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[PMID]:29403333
[Au] Autor:Leffler CT; Letocha CE; Pierson K; Schwartz SG
[Ad] Endereço:Department of Ophthalmology, Virginia Commonwealth University, Richmond.
[Ti] Título:Aspiration of cataract in 1815 in Philadelphia, Pennsylvania.
[So] Source:Digit J Ophthalmol;23(4):4-7, 2017.
[Is] ISSN:1542-8958
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We present and discuss the previously unrecognized evidence for the possible introduction of cataract extraction by aspiration into modern Western medicine on March 26, 1815, in Philadelphia, Pennsylvania, by surgeon Philip Syng Physick. On this date, he successfully extracted a cataract by suction through a tube, according to newspaper reports written by the patient, an attorney who sought a patent on the suction device. Aspects of the patient's account are confirmed by supporting evidence from the medical community and by a cataract instrument set attributed to Physick, which includes a cannula attached to a syringe. The evidence suggests that Physick was the first to reintroduce cataract aspiration to Western medicine.
[Mh] Termos MeSH primário: Extração de Catarata/história
Catarata/história
[Mh] Termos MeSH secundário: História do Século XIX
Seres Humanos
Philadelphia
Sucção/história
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE; PORTRAITS
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180207
[St] Status:MEDLINE
[do] DOI:10.5693/djo.01.2017.10.001


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[PMID]:29284026
[Au] Autor:Arenas DJ; Lett LA; Klusaritz H; Teitelman AM
[Ad] Endereço:Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
[Ti] Título:A Monte Carlo simulation approach for estimating the health and economic impact of interventions provided at a student-run clinic.
[So] Source:PLoS One;12(12):e0189718, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Student Run Clinics (SRCs) are a common aspect of medical education, present at more than half of US medical schools, and noted for providing care to communities that might otherwise lack access, including the uninsured and underinsured. To date, few studies have rigorously quantified the health and economic benefits of SRCs, and the present study remedies that. METHODS AND FINDINGS: We used Monte Carlo simulations to estimate the health impact of common preventive health interventions applied to individuals in quality-adjusted life-years (QALYs). We then used those measurements to estimate the health and economic impact of United Community Clinic (UCC), a student-run clinic in Philadelphia, PA. We found that with an annual operating budget of $50,000, UCC saves 6.5 QALYs, corresponding to over $850,000 saved. CONCLUSIONS: Using Monte Carlo simulation methods, the health and economic impact of SRCs can be reasonably estimated to demonstrate the utility of SRCs and justify their growing importance in the healthcare delivery landscape of the US.
[Mh] Termos MeSH primário: Instituições de Assistência Ambulatorial/organização & administração
Educação Médica/organização & administração
Método de Monte Carlo
Estudantes de Medicina
[Mh] Termos MeSH secundário: Instituições de Assistência Ambulatorial/economia
Seres Humanos
Philadelphia
Serviços Preventivos de Saúde/economia
Serviços Preventivos de Saúde/organização & administração
Anos de Vida Ajustados por Qualidade de Vida
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171229
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189718


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[PMID]:25816386
[Au] Autor:Margolies R; Gurnaney H; Egeth M; Fink N; Soosaar J; Shames A; Rehman M
[Ad] Endereço:Core Human Factors, Inc., Bala Cynwyd, PA, USA rebecca@corehf.com.
[Ti] Título:Positioning patient status monitors in a family waiting room.
[So] Source:HERD;8(2):103-9, 2015.
[Is] ISSN:1937-5867
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine where to place patient status displays for family members in the operating room family waiting room at The Children's Hospital of Philadelphia. METHODS: We calculated the percentage of seats from which wall monitors placed in hypothetical positions would be usable. We validated the usability of the new monitors by observing nonemployees' use of monitors in the waiting room 1 week before and 1 week after implementation. RESULTS: Compared to the legacy monitor, the new monitors were observed to be used from more locations within the waiting room and more people were observed to use the new monitors soon after entering the waiting room. CONCLUSIONS: Seemingly trivial decisions like where in a waiting room to place monitors can be informed by careful data collection and the consequences can observably impact communication between hospital staff and family members waiting for loved ones in surgery.
[Mh] Termos MeSH primário: Criança Hospitalizada
Terminais de Computador/normas
Família/psicologia
Monitorização Fisiológica/métodos
Sistemas de Informação em Salas Cirúrgicas/organização & administração
Relações Profissional-Família
[Mh] Termos MeSH secundário: Criança
Comunicação
Coleta de Dados
Ambiente de Instituições de Saúde
Hospitais Pediátricos
Seres Humanos
Monitorização Fisiológica/normas
Sistemas de Informação em Salas Cirúrgicas/normas
Philadelphia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150328
[St] Status:MEDLINE
[do] DOI:10.1177/1937586714566407


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[PMID]:29183535
[Au] Autor:Walker TR; Cowan SW; Yeo CJ; Beekley AC
[Ti] Título:Major General Malcolm C. Grow, M.D. (1887-1960) Soldier, Surgeon, Airman.
[So] Source:Am Surg;83(11):1298-1301, 2017 Nov 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:World War I (WWI) and World War II (WWII) both presented physicians with challenges unseen before in history. New inventions such as the machine gun and poisonous gas in WWI and the massive aircraft battles in WWII required physicians and surgeons to adapt and innovate to provide the best care and preventative measures for service members. One physician, Malcolm Cummings Grow, distinguished himself as an innovator, a researcher, and a leader. His contributions to the field of military medicine, flight surgery, and medical administration led to countless lives being saved during the two World Wars and laid the groundwork for many different combat protective equipment still in use today.
[Mh] Termos MeSH primário: Cirurgia Geral/história
Medicina Militar/história
[Mh] Termos MeSH secundário: Medicina Aeroespacial/história
História do Século XX
Equipamento de Proteção Individual/história
Philadelphia
Estados Unidos
I Guerra Mundial
II Guerra Mundial
[Pt] Tipo de publicação:BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE; PORTRAITS
[Ps] Nome de pessoa como assunto:Grow MC
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171204
[Lr] Data última revisão:
171204
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171130
[St] Status:MEDLINE


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[PMID]:28885425
[Au] Autor:Akers AY; Steinway C; Sonalkar S; Perriera LK; Schreiber C; Harding J; Garcia-Espana JF
[Ad] Endereço:Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia Research Institute, PolicyLab, Roberts Center for Pediatric Research, the Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania.
[Ti] Título:Reducing Pain During Intrauterine Device Insertion: A Randomized Controlled Trial in Adolescents and Young Women.
[So] Source:Obstet Gynecol;130(4):795-802, 2017 Oct.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To estimate the effect of a 1% lidocaine paracervical nerve block on pain during intrauterine device (IUD) insertion compared with a sham block in adolescents and young women. METHODS: We conducted a multisite, single-blind, sham-controlled randomized trial in adolescents and young women having a 13.5-mg levonorgestrel IUD inserted. Enrollment occurred at three family planning clinics in Philadelphia, Pennsylvania. Eligible adolescents and young women were aged 14-22 years, nulliparous, not currently or recently pregnant, and English-speaking. Participants were randomized using computer-generated allocation in block sizes of four to receive a 10-mL 1% lidocaine paracervical block or a sham block (1 cm depression of the vaginal epithelium at paracervical block sites with a wooden cotton-tipped applicator). Only patients were blinded. The primary outcome was pain after IUD insertion measured with a 100-mm visual analog scale. Using a two-sided t test and assuming a 20-mm difference in visual analog scale scores, a SD of 28 mm, an α of 0.05, and 90% power, a sample of 43 participants per group was estimated. RESULTS: Between March 2015 and July 2016, 95 participants enrolled (47 lidocaine block group; 48 sham block group). All were included in the analysis. Forty-four percent were white, 36% black, 65% privately insured, and 79% previously used contraception. The median visual analog scale score after IUD insertion was 30.0 (95% CI 20.0-58.0) in the lidocaine block group and 71.5 (95% CI 66.0-82.0) in the sham block (P<.001). CONCLUSION: A 10-mL 1% lidocaine paracervical nerve block reduces pain during IUD insertion in adolescents and young women compared with a sham block with pressure on the vaginal epithelium. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02352714.
[Mh] Termos MeSH primário: Anestésicos Locais/administração & dosagem
Dispositivos Intrauterinos Medicados/efeitos adversos
Lidocaína/administração & dosagem
Dor Pélvica/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Serviços de Saúde do Adolescente
Feminino
Seres Humanos
Injeções
Medição da Dor
Dor Pélvica/etiologia
Philadelphia
Método Simples-Cego
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Local); 98PI200987 (Lidocaine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002242


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[PMID]:28873224
[Au] Autor:Ilowite MF; Cronin AM; Kang TI; Mack JW
[Ad] Endereço:Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
[Ti] Título:Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity.
[So] Source:Cancer;123(20):3995-4003, 2017 Oct 15.
[Is] ISSN:1097-0142
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Most parents of children with cancer say they want detailed information about their child's prognosis. However, prior work has been conducted in populations of limited diversity. The authors sought to evaluate the impact of parental race/ethnicity on prognosis communication experiences among parents of children with cancer. METHODS: In total, 357 parents of children with cancer and the children's physicians were surveyed at Dana-Farber Cancer Institute/Boston Children's Hospital and Children's Hospital of Philadelphia. Outcome measures were parental preferences for prognostic information, physician beliefs about parental preferences, prognosis communication processes, and communication outcomes. Associations were assessed by logistic regression with generalized estimating equations to correct for physician clustering. RESULTS: Two hundred eighty-one parents (79%) were white, 23 (6%) were black, 29 (8%) were Hispanic, and 24 (7%) were Asian/other. Eighty-seven percent of parents wanted as much detail as possible about their child's prognosis, with no significant differences by race/ethnicity (P = .75). However, physician beliefs about parental preferences for prognosis communication varied based on parent race/ethnicity, with physicians considering black and Hispanic parents less interested in details about prognosis than whites (P = .003). Accurate understanding of a less favorable prognosis was greater among white (49%) versus nonwhite parents (range, 20%-29%), although this difference was not statistically significant (P = .14). CONCLUSIONS: Most parents, regardless of racial and ethnic background, want detailed prognostic information about their child's cancer. However, physicians underestimate the information needs of black and Hispanic parents. To meet parents' information needs, physicians should ask about parents' information preferences before prognosis discussions. Cancer 2017;123:3995-4003. © 2017 American Cancer Society.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Comunicação
Neoplasias
Pais
Preferência do Paciente
Relações Médico-Paciente
Médicos
Revelação da Verdade
[Mh] Termos MeSH secundário: Adolescente
Adulto
Grupo com Ancestrais do Continente Africano
Americanos Asiáticos
Boston
Criança
Pré-Escolar
Grupo com Ancestrais do Continente Europeu
Feminino
Hispano-Americanos
Seres Humanos
Lactente
Recém-Nascido
Masculino
Meia-Idade
Philadelphia
Prognóstico
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE
[do] DOI:10.1002/cncr.30960


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[PMID]:28817334
[Au] Autor:Kangovi S; Mitra N; Grande D; Huo H; Smith RA; Long JA
[Ad] Endereço:Shreya Kangovi, David Grande, Hairong Huo, Robyn A. Smith, and Judith A. Long are with Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia. Nandita Mitra is with Perelman School of Medicine, University of Pennsylvania, Department of Biostatist
[Ti] Título:Community Health Worker Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial.
[So] Source:Am J Public Health;107(10):1660-1667, 2017 Oct.
[Is] ISSN:1541-0048
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions. METHODS: We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013-2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences. RESULTS: Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: -0.4 vs 0.0; body mass index: -0.3 vs -0.1; cigarettes per day: -5.5 vs -1.3; systolic blood pressure: -1.8 vs -11.2; overall P = .08), self-rated mental health (12-item Short Form survey; 2.3 vs -0.2; P = .008), and quality of care (Consumer Assessment of Healthcare Providers and Systems; 62.9% vs 38%; P < .001), while reducing hospitalization at 1 year by 28% (P = .11). There were no differences in patient activation or self-rated physical health. CONCLUSIONS: A standardized CHW intervention improved chronic disease control, mental health, quality of care, and hospitalizations and could be a useful population health management tool for health care systems. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01900470.
[Mh] Termos MeSH primário: Agentes Comunitários de Saúde/organização & administração
Saúde Mental
Múltiplas Afecções Crônicas/terapia
Pobreza
Populações Vulneráveis
[Mh] Termos MeSH secundário: Adulto
Idoso
Pressão Sanguínea
Índice de Massa Corporal
Feminino
Hemoglobina A Glicada/análise
Nível de Saúde
Seres Humanos
Masculino
Meia-Idade
Philadelphia
Qualidade da Assistência à Saúde/organização & administração
Método Simples-Cego
Fumar/epidemiologia
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Glycated Hemoglobin A)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE
[do] DOI:10.2105/AJPH.2017.303985


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[PMID]:28715553
[Au] Autor:Binenbaum G; Ying GS; Tomlinson LA; Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study Group
[Ad] Endereço:Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
[Ti] Título:Validation of the Children's Hospital of Philadelphia Retinopathy of Prematurity (CHOP ROP) Model.
[So] Source:JAMA Ophthalmol;135(8):871-877, 2017 Aug 01.
[Is] ISSN:2168-6173
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The Children's Hospital of Philadelphia Retinopathy of Prematurity (CHOP ROP) model uses birth weight (BW), gestational age at birth (GA), and weight gain rate to predict the risk of severe retinopathy of prematurity (ROP). In a model development study, it predicted all infants requiring treatment, while greatly reducing the number of examinations compared with current screening guidelines. Objective: To validate the CHOP ROP model in a multicenter cohort that is large enough to obtain a precise estimate of the model's sensitivity for treatment-requiring ROP. Design, Setting, and Participants: This investigation was a secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study. The setting was 30 hospitals in the United States and Canada between January 1, 2006, and June 30, 2012. The dates of analysis were September 28 to October 5, 2015. Participants were premature infants at risk for ROP with a known ROP outcome. Main Outcomes and Measures: Sensitivity for Early Treatment of Retinopathy of Prematurity type 1 ROP and potential reduction in the number of infants requiring examinations. In the primary analysis, the CHOP ROP model was applied weekly to predict the risk of ROP. If the risk was above a cut-point level (high risk), examinations were indicated, while low-risk infants received no examinations. In a secondary analysis, low-risk infants received fewer examinations rather than no examinations. Results: Participants included 7483 premature infants at risk for ROP with a known ROP outcome. Their median BW was 1070 g (range, 310-3000 g), and their median GA was 28 weeks (range, 22-35 weeks). Among them, 3575 (47.8%) were female, and their race/ethnicity was 3615 white (48.3%), 2310 black (30.9%), 233 Asian (3.1%), 93 Pacific Islander (1.2%), and 40 American Indian/Alaskan native (0.5%). The original CHOP ROP model correctly predicted 452 of 459 infants who developed type 1 ROP (sensitivity, 98.5%; 95% CI, 96.9%-99.3%), reducing the number of infants requiring examinations by 34.3% if only high-risk infants received examinations. Lowering the cut point to capture all type 1 ROP cases (sensitivity, 100%; 95% CI, 99.2%-100%) resulted in only 6.8% of infants not requiring examinations. However, if low-risk infants were examined at 37 weeks' postmenstrual age and followed up only if ROP was present at that examination, all type 1 ROP cases would be captured, and the number of examinations performed among infants with GA exceeding 27 weeks would be reduced by 28.4%. Conclusion and Relevance: The CHOP ROP model demonstrated high but not 100% sensitivity and may be better used to reduce examination frequency. The model might be used reliably to guide a modified ROP screening schedule and decrease the number of examinations performed.
[Mh] Termos MeSH primário: Peso ao Nascer/fisiologia
Idade Gestacional
Hospitais Pediátricos
Modelos Logísticos
Retinopatia da Prematuridade/diagnóstico
Ganho de Peso/fisiologia
[Mh] Termos MeSH secundário: Estudos de Coortes
Grupos Étnicos
Feminino
Seres Humanos
Lactente
Recém-Nascido
Recém-Nascido Prematuro
Masculino
Philadelphia
Retinopatia da Prematuridade/fisiopatologia
Retinopatia da Prematuridade/terapia
Estudos Retrospectivos
Fatores de Risco
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; VALIDATION STUDIES
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170718
[St] Status:MEDLINE
[do] DOI:10.1001/jamaophthalmol.2017.2295


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[PMID]:28692393
[Au] Autor:Gevitz K; Madera R; Newbern C; Lojo J; Johnson CC
[Ad] Endereço:1 Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA, USA.
[Ti] Título:Risk of Fall-Related Injury due to Adverse Weather Events, Philadelphia, Pennsylvania, 2006-2011.
[So] Source:Public Health Rep;132(1_suppl):53S-58S, 2017 Jul/Aug.
[Is] ISSN:1468-2877
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Following a surge in fall-related visits to local hospital emergency departments (EDs) after a severe ice storm, the Philadelphia Department of Public Health examined the association between inclement winter weather events and fall-related ED visits during a 5-year period. METHODS: Using a standardized set of keywords, we identified fall-related injuries in ED chief complaint logs submitted as part of Philadelphia Department of Public Health's syndromic surveillance from December 2006 through March 2011. We compared days when falls exceeded the winter fall threshold (ie, "high-fall days") with control days within the same winter season. We then conducted matched case-control analysis to identify weather and patient characteristics related to increased fall-related ED visits. RESULTS: Fifteen high-fall days occurred during winter months in the 5-year period. In multivariable analysis, 18- to 64-year-olds were twice as likely to receive ED care for fall-related injuries on high-fall days than on control days. The crude odds of ED visits occurring from 7:00 am to 10:59 am were 70% higher on high-fall days vs control days. Snow was a predictor of a high-fall day: the adjusted odds of snow before a high-fall day as compared with snow before a control day was 13.4. CONCLUSIONS: The association between the number of fall-related ED visits and weather-related fall injuries, age, and timing suggests that many events occurred en route to work in the morning. Promoting work closures or delaying openings after severe winter weather would allow time for better snow or ice removal, and including "fall risk" in winter weather advisories might effectively warn morning commuters. Both strategies could help reduce the number of weather-related fall injuries.
[Mh] Termos MeSH primário: Acidentes por Quedas/estatística & dados numéricos
Serviço Hospitalar de Emergência/estatística & dados numéricos
Neve
[Mh] Termos MeSH secundário: Fatores Etários
Serviço Hospitalar de Emergência/organização & administração
Seres Humanos
Philadelphia
Vigilância da População/métodos
Risco
Estações do Ano
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170711
[St] Status:MEDLINE
[do] DOI:10.1177/0033354917706968


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[PMID]:28673747
[Au] Autor:Hark LA; Katz LJ; Myers JS; Waisbourd M; Johnson D; Pizzi LT; Leiby BE; Fudemberg SJ; Mantravadi AV; Henderer JD; Zhan T; Molineaux J; Doyle V; Divers M; Burns C; Murchison AP; Reber S; Resende A; Bui TDV; Lee J; Crews JE; Saaddine JB; Lee PP; Pasquale LR; Haller JA
[Ad] Endereço:Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Columbia University Medical Center, New York, NY. Electronic address: lhark@will
[Ti] Título:Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Methods and Screening Results.
[So] Source:Am J Ophthalmol;181:114-124, 2017 Sep.
[Is] ISSN:1879-1891
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. DESIGN: Screening program results for a prospective randomized clinical trial. METHODS: Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; white individuals over age 65 years; and any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a nonmydriatic, autofocus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICare rebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist. RESULTS: From April 1, 2015, to February 6, 2017, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African-American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve, 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy, and 68 (7.5%) had other retinal abnormalities. CONCLUSION: An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology.
[Mh] Termos MeSH primário: Técnicas de Diagnóstico Oftalmológico
Glaucoma de Ângulo Aberto/diagnóstico
Doenças do Nervo Óptico/diagnóstico
Telemedicina/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Pressão Sanguínea
Índice de Massa Corporal
Serviços de Saúde Comunitária/organização & administração
Feminino
Seguimentos
Glaucoma de Ângulo Aberto/epidemiologia
Hemoglobina A Glicada/metabolismo
Seres Humanos
Pressão Intraocular/fisiologia
Masculino
Meia-Idade
Hipertensão Ocular/diagnóstico
Hipertensão Ocular/epidemiologia
Doenças do Nervo Óptico/epidemiologia
Philadelphia/epidemiologia
Médicos de Atenção Primária/organização & administração
Estudos Prospectivos
Tonometria Ocular
Acuidade Visual/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Glycated Hemoglobin A); 0 (hemoglobin A1c protein, human)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170705
[St] Status:MEDLINE



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