IMPORTANCE Eye trauma is a common cause of vision loss and a substantial public health problem.OBJECTIVE To determine the changes in the incidence of eye trauma hospitalizations in the United States and compare the demographics of affected patients and outcomes of eye trauma as a primary or secondary admitting diagnosis. DESIGN, SETTING, AND PARTICIPANTSThis retrospective longitudinal cohort study used the National Inpatient Sample, a representative sample of all US community hospitals, to determine the incidence, characteristics, and causes of primary and secondary inpatient eye trauma admissions from 2001 through 2014. All inpatients with relevant diagnoses were included. Linear regression was used to estimate changes in incidence. Logistic regression was used to compare demographics and outcomes between primary and secondary diagnoses, including age, sex, race, income, primary payer, region, year of admission, length of stay, cost, and disposition at discharge. EXPOSURES Eye trauma.MAIN OUTCOMES AND MEASURES Incidence and characteristics of inpatient primary and secondary eye trauma. RESULTSFrom 2001 to 2014, there were an estimated 939 608 inpatient admissions (of whom 556 886 were male patients [59.3%]; overall mean [SD] age, 49.4 [25.2] years) in the United States because of eye trauma diagnoses, with 778 967 of these (82.9%) as a secondary diagnosis. The incidence of primary eye trauma decreased from 3.9 to 3.0 per 100 000 population (difference, 0.9 [95% CI, 0.2-1.6] per 100 000 population; P = .001). The incidence of eye trauma as a secondary admitting diagnosis increased from 14.5 to 19.0 per 100 000 population (difference, 4.5 [95% CI, 1.9-7.2] per 100 000 population; P = .004). This was largely attributed to an increasing number of falls in individuals older than 65 years. The most frequent diagnosis was orbital fracture (64 149 [39.9%]) for primary trauma and contusion of eye and adnexa (19 301 [37.8%]) for secondary trauma. Primary trauma was more common in children (adjusted odds ratio [aOR], 2.21 [95% CI, 2.09-2.32]) and adolescents (aOR, 1.25 [95% CI,) than adults (reference), African American individuals (aOR, 1.89 [95% CI, 1.81-1.97]) and Hispanic individuals (aOR, 1.52 [95% CI, 1.45-1.59]) than white individuals, and uninsured patients (aOR, 1.14 [95% CI, 1.07-1.22]) and those receiving Medicaid (aOR, 1.12 [95% CI, 1.05-1.19]) than Medicare beneficiaries. Patients with a primary diagnosis were more likely to have a stay of less than 3 days (patients with a primary diagnosis: 101 796 [63.4%]; secondary diagnosis: 274 538 [35.2%]), more likely to have costs in the lowest quartile (patients with a primary diagnosis: 51 212 [31.9%]; secondary diagnosis: 166 260 [21.3%]), and less likely to die (patients with a primary diagnosis: 526 [0.3%]; secondary diagnosis: 20 929 [2.7%]).CONCLUSIONS AND RELEVANCE These findings suggest that the increasing number of falls in individuals older than 65 years and the high risk of primary eye trauma in populations such as children and adolescents warrant the devel...

Background Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities. Objective The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community. Methods This study was a randomized controlled, outcome assessor–blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle. Results A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic BP<125 mm Hg (18/54, 33% vs 11/52, 21%; P=.16), diastolic BP<85 mm Hg (44/54, 81% vs 37/52, 71%; P=.21), HbA1c level<7% (36/55, 65% vs 30/40, 75%; P=.32), and low-density lipoprotein level<100 mg/dL (36/51, 70% vs 30/45, 67%; P=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4% vs 2/155, 1.3%), and this difference was statistically significant (P<.001). Conclusions The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability. Trial Registration ClinicalTrials.gov NCT02202330; https://www.clinicaltrials.gov/ct2/show/NCT02202330

ImportanceIt is important to establish reliable outcome measures to detect progression in retinitis pigmentosa (RP).BackgroundTo evaluate progression of RP using multimodal imaging, including spectral‐domain optical coherence tomography (SD‐OCT), fundus autofluorescence (FAF) and microperimetry (MP).DesignRetrospective longitudinal study at a tertiary teaching hospital.Participants205 eyes of 106 patients with RP with 1 to 5 y of follow‐up.MethodsDemographics and visual acuity (VA) were recorded, and each modality was graded at baseline and every annual follow‐up. SD‐OCT was graded for the width of ellipsoid zone (EZ), FAF was graded for the diameter and area of the hyperautofluorescent ring (if present), and MP was graded for mean, central and paracentral sensitivity. Spearman's correlation was used to measure correlations at baseline. Mixed effects models were used to estimate the annual change of each parameter, adjusted for disease duration.Main Outcome MeasuresRate of progression.ResultsThe median VA at baseline was 75 letters and was positively correlated with mean and central sensitivity (r: 0.372 and 0.394; P = 0.01 for both). All parameters (except paracentral sensitivity) were strongly correlated with each other (r: 0.673‐0.991; P < 0.001 for all). The annual rates of change for each parameter were as follows: VA, −2.3 letters (P < 0.001); EZ, −151 μm (P < 0.001); ring diameter, −132 μm (P < 0.001); ring area, −0.4 mm2 (P < 0.001); mean sensitivity, −0.3 dB (P < 0.001); central sensitivity, −0.7 dB (P < 0.001); paracentral sensitivity, −0.4 dB (P < 0.001).Conclusions and RelevanceStructural and functional measures are well correlated in RP and can reliably measure disease progression within the course of a year.

No abstract