A changing supply chain for a changing health care system: Barriers and facilitators of implementing enterprise resource planning.

Background: No studies have examined how health care mergers and acquisitions affected the hospital supply chain and its employees since the passing of the Patient Protection and Affordable Care Act.

Objective: To describe the barriers and facilitators of digital transformation in a hospital supply chain from the employee perspective.

Methods: We conducted two rounds of interviews, one year apart, with supply chain employees at an urban academic health system preparing to adopt an enterprise resource planning (ERP) software (N = 11 in Round I and N = 8 in Round II).

Determinants of SARS-CoV-2 vaccine willingness among people incarcerated in 3 Canadian federal prisons: a cross-sectional study.

Background: Maximizing uptake of SARS-CoV-2 vaccines among people in prison is essential in mitigating future outbreaks. We aimed to determine factors associated with willingness to receive SARS-CoV-2 vaccination before vaccine availability.

Methods: We chose 3 Canadian federal prisons based on their low uptake of influenza vaccines in 2019-2020.

Corneal nerve and nerve conduction abnormalities in children with type 1 diabetes.

Objective: In vivo corneal confocal microscopy (CCM) is a novel, rapid, and non-invasive technique that identifies early small fiber damage and can predict the progression and development of clinical neuropathy in adults with type 1 diabetes. However, its usefulness in children is not well established. This study compared corneal confocal microscopy with neuropathic symptoms, signs, and objective measures of neuropathy for the diagnosis of diabetic neuropathy in children with type 1 diabetes.

Corneal Confocal Microscopy Predicts the Development of Diabetic Neuropathy: A Longitudinal Diagnostic Multinational Consortium Study.

Objective: Corneal nerve fiber length (CNFL) has been shown in research studies to identify diabetic peripheral neuropathy (DPN). In this longitudinal diagnostic study, we assessed the ability of CNFL to predict the development of DPN.

Research Design And Methods: From a multinational cohort of 998 participants with type 1 and type 2 diabetes, we studied the subset of 261 participants who were free of DPN at baseline and completed at least 4 years of follow-up for incident DPN.

Early corneal nerve fibre damage and increased Langerhans cell density in children with type 1 diabetes mellitus.

Corneal confocal microscopy (CCM) has been used to identify corneal nerve damage and increased Langerhans cell (LC) density in adults with Type 1 diabetes mellitus (T1DM). The purpose of this study was to evaluate whether corneal confocal microscopy can identify early corneal nerve damage and change in LC density in children and adolescents with T1DM. 64 participants with T1DM (age-14.

Corneal confocal microscopy for identification of diabetic sensorimotor polyneuropathy: a pooled multinational consortium study.

Aims/hypothesis: Small cohort studies raise the hypothesis that corneal nerve abnormalities (including corneal nerve fibre length [CNFL]) are valid non-invasive imaging endpoints for diabetic sensorimotor polyneuropathy (DSP). We aimed to establish concurrent validity and diagnostic thresholds in a large cohort of participants with and without DSP.

Methods: Nine hundred and ninety-eight participants from five centres (516 with type 1 diabetes and 482 with type 2 diabetes) underwent CNFL quantification and clinical and electrophysiological examination.

Optic neuropathy in the context of leukemia or lymphoma: diagnostic approach to a neuro-oncologic emergency.

Background: Optic neuropathy in the context of leukemia or lymphoma has a broad differential diagnosis, including infiltration, infection, inflammation, compression, and medication effects. Confirming the underlying etiology in a timely manner is crucial as, while infiltration carries a poor prognosis, treatment modalities can have serious consequences themselves.

Methods: A review of the literature was conducted for cases of isolated optic neuropathy in the context of leukemia or lymphoma, in which the underlying etiology remained unclear following initial clinical examination and neuroimaging.

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The aim of this study was to examine association between IFNL4 gene ss469415590 and treatment efficiency in group of Ukrainian PEG-interferon/ribavirin-treated chronic hepatitis C patients. Study group consisted of 92 unrelated hepatitis C virus genotype 1 mono-infected patients: case group - 29 patients with late or absent virological response; control group - 63 patients with sustained virological response. Study material was genomic DNA.

Evidence for small fiber neuropathy in early Parkinson's disease.

Introduction: Parkinson's disease (PD) is neurodegenerative movement disorder affecting primarily the central nervous system with several recognized non-motor symptoms that can occur at various stages of the disease. Recently it has been shown that patients with PD may be prone to peripheral nervous system pathology in the form of a peripheral neuropathy (PN). It is unclear if PN is an inherent feature of PD or if it is an iatrogenic effect of the mainstay PD treatment Levodopa.

Punctiform and Polychromatophilic Dominant Pre-Descemet Corneal Dystrophy.

Purpose: To describe the slit-lamp appearance and corneal confocal microscopy of autosomal dominant punctiform and polychromatophilic pre-Descemet corneal dystrophy in 3 members of the same family.

Methods: Slit-lamp examination of a 9-year-old boy showed bilateral polychromatophilic corneal opacities in a pre-Descemet membrane location evenly deposited limbus to limbus, both horizontally and vertically, with an intervening clear cornea. The corneal endothelium was normal on corneal confocal microscopy, with hyperreflective opacities of various sizes located pre-Descemet membrane.

polymorphism as a predictor of chronic hepatitis C treatment efficiency in Ukrainian patients.

The aim of this study was to examine association between gene ss469415590 and treatment efficiency in group of Ukrainian PEG-interferon/ribavirin-treated chronic hepatitis C patients. Study group consisted of 92 unrelated hepatitis C virus genotype 1 mono-infected patients: case group-29 patients with late or absent virological response; control group-63 patients with sustained virological response. Study material was genomic DNA.

The Reliability and Reproducibility of Corneal Confocal Microscopy in Children.

Purpose: To assess the image and patient level interrater agreement and repeatability within 1 month for corneal nerve fiber length (CNFL) measured using in vivo corneal confocal microscopy (IVCCM) in children.

Methods: Seventy-one subjects (mean [SD] age 14.3 [2.

Normative values for corneal nerve morphology assessed using corneal confocal microscopy: a multinational normative data set.

Objective: Corneal confocal microscopy is a novel diagnostic technique for the detection of nerve damage and repair in a range of peripheral neuropathies, in particular diabetic neuropathy. Normative reference values are required to enable clinical translation and wider use of this technique. We have therefore undertaken a multicenter collaboration to provide worldwide age-adjusted normative values of corneal nerve fiber parameters.

Two cases of spontaneous filtering blebs, one idiopathic and one associated with Terrien marginal degeneration.

Purpose: To report a case of an idiopathic unilateral filtering bleb in an otherwise well patient and a case of bilateral spontaneous filtering blebs in association with Terrien marginal degeneration.

Methods: In this retrospective observational study of 2 cases, clinical notes, ultrasound biomicroscopy and gonioscopy images were reviewed.

Results: Case 1: A 32-year-old woman presented with a 1-year history of a gradually growing cyst in her right eye.

Bilateral cataracts associated with glucose-6-phosphate dehydrogenase deficiency.

Glucose-6-phosphate dehydrogenase (G6PD) has an essential role in the defense against cellular oxidative injury. In neonates, the most common manifestation of G6PD deficiency is jaundice and hemolysis due to factors causing oxidative stress. Less known are the ocular associations described with G6PD deficiency, including cataracts.

Intermittent exotropia: facts, opinions, and unknowns.

Introduction: Intermittent exotropia (IXT) can be a controversial topic, often eliciting lively discussion. This lecture will discuss its definition, incidence, age of onset, presentation, natural variation, criteria for deterioration, goals of treatment, effectiveness of surgical treatment, types of surgical treatment, and unwanted effects of surgical treatment.

Method: Results from the scientific literature, opinions of respected colleagues, the opinion of the author, and the results of live polling of the audience during the John Pratt-Johnson lecture are presented.

Diffraction-enhanced imaging of a porcine eye.

Background: Diffraction-enhanced imaging (DEI) is a synchrotron-based x-ray imaging technique that has dramatically improved contrast over standard x-ray imaging techniques. It is possible to acquire images that analyze the x-ray refraction and the apparent absorption (elimination of small-angle scattering) of the object.

Methods: Three formalin-fixed porcine eyes were studied at the National Synchrotron Light Source using DEI.

Indoor soccer-related eye injuries: should eye protection be mandatory?

Background: Our objectives were to present the spectrum of eye injuries caused by indoor soccer, as seen at our institution, and to initiate discussion as to whether eye protection should become mandatory for this indoor sport.

Methods: Chart review of patients presenting to our institution with eye injuries from indoor soccer.

Results: Five cases were identified from 2001-2005, all occurring during the winter or late fall.

Ophthalmic findings in Setleis syndrome: two new cases in a mother and son.

Case Report: Setleis syndrome is a rare ectodermal dysplasia with characteristic ophthalmic findings. We describe the first 2 reported cases in Canadian individuals of Aboriginal descent.

Comments: Although most ophthalmic findings are benign, it is important to recognize the clinical significance for management and genetic counselling.

Consecutive exotropia following surgically corrected cyclic esotropia.

Introduction: Cyclic esotropia is a rare form of strabismus consisting of regular intervals of esotropia alternating with periods of orthophoria in a rhythmic/cyclic manner. In the vast majority of cases, surgery appears to permanently correct the esotropia, with no sequelae after years of follow-up. We report a case of consecutive exotropia in a patient five years after bilateral medial rectus recessions for cyclic esotropia.

Long-term refractive change after intraocular lens implantation in childhood.

Background: To determine refractive change occurring with age in children who had cataract removal with intraocular lens implantation and in whom the immediate postoperative refraction was targeted either to match the refractive error of the opposite eye in unilateral cases, or for only a small refractive error when surgery was bilateral.

Methods: Retrospective review of the refractive error over time in 36 eyes of 25 children who underwent cataract removal (11 bilateral) with insertion of an intraocular lens from 1987 to 1998 and who had at least 4 years follow-up, but no glaucoma.

Results: Mean age at surgery was 5.

The natural history of surgically untreated intermittent exotropia-looking into the distant future.

Purpose: We studied patients with distance intermittent exotropia with at least 5 years follow-up before any surgical therapy, to determine how often amblyopia developed, whether there was progressive worsening in the angle or control of the exodeviation, whether there was deterioration in binocular vision, and other parameters.

Methods: Retrospective review of charts of patients with exodeviations examined consecutively over 17 years.

Results: There were 109 patients followed for a mean of 9 years (range 5 to 25).

The effect of limiting residents' work hours on their surgical training: a Canadian perspective.

Restrictions in residents' work hours have been in place in Canada for roughly a decade, having been negotiated rather than imposed. The changes in residents' schedules that resulted are roughly equivalent to the limitation of 80 duty hours per week in the United States. When work-hours restrictions began, surgery faculty were worried that residents' experience would be compromised.

Enhanced models for teaching slit-lamp skills.

This article describes enhancements to models previously devised for demonstrating slit-lamp findings to students and physicians. The models can simulate the optical appearance of the anterior segment, "flare" and "cells" in the anterior chamber, hypopyon, gross and microscopic hyphema, the red reflex, cataract, corneal epithelial defects (including fluorescein staining) and superficial corneal foreign bodies, whose removal can be practised.