Acuity Levels Research Articles

Comparison of low-energy FLACS and conventional cataract surgery: meta-analysis and systematic review.

To systematically compare the effectiveness of conventional phacoemulsification surgery (CPS) and low-energy femtosecond laser-assisted cataract surgery (FLACS) in patients with cataract. Cataract surgery is a common procedure, and comparing different techniques such as CPS and low-energy FLACS is crucial for optimizing patient outcomes. The PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane library databases were searched for clinical trials. Outcomes of procedure time, effective phacoemulsification time, balanced salt solution usage, cumulative dissipated energy, mean change of corrected distance visual acuity, endothelial cells reduction, central corneal thickness (CCT), and aqueous cytokine level were evaluated. The effect measures were weighted mean differences with 95% CI. The protocol was registered at the Prospective Register for Systematic Reviews (registration number CRD42023420173). 11 studies were included in this meta-analysis, of which 1680 eyes were analyzed (637 eyes in the low-energy FLACS group and 1043 eyes in the CPS group). Low-energy FLACS demonstrated significantly fewer reductions in endothelial cell count at 6 months ( P < .001) compared with CPS. It also exhibited a shorter effective phacoemulsification time ( P < .001) and less balanced salt solution usage ( P < .001). However, there were no differences in cumulative dissipated energy, corrected distance visual acuity, CCT changes, or aqueous cytokine levels between the 2 groups. Both low-energy FLACS and CPS are effective in treating cataracts, but low-energy FLACS may offer advantages such as reduced phacoemulsification time and less endothelial cell loss.

Difficulties faced by Novice School Principals at Irbid Governorate Schools and the degree of effectiveness of strategies that they use to counter them

This study aimed at identifying the difficulties faced by novice school principals at schools of Irbid Governorate, and the degree of effectiveness of strategies that they use to counter them, in addition to determining whether or not there are statistically significant differences that could be attributed to the demographic characteristics and organizational variables. The study applied the descriptive methodology. A two-part questionnaire composed of (45) statements, was administered to (243) novice principals after verifying its validity and reliability. The findings revealed difficulties with different levels of acuity, and that novice principals use strategies with different levels of effectiveness. Only one statistically significant difference was revealed and could be attributed to level of school in favor of secondary schools. The study recommended that the first-year post appointment be considered as a part of to the induction period; linking training of novice principals to the strategy of the Ministry of Education and replicating the study in other governorates.

Impact of diabetes on visual acuity and its association with blood glucose levels in diabetic patients attending Murtala Muhammad Specialist Hospital, Kano, Nigeria

Diabetic retinopathy is a known complication of Diabetes, underscoring the need for regular eye examinations and glycemic control. The aim of the study was to assess visual acuity (VA), and Fasting blood glucose (FBG) among diabetic patients at Murtala Muhammad Specialist Hospital Kano. It was a cross-sectional observational study consisting of 60 participants; 30 Diabetic patients &amp; 30 non-diabetic patients (controls), aged 30-60 years. Data was collected using questionnaire and FBG measured using glucometer. Data was analyzed using SPSS version 25, considering a p-value of &lt;0.05 as statistically significant. Majority of the participants were aged 51-60, with most diabetics having the disease for 1-10 years. Diabetic patients exhibited severe visual impairment (VI) in both eyes, followed by moderate VI, contrasting with controls who mostly had normal VA. Significant differences were noted between controls and diabetics in terms of duration of diabetes (DOD), VA, and FBG, but not age. While no significant gender differences were found in age, VA, or DOD within diabetic and control groups. Female diabetics had slightly higher FBG levels than males. Also, a significant relationship was observed between DOD and VI in the right eye of diabetic patients. In conclusion, this study reveals that diabetic patients had a higher frequency and more severe VI compared to controls, with significantly elevated FBG. No significant differences in age, DOD, VA, or FBG levels between genders in both groups. However, the severity of VI increased with DOD in the right eye. This emphasizes the importance of regular eye examinations and improved glycemic control to minimize the risk of VI in diabetics.

Linguistic dissection of nursing handoffs: Implications for patient safety in varied-acuity hospital settings.

This study examines the intricate language and communication patterns of nurse-to-nurse handoffs across three units with varying patient acuity levels and nurse-patient ratios, seeking to identify linguistic factors that may affect the quality of information transfer and patient outcomes. A mixed-methods cross-sectional design. This study used the Nurse-to-Nurse Transition of Care Communication Model to explore the content and meaning of language in nursing handoffs within a large academic medical centre. Data were collected on three units through digital audio recordings of 20 handoffs between June and September 2022, which were transcribed and analysed using the Linguistic Inquiry Word Count programme. Trustworthiness was established by adhering to COREQ and STROBE guidelines for qualitative and quantitative research, respectively. Analysis revealed a preference for casual, narrative language across all units, with ICU nurses demonstrating a higher confidence and leadership in communication. Cognitive processes such as insight and causation were found to be underrepresented, indicating a potential area for miscommunication. Communication motives driven by affiliation were more pronounced in ICU settings, suggesting a strong collaborative nature. No significant differences were observed among the units post multiple testing adjustments. Speech dysfluencies were most pronounced in ICU handoffs, reflecting possible stress and cognitive overload. The study highlights the need for improved communication strategies such as interventions to enhance language clarity and incorporating technological tools into handoff processes to mitigate potential miscommunications and errors. The findings advance nursing science by highlighting the critical role of nuanced language in varied-acuity hospital settings and the necessity for structured nurse education in handoff communication and standardized handoff procedures. This study underscores the critical role of language in nurse-to-nurse handoffs. It calls for enhanced communication strategies, technology integration and training to reduce medical errors, improving patient outcomes in high-acuity hospital settings. Nurses only.

Real-World Performance Benchmarks in the Reading Ability of Prescription Drug Labels by Community-Dwelling Older Adults

Background: Despite known recommendations regarding standards for print size and the intuitive importance of vision in reading prescription labels, the predictive nature of vision and prescription label readability remains largely undefined. Furthermore, while the importance of vision is recognized, various demographic factors associated with the ability to read prescription labels have not been fully elucidated. Objective: Describe relationships between visual acuity, point size, and readability of prescription labels and provide insight into demographic factors associated with prescription label readability. Methods: Cross-sectional examination of prescription label readability by older, community-dwelling adults. Subjects were evaluated as to demographics, visual acuity, and ability to read test instruments consisting of unaltered prescription label features of five medications dispensed by community pharmacies and two drug samples. Descriptive statistics in conjunction with a logit predictive model were employed for data analysis. Results: Instructions for medication use were most recognizable, identified and correctly read by 95.60% of the study cohort while directions for the use of drug samples were lowest (34.91%). Among prescription label features, auxiliary labels consistently demonstrated poor readability. Level of visual acuity was statistically related to the ability to read prescription labels while identifying prescription label components increased proportionally with point size. Race, gender, and history of a recent eye examination were statistically significant predictors of prescription label reading ability. Visual acuity alone was found to explain approximately 26% of the variablity in ability to read Rx labels. Conclusion: Visual acuity is predictive of the ability to access Rx label information and should be considered a modifiable variable for improving prescription label reading ability amenable by appropriate eye care and spectacle correction.

An ensemble model for predicting dispositions of emergency department patients

ObjectiveThe healthcare challenge driven by an aging population and rising demand is one of the most pressing issues leading to emergency department (ED) overcrowding. An emerging solution lies in machine learning’s potential to predict ED dispositions, thus leading to promising substantial benefits. This study’s objective is to create a predictive model for ED patient dispositions by employing ensemble learning. It harnesses diverse data types, including structured and unstructured information gathered during ED visits to address the evolving needs of localized healthcare systems.MethodsIn this cross-sectional study, 80,073 ED patient records were amassed from a major southern Taiwan hospital in 2018–2019. An ensemble model incorporated structured (demographics, vital signs) and pre-processed unstructured data (chief complaints, preliminary diagnoses) using bag-of-words (BOW) and term frequency-inverse document frequency (TF-IDF). Two random forest base-learners for structured and unstructured data were employed and then complemented by a multi-layer perceptron meta-learner.ResultsThe ensemble model demonstrates strong predictive performance for ED dispositions, achieving an area under the receiver operating characteristic curve of 0.94. The models based on unstructured data encoded with BOW and TF-IDF yield similar performance results. Among the structured features, the top five most crucial factors are age, pulse rate, systolic blood pressure, temperature, and acuity level. In contrast, the top five most important unstructured features are pneumonia, fracture, failure, suspect, and sepsis.ConclusionsFindings indicate that utilizing ensemble learning with a blend of structured and unstructured data proves to be a predictive method for determining ED dispositions.

Evaluating the level of visual acuity to minimise false-positives in different colour vision tests

ABSTRACT Clinical relevance Accurate colour vision assessment is important in clinical settings to minimise false-positive errors and enhance the reliability of diagnoses outcomes. Background Colour vision testing is valuable in assessing the visual system, particularly given the high proportion of individuals with poor vision. This study aimed to determine the minimum visual acuity level required to perform a colour-vision test without errors. Methods After fogging the right eyes of 52 healthy participants using plus lenses to 1.60 logMAR, vision was evaluated using Ishihara, Hardy – Rand – Rittler Standard Isochromatic, Waggoner Pseudo-isochromatic, City University, Waggoner Computerised, and Farnsworth D-15 tests. Participants then completed these tests at lower fogging degrees (in 0.1-logMAR intervals). The acuity at which 5% of the tested population was considered abnormal was determined. Results Significant differences were found in the average visual acuity required to perform colour vision tests without errors (p < 0.05). The Waggoner Computerized test required the highest average visual acuity among the tests utilised. The Farnsworth D-15 test yielded the highest logMAR values. No significant differences were observed between the Waggoner Pseudo-isochromatic test and Hardy – Rand – Rittler Standard Isochromatic, Ishihara, and Farnsworth D-15 tests (p > 0.05). Additionally, no significant differences were found between the Ishihara and Hardy – Rand – Rittler tests (p > 0.1) or between the Waggoner Computerized and City University tests (p = 0.11). Colour vision testing maintained an accuracy ≤ 1.0 logMAR with the Ishihara and Hardy – Rand – Rittler tests, 1.1 logMAR with the Waggoner Pseudo-isochromatic and Farnsworth D-15 tests, and 0.9 logMAR with the Waggoner Computerized and City University tests. Conclusions Insights are provided into the visual acuity thresholds required for accurate colour vision testing, which can serve as a basis for future research and provide a reference for clinical practice in this field.

Piloting Rasch model scoring of the National Eye Institute Visual Function Questionnaire in uveitis

IntroductionThe National Eye Institute Visual Function Questionnaire (NEI VFQ) is a common patient-reported outcome measure (PROM) in uveitis trials. Its psychometric properties using state-of-the-art scoring based on Rasch models, a latent trait model that improves accuracy of PROMs assessment, has not yet been investigated.MethodsThe study participants were recruited online from uveitis patient organizations, where individuals self-reported their uveitis diagnosis and visual acuity level. These participants then completed the NEI VFQ-25. The visual function (VF) and socioemotional (SE) subscales were psychometrically analysed in terms of item fit, targeting, internal consistency, dimensionality, and differential item functioning (DIF), using Rasch models. Criterion validity was examined based on associations between NEI VFQ person measures and recent visual acuity (VA) levels.ResultsNinety-nine participants recruited online from uveitis patient organizations (68 women, 31 men; mean age 50 ± 15 years; 46.5% self-reported receiving systematic therapy for uveitis, 0.6% NEI VFQ-25 missing data) were included. The mean difficulty of items was lower than the average person ability. None of the items demonstrated misfit to an extent that would induce noise into the measurement. The consistency metrics person reliability and person separation index of the subscales were 0.85 and 2.34 (NEI VFQ-VF), 0.86 and 2.52 (NEI VFQ-SE), respectively. There was no evidence of multidimensionality and none of the items showed DIF by gender. The differences between item and person measures were 1.44 (NEI VFQ-VF) and 1.03 (NEI VFQ-SE). NEI VFQ-25 person measures were significantly lower in participants with visual impairment (all p values ≤ 0.007).ConclusionRasch model-based scoring of the re-engineered NEI VFQ-25 demonstrates acceptable internal consistency, item fit and construct validity for assessing two key domains of quality of life in individuals self-reporting uveitis. The PROM was targeted at a higher level of difficulty than present in our heterogeneous sample.

Horticultural Therapy for Individuals Coping with Dementia: Practice Recommendations Informed by Related Non-Pharmacological Interventions.

Dementia care currently presents a challenge to healthcare providers on many levels. The rapid increase in the number of people with dementia and the costs of care certainly contribute to these challenges. However, managing the behavioral and psychological symptoms of dementia (BPSDs) has become one of the most significant tasks in providing care and can lead to poor health and well-being outcomes, not only for the people living with dementia (PLWD) but also for those providing their care. Cost-effective, easily implemented, highly adaptable, empirically based alternatives are needed. Interventions such as Horticultural Therapy (HT), which is naturally informed by Montessori-Based Methods for Dementia and sensory reminiscence therapies, meets these qualifying factors. This article, based on a review of current best practices and clinical experience, hopes to provide recommendations for such an intervention along with special considerations for PLWD and adaptations for different acuity levels. With additional safe and effective, person-centered, non-pharmacological interventions available for the complex cognitive and neuropsychiatric manifestations of this disease, a better care milieu can be provided, improving the quality of life for both patients and caregivers. This article also identifies the need for continued research into the synergistic effects of person-centered behavioral and psychosocial interventions combined with environmental approaches to provide the optimal healing environment for those coping with dementia.

Development and Implementation of a Pediatric Nursing Emergency Behavioral Health Assessment Tool

IntroductionThe national pediatric mental and behavioral health crisis dramatically increased emergency department mental and behavioral health visits and changed emergency nursing practice. Acuity assessment determines patient severity level and supports appropriate resources and interventions. There are no established nursing tools that assess pediatric mental or behavioral health acuity in the emergency department setting. Our goal was to develop and implement the novel pediatric emergency nurse Emergency Behavioral Health Acuity Assessment Tool. MethodsThis quality-improvement project used the plan, do, study, act model to design/refine the Emergency Behavioral Health Acuity Assessment Tool and a non-experimental descriptive design to assess outcomes. The setting was a 47-bed urban level 1 pediatric trauma center with more than 60,000 annual visits. The team designed the tool using published evidence, emergency nurse feedback, and expert opinion. The tool objectively captured patient acuity and suggested acuity-specific nursing interventions. Project outcomes included acuity, length-of-stay, restraint use, and patient/staff injuries. Analyses included descriptive statistics and correlations. ResultsWith over 3000 annual mental/behavioral-related visits, the emergency department had an average daily census of 23 mental and behavioral health patients. Implementation occurred in August 2021. The Emergency Behavioral Health Acuity Assessment Tool dashboard provided the number of patients, patient location, and acuity. Length-of-stay did not change; however, patient restraint use and patient/staff injuries declined. Number of restraints positively correlated with moderate acuity levels (r = 0.472, P = 0.036). DiscussionFor emergency nurses, the Emergency Behavioral Health Acuity Assessment Tool provided an objective measure of patient acuity. Targeted interventions can improve the care of this population.

Emergency medical service use at a pediatric center in Turkey, during the COVID-19 pandemic period.

This study aimed to evaluate aspects of pediatric patients presenting to a hospital in Turkey via emergency ambulance services, including incidence of visits to the hospital, acuity of illness and most common diagnoses, during the one-year period before and after the onset of the coronavrrus dsease 2019 (COVID-19) pandemic. This was a retrospective and single center analysis of children, transported by Emergency Medical Services to the Emergency Department (ED) of a children's hospital in Turkey, between 10 March 2019 and 11 March 2021. Percentage of high acuity group (68.1% vs.76.9%) during pandemic period was significantly lower than prepandemic period (p < 0.001). On the contrary, the percentage of patients using emergency ambulance service with a low level of acuity increased during the pandemic period compared to the prepandemic period (31.9% vs. 23.1%) (p < 0.001). A significant decrease was observed in the cases of lower respiratory tract infections, febrile status epilepticus and excessive alcohol use during the pandemic period. No significant differences were found hospitalizations requiring PICU and mortality in ED during the pandemic period. During the COVID-19 pandemic; also, a decrease in admissions was observed for those with high-risk conditions. On the contrary, an increase was detected in patients with low acuity levels. Efforts should be made to ensure access to safe and quality emergency care during the pandemic.

The development and implementation of the district nursing Welsh Levels of Care Tool.

District nurses provide a vital service to individuals and their families and carers in the community. With increasing complexity of care and changes in the needs of the UK population, developing evidence-based workforce and workload tools which are fit for purpose is essential. This article describes the development, piloting and implementation of the District Nursing Welsh Levels of Care (DN WLoC), acuity and dependency tool which has been designed to be used alongside nurses professional judgment, to evidence the acuity and dependency of patients, and to help inform decisions of nurse staffing requirements in district nursing services. The initial pilot successfully achieved its objective and demonstrated that the draft DN WLoC tool is applicable in practice by district nurses across Wales, with limited but positive findings in the reliability and validity of the WLoC tool when applied in clinical practice.

Biological properties of multifocal intraocular lens and evaluation of their visual quality in cataract

To enhance the visual quality of cataract patients after surgery, we conducted an innovative investigation into the biological properties of multifocal intraocular lens (MIOL) for cataract treatment. Our studies revealed that hydrophilic acrylates exhibited optimal biocompatibility with lens epithelial cells, effectively enhancing cell activity and inhibiting epithelial-mesenchymal transition. Moreover, hydrophilic acrylates demonstrated superior inhibition against Staphylococcus epidermidis attachment, thereby reducing the risk of postoperative infection. In terms of postoperative visual quality assessment, MIOL exhibited superior efficacy in enhancing patients’ visual acuity levels, particularly for corrected near and intermediate distances. Additionally, MIOL exhibits enhanced visual acuity within the defocus curve range of −1.00 D to −4.00 D. Compared to the single-focal IOL group, patients in the MIOL group exhibited enhanced contrast sensitivity across all spatial frequencies. Therefore, hydrophilic acrylate MIOL displayed excellent biocompatibility and resistance against bacterial adhesion while significantly improving patients’ visual quality at near and intermediate distances as well as contrast sensitivity.

Vision Management in Adolescents with Visually Impaired: The Effect of Yogic Visual Concentration

According to World Health Organization (WHO), 314 million individuals worldwide suffer from some degree of vision impairment. Yoga is an effective intervention for the purification and preparation of the body. The leading cleaning practices such as yoga postures, breathing control, and meditation, among others. These techniques include a yogic visual concentration technique known as Trataka. According to certain studies, yogic visual concentration improves eyesight. However, the immediate effect of trataka on visual acuity in adolescents with the visually impaired has not been investigated. Purpose. The present study investigated the effect of 6 weeks of trataka training on visual acuity in visually impaired adolescents. Material &amp; Methods. The study used a single group, before/after design, with ten visually challenged adolescents (Mage=16.5 years; SD=1.5; range 15-18 years) participating in a 6-week trataka training. In clinical settings, the Snellen chart is the most used tool for determining a participant's level of visual acuity. Results. The outcome score for left eyesight (44.44 per cent) and right eyesight (50.43 per cent) improved significantly. Furthermore, paired t-test findings revealed significant improvement in both left eyesight (p&lt;0.001; ES=0.87) and right eyesight (p&lt;0.001; ES=0.83) following 6 weeks of trataka training. Conclusions. The findings of this study objectively show that the yogic visual concentration training may be more effective in adolescents with the visually impaired. Future studies with larger sample size and a more substantial research design based on objective variables are required to strengthen the study's conclusions.

Quantifying Fluid and Function in Suboptimal Responders Switched From an Anti-vascular Endothelial Growth Factor (VEGF) to Faricimab.

Background Anti-vascular endothelial growth factor (VEGF) injections have been successful in reducing vision loss from neovascular age-related macular degeneration, a leading cause of blindness. Due to the high treatment burden and suboptimal responses, switching to bi-specific faricimab treatment may lead to improved outcomes. Methods This retrospective chart review evaluated if suboptimal responders to anti-VEGF injections had better outcomes when switched to faricimab. Suboptimal responders were defined as patients with a history of >3 months of injections and the presence of fluid after ≥3 injections. The primary endpoints were best-corrected visual acuity, treatment interval, and fluid levels. Visual acuity measurements and optical coherence tomography were performed before each injection. The total fluid area (TFA) was measured using MATLAB 2023a (MathWorks, Natick, MA, USA). Results Nineteen eyes were included in the analysis. After three faricimab injections, average letters increased from 54.5 to 59.0 (SD: 15.3; p<0.05), and the injection interval was extended from 7.6 to 9.3 weeks (SD: 3.9; p<0.01) after four injections. Patients also experienced anatomical retinal changes, with a reduction in the TFA to 47.3% (p<0.005) after the second injection and a reduction in pigment epithelial detachment height to 82.3% (p<0.005) after one injection. The central subfield thickness was significantly reduced after the second injection (90.6% (SD: 17.6%)p<0.05). Conclusion Switching to faricimab after a suboptimal anti-VEGF response results in improvements in visual acuity, reduced treatment burden, and reduced fluid levels.

Influence of demographic factors on prolonged length of stay in an emergency department.

A prolonged length of stay in an emergency department is related to lower quality of care and adverse outcomes, which are often linked with overcrowding. Examine the influence of demographic factors on prolonged length of stay in the emergency department. This study used a cross-sectional design. It used secondary data for all patients admitted during the specific duration at the emergency department of a governmental hospital in Saudi Arabia. The independent variables were gender, age, disposition status, shift time, and clinical acuity (CTAS) level while the dependent variable was prolonged length of stay. The study shows that 30% of patients stay at the emergency department for four hours or more. The results also show a significant association between demographic factors which are age, gender, disposition status, shift time, clinical acuity (CTAS) level and prolonged length of stay in an emergency department. Based on the results males are more likely to stay in the emergency department than females (OR = 1.20; 95% CI = 1.04 to 1.38). Patients aged 60 and older are less likely to stay in the emergency department than patients aged 29 or smaller (OR = 0.58; 95% CI = 0.39 to 0.84). According to disposition status discharged patients after examination stays in the emergency department more than admitted patients after the examination (OR = 2.78; 95% CI = 1.67 to 4.99). Patients who come to the night shift are less likely to stay in the emergency department than patients who come in the morning shift (OR = 0.67; 95% CI = 0.56 to 0.81). Patients who are classified in level three of CTAS are less likely to stay in the emergency department than patients who are classified in level one (OR = 0.28; 95% CI = 0.88 to 0.023). Demographic factors such as age, gender, shift time, disposition status and clinical acuity (CTAS) were important factors that needed to be considered to reduce the length of stay of patients in the emergency department. it is possible to formulate a machine learning model to predict the anticipated length of stay in the hospital for each patient. This prediction with an accepted margin of uncertainty will help the clinicians to communicate the evidence-based anticipated length of stay with the patient's caregivers. In addition, hospital managers need to provide the emergency department with enough staff and materials to reduce the length of stay of patients.

Sensory function and somatosensorial system changes according to visual acuity and throwing techniques in goalball players: A cross-sectional study.

The somatosensory system is a complect sensory system that differentiates individual athletes. The aim of this study is to investigate the effect of visual acuity level on throwing technique, proprioceptive sense of the shoulder joint, light touch and two-point discrimination sense of the upper extremity, and sensory function (postural control and reaction time) in visually impaired goalball players. Goalball players who have different visual acuities B1(unable to perceive light or recognize its shape); B2 (has a visual field of less than 5 degrees and can recognize shapes); B3 (visual field greater than 5 degrees and less than 20 degrees) participated in the study. The sensorial system was evaluated with proprioceptive sense of the shoulder joint and sensory tests (light touch and two-point discrimination sense of the dominant hand.). Sensory function (postural control and reaction time) was evaluated with the flamingo balance test, functional reach test, and pro-agility test. The goalball players' throwing technique was questioned. Seventeen male players, those aged 20-30 (20.8±3.9 years) who have been professionally engaged in goalball for at least three years (58.7-37.8 months) participated. Shoulder internal rotation joint position sense and the flamingo balance test were found to be different in the group with B1 visual acuity than in the group with B3 visual acuity (p = 0.042* and 0.028 respectively). There was no difference between groups with B1-B2 visual acuity (p = 0.394 and p = 0.065) and between groups with B2-B3 visual acuity (p = 0.792 and p = 0.931). There was no difference in the groups in terms of sensory tests and reaction time (p> 0.05). In goalball, joint position sense is related to throwing techniques. Although there is a general acceptance that other sensory systems should work harder to compensate for the sense of vision, fear of falling, athlete's branch year, sports year, muscle strength, and general physical condition of the athlete may affect the measurements made, especially in the dynamic position.

Direct Care Staff Vacancies and Adverse Youth Events in Illinois Child Welfare Residential Treatment During the COVID-19 Pandemic

ABSTRACT Direct care staff provide 24/7 care and supervision in residential treatment for youth; vacancy rates for these positions increased significantly during the COVID-19 pandemic. This study used multi-level, two-stage least squares regression to examine the relationship between staff vacancies and adverse events experienced by 1352 youth in Illinois child welfare residential care during October 2019-February 2022. Hierarchical cluster analysis was used to explore whether particular adverse event clusters were differentially related to vacancy rates. We hypothesized that direct care staff vacancies would be related to an increased number of adverse events overall and a specific increase in safety-related events. Although direct care staff vacancies were not significantly related to the overall number of adverse events, they were significantly associated with the magnitude of adverse events related to school suspensions, substance use, and law enforcement encounters. Several other novel, unanticipated findings emerged, with various youth- and facility-level factors (e.g. race, age, length of admission, facility level of clinical acuity) showing significant relationships with the magnitude of adverse events. This study fills a notable gap in the literature in its novel empirical approach to exploring administrative data capturing direct care staffing and adverse events in child welfare residential care.

Association Between Psychosocial Acuity and Glycemic Control in a Pediatric Type 1 Diabetes Clinic.

The purpose of this study was to describe the frequency of psychosocial risk and its associations with glycemic levels in youth with type 1 diabetes (T1D) seen by social work staff during regular clinical care. A retrospective longitudinal analysis of observational clinical data was conducted. Individuals (1-26 years) with known T1D who were seen at a pediatric diabetes clinic in a US academic medical center between 2014 and 2021 were included. Variables included psychosocial acuity, A1C, and demographic characteristics. Chi-square tests, Wilcoxon rank sum tests, and mixed linear regressions were used to examine associations between demographic variables, psychosocial acuity, and A1C. Of 966 patients, 513 (53.1%) were male, 76 (7.9%) were non-Hispanic Black, and 804 (83.2%) were non-Hispanic White. There was a mean of 6.9 annual social work encounters per patient, with 3 psychosocial domains measured at each visit. Results showed that as psychosocial acuity level increased, glycemic control decreased. There were significant differences in A1C according to race/ethnicity, insurance, age, and psychosocial acuity. In a real-world clinical population, psychosocial acuity was associated with glycemic control. Presenting for psychosocial issues in their diabetes clinic was associated with reduced glycemic control among youth with T1D. There is an opportunity to connect pediatric patients with appropriate mental health services and psychosocial supports.

Factors related to central nervous system involvement of primary vitreoretinal lymphoma.

This single center retrospective study aimed to investigate the factors associated with central nervous system (CNS) involvement of primary vitreoretinal lymphoma (PVRL). Clinical features of patients with PVRL (Group 1), those diagnosed with vitreoretinal lymphoma (VRL) after primary CNS lymphoma diagnosis (Group 2), and those concurrently diagnosed with CNS lymphoma and VRL (Group 3), were compared. The main outcomes included sex, age, types of treatment, survival, visual acuity, diagnostic methods, VRL recurrence, ocular manifestations, and interleukin levels in the aqueous humor. Groups 1, 2, and 3 included 66 eyes in 38 patients, 29 eyes in 18 patients, and 14 eyes in 8 patients, respectively. Group 3 had shorter overall survival (OS) than Groups 1 and 2 (P = 0.042 and P = 0.009, respectively). The three groups did not differ in progression-free survival (P = 0.060). The 5-year survival rates of Groups 1, 2, and 3 were 56.5%, 44.0%, and 25.0%, respectively (P = 0.001). Patients with CNS involvement in Group 1 exhibited VRL recurrence (P < 0.001), high interleukin-10 (P = 0.024), and sub-retinal pigment epithelium (RPE) infiltration (P = 0.009). Patients experiencing VRL recurrence in Group 1 tended to show CNS involvement (P < 0.001). Patients concurrently diagnosed with CNS lymphoma and VRL had a shorter OS and a lower 5-year survival rate. In patients with PVRL, the recurrence of VRL, high interleukin-10, and sub-RPE infiltration were associated with CNS involvement.