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1.
Are Dilated Fundus Examinations Needed for OCT-Guided Retreatment of Exudative Age-Related Macular Degeneration?
Patel, Y, Miller, DM, Fung, AE, Hill, LF, Rosenfeld, PJ
Ophthalmology. Retina. 2020;(2):141-147
Abstract
PURPOSE To determine whether presence of macular hemorrhage on dilated fundus examination (DFE) or fundus photography influences vision outcomes with OCT-guided pro re nata (PRN) ranibizumab retreatment in patients with neovascular age-related macular degeneration (nAMD), we investigated whether hemorrhage without OCT-detectable fluid impacted vision outcomes. DESIGN Post hoc analysis of prospectively collected data from the 24-month pHase III, double-masked, multicenter, randomized, Active treatment-controlled study of the efficacy and safety of 0.5 mg and 2.0 mg Ranibizumab administered monthly or on an as-needed Basis (PRN) in patients with subfoveal neOvascular age-related macular degeneration (HARBOR) trial (ClinicalTrials.gov identifier, NCT00891735). PARTICIPANTS This post hoc analysis examined 1097 patients from the intention-to-treat population of HARBOR. METHODS Dilated fundus examination and fundus photography were evaluated for hemorrhage, and spectral-domain (SD) OCT images from HARBOR participants were analyzed for macular fluid secondary to macular neovascularization. Agreement between methods was determined for each time point. Visual outcomes were evaluated for 82 patients with evidence of hemorrhage on DFE or fundus photography at 3 months and no evidence of SD-exudative activity requiring retreatment at month 3. MAIN OUTCOME MEASURES Pooled data from the intention-to-treat population of HARBOR were analyzed for hemorrhage on DFE or fundus photography and exudative activity on SD OCT. A subgroup of PRN patients were analyzed for best-corrected visual acuity gains at 24 months. RESULTS Most study eyes (89% [973/1095]) showed macular hemorrhages at baseline, declining to 31% (319/1042) at month 3 and stabilizing at 11% (111/989) by month 6 of follow-up. After baseline, exudative activity was detected on SD-OCT in more than 89% of eyes when hemorrhage was present on DFE or fundus photography. Patients not requiring a month 3 PRN ranibizumab injection achieved similar visual gains over 24 months, regardless of month 3 hemorrhage presence versus absence: 9.4 and 8.7 Early Treatment Diabetic Retinopathy Study letter scores, respectively (P = 0.74). CONCLUSIONS After 3 initial ranibizumab injections, SD-OCT detected nAMD activity in 89% of eyes when hemorrhage was present on fundus photography. Ranibizumab retreatment guided by monthly SD-OCT achieved similar vision gains with or without injection when hemorrhage was present without OCT-detectable fluid. This suggests that macular hemorrhages without OCT-detectable macular fluid may not require treatment and DFE may not be needed at every visit. These conclusions should be confirmed in a prospective randomized trial before firm recommendations regarding clinical practice can be made.
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2.
A novel prescription pedometer-assisted walking intervention and weight management for Chinese occupational population.
Yu, Y, Lv, Y, Yao, B, Duan, L, Zhang, X, Xie, L, Chang, C
PloS one. 2018;(1):e0190848
Abstract
BACKGROUND AND AIM Information technology has been previously used for the research and practice of health promotion. Appropriate and effective health promotion methods used by professional groups remain to be investigated. This study aimed to assess the feasibility and effectiveness of a weight management program among the Chinese occupational population using and a novel information technology exercise prescription. STUDY DESIGN AND PARTICIPANTS A 3-month open, self-monitored intervention trial, involving individualized pedometer-assisted exercise prescription and a one-time targeted dietary guidance prior to exercise was conducted on the Chinese occupational population aged 18-65 years in China from 2015 to 2016. Data were collected from March 2015 to May 2016 and analyzed from June 2016 to August 2016. Participants were also asked to synchronize exercise data of the pedometer to the Internet-based Health System Center daily (at least weekly), by connecting to the personal computer (PC) using a USB cable or via Bluetooth. RESULTS Eligible participants included 802 Chinese occupational persons, and 718 of them followed exercise interventions with 89.5% (718/802) adherence to the exercise programs. Of them, 688 participants completed the program with 85.8% (688/802) adherence to the exercise program and their data were analyzed. Weight decreased by 2.2% among all overweight/obese participants, with 1.8% reduction in waist circumference and 3.3% reduction in body fat percentage (p< 0.001). Weight and body fat percentage in normal-weight individuals decreased by 0.7% and 2.5%, respectively (p < 0.01). A weight gain of 1.0% was observed in all underweight participants (p< 0.05), and 68.2% (208/305) of overweight/obese participants experienced weight loss, with an average reduction of 3.5%, with 20.2% (42/208) of them achieving weight loss ≥5%. Blood pressure and fasting serum glucose decreased significantly in both the overweight/obese and the normal-weight individuals (p < 0.05). The incidence of hypertension was significantly lower and lifestyle behavior significantly improved (p < 0.05). CONCLUSION The prescription pedometer-assisted walking intervention can effectively improve exercise adherence and manage weight. This approach was also effective in controlling the risk factors of weight-related chronic diseases. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR) ChiCTR-OOh-16010229.
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3.
Comparison of two types of TPN prescription methods in preterm neonates.
Skouroliakou, M, Koutri, K, Stathopoulou, M, Vourvouhaki, E, Giannopoulou, I, Gounaris, A
Pharmacy world & science : PWS. 2009;(2):202-8
Abstract
OBJECTIVE Total parenteral nutrition is commonly used in neonates' intensive care units for nutritional support of preterm neonates. Adequacy and safety of parenteral nutrition support are amongst the major concerns of neonates' therapy. Parenteral nutrition prescription in Greek hospitals is not based on standardized protocols, thus resulting in wide diversity of formulations. In this study, the results of utilization of standardized computerized parenteral nutrition protocols and regimens for neonates are compared to the results of protocols and regimens prescribed by individual neonatologists on neonates' outcome (weight changes, adequacy of parenteral nutrition, days of hospitalization, clinical outcome). SETTING The study took place at "Mitera" Maternity Hospital of Greece. METHOD Two groups of 30 preterm infants (28-36 weeks) with respiratory failure were recruited for the study. They were admitted in a Greek maternity hospital and they all received total parenteral nutrition support in neonates' intensive care unit. Standardized, computer based protocols were applied for the prescription of parenteral nutrition formulations in the first group, while on the other, regimens prescribed by neonatologists were used. MAIN OUTCOME MEASURES Macro- and micronutrients provided by the different total parenteral nutrition protocols were recorded. Body weight was measured, blood count and biochemical profile were performed at the beginning and at the end of parenteral nutrition support. The number of days of total parenteral nutrition support as well as the total number of days of hospitalization was recorded. RESULTS Standardized protocols provided more energy (P-value: 0.05), protein (P-value: 0.023) and micronutrients than the non-standardised. Neonates that receive standardized total parenteral nutrition gained weight (+44 +/- 114 g) and had better blood count and biochemical values during total parenteral nutrition support compared to the other group, that lost weight during total parenteral nutrition support (-53 +/- 156 g). These differences were also statistically significant (P value < 0.05). Regarding the total days of hospitalization, no differences were found between the two groups. CONCLUSION The use of standardized protocols in preterm neonates resulted in more adequate provision of nutrients, weight gain and better blood count profile compared with protocols prescribed by individual physicians.
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4.
Visual function in anterior ischemic optic neuropathy: effect of Vision Restoration Therapy--a pilot study.
Jung, CS, Bruce, B, Newman, NJ, Biousse, V
Journal of the neurological sciences. 2008;(1-2):145-9
Abstract
OBJECTIVE To evaluate the effects of Vision Restoration Therapy (VRT) on the visual function of patients with anterior ischemic optic neuropathy. DESIGN Randomized controlled double-blind pilot trial. PATIENTS 10 patients with stable anterior ischemic optic neuropathy (AION). INTERVENTION All patients were evaluated before VRT and after 3 and 6 months of treatment by Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, contrast sensitivity, reading speed, 24-2 SITA-standard Humphrey visual field (HVF), High Resolution Perimetry (HRP) (perimetry obtained during VRT), and vision-based quality of life questionnaire. Patients were randomized between two VRT strategies (5 in each group): I) VRT in which stimulation was performed in the seeing VF of the affected eye ("seeing field-VRT"); II) VRT in which stimulation was performed along the area of central fixation and in the ARV (areas of residual vision) of the affected eye ("ARV-VRT"). MAIN OUTCOME MEASURES The results of the HRP, HVF, and clinical assessment of visual function were compared for each patient and between the two groups at each evaluation. RESULTS Visual acuity qualitatively improved in the ARV-VRT group, however the change was not statistically significant (p=0.28). Binocular reading speed significantly improved in the ARV-VRT group (p=0.03). HVF foveal sensitivity increased mildly in both groups (p=0.059). HRP analysis showed a similar increase in stimulus accuracy in both groups (mean improvement of about 15%). All patients reported functional improvement after VRT. CONCLUSIONS Despite a small sample, the study showed a trend toward improvement of visual function in the ARV-VRT group. Improvement of HRP in both groups may reflect diffusely increased visual attention (neuronal activation), or improvement of an underlying sub-clinical abnormality in the "seeing" visual field of patients with optic neuropathies.
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5.
Is severe obesity a form of addiction? Rationale, clinical approach, and controlled clinical trial.
Riva, G, Bacchetta, M, Cesa, G, Conti, S, Castelnuovo, G, Mantovani, F, Molinari, E
Cyberpsychology & behavior : the impact of the Internet, multimedia and virtual reality on behavior and society. 2006;(4):457-79
Abstract
For many, obesity is just a problem of energy input and expenditure: more energy input than expenditure. However, the clinical practice and epidemiological data clearly show that weight control is more complex than expected by this simple equation. This is particularly true in morbid obesity, a form of severe obesity in which a person's Body Mass Index (BMI, kg/m(2)) is over 40. If we compare the definitions and diagnostic criteria for "dependence" and "addiction" with the situation of many severe obese subjects, it is apparent that they match very well. Further, different neurological studies confirm this similarity: both addiction and obesity patients have a deficiency of dopamine receptors. Nevertheless, when we compare many of the actual obesity treatments with the ones used in the area of addictions it is possible to find relevant differences: obesity treatments neither consider different levels of type and intensity of care, nor a multidimensional approach. To overcome these limitations, in this paper we propose a bio-psychosocial approach in which the genetic influence (lack of dopamine receptors) is matched by psychosocial issues (pressure for thinness and diet as main body image dissatisfaction treatment). Further, the paper outlines how this approach may influence the treatment options, by focusing both on the lessons coming from actual addiction treatment and the opportunities offered by virtual reality. Finally, the paper presents and discusses the outcome of a controlled trial, based on the proposed approach, including a 6-month follow-up (211 morbid obese females with a BMI of >40 and a documented history of failures.
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6.
Patient-cooperative strategies for robot-aided treadmill training: first experimental results.
Riener, R, Lünenburger, L, Jezernik, S, Anderschitz, M, Colombo, G, Dietz, V
IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society. 2005;(3):380-94
Abstract
Task-oriented repetitive movements can improve motor performance in patients with neurological or orthopaedic lesions. The application of robotics and automation technology can serve to assist, enhance, evaluate, and document neurological and orthopedic rehabilitation. This paper deals with the application of "patient-cooperative" techniques to robot-aided gait rehabilitation of neurological disorders. We define patient-cooperative to mean that, during movement, the technical system takes into account the patient's intention and voluntary efforts rather than imposing any predefined movements or inflexible strategies. It is hypothesized that such cooperative robotic approaches can improve the therapeutic outcome compared to classical rehabilitation strategies. New cooperative strategies are presented that detect the patient's voluntary efforts. First, this enables the patient increased freedom of movement by a certain amount of robot compliance. Second, the robot behavior adapts to the existing voluntary motor abilities. And third, the robotic system displays and improves the patient contribution by visual biofeedback. Initial experimental results are presented to evaluate the basic principle and technical function of proposed approaches. Further improvements of the technical design and additional clinical testing is required to prove whether the therapeutic outcome can be enhanced by such cooperative strategies.
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7.
Efficacy of sequential or simultaneous interactive computer-tailored interventions for increasing physical activity and decreasing fat intake.
Vandelanotte, C, De Bourdeaudhuij, I, Sallis, JF, Spittaels, H, Brug, J
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2005;(2):138-46
Abstract
BACKGROUND Little evidence exists about the effectiveness of "interactive" computer-tailored interventions and about the combined effectiveness of tailored interventions on physical activity and diet. Furthermore, it is unknown whether they should be executed sequentially or simultaneously. PURPOSE The purpose of this study was to examine (a) the effectiveness of interactive computer-tailored interventions for increasing physical activity and decreasing fat intake and (b) which intervening mode, sequential or simultaneous, is most effective in behavior change. METHODS Participants (N = 771) were randomly assigned to receive (a) the physical activity and fat intake interventions simultaneously at baseline, (b) the physical activity intervention at baseline and the fat intake intervention 3 months later, (c) the fat intake intervention at baseline and the physical activity intervention 3 months later, or (d) a place in the control group. RESULTS Six months postbaseline, the results showed that the tailored interventions produced significantly higher physical activity scores, F(2, 573) = 11.4, p < .001, and lower fat intake scores, F(2, 565) = 31.4, p < .001, in the experimental groups when compared to the control group. CONCLUSIONS For both behaviors, the sequential and simultaneous intervening modes showed to be effective; however, for the fat intake intervention and for the participants who did not meet the recommendation in the physical activity intervention, the simultaneous mode appeared to work better than the sequential mode.
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8.
Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder.
Rothbaum, BO, Hodges, LF, Ready, D, Graap, K, Alarcon, RD
The Journal of clinical psychiatry. 2001;(8):617-22
Abstract
BACKGROUND Virtual reality (VR) integrates real-time computer graphics, body-tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion. VR exposure (VRE) is proposed as an alternative to typical imaginal exposure treatment for Vietnam combat veterans with posttraumatic stress disorder (PTSD). METHOD This report presents the results of an open clinical trial using VRE to treat Vietnam combat veterans who have DSM-IV PTSD. In 8 to 16 sessions, 10 male patients were exposed to 2 virtual environments: a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. RESULTS Clinician-rated PTSD symptoms as measured by the Clinician Administered PTSD Scale, the primary outcome measure, at 6-month follow-up indicated an overall statistically significant reduction from baseline (p = .0021) in symptoms associated with specific reported traumatic experiences. All 8 participants interviewed at the 6-month follow-up reported reductions in PTSD symptoms ranging from 15% to 67%. Significant decreases were seen in all 3 symptom clusters (p < .02). Patient self-reported intrusion symptoms as measured by the Impact of Event Scale were significantly lower (p < .05) at 3 months than at baseline but not at 6 months, although there was a clear trend toward fewer intrusive thoughts and somewhat less avoidance. CONCLUSION Virtual reality exposure therapy holds promise for treating PTSD in Vietnam veterans.