Use of flucinolone acetonide for patients with diabetic macular oedema:patient selection criteria and early outcomes in real world setting

Introduction: Fluocinolone acetonide slow release implant (Iluvien®) was approved in December 2013 in UK for treatment of eyes which are pseudophakic with DMO that is unresponsive to other available therapies. This approval was based on evidence from FAME trials which were conducted at a time when ranibizumab was not available. There is a paucity of data on implementation of guidance on selecting patients for this treatment modality and also on the real world outcome of fluocinolone therapy especially in those patients that have been unresponsive to ranibizumab therapy. Method: Retrospective study of consecutive patients treated with fluocinolone between January and August 2014 at three sites were included to evaluate selection criteria used, baseline characteristics and clinical outcomes at 3-month time point. Results: Twenty two pseudophakic eyes of 22 consecutive patients were included. Majority of patients had prior therapy with multiple intravitreal anti-VEGF injections. Four eyes had controlled glaucoma. At baseline mean VA and CRT were 50.7 letters and 631 μm respectively. After 3 months, 18 patients had improved CRT of which 15 of them also had improved VA. No adverse effects were noted. One additional patient required IOP lowering medication. Despite being unresponsive to multiple prior therapies including laser and anti-VEGF injections, switching to fluocinolone achieved treatment benefit. Conclusion: The patient level selection criteria proposed by NICE guidance on fluocinolone appeared to be implemented. This data from this study provides new evidence on early outcomes following fluocinolone therapy in eyes with DMO which had not responded to laser and other intravitreal agents.

Accommodative changes produced in response to overnight orthokeratology

Background To evaluate short-term (3 months) and long-term (3 years) accommodative changes produced by overnight orthokeratology (OK). Methods A prospective, longitudinal study on young adult subjects with low to moderate myopia was carried out. A total of 93 patients took part in the study. Out of these, 72 were enrolled into the short-term follow-up: 21 were on a control group, 26 on a Paragon CRT contact lenses group, and 25 on a Seefree contact lenses group. The other 21 patients were old CRT wearers on long-term follow-up. Accommodative function was assessed by means of negative and positive relative accommodation (NRA / PRA), monocular accommodative amplitude (MAA), accommodative lag, and monocular accommodative facility (MAF). These values were compared among the three short-term groups at the follow-up visit. The long- and short-term follow-up data was compared among the CRT groups. Results Subjective accommodative results did not suffer any statistically significant changes in any of the accommodative tests for any of the short-term groups when compared to baseline. There were no statistically significant differences between the three short-term groups at the follow-up visit. When comparing the short- and long-term groups, only the NRA showed a significant difference (p = 0.0006) among all the accommodation tests. Conclusions OK does not induce changes in the ocular accommodative function for either short-term or long-term periods.

Systems 1 and 2 thinking processes and cognitive reflection testing in medical students

Background: Diagnostic decision-making is made through a combination of Systems 1 (intuition or pattern-recognition) and Systems 2 (analytic) thinking. The purpose of this study was to use the Cognitive Reflection Test (CRT) to evaluate and compare the level of Systems 1 and 2 thinking among medical students in pre-clinical and clinical programs. Methods: The CRT is a three-question test designed to measure the ability of respondents to activate metacognitive processes and switch to System 2 (analytic) thinking where System 1 (intuitive) thinking would lead them astray. Each CRT question has a correct analytical (System 2) answer and an incorrect intuitive (System 1) answer. A group of medical students in Years 2 & 3 (pre-clinical) and Years 4 (in clinical practice) of a 5-year medical degree were studied. Results: Ten percent (13/128) of students had the intuitive answers to the three questions (suggesting they generally relied on System 1 thinking) while almost half (44%) answered all three correctly (indicating full analytical, System 2 thinking). Only 3-13% had incorrect answers (i.e. that were neither the analytical nor the intuitive responses). Non-native English speaking students (n = 11) had a lower mean number of correct answers compared to native English speakers (n = 117: 1.0 s 2.12 respectfully: p < 0.01). As students progressed through questions 1 to 3, the percentage of correct System 2 answers increased and the percentage of intuitive answers decreased in both the pre-clinical and clinical students. Conclusions: Up to half of the medical students demonstrated full or partial reliance on System 1 (intuitive) thinking in response to these analytical questions. While their CRT performance has no claims to make as to their future expertise as clinicians, the test may be used in helping students to understand the importance of awareness and regulation of their thinking processes in clinical practice.

El efecto de la definición regulatoria de banda ancha sobre la difusión y la competencia del mercado de servicios de Internet fijo en Colombia

A partir de la dinámica evolutiva de la economía de las Tecnologías de la Información y las Comunicaciones y el establecimiento de estándares mínimos de velocidad en distintos contextos regulatorios a nivel mundial, en particular en Colombia, en el presente artículo se presentan diversas aproximaciones empíricas para evaluar los efectos reales que conlleva el establecimiento de definiciones de servicios de banda ancha en el mercado de Internet fijo. Con base en los datos disponibles para Colombia sobre los planes de servicios de Internet fijo ofrecidos durante el periodo 2006-2012, se estima para los segmentos residencial y corporativo el proceso de difusión logístico modificado y el modelo de interacción estratégica para identificar los impactos generados sobre la masificación del servicio a nivel municipal y sobre las decisiones estratégicas que adoptan los operadores, respectivamente. Respecto a los resultados, se encuentra, por una parte, que las dos medidas regulatorias establecidas en Colombia en 2008 y 2010 presentan efectos significativos y positivos sobre el desplazamiento y el crecimiento de los procesos de difusión a nivel municipal. Por otra parte, se observa sustituibilidad estratégica en las decisiones de oferta de velocidad de descarga por parte de los operadores corporativos mientras que, a partir del análisis de distanciamiento de la velocidad ofrecida respecto al estándar mínimo de banda ancha, se demuestra que los proveedores de servicios residenciales tienden a agrupar sus decisiones de velocidad alrededor de los niveles establecidos por regulación.

Hallazgos tomográficos como predictores del resultado funcional en edema macular secundario a oclusiones venosas retinianas

INTRODUCCIÓN: El Edema Macular (EM) es la principal causa de perdida de agudeza visual en pacientes con Oclusión Venosa Retiniana (OVR); luego del tratamiento, algunos pacientes persisten con mala agudeza visual. OBJETIVO: Realizar una Revisión Sistemática de la Literatura (RSL), para identificar la evidencia existente sobre factores tomográficos que predicen el resultado visual en pacientes con EM secundario a OVR. FUENTE DE LA INFORMACIÓN: PUBMED, MEDLINE, EMBASE, LILACS, COCHRANE, literatura gris. SELECCIÓN DE LOS ESTUDIOS: Ensayos Clínicos Controlados (ECC) y estudios observacionales analíticos. EXTRACCIÓN Y SÍNTESIS DE LOS DATOS: Dos investigadores seleccionaron los artículos de forma independiente. Se realizó una síntesis cualitativa de la información siguiendo las recomendaciones de la declaración PRISMA 2009. MEDIDAS Y DESENLACE PRINCIPAL: Grosor Retiniano Central (GRC), integridad de Banda Elipsoide e Integridad de Membrana Limitante Externa (MLE), determinados por SD OCT. El desenlace principal es la Agudeza Visual Mejor Corregida (AVMC) a los 6, 12,18 y/o 24 meses. RESULTADOS: Se identificaron 872 abstract y se incluyeron 8 artículos en el análisis cualitativo. Seis estudios evaluaron el GRC sin encontrar asociación con resultado visual final. Solo 2 estudios evaluaron y encontraron asociación estadísticamente significativa de la integridad de la MLE con el desenlace visual, Kang, H 2012 (r2 0,51 p 0,000), Rodriguez, F 2014 (p< 0,001). La integridad de la BE fue asociada a pronostico visual en 4 de 5 estudios que evaluaron esta variable, con resultados estadísticamente significativos. La AVMC de base también se asocio con desenlace visual en 4 de 5 estudios que la evaluaron. El mejor modelo que predice el resultado funcional según el estudio de Kang, H 2012 fue: Integridad de MLE, integridad de BE y AVMC de base (R2 0,671 p 0,000), a los 12 meses de seguimiento. CONCLUSION: La evidencia actual sugiere que la integridad de la BE y la MLE son predictores del resultados funcional en pacientes con EM secundario a OVR después de 6 o mas meses de seguimiento. Es necesario la realización de estudios controlados para llegar a resultados mas concluyentes.

Authentic Leadership Questionnaire: invariance between samples of Brazilian and Portuguese employees

The Authentic Leadership Questionnaire (ALQ) is used to assess authentic leadership (AL). Although ALQ is often used in empirical research, cross-cultural studies with this measure are scarce. Aiming to contribute to filling this gap, this study assesses the invariance of the ALQ measure between samples of Brazilian (N = 1019) and Portuguese (N = 842) employees. A multi-group confirmatory factor analysis was performed, and the results showed the invariance of the first- and second-order factor models between the Brazilian and Portuguese samples. The results are discussed considering their cultural setting, with the study’s limitations and future research directions being pointed out.

Analisi di un nuovo indice di predizione dell'efficacia della terapia di resincronizzazione cardiaca

Nella gestione dello scompenso cardiaco, uno dei trattamenti più efficaci è rappresentato dalla terapia di resincronizzazione cardiaca. Tuttavia, circa un terzo dei pazienti non risponde alla terapia. Al fine di raggiungere esiti migliori, l’identificazione precoce dei potenziali soggetti che rispondono o meno alla terapia, potrebbe giocare un ruolo importante. In questa panoramica si inserisce il progetto TRAJECTORIES, che cerca di predire la risposta alla terapia sulla base delle variazioni della geometria della traiettoria 3D percorsa dall'elettrodo stimolato pre- e post-attivazione del dispositivo. Attraverso risultati preliminari, è stata verificata l'ipotesi che il pacing modifichi in acuto la traiettoria del punto di stimolazione sull’elettrodo in seno coronarico, e secondariamente che le variazioni temporali quantitative della traiettoria siano correlate al processo di rimodellamento inverso del ventricolo sinistro nel medio termine. E’ stato osservato che, nei pazienti responders, la geometria spaziale della traiettoria 3D cambiava significativamente all’inizio del pacing, acquisendo uniforma più circolare e regolare. Nel presente lavoro di tesi, è stata analizzata la veridicità delle previsioni, mediante il confronto tra gli esiti predetti e i risultati volumetrici della CRT, al follow-up di sei mesi.