Systemic prednisolone versus topical tranexamic acid for prevention of rebleeding in patients with traumatic hyphema: A randomized clinical trial.

PURPOSE: To compare the efficacy of systemic prednisolone and topical tranexamic acid (TA) on the rate of rebleeding in patients with macroscopic traumatic hyphema (MTH). METHOD: In a randomized clinical trial, patients with MTH were randomized to receive oral prednisolone (OP group) or topical TA drops (TA group). Comprehensive ophthalmic examinations including slit lamp examination and fundoscopy, intraocular pressure (IOP), best-corrected visual acuity (BCVA) and check for rebleeding were performed in all cases. RESULTS: Ninety eyes of 90 patients were included, and 45 patients were allocated into each group. Age, sex, IOP, BCVA and grade of hyphema were not different between groups. Rebleeding in the TA group (2 patients, 4.4%) occurred less frequently than in the OP group (7 patients, 15.6%), but this difference did not reach statistical significance (P=0.081). However, there was a significant difference between the two groups over time in terms of absorption of the MTH (P<0.001). CONCLUSION: Topical TA appears promising in the management of macroscopic traumatic hyphema.

Patient preferences for control in medical decision making: a scenario-based approach.

OBJECTIVE: This study evaluated patient preferences about involvement in medical decision making and factors that might influence these preferences. METHODS: A questionnaire was used that had one general question and 10 different clinical scenarios, followed by a list of seven options that described varying degrees of patient participation in the clinical decision-making process. The participants were patients presenting to a family practice residency clinic. RESULTS: Using paired t tests, patient responses to seven of 10 clinical scenarios (70%) were statistically significantly different from their responses as predicted by the general question. Six responses showed a positive relationship, ie, patients wanted to give the physician more control than they indicated by their response to the general question. Paired t tests then compared responses to each scenario with responses to every other scenario; 26 of 45 (58%) were significantly different. A factor analysis suggested groupings of scenarios. Significant differences for decision-making preferences were found among age groups and among educational levels. Cronbach's alpha, a measure of internal consistency, was calculated at .81. CONCLUSIONS: Although preference for level of control in medical decision making varied by scenario, our patients most often preferred physicians to play the primary role in decision making. Patient preferences for general decision making correlated poorly with preferences in specific scenarios.