Evaluation of an Intervention to Reduce Low-Value Preoperative Care for Patients Undergoing Cataract Surgery at a Safety-Net Health System.

Importance: Preoperative testing for cataract surgery epitomizes low-value care and still occurs frequently, even at one of the nation's largest safety-net health systems.

Objective: To evaluate a multipronged intervention to reduce low-value preoperative care for patients undergoing cataract surgery and analyze costs from various fiscal perspectives.

Design, Setting, And Participants: This study took place at 2 academic safety-net medical centers, Los Angeles County and University of Southern California (LAC-USC) (intervention, n = 469) and Harbor-UCLA (University of California, Los Angeles) (control, n = 585), from April 13, 2015, through April 12, 2016, with 12 additional months (April 13, 2016, through April 13, 2017) to assess sustainability (intervention, n = 1002; control, n = 511).

Assessment of Exposure to High-Performing Schools and Risk of Adolescent Substance Use: A Natural Experiment.

Importance: Although school environments are thought to influence health behaviors, experimental data assessing causality are lacking, and which aspects of school environments may be most important for adolescent health are unknown.

Objective: To test whether exposure to high-performing schools is associated with risky adolescent health behaviors.

Design, Setting, And Participants: This natural experiment used admission lotteries, which mimic random assignment, to estimate the association of school environments and adolescent health.

Liver Disease as a Predictor of New-Onset Atrial Fibrillation.

Background Impact of liver disease on development of atrial fibrillation ( AF ) is unclear. The purpose of the study was to evaluate prevalence of AF in the setting of liver disease and whether increasing severity of liver disease, using Model for End-Stage Liver Disease ( MELD ), is independently associated with increased risk of AF . Methods and Results Retrospective data analysis of 1727 patients with liver disease evaluated for liver transplantation between 2006 and 2015 was performed, and patient characteristics were analyzed from billing codes and review of medical records.

Association of Hospital Length of Stay and Complications With Readmission After Open Pancreaticoduodenectomy.

This study uses data from the American College of Surgeons National Quality Improvement Program databases to evaluate associations between hospital length of stay and postoperative complications with hospital readmission among patients who underwent open pancreaticoduodenectomy.

Neurodegenerative disease biomarkers Aβ, Aβ, tau, and p-tau in the vervet monkey cerebrospinal fluid: Relation to normal aging, genetic influences, and cerebral amyloid angiopathy.

Background: The Caribbean vervet monkey () is a potentially valuable animal model of neurodegenerative disease. However, the trajectory of aging in vervets and its relationship to human disease is incompletely understood.

Methods: To characterize biomarkers associated with neurodegeneration, we measured cerebrospinal fluid (CSF) concentrations of Aβ, Aβ, total tau, and p-tau in 329 members of a multigenerational pedigree.

Variation of Thyroidectomy-Specific Outcomes Among Hospitals and Their Association With Risk Adjustment and Hospital Performance.

Importance: Current surgical quality metrics might be insufficient to fully judge the quality of certain operations because they are not procedure specific. Hypocalcemia, recurrent laryngeal nerve (RLN) injury, and hematoma are considered to be the most relevant outcomes to measure after thyroidectomy. Whether these outcomes can be used as hospital quality metrics is unknown.

Choriocapillaris Imaging Using Multiple En Face Optical Coherence Tomography Angiography Image Averaging.

Importance: Imaging of the choriocapillaris in vivo is challenging with existing technology. Optical coherence tomography angiography (OCTA), if optimized, could make the imaging less challenging.

Objective: To investigate multiple en face image averaging on OCTA images of the choriocapillaris.

Melanoma-Associated Retinopathy 28 Years After Diagnosis.

This case report describes the 28-year follow-up of a man diagnosed with melanoma-associated retinopathy when he was in his 30s.

Spectral-Domain Optical Coherence Tomographic Angiography in Children With Amblyopia.

Importance: Amblyopia is the most common cause of visual impairment in childhood, with a prevalence of 1% to 4% in children in the United States. To date, no studies using noninvasive optical coherence tomographic angiography (OCTA) have measured blood flow in the retinal capillary layers in children with amblyopia.

Objective: To evaluate the retinal and microvascular features using OCTA in children (<18 years) with amblyopia.

Repeatability and Reproducibility of Superficial Macular Retinal Vessel Density Measurements Using Optical Coherence Tomography Angiography En Face Images.

Importance: The repeatability and reproducibility of quantitative metrics from optical coherence tomographic angiography (OCTA) must be assessed before these data can be confidently interpreted in clinical research and practice.

Objective: To evaluate the repeatability and reproducibility of OCTA-derived retinal vascular quantitative metrics.

Design, Setting And Participants: In this cross-sectional study, 21 healthy volunteers (42 eyes) and 22 patients with retinal disease (22 eyes), including 14 with age-related macular degeneration, 3 with epiretinal membrane, 2 with diabetic retinopathy, 2 with myopic macular degeneration, and 1 with retinal vein occlusion, were enrolled.

Clinicopathologic features and pathogenesis of melanocytic colonization in atypical meningioma.

Only two prior cases of benign dendritic melanocytes colonizing a meningioma have been reported. We add a third case, describe clinicopathologic features shared by the three, and elucidate the risk factors for this very rare phenomenon. A 29 year-old Hispanic woman presented with headache and hydrocephalus.

Incidence of Atrophic Lesions in Stargardt Disease in the Progression of Atrophy Secondary to Stargardt Disease (ProgStar) Study: Report No. 5.

Importance: Outcome measures that are sensitive to disease progression are needed as clinical end points for future treatment trials in Stargardt disease.

Objective: To examine the incidence of atrophic lesions of the retinal pigment epithelium in patients with Stargardt disease as determined by fundus autofluorescence imaging.

Design, Setting, And Participants: In this retrospective multicenter cohort study, 217 patients 6 years and older at baseline at tertiary referral centers in Europe, the United States, and the United Kingdom who were harboring disease-causing variants in the adenosine triphosphate (ATP)-binding cassette subfamily A member 4 (ABCA4) gene and who met the following criteria were enrolled: (1) at least 1 well-demarcated area of atrophy with a minimum diameter of 300 µm, with the total area of all atrophic lesions being less than or equal to 12 mm2 in at least 1 eye at the most recent visit, and (2) fundus autofluorescence images for at least 2 visits with a minimum of 6 months between at least 2 visits.

The KRAS-Variant and Cetuximab Response in Head and Neck Squamous Cell Cancer: A Secondary Analysis of a Randomized Clinical Trial.

Importance: There is a significant need to find biomarkers of response to radiotherapy and cetuximab in locally advanced head and neck squamous cell carcinoma (HNSCC) and biomarkers that predict altered immunity, thereby enabling personalized treatment.

Objectives: To examine whether the Kirsten rat sarcoma viral oncogene homolog (KRAS)-variant, a germline mutation in a microRNA-binding site in KRAS, is a predictive biomarker of cetuximab response and altered immunity in the setting of radiotherapy and cisplatin treatment and to evaluate the interaction of the KRAS-variant with p16 status and blood-based transforming growth factor β1 (TGF-β1).

Design, Setting, And Participants: A total of 891 patients with advanced HNSCC from a phase 3 trial of cisplatin plus radiotherapy with or without cetuximab (NRG Oncology RTOG 0522) were included in this study, and 413 patients with available samples were genotyped for the KRAS-variant.

Standards of care for obsessive-compulsive disorder centres.

In recent years, many assessment and care units for obsessive-compulsive disorder (OCD) have been set up in order to detect, diagnose and to properly manage this complex disorder, but there is no consensus regarding the key functions that these units should perform. The International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) together with the Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology (ECNP) and the Anxiety and Obsessive Compulsive Disorders Section of the World Psychiaric Association (WPA) has developed a standards of care programme for OCD centres. The goals of this collaborative initiative are promoting basic standards, improving the quality of clinical care and enhance the validity and reliability of research results provided by different facilities and countries.

Course of Glaucomatous Visual Field Loss Across the Entire Perimetric Range.

Importance: Identifying the course of glaucomatous visual field (VF) loss that progresses from normal to perimetric blindness is important for treatment and prognostication.

Objective: To model the process of glaucomatous VF decay over the entire perimetric range from normal to perimetric blindness.

Design, Setting, And Participants: A post hoc, retrospective analysis was performed using data from the Advanced Glaucoma Intervention Study and the UCLA (University of California, Los Angeles) Jules Stein Eye Institute Glaucoma Division.

Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea: A Meta-analysis.

Importance: Maxillomandibular advancement (MMA) is an invasive yet effective surgical option for obstructive sleep apnea (OSA) that achieves enlargement of the upper airway by physically expanding the facial skeletal framework.

Objective: To identify criteria associated with surgical outcomes of MMA using aggregated individual patient data from multiple studies.

Data Sources: The Cochrane Library, Scopus, Web of Science, and MEDLINE from June 1, 2014, to March 16, 2015, using the Medical Subject Heading keywords maxillomandibular advancement, orthognathic surgery, maxillary osteotomy, mandibular advancement, sleep apnea, surgical, surgery, sleep apnea syndrome, and obstructive sleep apnea.

Long-Acting Injectable Risperidone for Relapse Prevention and Control of Breakthrough Symptoms After a Recent First Episode of Schizophrenia. A Randomized Clinical Trial.

Importance: Long-acting, injectable, second-generation antipsychotic medication has tremendous potential to bring clinical stability to persons with schizophrenia. However, long-acting medications are rarely used following a first episode of schizophrenia.

Objective: To compare the clinical efficacy of the long-acting injectable formulation of risperidone with the oral formulation in the early course of schizophrenia.

Medical professional liability claims for Mohs micrographic surgery from 1989 to 2011.

Importance: Few studies specifically address lawsuits involving Mohs surgery.

Objective: To better characterize the types of medical professional liability claims involving Mohs surgery.

Design, Setting, And Participants: Retrospective legal document review of an online national database.

Importance of tumor grade in esthesioneuroblastoma survival: a population-based analysis.

Importance: There is a need for larger studies characterizing the effect of tumor grade on survival for patients with esthesioneuroblastoma.

Objective: To investigate prognostic factors for survival in patients diagnosed with esthesioneuroblastoma, including emphasis on tumor grade.

Design, Setting, And Participants: Retrospective, population-based cohort study of patients in the Surveillance, Epidemiology, and End Results (SEER) tumor registry who were diagnosed with esthesioneuroblastoma from January 1, 1973, to January 1, 2010.

Evaluation of hospital readmissions in surgical patients: do administrative data tell the real story?

Importance: The Centers for Medicare & Medicaid Services has developed an all-cause readmission measure that uses administrative data to measure readmission rates and financially penalize hospitals with higher-than-expected readmission rates.

Objectives: To examine the accuracy of administrative codes in determining the cause of readmission as determined by medical record review, to evaluate the readmission measure's ability to accurately identify a readmission as planned, and to document the frequency of readmissions for reasons clinically unrelated to the original hospital stay.

Design, Setting, And Participants: Retrospective review of all consecutive patients discharged from general surgery services at a tertiary care, university-affiliated teaching hospital during 8 consecutive quarters (quarter 4 [October through December] of 2009 through quarter 3 [July through September] of 2011).