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To evaluate the efficacy and feasibility of the eye protection chamber compared to adhesive tape in preventing corneal injury in critically ill adult patients. A two-arm, double-blind pilot randomized controlled trial following CONSORT guidelines. 80 critically ill patients were randomized into an intervention group (n = 40; eye drops plus eye protection chamber) and a control group (n = 40; eye drops plus micropore adhesive tape). Corneal health was assessed by a trained critical care nurse on days 1, 3, 5, 7, and 10 using fluorescein staining and portable slit-lamp examination. The primary outcome was the incidence of corneal injury. Secondary outcomes included the severity and associated risk factors. During the study period, 203 patients were assessed for eligibility. Of these, 123 (60.6 %) presented with corneal injury upon admission and were excluded, while 80 patients (39.4 %) met the inclusion criteria and were enrolled in the trial. In a randomized trial, corneal injury occurred in 11.2 % of participants, 7.5 % in the control group, and 3.75 % in the intervention group, indicating a 50 % reduction in risk with the chamber. Most injuries were classified as Grade 1. Grade 2 and bilateral injuries occurred only in the control group. The eye protection chamber was effective and viable in reducing the incidence and severity of corneal injuries compared to adhesive tape. The chamber demonstrated efficacy and feasibility in preventing corneal injuries in critically ill patients with impaired or absent blink reflexes, and it can be tested in other centers. Implementing preventive strategies, such as eyelid closure, lubrication, and mechanical protection, is essential to enhance patient safety and reduce avoidable ocular complications in intensive care settings.

Background The incidence of refractive surgery-related dry eye disease (DED) is rising due to the increasing popularity of corneal refractive surgery. The moisture chamber goggles (MCGs) have been shown to tear evaporation by increasing local humidity and minimizing airflow. The current study aims to evaluate the efficacy of moisture chamber goggles for refractive surgery-related DED. Methods In this nonrandomized open-label controlled study, 78 participants (156 eyes) receiving refractive surgery were enrolled between July 2021 and April 2022, and sequentially allocated to MGC and control groups. 39 participants were allocated to the MGC groups, of which 53.8% received small-incision lenticule extraction (SMILE) and 46.2% received femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and were instructed to wear MCGs for the duration of 1 month postoperatively, in addition to the standard postoperative treatment received by the control groups (56.4% SMILE, 43.6% FS-LASIK). Participants underwent full ophthalmic examinations, including visual acuity, manifest refraction, DED evaluations, and higher-order aberrations (HOAs), both preoperatively and at routine follow-ups 1 day, 1 week, and 1 month after surgery. DED parameters included non-invasive tear film break-up time (NIBUT), tear meniscus height (TMH), conjunctival congestion, lipid layer thickness (LLT), and ocular surface disease index (OSDI) questionnaires. Student’s t-test was used for comparisons between control and MCG groups, and between preoperative and postoperative parameters within groups. Results Postoperative NIBUT decreased in both SMILE and FS-LASIK control groups 1 day after the surgery (SMILE, P  = 0.001; FS-LASIK, P  = 0.008), but not in the corresponding MCG groups (SMILE, P  = 0.097; FS-LASIK, P  = 0.331). TMH in the MCG group was significantly higher at 1 week ( P  = 0.039) and 1 month ( P  = 0.015) in SMILE, and 1 day ( P  = 0.003) in FS-LASIK groups. In FS-LASIK participants, significantly lower HOAs and coma levels in the MCG group were observed 1 day (total HOAs, P  = 0.023; coma, P  = 0.004) and 1 week (total HOAs, P  = 0.010, coma, P  = 0.004) after surgery. No consistent statistically significant intergroup difference was observed between MCG and control groups in conjunctival congestion, LLT, and OSDI. Conclusions MCGs effectively slowed tear evaporation, increased tear film stability, and improved HOAs in patients receiving SMILE and FS-LASIK surgeries. MCG is an effective adjuvant therapy in the comprehensive management of refractive surgery-related DED.

Background Poor sleep is common in intensive care unit (ICU) patients, where environmental factors contribute to reduce and fragment sleep. The objective of this study was to evaluate the impact of earplugs and eye mask on sleep architecture in ICU patients. Methods A single-center randomized controlled trial of 64 ICU patients was conducted from July 2012 to December 2013. Patients were randomly assigned to sleep with or without earplugs and an eye mask from inclusion until ICU discharge. Polysomnography was performed on the first day and night following inclusion. The primary outcome was the proportion of stage N3 sleep over total sleep time. Secondary outcomes were other descriptors of sleep and major outcome variables. Results In the intervention group, nine (30%) patients did not wear earplugs all night long. The proportion of N3 sleep was 21 [7–28]% in the intervention group and 11 [3–23]% in the control group ( p  = 0.09). The duration of N3 sleep was higher among the patients in the intervention group who wore earplugs all night long than in the control group (74 [32–106] vs. 31 [7–76] minutes, p  = 0.039). The number of prolonged awakenings was smaller in the intervention group (21 [19–26] vs. 31 [21–47] in the control group, p  = 0.02). No significant difference was observed between the two groups in terms of clinical outcome variables. Conclusions Earplugs and eye mask reduce long awakenings and increase N3 duration when they are well tolerated. Trial registration ClinicalTrials.gov, NCT02292134 . Registered on 21 Nov 2013.

Ski helmet use has steadily increased worldwide over the last 10 years in part as a result of preventive helmet campaigns but also in part as a result of increased media coverage after fatal injuries involving celebrities. However, a commonly reported reason for nonuse is impaired vision. The aim of this pilot study was to investigate whether ski helmet use affects reaction time to peripheral stimuli. A randomized controlled trial using the Compensatory-Tracking-Test (CTT) was conducted in a laboratory situation. This test measures reaction time to peripheral stimuli during a tracking task and was carried out by 10 males and 10 females (age: 22.1 ± 2.5 years) during 4 conditions in a randomized order: (A) with a ski cap; (B) with a ski helmet; (C) with a ski cap and ski goggles; and (D) with a ski helmet and ski goggles. Friedman-tests revealed significant differences in reaction times (ms) between the 4 conditions ( p = .031). The lowest mean reaction time (± standard error) was measured for cap only use (477.3 ± 16.6), which was not different than helmet-only use (478.5 ± 19.1, p = 0.911). However, reaction time was significantly longer for cap + goggles use (514.1 ± 20.8, p = 0.005) and for helmet + goggles use (497.6 ± 17.3, p = 0.017) when compared to cap-only use. Our results showed that ski helmet use did not increase reaction time to peripheral stimuli. This information should be implemented in future preventive campaigns to increase helmet use in skiers and snowboarders.

Objective: To evaluate the protective eyewear promotion (PEP) project, which was a comprehensive educational strategy to increase the use of appropriate protective eyewear by squash players. Methods: An ecological study design was used. Four squash venues in one playing association were randomly chosen to receive PEP and four in another association maintained usual practice and hence formed a control group. The primary evaluation measurements were surveys of cross sectional samples of players carried out before and after the intervention. The surveys investigated players’ knowledge, behaviours, and attitudes associated with the use of protective eyewear. The survey carried out after the intervention also determined players’ exposure to PEP. Univariate and multivariate analyses were undertaken to describe differences at PEP venues from pre- to post-intervention and to compare these with the control venues. Results: The PEP players had 2.4 times the odds (95% confidence interval, 1.3 to 4.2) of wearing appropriate eyewear compared with control group players post-intervention, relative to the groups’ pre-intervention baselines. Components of PEP, such as stickers and posters and the availability and prominent positioning of the project eyewear, were found to contribute to players adopting favourable eyewear behaviours. Conclusions: Components of the PEP intervention were shown to be effective. The true success will be the sustainability and dissemination of the project, favourable eyewear behaviours, and evidence of the prevention of eye injuries long into the future.

Background: Epidemiological screening to examine possible ultraviolet-induced ocular changes and pathologies in Austrian farmers. Methods: The study was performed on behalf of the Austrian farmer insurance (Sozialversicherungsanstalt der Bauern). Randomly selected farmers and office workers as controls, both at the age of 35–55 years, underwent ophthalmic screening examinations. All subjects underwent complete ophthalmic examinations by slit lamp examination and Schirmer’s test 1. A survey, regarding per- sonal habits in the sun, was also conducted. Results: Three hundred and ninety-two subjects underwent ophthalmic examinations of whom 297 were farmers and 95 were controls. Due to the survey, 89.7% of the farmers claimed to protect themselves from the sun during work. From these subjects, 83.7% wear a head protection, 71.0% wear sunglasses, and 54.4% usually work in the shade. There were significant differences in lid (p = 0.021) and conjunctival pathologies (p < 0.0001) between farmers and controls. Conclusion: Austrian farmers are at a higher risk for developing lid and conjunctival tumours which require treatment at some point. We believe that the study group was too young to show significant differences within the lens and the posterior pole. A 5-year follow-up is planned.

Intraoperative hypothermia is a common event during laparoscopic operations. An external warming blanket has been shown to be effective in preventing hypothermia. It has now been proposed that using heated and humidified insufflation gas can prevent hypothermia and decrease postoperative pain. Therefore, we examined the extent of intraoperative hypothermia in patients undergoing laparoscopic Nissen fundoplication using an upper body warming blanket. We also attempted to determine whether using heated and humidified insufflation gas in addition to an external warming blanket would help to maintain intraoperative core temperature or decrease postoperative pain. Twenty patients were randomized to receive either standard carbon dioxide (CO2) gas (control, n = 10) or heated and humidified gas (heated and humidified, n = 10). After the induction of anesthesia, an external warming blanket was placed on all patients in both groups. Intraoperative core temperature and intraabdominal temperature were measured at 15-min intervals. Postoperative pain intensity was assessed using a visual analogue pain scale, and the amount of analgesic consumption was recorded. Volume of gas delivered, number of lens-fogging episodes, intraoperative urine output, and hemodynamic data were also recorded. There was no significant difference between the two groups in age, length of operation, or volume of CO2 gas delivered. Compared with baseline value, mean core temperature increased by 0.4 degrees C in the heated and humidified group and by 0.3 degrees C in the control group at 1.5 h after surgical incision. Intraabdominal temperature increased by 0.2 degrees C in the heated and humidified group but decreased by 0.5 degrees C in the control group at 1.5 h after abdominal insufflation. There was no significant difference between the two groups in visual analog pain scale (5.4 +/- 1.6 control vs 4.5 +/- 2.8 heated and humidified), morphine consumed (27 +/- 26 mg control vs 32 +/- 19 mg heated and humidified), urine output, lens-fogging episodes, or hemodynamic parameters. Heated and humidified gas, when used in addition to an external warming blanket, minimized the reduction of intraabdominal temperature but did not alter core temperature or reduce postoperative pain.

To survey healthcare workers (HCW) on availability and use of personal protective equipment (PPE) caring for COVID-19 patients in the intensive care unit (ICU). A web-based survey distributed worldwide in April 2020. We received 2711 responses from 1797 (67%) physicians, 744 (27%) nurses, and 170 (6%) Allied HCW. For routine care, most (1557, 58%) reportedly used FFP2/N95 masks, waterproof long sleeve gowns (1623; 67%), and face shields/visors (1574; 62%). Powered Air-Purifying Respirators were used routinely and for intubation only by 184 (7%) and 254 (13%) respondents, respectively. Surgical masks were used for routine care by 289 (15%) and 47 (2%) for intubations. At least one piece of standard PPE was unavailable for 1402 (52%), and 817 (30%) reported reusing single-use PPE. PPE was worn for a median of 4 h (IQR 2, 5). Adverse effects of PPE were associated with longer shift durations and included heat (1266, 51%), thirst (1174, 47%), pressure areas (1088, 44%), headaches (696, 28%), Inability to use the bathroom (661, 27%) and extreme exhaustion (492, 20%). HCWs reported widespread shortages, frequent reuse of, and adverse effects related to PPE. Urgent action by healthcare administrators, policymakers, governments and industry is warranted. [Display omitted] •Wide variability in what PPE is available for ICU staff caring for COVID-19 patients.•More than half report at least one PPE item missing or out of stock.•Adverse effects of wearing PPE reported by 80% of health care workers.•Adverse effects related to duration of a shift wearing PPE without taking a break.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. World Health Organization.

Goals—To assess the relative injury reduction effect and acceptability of face guards on batter's helmets. Methods—A non-randomized prospective cohort study among 238 youth league baseball teams in Central and Southern Indiana during the 1997 season. Coaches, parents, and players were asked to respond to pre-season and post-season questionnaires. Approximately one half of the teams were supplied with face guard helmets (intervention); all others used this protection at their discretion (comparison). Results—Parents, players, and coaches on the intervention teams reported a reduction in the incidence of oculofacial injuries compared with comparison team respondents (p=0.04). There was no reported adverse effect of face guard use on player performance. Conclusions—Helmet face guards should be required for batters to prevent facial injuries in baseball.