First-year Outcomes Research Articles

Sleeve gastrectomy with antral resection provides more effective weight loss in patients with super obesity

BackgroundObesity is a growing health issue that contributes to numerous diseases and lowers quality of life. In patients with super obesity (BMI > 50 kg/m²), bariatric surgery, particularly laparoscopic sleeve gastrectomy (LSG), is a common treatment option. However, the role of antral resection (AR) in LSG remains unclear, especially in this high-risk population. This study aims to compare the effectiveness of LSG with antral resection (LSG-AR) and LSG with antrum preservation (LSG-AP) on weight loss and postoperative complaints in patients with super obesity.MethodsThe medical records of patients with a BMI > 50 kg/m² who underwent LSG between 2016 and 2022 were retrospectively reviewed. Weight data were collected at admission, and at the first, second, and fifth-year follow-up. Patients were divided into two groups based on LSG-AR or LSG-AP procedures.ResultsSeventy-two patients were included. No significant difference was found in postoperative vomiting complaints between the groups (p = 0.67). First-year outcomes showed no significant differences in weight, BMI, or % Total Weight Loss (%TWL). However, second and fifth-year %TWL values were significantly higher in the LSG-AR group (p = 0.003 for both).ConclusionLSG-AR provides more effective long-term weight loss in patients with super obesity. Early postoperative vomiting complaints diminish over time, suggesting LSG-AR as a viable one-stage procedure for this patient population.

First-year outcomes of very low birth weight preterm singleton infants with hypoxemic respiratory failure treated with milrinone and inhaled nitric oxide (iNO) compared to iNO alone: A nationwide retrospective study.

Inhaled nitric oxide (iNO) has a beneficial effect on hypoxemic respiratory failure. The increased use of concurrent iNO and milrinone was observed. We aimed to report the trends of iNO use in the past 15 years in Taiwan and compare the first-year outcomes of combining iNO and milrinone to the iNO alone in very low birth weight preterm (VLBWP) infants under mechanical ventilation. This nationwide cohort study enrolled preterm singleton infants with birth weight <1500g treated with iNO from 2004 to 2019. Infants were divided into two groups, with a combination of intravenous milrinone (Group 2, n = 166) and without milrinone (Group 1, n = 591). After propensity score matching (PSM), each group's sample size is 124. The primary outcomes were all-cause mortality and the respiratory condition, including ventilator use and duration. The secondary outcomes were preterm morbidities within one year after birth. After PSM, more infants in Group 2 needed inotropes. The mortality rate was significantly higher in Group 2 than in Group 1 from one month after birth till 1 year of age (55.1% vs. 13.5%) with the adjusted hazard ratio of 4.25 (95%CI = 2.42-7.47, p <0.001). For infants who died before 36 weeks of postmenstrual age (PMA), Group 2 had longer hospital stays compared to Group 1. For infants who survived after 36 weeks PMA, the incidence of moderate and severe bronchopulmonary dysplasia (BPD) was significantly higher in Group 2 than in Group 1. For infants who survived until one year of age, the incidence of pneumonia was significantly higher in Group 2 (28.30%) compared to Group 1 (12.62%) (p = 0.0153). Combined treatment of iNO and milrinone is increasingly applied in VLBWP infants in Taiwan. This retrospective study did not support the benefits of combining iNO and milrinone on one-year survival and BPD prevention. A future prospective study is warranted.

Adequate Mentorship Program for Holmium Laser Enucleation of the Prostate (HoLEP) Leads to Satisfactory Short-Term Outcomes in the Early Learning Curve of Young Urologists: First-Year Outcomes of a Newly Established Mentorship Training in Mexico.

Introduction Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms in men. Holmium Laser Enucleation of the Prostate (HoLEP) has been recommended by international guidelines as an alternative to transurethral resection of the prostate (TURP). HoLEP's learning curve and the lack of adequate mentorship remains an obstacle for the worldwide adoption of this technique. Objective To report the first-year learning curve of a newly established mentorship program in young urologists without any previous HoLEPexperience. Methods We report a cohort of patients with BPH, with prostate size ≥70 grams, treated with HoLEP, analyzed for perioperative data and complications, and short-term postoperative complications and functional outcomes, at three and six months after surgery. Results A total of 47 patients were managed with HoLEP. Mean total operative time was 149.8 ± 42.9 minutes. We experienced five (10.6%) intraoperative complications, including one intravesical resection of the prostate with bipolar energy, three conversions to TURP and one conversion to open prostatectomy. We experienced four postoperative complications, all of them Clavien-Dindo ≤2. Median International Prostate Symptom Score (IPSS) decrease at six months was -17 points from baseline. Mean post-void residual volume and prostate-specific antigen significantlydecreased by the third postoperative month. Multiple linear regression showed that prostate size is directly related to increased surgical time during the early learning curve. Discussion Our experience adequately reflects the importance of HoLEP mentorship in young urologists seeking training in this technique. Both surgeons had perioperative and postoperative outcomes deemed satisfactory based on previously published learning curves. Conclusions HoLEP is a technically difficult procedure, however, adequate mentorship leads to satisfying short-term outcomes since the early stages of the learning curve in young urologists with no previous training on this technique.

004 Does methotrexate affect treatment persistence or effectiveness of adalimumab for psoriasis? A trial emulation cohort study

Abstract It is unclear whether concomitant methotrexate enhances the effectiveness and/or persistence of adalimumab in treating psoriasis. The OPTIMAP study (Optimizing Adalimumab Treatment in Psoriasis with Concomitant Methotrexate), a randomized controlled trial testing adalimumab against adalimumab + methotrexate, could not adequately answer this question due to under-recruitment. The aim of the current study is to replicate key aspects of the OPTIMAP trial design in a cohort study to provide a more precise estimate for the effect of concomitant methotrexate on adalimumab persistence and effectiveness. We conducted a cohort study using the British Association of Dermatologists Biologics and Immunomodulators Register, a national pharmacovigilance registry for people on systemic treatments for psoriasis, between 2007 and 2021. We included participants ≥ 18 years old who had at least one record of a Psoriasis Area and Severity Index (PASI) ≥ 8 and were naïve to adalimumab. We used the same exclusion criteria as in the OPTIMAP study. Participants received either adalimumab (Humira®) in the comparison arm or adalimumab (Humira) in addition to methotrexate and folic acid, with dosage as determined by the clinician in the intervention arm from initiation at cohort entry, and were censored if they deviated from the treatment strategy. The primary outcome is in the difference in the survival function for adalimumab at 1 year. The secondary outcome was the difference in the proportion of patients achieving a 75% reduction in PASI (PASI 75) at 1 year. We used inverse probability treatment weighting to correct for known differences in participant characteristics precomparison. Missing outcomes were accounted for using inverse probability of censoring weighting. We fitted a flexible parametric survival model and a generalized linear model with an identity link for the primary and secondary outcomes, respectively. There were 219 and 1376 participants in the intervention and comparison arms, respectively. Drug survival for the monotherapy arm at 1 year was 77.5% [95% confidence interval (CI) 75.3–79.8], and for the intervention arm, it was 75.3% (95% CI 66.9–84.7), with a difference of −2.3% (95% CI −11.4 to 6.9). The risk difference for PASI 75 at 1 year was −10.7% (95% CI −29.3 to 8.0), with a PASI 75 rate of 43.5% for the intervention arm (95% CI 25.4–61.9) and 54.2% for the comparison arm (95% CI 49.6–58.7). We did not find any significant difference for the persistence and effectiveness of adalimumab in people with psoriasis on methotrexate vs. those who were not on methotrexate in this study. This result is in keeping with the reported first-year outcomes of OPTIMAP. Clinicians and patients should consider alternative strategies to improve treatment outcomes in people with severe psoriasis.

Establishment of Saudi Arabia’s Plastic Surgery Interest Club: First-year Outcomes and Future Directions

This cross-sectional study utilized a self-developed questionnaire that experts in the field revised. The authors recruited active PSIC members during the year 2021-2022 to assess the overall impact of the club in their various interests of the field as well as to have an overview of their opinions of this newly done initiative in Saudi Arabia. The data collection spanned from October 2021 to September 2022. The authors analyzed the responses from 66 active members with a response rate of 78%. We found various significant positive impacts of the PSIC in the community of plastic surgery in Saudi Arabia. There was a significant difference in the interest in pursuing a career in plastic surgery before and after being a member of PSIC, with a P value of 0.0001. The members became noticeably more interested in pursuing an academic career and publishing field data after enrolling in PSIC research activities. The authors provided an analysis of 1-year outcomes of the PSIC in Saudi Arabia; there were many positive impacts of such an initiative in enhancing the local community of plastic and reconstructive surgery. The authors strongly encourage the adaption of such initiatives in various parts of the globe to develop the field of plastic surgery further.

Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine Program: First-Year Outcomes and Implementation Costs

The Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (MI-SIGHT) program aims to engage people who are at high risk of glaucoma; we assess first-year outcomes and costs. Clinical cohort study. Participants ≥18 years of age were recruited from a free clinic and a federally qualified health center in Michigan. Ophthalmic technicians in the clinics collected demographic information, visual function, ocular health history, measured visual acuity, refraction, intraocular pressure, pachymetry, pupils, and took mydriatic fundus photographs and retinal nerve fiber layer optical coherence tomography. Data were interpreted by remote ophthalmologists. During a follow-up visit, technicians shared ophthalmologist recommendations, dispensed low-cost glasses, and collected participant satisfaction. The primary outcome measures were prevalence of eye disease, visual function, program satisfaction, and costs. Observed prevalence was compared with national disease prevalence rates using z tests of proportions. Among 1171 participants, the average age was 55 years (SD 14.5 years), 38% were male, 54% identified as Black, 34% as White, 10% as Hispanic, 33% had less than or equal to a high school education, and 70% had an annual income <$30,000. The prevalence of visual impairment was 10.3% (national average 2.2%), glaucoma and suspected glaucoma 24% (national average 9%), macular degeneration 2.0% (national average 1.5%), and diabetic retinopathy 7.3% (national average 3.4%) (P < .0001). Seventy-one percent of participants received low-cost glasses, 41% were referred for ophthalmology follow-up, and 99% were satisfied or very satisfied with the program. Startup costs were $103,185; recurrent costs were $248,103 per clinic. Telemedicine eye disease detection programs in low-income community clinics effectively identify high rates of pathology.

Outcomes of an Acute Palliative Care Unit at a Comprehensive Cancer Center in Korea.

The acute palliative care unit (APCU) bridges between active cancer treatment and hospice care. However, no study has proven the efficacy of APCU in Korea. To evaluate the first-year outcomes of the patients admitted to an APCU at a tertiary hospital in Korea. The APCU admitted 205 patients between April 14, 2014, and April 30, 2015. Of these patients, 57 were evaluable for baseline and one-week follow-up Edmonton Symptom Assessment System (ESAS). Of the 57 participants, 56.1% were male, with a median age of 60 years (range, 52.8-69.5 years). All patients had advanced cancer, and 42 out of 57 had terminal illnesses. The median APCU stay was 14 days (range, 10-17 days). The 42 (73.7%) patients were referred to the APCU after anticancer treatment was completed. Ten (17.5%) patients died during their stay, and 20 (35.1%) were discharged home. Among those who completed the ESAS, there were significant improvements in scores in the following symptoms: fatigue, depression, loss of appetite, and shortness of breath. Physical symptoms (pain, fatigue, nausea, drowsiness, appetite, and shortness of breath) and the total ESAS scores were significantly improved (p = 0.002 and p = 0.005, respectively). Each non-medical palliative care program, such as art and music therapy, yoga, foot massage, haircut, and body care, showed no significant differences between the group who received them and those who did not. During the APCU stay, the overall symptoms of inpatients were reduced. A comprehensive and multidisciplinary team approach is essential for patients who need palliative care.

Tissue Stents (Bio Stents): Search For Non- Metallic Stent And Can It Be A Game Changer In Cardiovascular Interventions?

Coronary and Vascular stenosis poses great challenge in terms of cardiovascular disease burden. Evolution of metallic stents has been key in treating Coronary Artery Disease both acute and chronic and has met challenges successfully. The last 2 decades have seen substantial reform in technology, bringing second and third generations of coronary and vascular stents mainly metallic drug-eluting stents (DES). Though stent related stenosis is big challenge, DES has met relatively much success especially during initial years. DES are found to be associated with good first-year outcomes but subsequent risk of stentrelated adverse events like thrombosis, myocardial infarction, restenosis usually appear after 1 year following implantation. The pathogenesis of these late events is related to the permanent presence of the metal stent frame or polymer within coronaries. Besides intimal hyperplasia, late stent thrombosis, and noncompliance with DAPT are still major issues leading to stent failure and often the need for reintervention. As an effective alternative to metallic stents, Bioresorbable scaffolds were developed to provide drug delivery and mechanical support functions similar to metallic drug-eluting stents (DES), followed by complete resorption with recovery of vascular structure and function, potentially improving very late clinical outcomes. A first-generation bioresorbable scaffold demonstrated to be no inferior to a contemporary metallic drug-eluting stents for overall 1-year patient-oriented and deviceoriented outcomes. However, increased rates of scaffold thrombosis and target vessel-related myocardial infarction were noted subsequently at 5 year follow up. Tissue/Bio Stents can present as a path breaking alternative approach to avoid intimal hyperplasia. They are characterised by presence of biodegradable struts with tissue mesh and complete absence of metal preventing ingrowth of the neointimal tissue into the lumen. Currently used stent materials include mainly metals and synthetic polymers. Their main limitation is lack of hemocompatibility, which can induce thrombosis and ultimately reocclusion, thus impairing the long-term performance of these devices. We are proposing use of biologically derived material to overcome this issue with the aim of enhancing the biocompatibility and the capability of this type of stents to support endothelialilzation. The aim of this article is to give a comprehensive overview of the manufacturing and applications of Tissue or Bio Stents as well as the different strategies followed for their development from the perspective of the material selection, fabrication approaches, and logical validation of the different concepts into animal and clinical trials.

Year-to-Year Comparison of Virginia’s Hepatitis Education and Patient Connection Referral on Release Program Outcomes for those Recently Released from Incarceration

Purpose of Review The purpose of this review is to outline the Virginia Hepatitis Education and Patient Connection. Referral on Release (HEPC-RoR. This program for increasing access to treatment for hepatitis C for those recently released from incarceration, including first-year outcomes, quality improvement practices that were implemented post first year, and second year program data. Using this information, we hope to inform organizations attempting to implement similar programs of potential challenges and corresponding solutions. Alternatively, we hope to share potential program designs for organizations that have identified a need for programs to support linkage to care for those recently released from incarcerated. Recent Findings After analyzing first-year program data, we identified areas for improvement. Based on these findings, the team implemented new processes. After a review of the second-year data, we found significant improvement in clinical data, program workflow, and data quality from the previous year. A change in workflow allowed us to collect additional correct contact data, connect more patients to care and ultimately to cure their hepatitis C. Our database, which was redesigned following year one, provided formatting changes allowing for expedited data extraction and review. The process between facilities also improved, streamlining efforts and alleviating some strain associated with limited staffing. Summary Following the review of first-year HEPC-RoR data, program strengths and weaknesses were identified, and a quality improvement plan was developed to addresses areas of need. Changes included more frequent and varied outreach, follow-ups to community partners for confirmation of appointments and lab results, and a redesigned database for more comprehensive data collection. Second-year program data found significant clinical outcomes, such as an 86.7% linkage to care rate and a 23.5% cure rate, and improved referral and database quality.

Introducing a Bariatric Surgery Program at a Large Urban Safety Net Medical Center Serving a Primarily Hispanic Patient Population.

BackgroundFew bariatric surgery programs exist at safety net hospitals which often serve patients of diverse racial and socioeconomic backgrounds. A bariatric surgery program was developed at a large urban safety net medical center serving a primarily Hispanic population. The purpose of this study was to evaluate safety, feasibility, and first-year outcomes to pave the way for other safety net bariatric programs.MethodsThe bariatric surgery program was started at a safety net hospital located in a neighborhood with over twice the national poverty rate. A retrospective review was performed for patient demographics, comorbidities, preoperative diet and exercise habits, perioperative outcomes, and 1-year outcomes including percent total weight lost (%TWL) and comorbidity reduction.ResultsA total of 153 patients underwent laparoscopic sleeve gastrectomy from May 2017 through December 2019. The average preoperative BMI was 47.9kg/m2, and 54% of patients had diabetes. The 1-year follow-up rate was 94%. There were no mortalities and low complication rates. The average 1-year %TWL was 22.8%. Hypertension and diabetes medications decreased in 52% and 55% of patients, respectively. The proportion of diabetic patients with postoperative HbA1c <6.0% was 49%.ConclusionThis is one of the first reports on the outcomes of a bariatric surgery program at a safety net hospital. This analysis demonstrates feasibility and safety, with no mortalities, low complication rates, and acceptable %TWL and comorbidity improvement. More work is needed to investigate the impacts of race, culture, and socioeconomic factors on bariatric outcomes in this population.Graphical abstract

A meta-analysis of randomized clinical trials on the impact of oral vitamin C supplementation on first-year outcomes in orthopedic patients

This meta-analysis aimed at investigating the impact of oral vitamin C supplementation on the post-procedural recovery of orthopedic patients, including functional outcomes and complex regional pain syndrome type I (CRPS I). Literature search using the Medline, Cochrane Library, and Embase databases from inception till March 2021 identified seven eligible randomized controlled trials with 1,361 participants. Forest plot revealed no significant difference in the functional outcomes at 6–12 months [standardized mean difference (SMD) = −0.00, 95% CI − 0.19 to 0.18, 467 patients], risk of overall complications (RR = 0.98, 95% CI 0.68 to 1.39, 426 patients), and pain severity at 3–6 months (SMD = − 0.18, 95% CI − 0.49 to 0.12, 486 patients) between patients with and without oral vitamin C supplementation. Pooled analysis showed that vitamin C treatment reduced the risk of CRPS I regardless of dosage (RR = 0.46, 95% CI 0.25 to 0.85, 1143 patients). In conclusion, the current meta-analysis demonstrated that oral vitamin C supplementation may reduce the risk of complex regional pain syndrome type I but did not improve the functional outcomes in orthopedic patients. Nevertheless, because of the small number of trials included in the present study, further large-scale clinical studies are warranted to support our findings.

Skin cancer biopsy and detection rates with total body skin examination: A cross-sectional retrospective analysis

To The Editor: Office-based skin cancer screening is limited in its capacity to screen entire populations. 1 Ferris L.K. Saul M.I. Lin Y. et al. A large skin cancer screening quality initiative: description and first-year outcomes. JAMA Oncol. 2017; 3: 1112-1115 Crossref PubMed Scopus (30) Google Scholar ,2 Welch H.G. Mazer M.L. Adamson A.S. The rapid rise in cutaneous melanoma diagnoses. N Engl J Med. 2021; 384: 72-79 Crossref Scopus (40) Google Scholar Most organizations worldwide recommend screening only at-risk individuals. 2 Welch H.G. Mazer M.L. Adamson A.S. The rapid rise in cutaneous melanoma diagnoses. N Engl J Med. 2021; 384: 72-79 Crossref Scopus (40) Google Scholar ,3 Ebell M.H. Thai T.N. Royalty K.J. Cancer screening recommendations: an international comparison of high income countries. Public Health Rev. 2018; 39: 1-9 Crossref PubMed Scopus (51) Google Scholar In the United States, less than a quarter of those deemed to be at a high risk of skin cancer per the United States Preventative Services Task Force criteria undergo a total body skin examination (TBSE) in their lifetime. 4 Lakhani N.A. Saraiya M. Thompson T.D. King S.C. Guy Jr., G.P. Total body skin examination for skin cancer screening among U.S. adults from 2000 to 2010. Prev Med. 2014; 61: 75-80 Crossref PubMed Scopus (37) Google Scholar A lack of consensus for skin cancer screening guidelines has led to patient-driven screening. 5 Johnson M.M. Leachman S.A. Aspinwall L.G. et al. Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy. Melanoma Manag. 2017; 4: 13-37 Crossref PubMed Google Scholar This study evaluated factors that influence the likelihood of a skin biopsy during a TBSE and skin cancer detection upon biopsy.

Torpedo Maculopathy in Newborns and First-year Outcomes

Torpedo Maculopathy in Newborns and First-year Outcomes

Shining the Spotlight on Those outside Florida’s Reform Limelight: The Impact of Developmental Education Reform for Nonexempt Students

ABSTRACT Since the 2000s, states have experimented with reforms to improve success among underprepared students traditionally assigned to developmental education (DE). Florida’s reform under Senate Bill 1720 has been among the most comprehensive and wide-reaching. Recent public high school graduates and military personnel became exempt from DE, but nearly one-third of students, including those without a Florida standard high school diploma, were still required to take a placement test and enroll in DE if they scored below college-ready. The legislation also required colleges to offer accelerated instructional strategies for students remaining in DE, and provide enhanced advising and support services. Focusing specifically on nonexempt students, we use statewide data to conduct a difference-in-regression discontinuity analysis to examine differences in first-year math coursetaking outcomes for students on the margins of college readiness before and after the reform. While students narrowly assigned to DE tend to have a lower likelihood of taking and passing college-level courses relative to their college-ready peers, these students experienced larger gains after the reform when DE courses were offered in accelerated formats accompanied by support services. The reform also improved outcomes for students scoring above college-ready, which suggests that nonexempt students benefited from enhanced advising and support services too.

Effect of a Place-Based Learning Community on Belonging, Persistence, and Equity Gaps for First-Year STEM Students

We combined tenets of learning communities and place-based learning to develop an innovative first-year program for STEM students. Using a quasi-experimental design, we found that participants in the place-based learning community had a stronger sense of belonging, improved academic performance, and increased first-year persistence relative to a matched reference group. We also showed that participation narrowed equity gaps in first-year outcomes for students underrepresented in the sciences. A sense of place arises not just from a location, but from interrelationships between people and the natural world, and these results suggest organizing learning around place can promote inclusive student success.

Amulticomponent secondary school health promotion intervention and adolescent health: An extension of the SEHER cluster randomised controlled trial in Bihar,India.

BackgroundStrengthening Evidence base on scHool-based intErventions for pRomoting adolescent health (SEHER) is a multicomponent, whole-school health promotion intervention delivered by a lay counsellor or a teacher in government-run secondary schools in Bihar, India. The objective of this study is to examine the effects of the intervention after two years of follow-up and to evaluate the consistency of the findings observed over time.Methods and findingsWe conducted a cluster randomised trial in which 75 schools were randomised (1:1:1) to receive the SEHER intervention delivered by a lay counsellor (SEHER Mitra [SM]) or a teacher (Teacher as SEHER Mitra [TSM]), respectively, alongside a standardised, classroom-based life skills Adolescence Education Program (AEP), compared to AEP alone (control group). The trial design was a repeat cross-sectional study. Students enrolled in grade 9 (aged 13–15 years) in the 2015–2016 academic year were exposed to the intervention for two years and the outcome assessment was conducted at three time points─at baseline in June 2015; 8-months follow-up in March 2016, when the students were still in grade 9; and endpoint at 17-months follow-up in December 2016 (when the students were in grade 10), the results of which are presented in this paper. The primary outcome, school climate, was measured with the Beyond Blue School Climate Questionnaire (BBSCQ). Intervention effects were estimated using mixed-effects linear or logistic regression, including a random effect to adjust for within-school clustering, minimisation variables, baseline cluster-level score of the outcome, and sociodemographic characteristics. In total, 15,232 students participated in the 17-month survey. Compared with the control group, the participants in the SM intervention group reported improvements in school climate (adjusted mean difference [aMD] = 7.33; 95% CI: 6.60–8.06; p < 0.001) and most secondary outcomes (depression: aMD = −4.64; 95% CI: −5.83–3.45; p < 0.001; attitude towards gender equity: aMD = 1.02; 95% CI: 0.65–1.40; p < 0.001; frequency of bullying: aMD = −2.77; 95% CI: −3.40 to −2.14; p < 0.001; violence victimisation: odds ratio [OR] = 0.08; 95% CI: 0.04–0.14; p < 0.001; and violence perpetration: OR = 0.16; 95% CI: 0.09–0.29; p < 0.001). There was no evidence of an intervention effect in the TSM group compared with control group. The effects of the lay counsellor–delivered intervention were larger for most outcomes at 17-months follow-up compared with those at 8 months: school climate (effect size [ES; 95% CI] = 2.23 [1.97–2.50] versus 1.88 [1.44–2.32], p < 0.001); depression (ES [95% CI] = −1.19 [−1.56 to −0.82] versus −0.27 [−0.44 to −0.11], p < 0.001); attitude towards gender equity (ES [95% CI] = 0.53 [0.27–0.79] versus 0.23 [0.10–0.36], p < 0.001); bullying (ES [95% CI] = −2.22 [−2.84 to −1.60] versus −0.47 [−0.61 to −0.33], p < 0.001); violence victimisation (OR [95% CI] = 0.08 [0.04–0.14] versus 0.62 [0.46–0.84], p < 0.001); and violence perpetration (OR [95% CI] = 0.16 [0.09–0.29] versus 0.68 [0.48–0.96], p < 0.001), suggesting incremental benefits with an extended intervention. A limitation of the study is that 27% of baseline participants did not complete the 17-month outcome assessment.ConclusionsThe trial showed that the second-year outcomes were similar to the first-year outcomes, with no effect of the teacher-led intervention and larger benefits on school climate and adolescent health accruing from extending lay counsellor–delivered intervention.Trial registrationClinicalTrials.gov NCT02907125.

Evaluating the Role of Autistic Traits, Social Anxiety, and Social Network Changes During Transition to First Year of University in Typically Developing Students and Students on the Autism Spectrum

This is the first longitudinal study to quantitatively evaluate changes in social network structure (SNS) and perceived social support (PSS) amongst first-year students on the autism spectrum (n = 21) and typically developing (TD; n = 182) students transitioning to university. The relative impact of changes in SNS/PSS, students’ social anxiety and autistic traits, on first-year university transition outcomes were also examined. Both groups gained friends over time who provided better support quantity and quality during first year of university. Social anxiety showed long-term differential negative impact on students on the autism spectrum and TD students’ academic, social and personal/emotional adjustments, and institutional attachment, suggesting stakeholders should focus on delivering interventions to reduce social anxiety to improve university transition outcomes.

First-Year Outcomes of Cataract Surgery Combined with Intravitreal Ranibizumab Injection in Wet Age-Related Macular Degeneration

Objectives:To compare the first-year results of patients with active neovascular age-related macular degeneration (nAMD) under intravitreal ranibizumab (IVR) treatment who did and did not undergo cataract surgery.Materials and Methods:The records of 72 patients with active nAMD were reviewed retrospectively. Group 1 consisted of 23 patients who underwent uncomplicated cataract surgery and continued with IVR treatment and group 2 consisted of 49 patients without cataract who received only IVR treatment. The groups were compared according to pretreatment and first year best spectacle-corrected visual acuity (BCVA), central foveal thickness (CFT), number of injections, and nAMD activity (presence of subretinal or intraretinal fluid). Logarithm of minimum angle of resolution (LogMAR) was used for the determination of visual acuity. Activity findings were evaluated with optical coherence tomography.Results:Pretreatment BCVA was 0.94±0.21 in group 1 and 0.77±0.36 in group 2 (p=0.041). At the end of the first year, BCVA was 0.48±0.35 in group 1 and 0.49±0.33 in group 2 (p=0.902). BCVA change was 0.46±0.29 in group 1 and 0.28±0.31 in group 2 (p=0.026). Pretreatment CFT was 305±146 μm in group 1 and 340±120 μm in group 2 (p=0.292). At the end of the first year, CFT was 246±110 μm and 245±82 μm in group 2 (p=0.977). CFT change was 59±45 μm in group 1 and 92±97 μm in group 2 (p=0.135). Mean number of injections over 1 year was 6.2±1.9 in group 1 and 5.7±1.8 in group 2 (p=0.271). At the end of the first year, subretinal fluid was observed in 3 patients in group 1 (13%) and 5 patients in group 2 (10.2%) (p=0.721) and intraretinal fluid was present in 3 patients in group 1 (13%) and 4 patients in group 2 (8.2%) (p=0.515).Conclusion:Cataract surgery combined with IVR treatment yielded significant visual gain in patients with active nAMD. Anatomic results suggest that cataract surgery does not worsen nAMD.

SABR implementation at a regional cancer centre: first-year outcomes and challenges at the Kent Oncology Centre

SABR implementation at a regional cancer centre: first-year outcomes and challenges at the Kent Oncology Centre

First-Year Outcomes of Critical Congenital Heart Disease Screening in Maryland.

Objectives. Newborn screening for critical congenital heart disease (CCHD) was added to the Recommended Uniform Screening Panel in 2011, and states have been gradually adding pulse oximetry as point-of-care screening to panels. Few data are available on the effectiveness of pulse oximetry as a mandated screening. This study describes outcomes of the first year of screening in Maryland. Methods. A web-based data collection tool for screening results and outcomes, eScreener Plus, was utilized. Data collected from the start of screening from September 1, 2012, to December 31, 2013, were analyzed. Well-baby nursery data were evaluated separately from neonatal intensive care unit (NICU) data to determine whether setting influenced effectiveness. Results. In the first 15 months of newborn screening for CCHD in Maryland, 4 asymptomatic infants were diagnosed with a critical cardiac condition by newborn screening. Eleven infants passed but were later identified with a primary or secondary target condition. Seventy-one percent of infants with CCHD were identified prenatally or by clinical signs and symptoms. Pulse oximetry screening for CCHD had a specificity of more than 99% in both the well-baby nursery and the NICU. Sensitivity in the well-baby nursery was 10% and 60% in the NICU. Conclusion. Further investigation and interpretation of specific protocols that were used and outcomes of screening is needed for continued refinement of the well-baby algorithm and NICU protocol development. Pulse oximetry screening in newborns provides valuable clinical information, but many infants with CCHD are still not identified with current protocols.