Explore the vast range of titles available.

Given the low inherent risk posed by modern cataract surgery, there is ongoing debate regarding the need for anesthesia personnel for this procedure. However, few studies report patient perspectives about cataract surgery sedation. We sought to characterize patient perspectives regarding their experiences undergoing cataract surgery with monitored anesthesia care (MAC) and their willingness to consider cataract surgery with sedation alternatives to MAC. Semi-structured interviews were conducted with 9 patients (4 women) who recently underwent routine cataract surgery at the University of California, San Francisco. Participants were recruited from the Parnassus Outpatient Surgery Center. Interviews were recorded, de-identified, transcribed, and analyzed using an inductive thematic analysis approach. We ascertained the most relevant themes related to patients' experience with cataract surgery and their perspectives on alternatives to anesthesia-led sedation during routine cataract surgery. We found that patients are most concerned about achieving the best surgical outcome due to the importance they placed on preserving their vision. They expressed their fear of disrupting surgery intraoperatively and shared that they experienced a relative lack of communication about sedation in advance of surgery. However, while patients expressed a strong preference for anesthesia-led sedation during cataract surgery, they conveyed their openness to considering sedation alternatives in the presence of appropriate perioperative education, the availability of recent evidence supporting the safety of alternative approaches for cataract surgery, and their strong trust in their ophthalmologist's professional recommendations. Patients prefer anesthesia-led sedation for cataract surgery but are willing to consider alternatives to MAC if the published evidence and their ophthalmologist attest that the alternatives are safe and effective.

Background Cataract surgery is one of the most common elective outpatient surgeries performed among older adults in the United States. Modern surgical technique makes cataract surgery a relatively quick, low-risk, minimally invasive outpatient procedure that can be performed solely under ophthalmologist-directed local or topical anesthesia. However, in the US, the procedure is routinely performed with additional monitoring and intravenous sedation administered by anesthesia-trained personnel. Given the procedure’s safety profile, we sought to characterize ophthalmologists’ perspectives on barriers preventing the adoption of more individualized approaches to cataract surgery sedation that do not automatically default to employing routine anesthesia care. Methods This study was conducted between December 2022 to January 2024. Using a semi-structured interview guide developed with the Consolidated Framework for Implementation Research (CFIR) framework, we completed interviews with ophthalmologists who performed cataract surgery with or without anesthesia care in hospital outpatient departments, ambulatory surgery centers, minor procedure rooms, and/or office-based surgery suites across the United States. Data were analyzed using an inductive thematic analysis approach to uncover descriptive themes. Results We interviewed 19 ophthalmologists (5 women), including 6 who had experience routinely performing cataract surgery without anesthesia care. Three major themes emerged: (1) inertia, defined as the tendency to continue established practices that serve to maintain the status quo, (2) financial considerations, and (3) the interdependent relationship between ophthalmology and anesthesiology. While some participants supported a more selective approach to the use of anesthesia services, study participants identified multiple barriers to change, including difficulty overcoming the current inertia, decreased reimbursement for office-based surgery, and concerns about implications for patient safety without routine anesthesia involvement. Conclusion Ophthalmologists identified multiple barriers to changing current anesthesia-led sedation models for cataract surgery. Our findings can help inform future efforts to better align anesthesia care with patient and procedural needs in an aging US population.

Background Cataract surgery is one of the most common elective surgeries and has been shown to be safe with low adverse event rates. Most cataract patients in the US receive one-to-one intraoperative monitoring and sedation administered by an anesthesiologist or nurse anesthetist, termed “monitored anesthesia care” (MAC). Recent studies have suggested that non-anesthesia-led sedation approaches may safely be used in older adults undergoing cataract surgery. However, it is unknown how individual ophthalmologists perceive the risks of cataract surgery with respect to the need for MAC. We sought to characterize physician beliefs and opinions about the risks of performing cataract surgery when considering potential non-anesthesia-led approaches to cataract surgery sedation. Methods Using a semi-structured interview guide developed with the Consolidated Framework for Implementation Research (CFIR) framework, between December 2022 and May 2023, we conducted virtual interviews with ophthalmologists who routinely performed cataract surgeries in the United States with or without anesthesia care in outpatient clinical settings across the continental US. Data were analyzed from June 2023 through January 2024 using an inductive thematic analysis approach. Results Interviews of 19 ophthalmologists revealed 2 major themes that formed the foundational understanding of how ophthalmologists perceive cataract surgery risk in the context of non-anesthesia-led models of sedation: (1) overall safety of cataract surgery and (2) concerns about assuming sedation responsibilities. Despite conceding that cataract surgery is a low-risk procedure for the vast majority of patients, participants were hesitant to change their current practice and desired an anesthesia “safety net” at all times in case of an unexpected intraoperative event or emergency. Many ophthalmologists’ responses underscored their aversion to any potential loss of routine anesthesia support without an acceptable alternative present. Conclusions Despite acknowledging its low-risk profile, ophthalmologists are wary of making changes to current sedation approaches for routine cataract surgery.

Autophagy activation has the potential to ameliorate neurodegenerative disease phenotypes, including protein aggregation, lipid level perturbations and axonal trafficking defects. We performed a high content imaging-based screen assessing 940,000 small molecules to identify those that accelerate lipid droplet clearance. Hits were validated in diverse cell lines and by counter-screening. Of the 77 structurally diverse validated hits, 24 increase autophagy flux. Herein, we highlight CCT020312 as a mammalian target of rapamycin (mTOR) inhibitor-independent autophagy activator, which should function without compromising human immune function. CCT020312 dose-dependently reduces cytotoxic axonal mutant prion protein aggregate levels within endosomes of primary murine hippocampal neurons and normalizes axonal trafficking deficiencies. Moreover, CCT020312 robustly clears phosphorylated insoluble tau, while reducing tau-mediated neuronal stress vulnerability in patient-derived neuronal models. CCT020312 also restores lysosomal function in neurons differentiated from sporadic Alzheimer's patients' fibroblasts bearing epigenetic marks of aging. Taken together, we describe a promising strategy to uncover novel pharmacological agents that normalize cellular neurodegenerative disease pathology. Competing Interest Statement The authors have declared no competing interest.