Fellow Eye Comparison of Descemet Membrane Endothelial Keratoplasty and Penetrating Keratoplasty.

Fellow Eye Comparison of Descemet Membrane Endothelial Keratoplasty and Penetrating Keratoplasty.

Cornea. 2013 Aug 7;
Maier AK, Gundlach E, Gonnermann J, Klamann MK, Eulufi C, Bertelmann E, Joussen AM, Torun N

To compare the visual outcomes and postoperative complications in patients undergoing penetrating keratoplasty (PKP) in 1 eye followed by Descemet membrane endothelial keratoplasty (DMEK) in their fellow eye.A retrospective analysis of 11 patients, who underwent a PKP procedure first in 1 eye and then a DMEK surgery in their fellow eye, was performed. Intraoperative and postoperative complications were recorded. Visual and refractive outcomes were also evaluated, including higher-order aberrations (HOAs) and contrast thresholds. A subjective questionnaire was used to evaluate patient satisfaction.Both uncorrected and best-corrected visual acuities were significantly better in the case of DMEK when compared with that in the case of PKP (0.82 vs. 0.37 logMAR, P = 0.005; 0.61 vs. 0.21 logMAR, P = 0.011, respectively). Postkeratoplasty astigmatism, mean spherical equivalent, and HOAs were also significantly lower in eyes after undergoing DMEK than after undergoing PKP (3.90 vs. 0.89 diopters, P = 0.005; -3.90 vs. -0.68 diopters, P = 0.005; 6.81 vs. 1.71 µm, P = 0.043, respectively). Visual outcome and patient satisfaction were significantly better in those who underwent DMEK (2.91 vs. 4.45, P = 0.011; 3.27 vs. 5.64, P = 0.016, respectively). The estimated time for recovery and rehabilitation was significantly shorter after DMEK (64.0 vs. 9.3 days, P = 0.012). Contrast threshold was better after the DMEK. Ten of 11 patients preferred DMEK procedure.The Patients preferred DMEK to PKP. The reasons for better patient satisfaction after DMEK included better uncorrected visual acuity, better best-corrected visual acuity, avoidance of surgery-induced astigmatism, and lower HOA. HubMed – rehab

Early Versus Late Initiation of Rehabilitation After Lumbar Spinal Fusion: Economic Evaluation Alongside a Randomized Controlled Trial.

Spine (Phila Pa 1976). 2013 Aug 7;
Oestergaard LG, Christensen FB, Nielsen CV, Bünger CE, Fruensgaard S, Sogaard R

Study Design. Economic evaluation conducted alongside a randomized controlled trial with 1-year follow-up.Objective. To examine the cost-effectiveness of initiating rehabilitation 6 weeks after surgery as opposed to 12 weeks after surgery.Summary of Background Data. In a previously reported randomised controlled trial, we assessed the impact of timing of rehabilitation after a lumbar spinal fusion and found that a fast-track strategy led to poorer functional ability. Before making recommendations, the societal perspective including return to work, quality of life, and costs seems relevant to address.Methods. A cost-effectiveness analysis and a cost-utility analysis were conducted. 82 patients undergoing instrumented lumbar spinal fusion due to degenerative disc disease or spondylolisthesis (grade I or II) were randomised to an identical protocol of four sessions of group-based rehabilitation and were instructed in home exercises focusing on active stability training. Outcome parameters included functional disability (Oswestry Disability Index) and quality-adjusted life years. Health care and productivity costs were estimated from national registries and reported in Euros (EUR). Costs and effects were transformed into net benefit. Bootstrapping was used to estimate 95% confidence intervals (95% CI).Results. The fast-track strategy tended to be more costly by 6,869 EUR (95% CI -4,640;18,378) while at the same time leading to significantly poorer outcomes of functional disability by 9 points (95% CI 1;16) and a tendency for a reduced gain in quality-adjusted life years by -.04 (95% CI -.11;.03). The overall probability for the fast-track strategy being cost-effective does not reach 10% at conventional thresholds for cost-effectiveness.Conclusion. Initiating rehabilitation 6 weeks as opposed to 12 weeks after surgery is on average more costly and less effective. The uncertainty of this result did not seem to be sensitive to methodological issues, and clinical managements who have already adapted fast-track rehabilitation strategies have reason to reconsider their choice. HubMed – rehab

Efficacy of exercise training in symptomatic patients with hypertrophic cardiomyopathy: Results of a structured exercise training program in a cardiac rehabilitation center.

Eur J Prev Cardiol. 2013 Aug 8;
Klempfner R, Kamerman T, Schwammenthal E, Nahshon A, Hay I, Goldenberg I, Dov F, Arad M

Recent data suggest that exercise training (ET) confers significant symptomatic and functional improvements in patients with diastolic dysfunction, and thus may be beneficial in patients with hypertrophic cardiomyopathy (HCM). However, there are no data regarding the safety or efficacy of ET in HCM patients.A prospective non-randomized intervention design was used.We enrolled 20 patients with symptomatic HCM, significantly limited in everyday activity, into a supervised cardiac rehabilitation exercise program.Patients were 62?±?13 years old, in New York Heart Association (NYHA) functional class II (35%) or III (65%), had a mean interventricular septum dimension of 17?±?5?mm and left ventricular ejection fraction (LVEF) of 53?±?15%. Left ventricular outflow gradient was present at rest in nine patients (mean 51?±?24?mm Hg) and six patients had an implantable defibrillator. Exercise prescription was based on heart rate reserve (HRR) determined from a symptom-limited graded exercise stress test. Exercise intensity was gradually increased from 50% to 85% of the HRR over the training period. Patients completed an average of 41?±?8?hours of aerobic ET. No adverse events or sustained ventricular arrhythmias occurred during the training program. Functional capacity, assessed by a graded exercise test, improved from 4.7?±?2.2 to 7.2?±?2.8 metabolic equivalents (METs) (p?=?0.01). NYHA functional class improved from baseline by ?1 grade in 10 patients (50%) and none experiencing deterioration during follow-up.The present study suggests that patients with HCM who remain symptomatic despite medical therapy may achieve considerable functional improvement through a supervised ET program. HubMed – rehab

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