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Judith Alexander

Publications and source records attributed to Judith Alexander.

6 recordsLinked to original sources
PubMed2004

The age-related macular degeneration radiotherapy trial (AMDRT): one year results from a pilot study.

PURPOSE: To assess the short-term safety and efficacy of treating subfoveal choroidal neovascularization (CNV) with external beam radiation delivered in 5 x 4 Gy fractions among patients having age-related macular degeneration (AMD). DESIGN: A multicenter prospective randomized controlled pilot study. METHODS: Eighty-eight patients were enrolled through 10 sites and were randomized to radiotherapy (20 Gy delivered in 5 daily fractions of 4 Gy each; 6 MV [N = 41]) or no radiotherapy (sham radiotherapy [N = 22] or observation [N = 25]). Eligibility criteria included visual acuity of at least 20/320 and subfoveal CNV not amenable to treatment. Randomization was stratified by lesion type (new or recurrent CNV) and blood (<50% or >/=50% of the lesion [N = 13]). The primary outcome measure was loss of >/=3 lines of visual acuity. Secondary outcome measures were angiographic response and side effects. RESULTS: At baseline, patient and ocular characteristics were similar between treatment groups. At six months, 9 radiated eyes (26%) and 17 eyes not radiated (49%) lost >/=3 lines of visual acuity (P = .04; stratified chi(2) test). At 12 months, 13 radiated eyes (42%) and 9 observed eyes (49%) lost >/=3 visual acuity lines (P = .60). The radiated group demonstrated smaller lesions and less fibrosis than the nonradiated group (P = .05 and .004, respectively) at 12 months. Radiation-induced complications were not observed except for one radiated eye with numerous cotton wool spots and possible radiation retinopathy. CONCLUSIONS: External beam radiation at 5 x 4 Gy may have a modest and short-lived (six month) benefit in preserving visual acuity.

Aged↗
PubMed2004

Rural nurse anesthesia practice: a pilot study.

Certified Registered Nurse Anesthetists (CRNAs) have been identified as the predominant anesthesia providers in rural areas; however, little information is available about the types of services provided by rural CRNAs. The purposes of this study were to pilot test the Nurse Anesthesia Rural Practice Inventory (NARPI); determine whether CRNAs can provide the requested data; and provide data about characteristics of rural nurse anesthesia practice. The NARPI is a newly developed, self-administered questionnaire containing 39 items related to anesthesia practice. The survey was mailed to a stratified convenience sample of 146 actively practicing CRNAs living in rural areas. Of the 33 surveys returned (23%), 28 were usable for data analysis with descriptive statistics. The findings revealed that rural CRNAs provide a broad range of anesthesia and anesthesia-related services within and outside the operating room and support the American Association of Nurse Anesthetists' statement that CRNAs are the predominant anesthesia providers in rural areas. Significant differences were found in the employment settings of independent and medically directed CRNAs, the availability of certain anesthetic agents and monitoring devices, and the representation of surgical specialists based on community and hospital size. The NARPI has the potential to provide needed information about rural anesthesia practice in future studies.

Humans↗
PubMed2002

Variability in fluorescein angiography interpretation for photodynamic therapy in age-related macular degeneration.

OBJECTIVES: To investigate the variability in fluorescein angiography interpretation for photodynamic therapy in age-related macular degeneration. METHODS: Eight graders, who included two TAP-certified ophthalmologists, three other retinal specialists, two fellows in vitreoretinal diseases, and a senior fundus photograph grader, evaluated fluorescein angiograms of six patients treated according to the Treatment for ARMD With Verteporfin (TAP) protocol at a single center. Each patient's baseline angiogram was evaluated to determine whether the CNV lesion was predominantly (> or =50%) classic. For each follow-up angiogram, at 3, 6, 12, and 24 months, the grader was required to determine whether fluorescein leakage was present. Six months after the initial gradings, each reader was again presented with the baseline angiogram for each patient and once again asked to determine whether the CNV lesion was predominantly classic without knowledge of the previous grading. All gradings were performed without knowledge of the clinical course. RESULTS: In grading initial visit and follow-up visit angiograms, the overall concordance rates were 81% and 82%, respectively. Concordance rates were not statistically different between the group as a whole when compared with the gradings of the two TAP-certified ophthalmologists. When initial visit angiograms were regraded, an intraobserver variability of 17% was noted. Overall, gradings were discordant with the majority opinion in approximately 19% of decisions. CONCLUSIONS: Considerable variability can be expected in fluorescein angiography interpretation as the results of the TAP investigation are applied to clinical practice.

Choroidal Neovascularization↗
PubMedDate not supplied

Relation between retinal thickening and clinically visible fundus pathologies in mild nonproliferative diabetic retinopathy.

BACKGROUND AND OBJECTIVE: To determine the association of retinal thickening (RT) with clinically observable retinal pathologies in eyes with mild nonproliferative diabetic retinopathy. PATIENTS AND METHODS: Using an objective quantitative imaging method (Retinal Thickness Analyzer), the ratio relative to normal RT (RTI) was measured in 23 eyes with and 35 eyes without clinically observable diabetic fundus pathology. RTI was analyzed in relation to presence of mild diabetic retinal lesions in the +/-0.5 mm vicinity. RESULTS: The percent of eyes with RTI significantly above normal values did not differ significantly between eyes with and without retinopathy (30% vs 34%). Mean RTI was not associated with local presence of microaneurysms (P=0.92), soft exudates (P=0.55), or retinal hemorrhages (P=0.31). Areas without hard exudates had significantly greater mean RTI (1.10) than areas with exudates (0.97, P=0.009). CONCLUSION: In diabetic patients with mild retinopathy, areas with and without clinically observable retinal pathologies had similar retinal thickness. We conclude that clinical strategies for detection of retinal thickening should not be limited to areas with visible fundus pathologies.

Adult↗
PubMedDate not supplied

A comparison of quantitative mapping and stereoscopic fundus photography grading of retinal thickness in diabetic eyes with macular edema.

OBJECTIVE: To evaluate the ability of a retina specialist's grading of 30 degrees color stereoscopic fundus photographs to identify areas of significant retinal thickening as assessed by the Retinal Thickness Analyzer (RTA) and to determine whether this ability was affected by the presence of retinal pathology. MATERIALS AND METHODS: Thirty-two eyes in 29 patients clinically diagnosed as having diabetic macular edema underwent RTA scanning and nonsimultaneous 30 degrees color stereoscopic fundus photography. Retinal thickness maps of the macular area were generated, and regions with significant retinal thickening (> or = 2 SD above normal values) were identified. A retina specialist reader, masked to the RTA measurements, identified areas with macular edema on the stereoscopic fundus photographs, which subsequently were overlaid on the retinal thickness maps. The sensitivity (percent of significant retinal thickening areas identified by the retina specialist grading the stereoscopic fundus photographs) was calculated separately for areas with and without retinal pathology. Specificity of the stereoscopic fundus photograph grading was assessed similarly. RESULTS: The retina specialist's stereoscopic fundus photography grading identified 78.8% of areas with significant retinal thickening (range over eyes: 20.4%-100%) and was slightly more likely to identify significant retinal thickening when pathology was present (89.6%) than when pathology was not present (78.4%; pooled risk ratio, 1.14 [95% CI = 0.54, 2.42]). Specificity of stereoscopic fundus photography grading was 58%, ie, 42% of areas without significant retinal thickening were (incorrectly) identified as edematous by the stereoscopic fundus photograph grading. This misidentification was more likely if pathology was present (76.9%) than if pathology was not present (41.1%; pooled risk ratio, 1.87 [95% CI = 1.28, 2.73]). CONCLUSION: This study shows the determination of macular edema by a retina specialist reading color stereoscopic fundus photographs is sensitive but not specific with reference to edema identified by the RTA. Furthermore, the presence of retinopathy tends to cause false-positive readings with reference to edema identified by the RTA. These findings indicate the need to use objective, quantitative methods in clinical studies to detect and monitor macular edema.

Diabetic Retinopathy↗