Publications by authors named "Amy Kloosterboer"

11 Publications

  • Page 1 of 1

Assessing the Quality, Content, and Readability of Freely Available Online Information for Patients Regarding Age-Related Macular Degeneration.

Semin Ophthalmol 2021 Mar 1:1-6. Epub 2021 Mar 1.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States of America.

: One of the top ten causes of disability in the United States is vision loss, primarily due to age-related eye diseases such as age-related macular degeneration. With an aging population, the number of people affected by this condition is expected to rise. Patients increasingly turn to the internet for health-related information, but no standard exists across published websites.: To assess the quality, content, accountability and readability of information found online for age-related macular degeneration.: This cross-sectional study analyzed 12 freely available medical sites with information on age-related macular degeneration and used PubMed as a gold standard for comparison. Thirty-four questions were composed to include information most relevant to patients and each website was independently evaluated by one vitreoretinal surgeon, two vitreoretinal fellows and one ophthalmology resident. Readability was analyzed using an online readability tool. The JAMA benchmarks were used to evaluate the accountability of each site.: Freely available online information was used in this study.: The average questionnaire score for all websites was 90.23 (SD 17.56, CI 95% ±9.55) out of 136 possible points. There was a significant difference between the content quality of the websites ( = .01). The mean reading grade for all websites was 11.44 (SD 1.75, CI 95% ±0.99). No significant correlation was found between content accuracy and the mean reading grade or Google rank (r = 0.392, = .207 and r = 0.133, = .732, respectively). Without including PubMed, only one website achieved the full 4 JAMA benchmarks. There was no correlation between the accuracy of the content of the website and JAMA benchmarks (r = 0.344, = .273). The interobserver reproducibility was similar among 3 out of 4 observers (r = 0.747 between JS and NT, r = 0.643 between JS and NP, r = 0.686 between NP and NT, r = 0.581 between JS and NY; P ≤ 0.05).: The freely available information online on age-related macular degeneration varies by source but is generally of low quality. The material presented is difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide sufficient information using the grading scheme we used to support the patient in making medical decisions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08820538.2021.1893761DOI Listing
March 2021

Evaluation of the Content, Quality, and Readability of Patient Accessible Online Resources Regarding Cataracts.

Semin Ophthalmol 2021 Feb 26:1-8. Epub 2021 Feb 26.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

Purpose: To evaluate the content quality, accuracy, and readability of commonly visited websites by cataract patients contemplating cataract surgery.

Setting: Freely available online information.

Design: Cross-sectional study.

Methods: Ten websites were evaluated in a cross-sectional study for content analysis using a grading sheet of 40 questions individually scored by three ophthalmologists. JAMA benchmarks were used to assess the quality. An online readability tool, , was used to assess the readability.

Results: There was a significant difference between the content and accuracy of each website according to a Kruskal-Wallis test (H = 22.623, = .007). The average score for all websites using the grading sheet was 90.85 out of 160 points, or 57% (SD 29.93, CI 95%±17.69). There was no significant correlation between website rank on Google.com and content quality of the website (r = 0.049, = .894). No websites complied with all 4 JAMA criteria for authorship. There was no significant correlation between content quality of each website and number of JAMA requirements met (r = -0.563, = .09). The average Flesch Reading Ease Score for all websites was 52.64 (SD 11.94, CI 95%±7.40), and the average Mean Reading Grade was 10.72 (SD 1.58, CI 95%±0.98). There was a significant difference in Mean Reading Grades between websites (H = 23.703, = .005). There was no significant correlation between content quality of the website and Mean Reading Grade (r = -0.552, = .098).

Conclusion: Commonly accessed online resources on cataracts and cataract surgery are insufficient to provide patients with a clear and complete understanding of their condition as well as available medical and surgical treatment options.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08820538.2021.1893758DOI Listing
February 2021

Catecholamine-induced cerebral vasospasm and multifocal infarctions in pheochromocytoma.

Endocrinol Diabetes Metab Case Rep 2020 Aug 20;2020. Epub 2020 Aug 20.

Department of Anesthesiology, Perioperative and Pain Medicine.

Summary: We report the case of a 76-year-old male with a remote history of papillary thyroid cancer who developed severe paroxysmal headaches in the setting of episodic hypertension. Brain imaging revealed multiple lesions, initially of inconclusive etiology, but suspicious for metastatic foci. A search for the primary malignancy revealed an adrenal tumor, and biochemical testing confirmed the diagnosis of a norepinephrine-secreting pheochromocytoma. Serial imaging demonstrated multiple cerebral infarctions of varying ages, evidence of vessel narrowing and irregularities in the anterior and posterior circulations, and hypoperfusion in watershed areas. An exhaustive work-up for other etiologies of stroke including thromboembolic causes or vasculitis was unremarkable. There was resolution of symptoms, absence of new infarctions, and improvement in vessel caliber after adequate alpha-adrenergic receptor blockade for the management of pheochromocytoma. This clinicoradiologic constellation of findings suggested that the etiology of the multiple infarctions was reversible cerebral vasoconstriction syndrome (RCVS). Pheochromocytoma remains a poorly recognized cause of RCVS. Unexplained multifocal cerebral infarctions in the setting of severe hypertension should prompt the consideration of a vasoactive tumor as the driver of cerebrovascular dysfunction. A missed or delayed diagnosis has the potential for serious neurologic morbidity for an otherwise treatable condition.

Learning Points: The constellation of multifocal watershed cerebral infarctions of uncertain etiology in a patient with malignant hypertension should trigger the consideration of undiagnosed catecholamine secreting tumors, such as pheochromocytomas and paragangliomas. Reversible cerebral vasoconstriction syndrome is a serious but reversible cerebrovascular manifestation of pheochromocytomas that may lead to strokes (ischemic and hemorrhagic), seizures, and cerebral edema. Alpha-adrenergic receptor blockade can reverse cerebral vasoconstriction and prevent further cerebral ischemia and infarctions. Early diagnosis of catecholamine secreting tumors has the potential for reducing neurologic morbidity and mortality in patients presenting with cerebrovascular complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1530/EDM-20-0078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487175PMC
August 2020

Pars Plana Vitrectomy Reoperations for Complications of Proliferative Diabetic Retinopathy.

Clin Ophthalmol 2020 10;14:1559-1563. Epub 2020 Jun 10.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

Objective: To report visual acuity in patients undergoing pars plana vitrectomy (PPV) reoperations for complications of proliferative diabetic retinopathy (PDR).

Design: Retrospective case series.

Subjects: Diabetic patients undergoing reoperation with PPV between 2015 and 2018 at a university referral center.

Methods: Patient charts were reviewed for indication for initial and repeat PPV, baseline clinical characteristics including gender, age, and lens status, and pre- and post-operative best-corrected visual acuity.

Main Outcome Measures: Best-corrected visual acuity at last follow-up.

Results: Of 538 eyes (409 patients) undergoing a PPV for diabetic retinopathy, 153 (28.4%) eyes had reoperation. Among the 130 eyes (119 patients) that met the inclusion criteria, 55 eyes (50 patients) underwent reoperation for complications of PDR, defined as non-clearing vitreous hemorrhage (NCVH) and/or tractional retinal detachment (TRD). Within this subgroup of 55 eyes, 19 (34.5%) eyes had an indication for the first surgery of NCVH. Fourteen (73.7%) of these NCVH eyes achieved a visual acuity of 20/80 or better. When the indication for the first surgery was TRD (33 eyes, 60%), 8 (24.2%) eyes achieved this same outcome (p=0.0011).

Conclusion: Approximately one of every four eyes treated with PPV for PDR will undergo repeat PPV during follow-up. VA outcomes after the repeat PPV were variable, with NCVH cases achieving better outcomes compared to TRD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OPTH.S252285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293964PMC
June 2020

Educational Impact of Podcasts in the Retina Community.

Ophthalmol Retina 2020 09 5;4(9):958-961. Epub 2020 May 5.

Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oret.2020.04.024DOI Listing
September 2020

Diagnostic tests in dry eye.

Expert Rev Ophthalmol 2019 29;14(4-5):237-246. Epub 2019 Aug 29.

Miami Veterans Administration Medical Center, Miami, Florida, USA.

Introduction: Dry Eye (DE) is a multifactorial condition with a variable clinical presentation. This highly prevalent disease has multiple symptoms and signs that often do not correlate with one another. As such, the diagnosis of DE can be challenging to make, and a systematic approach must be taken.

Areas Covered: We review the different methods commonly utilized to evaluate a patient complaining of DE symptoms. Included in this review are clinical examination techniques, point of care tests, and imaging techniques.

Expert Opinion: DE is an umbrella term that encompasses different etiologies and pathophysiological mechanisms. The current definition recognizes tear instability, high osmolarity, inflammation, and neuro-sensory dysfunction as causative entities. The approach to DE begins with a systematic assessment of symptoms and signs, evaluating for both nociceptive and neuropathic sources of symptoms. Future research is needed to develop tests that assess neurosensory status in DE and couple point of care tests with therapeutic algorithms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/17469899.2019.1657833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812581PMC
August 2019

Association Between Early Sjögren Markers and Symptoms and Signs of Dry Eye.

Cornea 2020 Mar;39(3):311-315

Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL; and.

Purpose: Animal models suggest that early markers of Sjögren syndrome (EMS)-antibodies against salivary protein 1, parotid secretory protein, and carbonic anhydrase 6 (CA6)-are more accurate signals of early Sjögren when compared with classic markers (anti-Ro and anti-La). To further understand the relationship between EMS and dry eye (DE), we compared symptoms and signs of DE in subjects who tested positive versus negative for EMS.

Methods: In this cross-sectional study, patients at the Miami Veterans Affairs Eye Clinic who were tested for EMS underwent a standard ocular surface examination. Indications for EMS testing included DE symptoms in combination with dry mouth symptoms, low tear production, corneal staining, or a Sjögren disease-associated autoimmune disease. Statistical tests performed were the χ test, Fisher exact test, independent sample t test, and Spearman correlation.

Results: Seventy-three percent of 44 patients tested positive for 1 or more EMS. CA6 IgG was most frequently elevated, followed by CA6 IgM and parotid secretory protein IgG. EMS-positive versus EMS-negative subjects were more likely to escalate DE treatment past artificial tears to topical cyclosporine (n = 32, 100% vs. n = 9, 75%, P = 0.02). There were no demographic or comorbidity differences between EMS-positive and EMS-negative subjects, and marker levels did not correlate with more severe tear film measures.

Conclusions: Most of the individuals with DE tested positive for 1 or more EMS antibodies, including men and Hispanics. Future studies will be needed to understand how to incorporate EMS data into the care of an individual with DE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICO.0000000000002171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007845PMC
March 2020

Residency Program Directors of United States Ophthalmology Programs: A Descriptive Analysis.

Am J Ophthalmol 2020 01 13;209:71-76. Epub 2019 Sep 13.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. Electronic address:

Purpose: To analyze the academic background, scholarly achievements, and demographic characteristics of all US ophthalmology residency program directors (PDs).

Design: Cross-sectional study.

Methods: Online search of publicly available resources conducted from February 16, 2019, to February 26, 2019.

Study Population: 116 ophthalmology residency PDs. Main outcome measurements were demographic and academic data.

Results: A total of 116 program directors were analyzed. Eighty-four of 116 (72%) PDs were male. The average age was 50.0 years old. The mean age at appointment was 42.9 years old. Ninety-three percent graduated from an American medical school, and 97% received an MD degree. Twenty percent of PDs completed an additional graduate degree, most commonly a master's degree (7 of 23) and doctor of philosophy (7 of 23). Seventy-eight percent completed a fellowship, with the most frequent in glaucoma (24%), cornea and external diseases (22%), and neuroophthalmology (21%). The mean number of publications according to PubMed was 17.6 (range, 0-92). There were no significant differences between the average number of publications by male PDs and those by female PDs (19.2 ± 20.5 vs. 13.5 ± 23.1, respectively; P = 0.21). On average, the H-index was 8.7 (range, 0-35) and was higher in male than in female PDs (9.8 ± 8.3 vs. 5.4 ± 4.0, respectively; P = 0.01).

Conclusions: Ophthalmology PDs are predominantly male with fellowship training in glaucoma, cornea, or neuro-ophthalmology. Women remain underrepresented, and future efforts should be aimed at addressing this disparity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajo.2019.09.003DOI Listing
January 2020

Assessment of the Quality, Content, and Readability of Freely Available Online Information for Patients Regarding Diabetic Retinopathy.

JAMA Ophthalmol 2019 Aug 22. Epub 2019 Aug 22.

Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.

Importance: Diabetic retinopathy is a global leading cause of blindness. Patients increasingly use the internet to search for health-related information that may affect medical decision-making, but to date, no standard exists across published websites.

Objective: To assess the quality, content, and readability of information found online for diabetic retinopathy.

Design And Setting: This cross-sectional study analyzed 11 medical sites with information on diabetic retinopathy. Twenty-six questions were composed to include information most relevant to patients, and each website was independently evaluated by 1 vitreoretinal surgeon and 2 vitreoretinal fellows. Readability was analyzed using an online readability tool. The JAMA benchmarks were used to evaluate the quality of each site. Data were collected from December 2018 to January 2019 and analyzed in February 2019.

Main Outcomes And Measures: A 26-question survey, JAMA benchmarks, Flesch reading ease score, Flesch-Kincaid grade level, Gunning Fog Index, Coleman Liau Index, and Simple Measure of Gobbledygook Index.

Results: The mean (SD) questionnaire score for all websites was 55.76 (13.38) (95% CI, 47.85-63.67) of 104 possible points. There was a difference between the content quality of the websites (H = 25.811, P = .004). The mean (SD) reading grade for all websites was 11.30 (1.79; 95% CI, 10.24-12.36). No correlation was found between content accuracy and the mean reading grade (r = 0.445, P = .17) or Google rank (r = -0.260, P = .43). No website achieved the full 4 JAMA benchmarks, and only 1 website achieved 3 of the 4 JAMA benchmarks. No correlation was found between the accuracy of the content of the website and JAMA benchmarks (r = 0.422, P = .20). The interobserver reproducibility was similar among the 3 observers (r = 0.87 between observers 1 and 2, r = 0.83 between observers 1 and 3, and r = 0.84 between observers 2 and 3, P < .001).

Conclusions And Relevance: These findings suggest that freely available information online about diabetic retinopathy varies by source but is generally of low quality. The material presented seems difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide sufficient information using the grading scheme used to support the patient in making medical decisions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2019.3116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707011PMC
August 2019

Palliative Care Opportunities Among Adults With Congenital Heart Disease-A Systematic Review.

J Pain Symptom Manage 2019 11 9;58(5):891-898. Epub 2019 Aug 9.

Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Stanford, California, USA; Palliative Care Section, Division of Primary Care and Population Health, Department of Medicine, Stanford University Medical Center, Stanford, California, USA.

Context: Little is known about advance care planning (ACP) and palliative care needs among adults with congenital heart disease (ACHD).

Objectives: The objective of this study was to identify and synthesize studies concerning palliative care among ACHD patients.

Methods: We searched five electronic databases (PubMed, Embase, SCOPUS, Web of Science, and CINAHL) using the keywords palliative care and congenital heart disease. Inclusion criteria were adults (age > 18 years) with congenital heart disease and publications in English through March 3, 2019.

Results: Our search yielded 2872 studies, and after removal of duplicates, we screened 2319 abstracts and identified seven for inclusion. Study findings were grouped into three domains: ACP, symptomatology, and end-of-life care. Among the five cross-sectional studies, only 1%-28% of ACHD patients recalled participating in ACP discussions with their doctors but 69%-78% reported a strong interest and desire to participate in ACP. In one study, 46% (n = 67) of patients had elevated anxiety symptoms (Hospital Anxiety and Depression Scale [HADS-A] ≥ 8) and 11% (n = 15) had elevated depressive symptoms (HADS-A ≥ 8). ACHD patients who had a documented goals of care conversation before cardiac decompensation had a lower incidence of resuscitation and aggressive treatments at end of life (12% [n = 3] vs. 100% [n = 12], P < 0.001).

Conclusion: While few ACHD patients complete advance directives, our findings support that many ACHD patients recognize the value of initiating end-of-life and goals of care conversations early on in the course of illness. Future studies investigating communication and implementation strategies of ACP as well as the symptom experience of patients with ACHD are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2019.07.025DOI Listing
November 2019

Osteopontin deficiency ameliorates Alport pathology by preventing tubular metabolic deficits.

JCI Insight 2018 03 22;3(6). Epub 2018 Mar 22.

Interdisciplinary Stem Cell Institute.

Alport syndrome is a rare hereditary renal disorder with no etiologic therapy. We found that osteopontin (OPN) is highly expressed in the renal tubules of the Alport mouse and plays a causative pathological role. OPN genetic deletion ameliorated albuminuria, hypertension, tubulointerstitial proliferation, renal apoptosis, and hearing and visual deficits in the Alport mouse. In Alport renal tubules we found extensive cholesterol accumulation and increased protein expression of dynamin-3 (DNM3) and LDL receptor (LDLR) in addition to dysmorphic mitochondria with defective bioenergetics. Increased pathological cholesterol influx was confirmed by a remarkably increased uptake of injected DiI-LDL cholesterol by Alport renal tubules, and by the improved lifespan of the Alport mice when crossed with the Ldlr-/- mice with defective cholesterol influx. Moreover, OPN-deficient Alport mice demonstrated significant reduction of DNM3 and LDLR expression. In human renal epithelial cells, overexpressing DNM3 resulted in elevated LDLR protein expression and defective mitochondrial respiration. Our results suggest a potentially new pathway in Alport pathology where tubular OPN causes DNM3- and LDLR-mediated enhanced cholesterol influx and impaired mitochondrial respiration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1172/jci.insight.94818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926939PMC
March 2018