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Ducloyer JB, Poinas A, Duchesne L, Caillet P, Ivan C, Lejus-Bourdeau C, Limousin N, Desmidt T, Pladys P, Pisella PJ, Bernard A, Lardy H, Gohier P, Martin L, Mouriaux F, Lebranchu P, Khanna RK. Educational Concerns About the Safety of Cataract Surgery During Residency: The E3CAPS Pedagogic Study. Ophthalmol Ther 2023; 12:2801-2812. [PMID: 37531031 PMCID: PMC10441871 DOI: 10.1007/s40123-023-00774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Cataract surgery is the most common surgical procedure performed in France. While the incidence of intraoperative complications affecting visual prognosis is extremely low, given the large number of patients operated on, the absolute number of patients affected by complications is quite high. Complication rates are significantly higher when ophthalmology residents (ORs) perform the surgery. Although lack of experience remains the main risk factor, sleep deprivation may adversely affect ORs' successful surgery rate. The value of the EyeSi® surgical simulator in initial training has been demonstrated to increase cataract surgery safety through the transfer of surgical skills from the simulator to the operating room. However, there is no consensus regarding how much training is needed before the first-time ORs are allowed to operate. There is also no scientific evidence that sleep deprivation is associated with a decrease in surgical performance. Establishing a validated protocol for cataract surgery training using the EyeSi surgical simulator (referred to further as the EyeSi) and identifying risk factors for intraoperative complications related to sleep deprivation will improve cataract surgery safety and lead to the reorganization of our healthcare systems. METHODS AND PLANNED OUTCOMES This multi-centre educational cohort study will include two distinct axes which will both aim to reduce the risks of cataract surgery. Enrollment will include 16 first-year ORs for Axis 1 and 25 experienced residents for Axis 2, all from the University Hospitals of Nantes, Tours, Angers and Rennes. Axis 1 will focus on investigating the learning curve of first-year ORs using the EyeSi, following the training program recommended by the "College des Ophtalmologistes Universitaires de France" in order to set up a future "licence to operate." Axis 2 will evaluate the impact of sleep deprivation on the surgical performance of experienced ORs using the EyeSi. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT05722080.
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Affiliation(s)
- Jean-Baptiste Ducloyer
- Ophthalmology Department, Nantes University-CHU Nantes, Nantes, France
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France
| | - Alexandra Poinas
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France.
| | - Léa Duchesne
- Public Health Department, CHU Nantes-Nantes University, Nantes, France
| | - Pascal Caillet
- Public Health Department, CHU Nantes-Nantes University, Nantes, France
| | - Catherine Ivan
- Ophthalmology Department, Nantes University-CHU Nantes, Nantes, France
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France
| | - Corinne Lejus-Bourdeau
- Department of Anaesthesia and Intensive Care, CHU Nantes-Nantes University, Nantes, France
| | - Nadège Limousin
- Department of Neurology and Clinical Neurophysiology, University Hospital Bretonneau, Tours, France
| | - Thomas Desmidt
- Inserm, UMR 1253, IBrain, Université de Tours, Tours, France
- CHU de Tours, Tours, France
| | - Patrick Pladys
- LTSI-UMR 1099, INSERM, CHU Rennes-Rennes University, Rennes, France
| | - Pierre-Jean Pisella
- Department of Ophthalmology, CHU Tours-Bretonneau Hospital, 37000, Tours, France
| | - Anne Bernard
- Department of Cardiology, Tours University Hospital, Tours, France
| | - Hubert Lardy
- Division of Pediatric Surgery, CHU-Centre de Pédiatrie de Clocheville, Tours, France
| | - Philippe Gohier
- Department of Ophthalmology, CHU de Angers, 49100, Angers, France
| | - Ludovic Martin
- Department of Dermatology, Angers University Hospital, Angers, France
- All'Sims Centre for Healthcare Simulation, Angers University Hospital, Angers, France
| | - Frederic Mouriaux
- Ophthalmology Department, CHU Rennes-Université Rennes 1, Rennes, France
| | - Pierre Lebranchu
- Ophthalmology Department, Nantes University-CHU Nantes, Nantes, France
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France
| | - Raoul Kanav Khanna
- Department of Ophthalmology, UMR 1253, iBrain, Bretonneau University Hospital of Tours, Tours, France
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Latka K, Kołodziej W, Rajski R, Pawuś D, Chowaniec J, Latka D. Outpatient Spine Surgery in Poland: A Survey on Popularity, Challenges, and Future Perspectives. Risk Manag Healthc Policy 2023; 16:1839-1848. [PMID: 37719687 PMCID: PMC10505014 DOI: 10.2147/rmhp.s425465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
Objective This study aimed to investigate the popularity of outpatient spine surgery in Poland, identify factors influencing its adoption, and assess its benefits, challenges, and impact on patient outcomes and healthcare costs. Additionally, the study proposes strategies to improve outpatient spine surgery adoption and ensure its safe implementation in Poland. Materials and Methods An electronic survey was distributed to members of the Polish Spine Surgery Society and the Polish Neurosurgery Society. Data were analyzed using Matlab R2020b statistical software, employing descriptive statistics to summarize the responses. Results The survey indicated that 67% of respondents provide spinal procedures commercially, with 58% performing them on an outpatient basis, showing the growing role of the private sector in providing spinal surgery services in Poland. Root nerve blocks and joint blocks were the most common outpatient procedures, followed by microdiscectomy, endoscopic discectomy, and L-S spinal fusion. The public NHF was the most common payer for outpatient procedures. Conclusion Outpatient spine surgery in Poland is not yet widespread, but improvements can be made to reduce hospital stays and enhance recovery. Changes in reimbursement systems to cover outpatient procedures and addressing physicians' liability concerns, particularly by emphasizing the NO-fault system, are essential. With proper support, outpatient spine surgery could become a valuable addition to Poland's healthcare system.
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Affiliation(s)
- Kajetan Latka
- Department of Neurosurgery, The St. Hedwig’s Regional Specialist Hospital, Opole, Poland
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, Opole, Poland
| | - Waldemar Kołodziej
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, Opole, Poland
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Rafal Rajski
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Dawid Pawuś
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, Opole, Poland
| | - Jacek Chowaniec
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Dariusz Latka
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, Opole, Poland
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Opole, Poland
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Voicu B, Fărcășanu D, Mustață M, Deliu A, Vișinescu I. Using laws, common sense, and statistical approaches to design indicators for 'medical desertification'. An application on the Romanian case. Soc Sci Med 2023; 327:115944. [PMID: 37150112 DOI: 10.1016/j.socscimed.2023.115944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/30/2023] [Accepted: 04/30/2023] [Indexed: 05/09/2023]
Abstract
The study of spatial accessibility to healthcare services is key to health policy (Pförtner et al., 2019; Vergier et al., 2017). Terms such as 'rurality' or 'medical desertification' were employed to stress the relevance of the topic. Within the existing literature, there is little (if any) concern with the legitimacy of the existing ways to measure inequality. Expert systems were assumed to be in place, and discrepancies or consistency with existing regulations or to views of relevant stakeholders were not considered. This paper discusses spatial accessibility of medical services in three distinct approaches: normative, that is following what national regulations consider as standard; relative, that is what statistical approaches reveal; consensual, which adjusts the indexes based on representations of stakeholders. The three approaches are compared for the case of Romania, an EU country with low population density, ideal to inspect geographical discrepancies. For the relative and the consensual approach, population is adjusted according to different demand expressed by age groups, and also including population and providers from the nearby localities. The normative approach follows official regulations. The refinements in the consensual model are based on survey data from stakeholders and consider distances to neighbouring localities and adjustments according to the age structure of the population in the catchment area. The results reveal high consistency between the consensual and the relative approach. Both are more permissive with respect to detecting medical desertification as compared to the normative approach but prove to be more effective in directing policy when resources are scarce. The normative approach, however, is relevant in depicting the state of the system as contrasted to a desired standard. The relative approach also overlaps with the consensual one. Therefore, to fully characterize spatial accessibility to general practitioners (GPs) and pharmacies, one needs to consider at least the normative and the relative approaches.
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Affiliation(s)
- Bogdan Voicu
- Romanian Academy, Research Institute for Quality of Life, Romania; Lucian Blaga University of Sibiu, Romania; Politehnica University of Bucharest, Romania.
| | | | | | - Alexandra Deliu
- Romanian Academy, Research Institute for Quality of Life, Romania.
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Duroi Q, Baudet JM, Bigoteau M, Slim M, Pichard T, Pisella PJ, Khanna RK. Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study. Sci Rep 2021; 11:8311. [PMID: 33859328 PMCID: PMC8050067 DOI: 10.1038/s41598-021-87926-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.
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Affiliation(s)
- Quentin Duroi
- Department of Ophthalmology, Centre Hospitalier Universitaire Régional de Bretonneau, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France.,Department of Ophthalmology, Centre Hospitalier Jacques Coeur, Bourges, France
| | - Jean-Marie Baudet
- Department of Ophthalmology, Centre Hospitalier Jacques Coeur, Bourges, France
| | - Maxime Bigoteau
- Department of Ophthalmology, Centre Hospitalier Universitaire Régional de Bretonneau, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France.,Department of Ophthalmology, Centre Hospitalier Jacques Coeur, Bourges, France
| | - Malek Slim
- Department of Ophthalmology, Centre Hospitalier Jacques Coeur, Bourges, France
| | - Tiphanie Pichard
- Department of Ophthalmology, Centre Hospitalier Jacques Coeur, Bourges, France
| | - Pierre-Jean Pisella
- Department of Ophthalmology, Centre Hospitalier Universitaire Régional de Bretonneau, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Raoul Kanav Khanna
- Department of Ophthalmology, Centre Hospitalier Universitaire Régional de Bretonneau, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France. .,INSERM 1253 iBrain «Neurogénomique & Physiopathologie neuronale», Tours, France.
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