Faculty Bibliography

We designed this study to assess if surgical safety can be improved by intraoperative use of intraocular lens (IOL) for cataract phacoemulsification. We performed phacoemulsification cataract removal on 401 patients. We randomly assigned these patients into three groups: the standard setting (Group I, n = 134), with reduced vacuum and flow rate (Group II, n = 137), and with IOL insertion before the last quadrant was emulsified with standard setting (Group III, n = 130). The primary outcomes included the risk of posterior capsular rupture (PCR), ultrasound time, energy, and complications. The secondary outcomes included central corneal thickness (CCT), CCT changes, endothelial cells (ETC) counting, ETC loss, and the best corrected distance visual acuity (BCVA) measured on day 1, day 7 and day 30. If PCR occurred, we emulsified the residual lens materials after insertion of IOL and clean of the prolapsed vitreous. We found that the risk of PCR in Group III (0/130) was lower than Group I (9/134, corrected relative risk (RR) = 18.44, 95% CI: 1.08-313.56) and Group II (3/137, corrected RR = 6.64, 95% CI: 0.35-27.41). Group III showed better BCVA on day 1 and 7, less ECC loss on day 7 and 30, and less CCT increase on day 1 and 7. No cases converted to extracapsular cataract extraction. No residual lens materials misdirected into vitreous cavity. Intraoperative use of IOL can improve surgical safety for dense cataract phacoemulsification.

In recent years, real-world studies (RWS) are gaining increasing interests, because they can generate more realistic and generalizable results than randomized controlled clinical trials (RCT). In 2017, we published a RCT in 741 early childhood care and education providers (CCPs). It is the Phase I of our iLookOut for Child Abuse project (iLookOut), an online, interactive learning module about reporting suspected child maltreatment. That study demonstrated that in a RCT setting, the iLookOut is efficient at improving CCPs' knowledge of and attitudes towards child maltreatment reporting. However, the generalizability of that RCT's results in a RWS setting remains unknown. To address this question, we design and conduct this large RWS in 11,065 CCPs, which is the Phase II of the iLookOut. We hypothesize replication of the earlier RCT findings, i.e., the iLookOut can improve CCPs' knowledge of and attitudes toward child maltreatment reporting in a real world setting. In addition, this RWS also explores whether demographic factors affect CCPs' performance. Results of this RWS confirmed the generalizability of the previous RCT's results in a real world setting. It yielded similar effect sizes for knowledge and attitudes as were found in the earlier RCT. Cohen's d for knowledge improvement was 0.95 in that RCT, 0.96 in this RWS; Cohen's d for attitude improvement was 0.98 in that RCT, 0.80 in this RWS. Also, we found several significant differences in knowledge and attitude improvement with regard to age, race, education, and employment status. In conclusion, iLookOut improves knowledge and attitudes of CCPs about child maltreatment prevention and reporting in a real-world setting. The generalizability of the initial RCT findings to this RWS provides strong evidence that the iLookout will be effective in other real world settings. It can be a useful model for other interventions aimed at preventing child maltreatment. Clinical trial registration for the original RCT: NCT02225301 (ClinicalTrials.gov Identifier).

BACKGROUND/UNASSIGNED:Children's oral health-related quality of life (COHQoL) measures are well known and widely used. However, rigorous systematic reviews of these measures and analyses of their quality are in absence. OBJECTIVES/UNASSIGNED:To systematically review and quantitatively assess the quality of COHQoL measures through a scoping review. DATA SOURCES/UNASSIGNED:Systematic literature search of PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE (Excerpta Medica database), HaPI (Health and Psychosocial Instruments), and DOSS (Dentistry and Oral Sciences Source). STUDY ELIGIBILITY/UNASSIGNED:The measure's focus was COHQoL; the child age ranged from 5 to 14 years; the publication was either a research article or a systematic review and related to caries; and it was written in English or had an English abstract. Two authors independently selected the studies. Disagreements were reconciled by group discussions with a third author. APPRAISAL/UNASSIGNED:The International Society for Quality of Life Research minimum standards for patient-reported outcome measures were used for quality appraisal. SYNTHESIS/UNASSIGNED:Descriptive analysis. RESULTS/UNASSIGNED:We identified 18 measures. Their quality scores ranged from 9.5 to 15.0 on a scale of 16. The quality appeared to bear no relationship to the citation and use of these measures. However, elements of these measures might be more useful than others, depending on the age-specific use and primary quality concerns. LIMITATIONS/UNASSIGNED:Some of the information on the minimum standards of the 18 measures cannot be found in the existing literature. Measures published without English abstract were not searched. CONCLUSIONS/UNASSIGNED:The quality of these measures is suboptimal. Researchers and practitioners in this field should exercise caution when choosing and using these measures. Efforts at improving the quality of the COHQoL measures, such as refining existing ones or developing new measures, are warranted. KNOWLEDGE TRANSFER STATEMENT/UNASSIGNED:Researchers, clinician scientists, and clinicians can use the results of this study when deciding which oral health-related quality of life measure they wish to use in children.

Objective: To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression. Methods: In this study, we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology, Tongji Medical College, Huazhong University of Science and Technology from May to September, 2018. The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n = 150), and those who were not to the control group (n = 150). Labor duration and delivery outcomes were analyzed by Student's t test, Mann-Whitney U test, Chi-square test, and Fisher's exact test. Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration. Results: The median durations of first- and second-stage labor in the epidural group were 600 (400 - 840) and 66 (45 - 98) min, respectively, which were significantly longer than those of the control group [420 (320 - 610) and 52 (33 - 87) min] (z = -4.273, p < 0.001; z = -3.210, p = 0.001). Quantile regression analysis showed that, for the first stage of labor, epidural analgesia was associated with labor prolongation, and had significant effects on all the percentiles (all p < 0.05). The regression coefficients increased (95.630 - 285.000) correspondingly as the percentiles of the labor duration (from 10th to 90th percentiles) increased. For the second stage of labor, epidural analgesia showed a significant impact on prolongation only between the 25th and 75th percentiles (coefficients: 10.000 - 18.143; all p < 0.05). Although the epidural group had a significant higher episiotomy rate [46.8ï¼… (65/139) vs. 33.3ï¼… (48/144), Chi-square = 5.318, p = 0.02l], more times of urine catheterization during labor [1(0-1) vs. 0 (0-1), z = -0.974, p = 0.001] and higher rate of oxytocin administration during labor [48.7ï¼… (73/150) vs. 30.0ï¼… (45/150), Chi-square = 10.952, p = 0.001] when compared with the control group, there was no significant difference in cesarean section rate, assisted vaginal delivery rate, and neonatal outcomes between the two groups (all p > 0.05). Conclusion: Epidural analgesia may be associated with the prolongation of the first and second stage of labor, especially with the first stage of labor, but has no adverse effects on maternal and neonatal outcomes

BACKGROUND:Home blood pressure monitoring (HBPM) is cited as an effective approach for improving blood pressure control. The objective of this study was to determine the effectiveness of HBPM combined with a health education session in reducing blood pressure and improving medication adherence among adults with hypertension. METHODS:Two hundred and thirteen participants were enrolled in a 3-month study and randomized to receive home blood pressure monitoring or usual care. Participants were also randomized to receive an educational session delivered using a pamphlet or a computer-based program. Topics of the educational session included preventing hypertension, weight management, staying active, and cutting down on salt and fat. RESULTS:At the 3 month follow-up there was a reduction in ambulatory blood pressure among the HBPM group. However, the differences found within the HBPM group were no greater than those found among the control group. We did not detect a statistically significant difference in adherence to medication when comparing the HBPM to the usual care group. CONCLUSIONS:HBPM and educational session did not lower blood pressure or improve medication adherence in our sample. A greater effect may have been seen if coupled with an enhanced educational intervention and if blood pressure measures were shared with the provided. The findings of this study provides useful insights for future HBPM studies.

BACKGROUND:Optimizing recruitment efficiency is an important strategy to address the resource limitations that typically constrain clinical research. Surprisingly, little empiric data exist to guide research teams attempting to recruit a difficult population into similar studies. Our objective was to investigate factors associated with enrollment into an advance care planning interventional trial. METHODS:This study used secondary data of patients with advanced cancer receiving treatment at an academic medical center in central Pennsylvania who were referred to a randomized controlled trial of an advance care planning intervention. Enrolled participants were compared to nonparticipants with regard to age, gender, race, season of recruitment, elapsed time between recruitment stage, distance to study site, and number of recruitment calls. RESULTS:Of the 1988 patients referred, 200 participants were enrolled yielding a recruitment efficiency of 10%. Two-thirds of all enrolled participants were recruited with 1 or less phone calls, whereas only 5% were enrolled after 3 calls. There were no statistically significant differences in enrollment based on gender ( P = .88) or elapsed time between recruitment contacts ( P = .22). However, nonparticipants were slightly older ( P = .02). CONCLUSIONS:Our finding that individuals were more likely to enroll within the first 3 phone calls suggests that recruitment efforts should be focused on making initial contacts with potential participants, rather than continuing attempts to those who are unable to be contacted easily. Researchers could optimize their recruitment strategy by periodically performing similar analyses, comparing differences between participants and nonparticipants.

Background: Psychometric instruments such as the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) are commonly used under conditions for which they were not developed or validated. They may then generate troublesome data that could conceal potential findings. Methods: Based on a previously published refinement of the RBANS, we reanalyzed the data on 303 patients from two National Institutes of Health (NIH) trails in Parkinson’s disease and contrasted the results using the original versus refined scores. Results: Findings from the original RBANS scores were inconsistent; however, use of the refined scores produced potential findings that were in agreement with independent reports. Conclusion: This study demonstrates that, for negative trials using instrument scores as primary outcomes, it is possible to rescue potential findings. The key to this new strategy is to validate and refine the instrument for the specific disease and conditions under study and then to reanalyze the data. This study offers a demonstration of this new strategy for general approaches