two, 20 and 76 months respectively after access construction, with cannulation for dialysis occurring three times a week. Autogenous hemodialysis access construction does not seem to contribute to lymphedema development after ALND. Physicians and other medical personnel caring for patients with breast cancer should not oppose the use of the ipsilateral arm if it is the only arm with vasculature suitable for autogenous access construction. Recommendations for lymphedema prevention may exaggerate the extent of risk attributable to interventions in the ipsilateral arm.