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Pesudovs K, Lansingh VC, Kempen JH, Tapply I, Fernandes AG, Cicinelli MV, Arrigo A, Leveziel N, Resnikoff S, Taylor HR, Sedighi T, Flaxman S, Bikbov MM, Braithwaite T, Bron A, Cheng CY, Del Monte MA, Ehrlich JR, Ellwein LB, Friedman D, Furtado JM, Gazzard G, George R, Hartnett ME, Jonas JB, Kahloun R, Khairallah M, Khanna RC, Leasher J, Little JA, Nangia V, Nowak M, Peto T, Ramulu P, Topouzis F, Tsilimbaris M, Wang YX, Wang N, Bourne R, Pesudovs K, Lansingh VC, Kempen JH, Tapply I, Fernandes AG, Cicinelli MV, Arrigo A, Leveziel N, Briant PS, Vos T, Resnikoff S, Flaxman S, Abate YH, Abdollahi M, Abdollahi M, Abebe AM, Abiodun O, Aboagye RG, Abrha WA, Abualruz H, Ali HA, Abu-Gharbieh E, Aburuz S, Adal TGG, Adane MM, Addo IY, Adnani QES, Afzal MS, Aghamiri S, Ahinkorah BO, Ahmad A, Ahmad S, Ahmadi A, Ahmed A, Ahmed H, Alfaar AS, Ali A, Ali SSS, Altaf A, Amu H, Androudi S, Anguita R, Anil A, Anvari S, Anyasodor AE, Appiah F, Arabloo J, Arafat M, Areda D, Arefnezhad R, Aregawi BB, Asgedom AA, Ashraf T, Athari SS, Atinafu BTT, Atout MMW, Atreya A, Ayatollahi H, Azzam AY, Babamohamadi H, Bagherieh S, Bahurupi Y, Baig AA, Banik B, Bardhan M, Basu S, Batra K, Bayileyegn NS, Bazvand F, Beyene AS, Bhagat DS, Bhagavathula AS, Bhardwaj P, Bhaskar S, Bhatti JS, Bikbov M, Bineshfar N, Birck MG, Bitra VR, Braithwaite T, Burkart K, Bustanji Y, Butt ZA, dos Santos FLC, Cámera LA, Carneiro VLA, Cenderadewi M, Chandrasekar EK, Chattu VK, Chitranshi N, Chopra H, Chu DT, Coberly K, Coelho JM, Cruz-Martins N, Dadras O, Dai X, Das S, Dascalu AM, Dashti M, Dastmardi M, Demessa BH, Demisse B, Dereje D, Derese AMA, Dervenis N, Devanbu VGC, Do TC, Do THP, dos Santos Figueiredo FW, Dziedzic AM, Edinur HA, Efendi F, Ehrlich JR, Ekholuenetale M, Ekundayo TC, Sayed IE, Elhadi M, Emamian MH, Emamverdi M, Etemadimanesh A, Fagbamigbe AF, Fahim A, Farrokhpour H, Fatehizadeh A, Feizkhah A, Desideri LF, Fetensa G, Fischer F, Forouhari A, Foschi M, Fowobaje KR, Gaidhane AM, Gandhi AP, Gebregergis MWW, Gebrehiwot M, Gebremariam B, Gerema U, Ghassemi F, Ghozy S, Golechha M, Goleij P, Goulart BNG, Guan SY, Gudisa Z, Gupta S, Gupta VB, Gupta VK, Haj-Mirzaian A, Halimi A, Hallaj S, Hamidi S, Harorani M, Hasani H, Heyi DZ, Hoan NQ, Holla R, Hong SH, Hosseinzadeh M, Hu C, Huang JJ, Huynh HH, Ibitoye SE, Ilic IM, Immurana M, Islam MR, Islam SMS, Iwu CCD, Jacob L, Jairoun AA, Janodia MD, Jayaram S, Jindal HA, Jokar M, Joseph N, Joshua CE, Kadashetti V, Kalankesh LR, Kalhor R, Kamath S, Kandel H, Kantar RS, Karaye IM, Kasraei H, Kaup S, Kaur N, Kaur RJ, Kayode GA, Khader YS, Khajuria H, Khalilov R, Khatib MN, Kisa A, Kosen S, Koyanagi A, Krishan K, Kulimbet M, Kumar N, Kurmi OP, Lahariya C, Lan T, Landires I, Leasher JL, Lee M, Lee SW, Lee WC, Lim SS, Little JA, Mahajan PB, Maharaj SB, Mahmoudi A, Mahmoudi R, Malhotra K, Mallhi TH, Mansouri V, Manu E, Marzo RR, Maugeri A, McAlinden C, Mebratu W, Meto TM, Meng Y, Mersha AM, Mestrovic T, Minh LHN, Misganaw A, Mishra M, Misra S, Mohamed NS, Mohammadi S, Mohammed M, Mojiri-forushani H, Mokdad AH, Vardanjani HM, Moni MA, Montazeri F, Moradi M, Motappa R, Mousavi P, Mulita A, Murray CJL, Naik GR, Naik G, Nargus S, Natto ZS, Nayak BP, Negaresh M, Negash H, Nguyen DH, Nguyen PT, Nguyen VT, Niazi RK, Okonji OC, Olagunju AT, Olatubi MI, Ordak M, Osuagwu UL, Otstavnov N, Owolabi MO, Padubidri JR, Pandey A, Panos GD, Pardhan S, Park S, Patel J, Pawar S, Peprah P, Petcu IR, Peyman A, Pham HT, Pourazizi M, Quan NK, Rahim F, Rahimi-Movaghar V, Rahman MHU, Rajaa S, Ramasamy SK, Ramasubramani P, Ranjan S, Rashidi MM, Rath RS, Rauf AU, Rawaf S, Damavandi AR, Redwan EMM, Roy P, Pramanik KR, Saadatian Z, Sabour S, Saddik B, Saeed U, Safi S, Safi SZ, Saghazadeh A, Sharif-Askari FS, Sahebkar A, Sahraian MA, Sakshaug JW, Saleh MA, Samadzadeh S, Samodra YL, Samuel VP, Samy AM, Saravanan A, Selvaraj S, Semnani F, Senapati S, Sethi Y, Seyedi SA, Seylani A, Shaheen AA, Shahid S, Shahwan MJ, Shaikh MA, Sham S, Shamim MA, Shannawaz M, Shashamo BB, Shayan M, Shittu A, Shiue I, Shivakumar KM, Shorofi SA, Sibhat MM, Siddig EE, Silva JC, Singh JA, Singh P, Skiadaresi E, Solomon Y, Sousa RARC, Sreeramareddy CT, Starodubov VI, Subramaniam MD, Susanty S, Tabatabaei SM, Taye BT, Teklay G, Temsah MH, Terefa DR, Ticoalu JHV, Toma TM, Tsatsakis A, Tsegay GM, Tumurkhuu M, Tusa BS, Ty SS, Ubah CS, Umair M, Umar TP, Valizadeh R, Van den Eynde J, Watson SLW, Wonde TE, Wondimagegn GS, Xiao H, Yao Y, Nia IY, Yiğit A, Yismaw Y, Yon DK, Yonemoto N, You Y, Yu C, Zastrozhin MS, Zhao H, Ziafati M, Zielińska M, Zikarg YT, Zoladl M, Steinmetz JD. Global estimates on the number of people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020. Eye (Lond) 2024; 38:2156-2172. [PMID: 38461217 PMCID: PMC11269584 DOI: 10.1038/s41433-024-02961-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by cataract and their proportion of the total number of vision-impaired individuals. METHODS A systematic review and meta-analysis of published population studies and gray literature from 2000 to 2020 was carried out to estimate global and regional trends. We developed prevalence estimates based on modeled distance visual impairment and blindness due to cataract, producing location-, year-, age-, and sex-specific estimates of moderate to severe vision impairment (MSVI presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60). Estimates are age-standardized using the GBD standard population. RESULTS In 2020, among overall (all ages) 43.3 million blind and 295 million with MSVI, 17.0 million (39.6%) people were blind and 83.5 million (28.3%) had MSVI due to cataract blind 60% female, MSVI 59% female. From 1990 to 2020, the count of persons blind (MSVI) due to cataract increased by 29.7%(93.1%) whereas the age-standardized global prevalence of cataract-related blindness improved by -27.5% and MSVI increased by 7.2%. The contribution of cataract to the age-standardized prevalence of blindness exceeded the global figure only in South Asia (62.9%) and Southeast Asia and Oceania (47.9%). CONCLUSIONS The number of people blind and with MSVI due to cataract has risen over the past 30 years, despite a decrease in the age-standardized prevalence of cataract. This indicates that cataract treatment programs have been beneficial, but population growth and aging have outpaced their impact. Growing numbers of cataract blind indicate that more, better-directed, resources are needed to increase global capacity for cataract surgery.
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Ginel J, Burguera N, Piñero D, Sáez-Martín A, Haro De Rosario A, Fernández J. Economic evaluations in cataract surgery: a narrative review. Eye (Lond) 2024; 38:1418-1424. [PMID: 38347178 PMCID: PMC11126667 DOI: 10.1038/s41433-024-02965-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 12/07/2023] [Accepted: 01/26/2024] [Indexed: 05/26/2024] Open
Abstract
Economic evaluations are tools for assessing emerging technologies and a complement for decision-making in healthcare systems. However, this topic may not be familiar for doctors and academics, who may be confused when interpreting the results of studies using these tools. Cataract is a disease which has received special attention in healthcare systems due to its high incidence, the great impact that it could have on patients' quality of life, and the fact that it can be definitively solved in almost all cases through cataract surgery. Historically, economic evaluations in cataract surgery have been conducted for many purposes by simply assessing whether the surgery is cost-effective for specific questions related to the implantation of multifocal intraocular lenses, surgical techniques, optimizing assessments, preventing diseases or complications, etc. Moreover, although there are systematic reviews about cataract surgery and narrative reviews introducing the concept of economic evaluations, as far as we know, no previous study has been conducted that synthesizes and integrates evidence coming from both fields. Thus, the purpose of this narrative review is to introduce doctors and academics to economic evaluation tools, to describe how these have been historically applied to cataract surgery, and to provide special considerations for the correct interpretation of economic studies.
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Affiliation(s)
- José Ginel
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, 04120, Almería, Spain.
| | - N Burguera
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, 04120, Almería, Spain
| | - D Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Department of Ophthalmology (IMQO-Oftalmar), Vithas Medimar International Hospital, Alicante, Spain
| | - A Sáez-Martín
- Department of Economics and Business, Faculty of Economics and Business Studies, University of Almería, Ctra. Sacramento s/n, La Cañada de San Urbano, 04120, Almería, Spain
| | - A Haro De Rosario
- Department of Economics and Business, Faculty of Economics and Business Studies, University of Almería, Ctra. Sacramento s/n, La Cañada de San Urbano, 04120, Almería, Spain
| | - J Fernández
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, 04120, Almería, Spain
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McGuinness MB, Moo E, Varga B, Dodson S, Lansingh VC, Resnikoff S, Schmidt E, Ravilla T, Balu Subburaman GB, Khanna RC, Rathi VM, Arunga S, Limburg H, Congdon N. The Better Operative Outcomes Software Tool (BOOST) Prospective Study: Improving the Quality of Cataract Surgery Outcomes in Low-Resource Settings. Ophthalmic Epidemiol 2024:1-11. [PMID: 38635874 DOI: 10.1080/09286586.2024.2336518] [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: 10/13/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Post-operative vision impairment is common among patients who have undergone cataract surgery in low-resource settings, impacting quality of clinical outcomes and patient experience. This prospective, multisite, single-armed, pragmatic validation study aimed to assess whether receiving tailored recommendations via the free Better Operative Outcomes Software Tool (BOOST) app improved surgical outcomes, as quantified by post-operative unaided distance visual acuity (UVA) measured 1-3 days after surgery. METHODS During the baseline data collection round, surgeons in low and middle-income countries recorded clinical characteristics of 60 consecutive cataract cases in BOOST. Additional data on the causes of poor outcomes from 20 consecutive cases with post-operative UVA of <6/60 (4-12 weeks post-surgery) were entered to automatically generate tailored recommendations for improvement, before 60 additional consecutive cases were recorded during the follow-up study round. Average UVA was compared between cases recorded in the baseline study round and those recorded during follow-up. RESULTS Among 4,233 cataract surgeries performed by 41 surgeons in 18 countries, only 2,002 (47.3%) had post-operative UVA 6/12 or better. Among the 14 surgeons (34.1%) who completed both rounds of the study (1,680 cases total), there was no clinically significant improvement in post-operative average UVA (logMAR units ±SD) between baseline (0.50 ± 0.37) and follow-up (0.47 ± 0.36) rounds (mean improvement 0.03, p = 0.486). CONCLUSIONS Receiving BOOST-generated recommendations did not result in improved UVA beyond what could be expected from prospective monitoring of surgical outcomes alone. Additional research is required to assess whether targeted support to implement changes could potentiate the uptake of app-generated recommendations and improve outcomes.
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Affiliation(s)
- Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Elise Moo
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Beatrice Varga
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Sarity Dodson
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Van Charles Lansingh
- Help Me See, Jersey City, New Jersey, USA
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Elena Schmidt
- Evidence Research and Innovations, Sightsavers, Chippenham, UK
| | | | | | - Rohit C Khanna
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Hyderabad, India
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Simon Arunga
- Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hans Limburg
- Health Information Services, Grootebroek, Netherlands
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Orbis International, New York, New York, USA
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Nowrouzi A, Alió JL. Immediately sequential bilateral cataract surgery. Curr Opin Ophthalmol 2024; 35:17-22. [PMID: 38390776 DOI: 10.1097/icu.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW This review aims to clarify the advantages and disadvantages of immediately sequential bilateral cataract surgery (ISBCS) based on recent studies, illustrate the safety of this approach, the cost-effectiveness, and present the importance of inclusion protocols for the best results. RECENT FINDINGS In recent studies, the authors found no evidence of an increased risk of bilateral devastating complications such as endophthalmitis with ISBCS based on descriptive evidence compared to delayed sequential bilateral cataract surgery (DSBCS). Furthermore, recent studies on cost analyses showed that ISBCS resulted in fewer costs and significant cost savings to third-party payers, patients, and society compared to DSBCS. SUMMARY The ISBCS surgical approach decreases hospital visits, reduces costs, and provides rapid visual rehabilitation and neuro adaptation. The risk of bilateral simultaneous complications is now recognized to be very rare with intracameral antibiotics and compliance with correct protocols. With new generations of optical biometry and lens calculation formulas, refractive surprises are occasional for normal eyes. However, refractive surprise is controversial, especially in the implantation of presbyopia correction intra-ocular lenses, which must be evaluated carefully in the ISBCS approach.
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Affiliation(s)
- Ali Nowrouzi
- Cornea, Cataract and Refractive Surgery Unit, Department of Ophthalmology, Hospital Quironsalud Marbella, Marbella
| | - Jorge L Alió
- Research and Development Department, and Refractive Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Grupo Miranza
- Department of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Suclupe S, Efrain Pantoja Bustillos P, Bracchiglione J, Requeijo C, Salas-Gama K, Solà I, Merchán-Galvis A, Uya Muntaña J, Robleda G, Martinez-Zapata MJ. Effectiveness of nonpharmacological interventions to prevent adverse events in the intensive care unit: A review of systematic reviews. Aust Crit Care 2023; 36:902-914. [PMID: 36572576 DOI: 10.1016/j.aucc.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Different types of interventions have been assessed for the prevention of adverse events. However, determining which patient-safety practice is most effective can be challenging when there is no systematised evidence synthesis. An overview following the best methodological standards can provide the best reliable integrative evidence. OBJECTIVES The objective of this study was to provide an overview of effectiveness nonpharmacological interventions aimed at preventing adverse events in the intensive care unit. METHODS A review of systematic reviews (SRs) was conducted according to the Cochrane Handbook and PRISMA recommendations. PubMed, CINAHL, and Cochrane Library were searched for SRs published until March 2022. Two reviewers independently assessed the study's quality, using AMSTAR-2, and extracted data on intervention characteristics and effect on prevention of adverse events. RESULTS Thirty-seven SRs were included, and 27 nonpharmacological interventions were identified to prevent 11 adverse events. Most of the reviews had critically low methodological quality. Among all the identified interventions, subglottic secretion drainage, semirecumbent position, and kinetic bed therapy were effective in preventing ventilator-associated pneumonia; the use of earplugs, early mobilisation, family participation, and music in reducing delirium; physical rehabilitation in improving muscle strength; use of respiratory support in preventing reintubation; the use of a computerised physician order entry system in reducing risk of medication errors; and the use of heated water humidifier was effective in reducing artificial airway occlusion. CONCLUSIONS Some nonpharmacological interventions reduced adverse events in the intensive care setting. These findings should be interpreted carefully due to the low methodological quality. SRs on preventing adverse events in the intensive care unit should adhere to quality assessment tools so that best evidence can be used in decision-making.
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Affiliation(s)
- Stefanie Suclupe
- Universitat Autònoma de Barcelona, Spain; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain.
| | | | - Javier Bracchiglione
- Universitat Autònoma de Barcelona, Spain; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain; Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Chile
| | - Carolina Requeijo
- Epidemiology and Public Health Department, Hospital de La Santa Creu I Sant Pau, Institut de Recerca IIB Sant Pau, Barcelona, Spain
| | - Karla Salas-Gama
- Universitat Autònoma de Barcelona, Spain; Vall D'Hebron University Hospital, Barcelona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain; Epidemiology and Public Health Department, Hospital de La Santa Creu I Sant Pau, Institut de Recerca IIB Sant Pau, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain
| | - Angela Merchán-Galvis
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain; Department of Social Medicine and Family Health, Universidad Del Cauca, Colombia
| | - Jaume Uya Muntaña
- Hospital Universitario de Bellvitge, Instituto Català de Salut, Nursing Research Group, Bellvitge Institute for Biomedical Research, Spain
| | - Gemma Robleda
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain; Nursing School of Barcelona, Campus Docent Sant Joan de Déu-Private Foundation, University of Barcelona, Spain
| | - Maria Jose Martinez-Zapata
- Universitat Autònoma de Barcelona, Spain; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain
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Gobeka HH, Erakgün T. Optimising image quality with EyeMax Mono lens in dry age-related macular degeneration. Ir J Med Sci 2023; 192:1979-1986. [PMID: 36094732 DOI: 10.1007/s11845-022-03151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND To investigate clinical outcomes in patients with dry age-related macular degeneration (AMD) after intracapsular implantation of a novel EyeMax Mono macular lens. METHODS In this study, 22 phakic eyes of 19 moderate to advanced dry AMD patients with macular disciform scar and/or macular atrophy who were followed up for ≥ 3 months after surgery were studied. A thorough pre-operative ophthalmological examination was performed, including measurement of corrected distance visual acuity in logMAR and ETDR. Following phacoemulsification, the EyeMax Mono lens was implanted intracapsularly via a 2.2-mm clear corneal incision to improve retinal image quality in all areas of the macula ≤ 10° from the central fovea. Main outcome measures included optimisation of corrected distance visual acuity and surgical safety. RESULTS Male-to-female ratio was 13:6. Mean age at surgery was 68.37 ± 10.23 years. The mean duration of post-operative follow-up was 7.91 ± 3.42 months. The mean post-operative refractive spherical equivalent improved to + 2.31 ± 1.56 D with significant visual improvement as early as 3 months post-operatively. Post-operative corrected distance visual acuity improved significantly from 1.05 ± 0.45 to 0.72 ± 0.43 logMAR (P < 0.001), equivalent to mean ETDRS of 49.55 ± 20.05 (P < 0.001). There were no major surgical complications, either intra- or post-operatively, except in two patients who experienced intra-operative haptic rupture. CONCLUSIONS Extended macular vision lenses appear to have a comparable safety profile as standard IOLs in the short to medium term. It could be the preferred lens for improving and preserving visual acuity in moderate to advanced dry AMD patients.
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Affiliation(s)
- Hamidu Hamisi Gobeka
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Faculty of Medicine, Afyonkarahisar, Turkey.
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Heidinger M, Simonnet E, Koh LM, Frey Tirri B, Vetter M. Therapeutic approaches in patients with bone metastasis due to endometrial carcinoma - A systematic review. J Bone Oncol 2023; 41:100485. [PMID: 37250286 PMCID: PMC10213377 DOI: 10.1016/j.jbo.2023.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Bone metastases (BM) are uncommon in endometrial carcinoma (EC), without information on the optimal oncologic management of patients with BM in EC. Here, we systematically review clinical characteristics, treatment approaches and prognosis in patients with BM in EC. Methods We conducted a systematic literature search until 27th March 2022 on PubMed, MEDLINE, Embase and clinicaltrials.gov. Outcomes included treatment frequency and survival after BM with comparators being treatment approaches (local cytoreductive bone surgery, systemic therapy, and local radiotherapy). Risk of bias was assessed using the NIH Quality Assessment Tool and Navigation Guide methodology. Results We retrieved 1096 records of which 112 retrospective studies (12 cohort studies, 12/12 fair quality; 100 case studies, 100/100 low quality) with a total of 1566 patients were included. The majority had a primary diagnosis of FIGO stage IV, grade 3 endometrioid EC. Singular BM were present in a median of 39.2%, multiple BM in 60.8% and synchronous additional distant metastases in 48.1% of patients respectively. In patients with secondary BM median time to bone recurrence was 14 months. Median survival after BM was 12 months. Local cytoreductive bone surgery was assessed in 7/13 cohorts and performed in a median of 15.8% (interquartile range [IQR] 10.3-43.0) of patients. Chemotherapy was assessed in 11/13 cohorts and administered in a median of 55.5% (IQR 41.0-63.9), hormonal therapy (7/13 cohorts) in 24.7% (IQR 16.3-36.0), and osteooncologic therapy (4/13 cohorts) in 2.7% (IQR 0.0-7.5) of patients respectively. Local radiotherapy was assessed in 9/13 cohorts and performed in a median of 66.7% (IQR 55.6-70.0) of patients. Survival benefits were seen in 2/3 cohorts after local cytoreductive bone surgery, and in 2/7 cohorts after chemotherapy without survival benefits in the remaining cohorts and investigated therapies. Limitations include the lack of controlled intervention studies, the heterogeneity and retrospective nature of the investigated populations. Conclusions This systematic review shows heterogenous therapeutic approaches in clinical practice without clear evidence for optimal oncologic management for patients with BM in EC.
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Affiliation(s)
- Martin Heidinger
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Elisa Simonnet
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Li Mei Koh
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Brigitte Frey Tirri
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Marcus Vetter
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
- Medical Oncology, Cantonal Hospital Baselland, Medical University Clinic, Muehlemattstrasse 13, 4410 Liestal, Switzerland
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Rice S, Carr K, Sobiesuo P, Shabaninejad H, Orozco-Leal G, Kontogiannis V, Marshall C, Pearson F, Moradi N, O'Connor N, Stoniute A, Richmond C, Craig D, Allegranzi B, Cassini A. Economic evaluations of interventions to prevent and control health-care-associated infections: a systematic review. THE LANCET. INFECTIOUS DISEASES 2023; 23:e228-e239. [PMID: 37001543 DOI: 10.1016/s1473-3099(22)00877-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/23/2022] [Accepted: 12/14/2022] [Indexed: 03/30/2023]
Abstract
Almost 9 million health-care-associated infections have been estimated to occur each year in European hospitals and long-term care facilities, and these lead to an increase in morbidity, mortality, bed occupancy, and duration of hospital stay. The aim of this systematic review was to review the cost-effectiveness of interventions to limit the spread of health-care-associated infections), framed by WHO infection prevention and control core components. The Embase, National Health Service Economic Evaluation Database, Database of Abstracts of Reviews of Effects, Health Technology Assessment, Cinahl, Scopus, Pediatric Economic Database Evaluation, and Global Index Medicus databases, plus grey literature were searched for studies between Jan 1, 2009, and Aug 10, 2022. Studies were included if they reported interventions including hand hygiene, personal protective equipment, national-level or facility-level infection prevention and control programmes, education and training programmes, environmental cleaning, and surveillance. The British Medical Journal checklist was used to assess the quality of economic evaluations. 67 studies were included in the review. 25 studies evaluated methicillin-resistant Staphylococcus aureus outcomes. 31 studies evaluated screening strategies. The assessed studies that met the minimum quality criteria consisted of economic models. There was some evidence that hand hygiene, environmental cleaning, surveillance, and multimodal interventions were cost-effective. There were few or no studies investigating education and training, personal protective equipment or monitoring, and evaluation of interventions. This Review provides a map of cost-effectiveness data, so that policy makers and researchers can identify the relevant data and then assess the quality and generalisability for their setting.
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Affiliation(s)
- Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Katherine Carr
- Dental School, Newcastle University, Newcastle upon Tyne, UK
| | - Pauline Sobiesuo
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hosein Shabaninejad
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Giovany Orozco-Leal
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Christopher Marshall
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Pearson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Najmeh Moradi
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicole O'Connor
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Akvile Stoniute
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Alessandro Cassini
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
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9
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Economic Evaluation of Cataract: A Systematic Mapping Review. Ophthalmol Ther 2023; 12:789-807. [PMID: 36809595 PMCID: PMC10011294 DOI: 10.1007/s40123-023-00678-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION The purpose of this article was to ascertain the existing literature and find the gaps in economic evaluations of cataracts. METHODS Systematic methods were used to search and collect the published literature on economic evaluations of cataracts. A mapping review of studies published in the following bibliographical databases was performed: the National Library of Medicine (PubMed), EMBASE, Web of Science (WOS), and the Central of Reviews and Dissemination (CRD) database. A descriptive analysis was conducted and relevant studies were classified into different groups. RESULTS Among 984 studies screened, 56 studies were included in the mapping review. Four research questions were answered. There has been a progressive increase of publications during the last decade. The majority of the included studies were published by authors from institutions in the USA and UK. The most commonly investigated area was cataract surgery followed by intraocular lenses (IOLs). The studies were classified into different categories according to the main outcome evaluated, such as comparisons between different surgical techniques, costs of the cataract surgery, second eye cataract surgery costs, quality of life gain after cataract surgery, waiting time of cataract surgery and costs, and cataract evaluation, follow-up, and costs. In the IOL classification, the most frequently studied area was the comparison between monofocal and multifocal IOLs, followed by the comparison between toric and monofocal IOLs. CONCLUSIONS Cataract surgery is a cost-effective procedure compared with other non-ophthalmic and ophthalmic interventions and surgery waiting time is an important factor to consider because vision loss has a huge and broad-ranging impact on society. Numerous gaps and inconsistencies are found among the studies included. For this reason, there is a need for further studies according to the classification described in the mapping review.
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Cicinelli MV, Buchan JC, Nicholson M, Varadaraj V, Khanna RC. Cataracts. Lancet 2023; 401:377-389. [PMID: 36565712 DOI: 10.1016/s0140-6736(22)01839-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/03/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022]
Abstract
94 million people are blind or visually impaired globally, and cataract is the most common cause of blindness worldwide. However, most cases of blindness are avoidable. Cataract is associated with decreased quality of life and reduced life expectancy. Most cases of cataract occur after birth and share ageing and oxidative stress as primary causes, although several non-modifiable and modifiable risk factors can accelerate cataract formation. In most patients, phacoemulsification with intraocular lens implantation is the preferred treatment and is highly cost-effective. There has been an increase in the use of comprehensive cataract surgical services, including diagnoses, treatment referrals, and rehabilitation. However, global inequity in surgical service quality is still a limitation. Implementation of preoperative risk assessment, risk reduction strategies, and new surgical technologies have made cataract surgery possible at an earlier stage of cataract severity with the expectation of good refractive outcomes. The main challenge is making the service that is currently available to some patients accessible to all by use of universal health coverage.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maneck Nicholson
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | | | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, Hyderabad, India; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
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11
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Abstract
PURPOSE OF REVIEW The aim of this study was to present an overview of recent publications and opinions in the field of same-day bilateral cataract surgery. RECENT FINDINGS A Cochrane review was published comparing immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) with regard to safety outcomes, costs and cost-effectiveness. In addition, several large database studies provided more information on incidences of rare complications such as unilateral and bilateral endophthalmitis rates. SUMMARY Recently available evidence showed that ISBCS is an effective and cost-effective alternative to DSBCS. Nonetheless, additional (randomized) registry studies, randomized controlled trials and cost-effectiveness studies are needed to evaluate bilateral endophthalmitis rates, refractive outcomes and cost-effectiveness of ISBCS compared with DSBCS.
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Affiliation(s)
- Lindsay S Spekreijse
- Maastricht University Medical Center+, University Eye Clinic Maastricht, Maastricht, the Netherlands
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12
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Alió JL, Nowrouzi A. Immediately sequential bilateral cataract surgery importance during the COVID-19 pandemic. Saudi J Ophthalmol 2022; 36:124-128. [PMID: 36211314 PMCID: PMC9535909 DOI: 10.4103/sjopt.sjopt_44_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/17/2021] [Accepted: 11/18/2021] [Indexed: 11/11/2022] Open
Abstract
Cataract surgery is one of the most frequently performed types of surgery in the world. Most patients suffer from bilateral cataract and while cataract surgery of only one eye is effective in restoring functional vision, second eye surgery leads to further improvements in health-related quality of life, and is cost effective. At present, most patients undergo cataract surgery in both eyes on separate days, referred to as delayed sequential bilateral cataract surgery (DSBCS). An alternative procedure involves operating both eyes on the same day, but as separate procedures, known as immediately sequential bilateral cataract surgery (ISBCS). The aim of this study is to evaluate the effectiveness and costs of ISBCS compared to DSBCS. ISBCS is an important topic in ophthalmology, especially during the recent COVID-19 pandemic as it is necessary to decrease the hospital visits in order to prevent the contagious risk of this disease. There are well-documented advantages in terms of reduced costs for patients and health-care systems as well as more rapid visual rehabilitation and neuroadaptation. Based on recent studies, the risk of bilateral simultaneous complications is now recognized to be rare with the advent of intracameral antibiotics and strict protocols in this surgical approach. With the use of more sophisticated optical biometry and the newest generation lens calculation, refractive surprises are rare for normal eyes. A widely recognized protocol from the International Society of Bilateral Cataract Surgeons needs to adhere in order to prevent any further complications and obtaining better outcomes.
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Affiliation(s)
- Jorge L. Alió
- Department of Research and Development, and Refractive Surgery, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Grupo Miranza,Department of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain,Address for correspondence: Prof. Jorge L. Alió, Street Cabañal1, Alicante 03016, Spain. E-mail:
| | - Ali Nowrouzi
- Department of Ophthalmology, Hospital Quironsalud, Marbella, Spain
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Sheppard WEA, McCarrick D, Wilkie RM, Baraas RC, Coats RO. A Systematic Review of the Effects of Second-Eye Cataract Surgery on Motor Function. FRONTIERS IN AGING 2022; 3:866823. [PMID: 35821847 PMCID: PMC9261376 DOI: 10.3389/fragi.2022.866823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022]
Abstract
Cataract removal surgery is one of the most commonly performed surgical procedure in developed countries. The financial and staff resource cost that first-eye cataract surgery incurs, leads to restricted access to second-eye cataract surgery (SES) in some areas, including the United Kingdom. These restrictions have been imposed despite a lack of knowledge about the impact of not performing SES on visuo-motor function. To this end, a systematic literature review was carried out, with the aim of synthesising our present understanding of the effects of SES on motor function. Key terms were searched across four databases, PsycINFO, Medline, Web of Science, and CINAHL. Of the screened studies (K = 499) 13 met the eligibility criteria. The homogeneity between participants, study-design and outcome measures across these studies was not sufficient for meta-analyses and a narrative synthesis was carried out. The evidence from objective sources indicates a positive effect of SES on both mobility and fall rates, however, when considering self-report measures, the reduction in falls associated with SES becomes negligible. The evidence for any positive effect of SES on driving is also mixed, whereby SES was associated with improvements in simulated driving performance but was not associated with changes in driving behaviours measured through in vehicle monitoring. Self-report measures of driving performance also returned inconsistent results. Whilst SES appears to be associated with a general trend towards improved motor function, more evidence is needed to reach any firm conclusions and to best advise policy regarding access to SES in an ageing population. Systematic Review Registration:https://osf.io/7hne6/, identifier INPLASY2020100042.
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14
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Dickman MM, Spekreijse LS, Winkens B, Schouten JS, Simons RW, Dirksen CD, Nuijts RM. Immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts. Cochrane Database Syst Rev 2022; 4:CD013270. [PMID: 35467755 PMCID: PMC9037598 DOI: 10.1002/14651858.cd013270.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Age-related cataract affects both eyes in most cases. Most people undergo cataract surgery in both eyes on separate days, referred to as delayed sequential bilateral cataract surgery (DSBCS). An alternative procedure involves operating on both eyes on the same day, but as two separate procedures, known as immediate sequential bilateral cataract surgery (ISBCS). Potential advantages of ISBCS include fewer hospital visits for the patient, faster visual recovery, and lower healthcare costs. Nevertheless, concerns exist about possible bilateral, postoperative, sight-threatening adverse effects with ISBCS. Therefore, there is a clear need for evaluating evidence regarding the safety, effectiveness, and cost-effectiveness of ISBCS versus DSBCS. OBJECTIVES To assess the safety of ISBCS compared to DSBCS in people with bilateral age-related cataracts and to summarise current evidence for the incremental resource use, utilities, costs, and cost-effectiveness associated with the use of ISBCS compared to DSBCS in people with bilateral age-related cataracts (primary objectives). The secondary objective was to assess visual and patient-reported outcomes of ISBCS compared to DSBCS in people with bilateral age-related cataracts. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 5); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov; the WHO ICTRP; and DARE and NHS EED on the CRD Database on 11 May 2021. There were no language restrictions. We limited the searches to a date range of 2007 onwards. SELECTION CRITERIA We included randomised controlled trials (RCTs) to assess complications, refractive outcomes, best-corrected distance visual acuity (BCDVA) and patient-reported outcome measures (PROMs) with ISBCS compared to DSBCS. We included non-randomised (NRSs), prospective, and retrospective cohort studies comparing ISBCS and DSBCS for safety assessment, because of the rare incidence of important adverse events. To assess cost-effectiveness of ISBCS compared to DSBCS, we included both full and partial economic evaluations, and both trial-based and model-based economic evaluations. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures and assessed risk of bias for NRSs using the ROBINS-I tool. For cost-evaluations, we used the CHEC-list, the CHEERS-checklist, and the NICE-checklist to investigate risk of bias. We assessed the certainty of evidence with the GRADE tool. We reported results for economic evaluations narratively. MAIN RESULTS We included 14 studies in the review; two RCTs, seven NRSs, and six economic evaluations (one study was both an NRS and economic evaluation). The studies reported on 276,260 participants (7384 for ISBCS and 268,876 for DSBCS) and were conducted in Canada, the Czech Republic, Finland, Iran, (South) Korea, Spain (Canary Islands), Sweden, the UK, and the USA. Overall, we considered the included RCTs to be at 'high to some concerns' risk of bias for complications, 'some concerns' risk of bias for refractive outcomes and visual acuity, and 'high' risk of bias for PROMs. The overall risk of bias for NRSs was graded 'serious' regarding complications and 'serious to critical' regarding refractive outcomes. With regard to endophthalmitis, we found that relative effects were estimated imprecisely and with low certainty, so that relative estimates were not reliable. Nonetheless, we found a very low risk of endophthalmitis in both ISBCS (1/14,076 participants) and DSBCS (55/556,246 participants) groups. Based on descriptive evidence and partially weak statistical evidence we found no evidence of an increased risk of endophthalmitis with ISBCS. Regarding refractive outcomes, we found moderate-certainty (RCTs) and low-certainty (NRSs) evidence there was no difference in the percentage of eyes that did not achieve refraction within 1.0 dioptre of target one to three months after surgery (RCTs: risk ratio (RR) 0.84, 95% confidence interval (CI) 0.57 to 1.26; NRSs: RR 1.02, 95% CI 0.60 to 1.75). Similarly, postoperative complications did not differ between groups (RCTs: RR 1.33, 95% CI 0.52 to 3.40; NRSs: 1.04, 95% CI 0.47 to 2.29), although the certainty of this evidence was very low for both RCTs and NRSs. Furthermore, we found low-certainty (RCTs) to very low-certainty (NRSs) evidence that total costs per participant were lower for ISBCS compared to DSBCS, although results of individual studies could not be pooled. Only one study reported on cost-effectiveness. This study found that ISBCS is cost-effective compared to DSBCS, but did not measure quality-adjusted life years using preferred methods and calculated costs erroneously. Finally, regarding secondary outcomes, we found limited evidence on BCDVA (data of two RCTs could not be pooled, although both studies individually found no difference between groups (very low-certainty evidence)). Regarding PROMs, we found moderate-certainty evidence (RCTs only) that there was no difference between groups one to three months after surgery (standardised mean difference -0.08, 95% CI -0.19 to 0.03). AUTHORS' CONCLUSIONS Current evidence supports there are probably no clinically important differences in outcomes between ISBCS and DSBCS, but with lower costs for ISBCS. However, the amount of evidence is limited, and the certainty of the evidence was graded moderate to very low. In addition, there is a need for well-designed cost-effectiveness studies.
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Affiliation(s)
- Mor M Dickman
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Lindsay S Spekreijse
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
| | - Johannes Sag Schouten
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Rob Wp Simons
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Carmen D Dirksen
- Clinical Epidemiology and Medical Technology Assessment Department, Maastricht University (CAPHRI), Maastricht, Netherlands
| | - Rudy Mma Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
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15
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Balgos MJTD, Piñero DP, Canto-Cerdan M, Alió del Barrio JL, Alió JL. Comparison of the Cost-Effectiveness of SMILE, FS-LASIK, and PRK for Myopia in a Private Eye Center in Spain. J Refract Surg 2022; 38:21-26. [PMID: 35020543 DOI: 10.3928/1081597x-20211007-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe and compare the cost-effectiveness of small incision lenticule extraction (SMILE), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and photorefractive keratectomy (PRK) for treating myopia and myopic astigmatism in a private eye center. METHODS The perspectives for this cost-effectiveness analysis were for the payer and the health care sector. For the payer's perspective, a decision tree model was made, with a time period of 30 years, and the average weighted utility values and quality-adjusted life years (QALY) were computed for each procedure. The average weighted costs were derived for each procedure and divided by the QALY to obtain the incremental cost-effectiveness ratios (ICER). For the health care sector's perspective, the direct and indirect costs of acquiring the equipment and maintaining the facilities-including consumables and personnel salaries-were obtained to compute the minimum number of patients treated per year. RESULTS The weighted utility values were 0.8 for SMILE and PRK and 0.77 for FS-LASIK. The weighted QALYs were 24 for SMILE and PRK, and 23.1 for FS-LASIK. The average weighted costs were 335.45, 443, and 346.96€, respectively. The resulting incremental cost-effectiveness ratios were 13.98 €/QALY for SMILE, 18.46 €/QALY for PRK, and 15.02 €/QALY for FS-LASIK. There was a negative correlation between the ICER and the time (in years) after the surgery. To achieve a profit, the minimum number of patients treated per year is 155 for SMILE, 136 for PRK, and 155 for FS-LASIK. CONCLUSIONS Laser corneal refractive surgery is cost-effective for a person desirous of refractive correction for myopia. SMILE had the lowest ICER, followed by FS-LASIK and PRK. This trend was noted at all time periods. The cost of investing in laser refractive surgery facilities is outweighed by the potential income in high-volume eye centers. [J Refract Surg. 2022;38(1):21-26.].
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16
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Farquhar E, Harley U, Rotchford A, Ramaesh K. Should We Perform Early Cataract Surgery? A Patient Reported Outcome Study. Clin Ophthalmol 2021; 15:4707-4714. [PMID: 34938067 PMCID: PMC8687683 DOI: 10.2147/opth.s323348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Current guidance states that access to cataract surgery should not be restricted by visual acuity (VA); nevertheless, 6/12 is used as a cut-off criterion in some health institutions. This study aims to determine the benefits of performing cataract surgery in patients with VA of 6/9 or better in both eyes; determine whether these benefits change over time; and compare the benefit observed between early first eye and second eye surgery. Patients and Methods Fifty adults with VA at least 6/9 in the worst eye and no ocular comorbidity were recruited. The Visual Function Index (VF-14) and Impact of Visual Impairment (IVI) questionnaires were conducted pre-operatively, 4 months post-operatively, and 12 months post-operatively. The t-test or a non-parametric equivalent was used to compare averages between groups. Results The mean change in VF-14 from baseline to 4 months was 16.43 (95% CI 12.49–20.50, p < 0.001) and the median change in IVI was 6.5 (IQR 9.75, p < 0.001). There was no significant difference between 4-month and 12-month follow-up (p > 0.05). There was no significant difference in the change in visual function between the first and second eye surgery (p > 0.05). Conclusion This study provides evidence that visual function improves after cataract surgery in patients with pre-operative VA of 6/9 or better. The improvement observed was clinically significant and unchanged a year after surgery. Visual function improved after second eye as much as after first eye surgery. Assessing patient reported visual function may give a more realistic indication of the benefit of early cataract surgery than relying on VA alone.
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Affiliation(s)
- Eilidh Farquhar
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Umiya Harley
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Alan Rotchford
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Kanna Ramaesh
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
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17
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Sheppard WEA, Dickerson P, Baraas RC, Mon-Williams M, Barrett BT, Wilkie RM, Coats RO. Exploring the effects of degraded vision on sensorimotor performance. PLoS One 2021; 16:e0258678. [PMID: 34748569 PMCID: PMC8575268 DOI: 10.1371/journal.pone.0258678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Many people experience unilateral degraded vision, usually owing to a developmental or age-related disorder. There are unresolved questions regarding the extent to which such unilateral visual deficits impact on sensorimotor performance; an important issue as sensorimotor limitations can constrain quality of life by restricting 'activities of daily living'. Examination of the relationship between visual deficit and sensorimotor performance is essential for determining the functional implications of ophthalmic conditions. This study attempts to explore the effect of unilaterally degraded vision on sensorimotor performance. METHODS In Experiment 1 we simulated visual deficits in 30 participants using unilateral and bilateral Bangerter filters to explore whether motor performance was affected in water pouring, peg placing, and aiming tasks. Experiment 2 (n = 74) tested the hypothesis that kinematic measures are associated with visuomotor deficits by measuring the impact of small visual sensitivity decrements created by monocular viewing on sensorimotor interactions with targets presented on a planar surface in aiming, tracking and steering tasks. RESULTS In Experiment 1, the filters caused decreased task performance-confirming that unilateral (and bilateral) visual loss has functional implications. In Experiment 2, kinematic measures were affected by monocular viewing in two of three tasks requiring rapid online visual feedback (aiming and steering). CONCLUSIONS Unilateral visual loss has a measurable impact on sensorimotor performance. The benefits of binocular vision may be particularly important for some groups (e.g. older adults) where an inability to complete sensorimotor tasks may necessitate assisted living. There is an urgent need to develop rigorous kinematic approaches to the quantification of the functional impact of unilaterally degraded vision and of the benefits associated with treatments for unilateral ophthalmic conditions to enable informed decisions around treatment.
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Affiliation(s)
| | - Polly Dickerson
- Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, North Yorkshire, United Kingdom
| | - Rigmor C. Baraas
- Department of Optometry, Radiography and Lighting Design, National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
| | - Mark Mon-Williams
- School of Psychology, University of Leeds, Leeds, West Yorkshire, United Kingdom
- Department of Optometry, Radiography and Lighting Design, National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
- Bradford Institute of Health Research, Bradford Teaching Hospital NHS Foundation Trust, West Yorkshire, United Kingdom
| | - Brendan T. Barrett
- Faculty of Life Sciences, School of Optometry & Vision Science, University of Bradford, West Yorkshire, United Kingdom
| | - Richard M. Wilkie
- School of Psychology, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Rachel O. Coats
- School of Psychology, University of Leeds, Leeds, West Yorkshire, United Kingdom
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Rewri P, Lohan A, Aggarwal S, Chodhary P, Singhal A. Cataract surgical reach: Falling short to catch white cataracts! Indian J Ophthalmol 2021; 69:1575-1578. [PMID: 34011744 PMCID: PMC8302299 DOI: 10.4103/ijo.ijo_2560_20] [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] [Indexed: 12/02/2022] Open
Abstract
Purpose: The aim of this study was to know proportion of white cataracts from among patients coming for cataract surgery, and to find causes delaying uptake of cataract surgery. Methods: A hospital-based, prospective study enrolled patients of senile cataract between April 2018 and March 2019. The proportion of white cataract was calculated and underlying causes delaying uptake of cataract surgery studied. Results: White cataracts constituted 13.5% of total 3634 senile cataract patients, with gender disparity disfavoring women. Bilateral white cataract was presentation in 39 (8%) patients and lens-related glaucoma in 24 (5%) patients. Pseudophakia in the other eye was single most common cause of delay. Conclusion: A large proportion of white cataracts suggest that penetration of cataract surgical services in not reaching to the most eligible individual.
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Affiliation(s)
- Parveen Rewri
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha (Hisar), Haryana, India
| | - Aprajita Lohan
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha (Hisar), Haryana, India
| | - Sagarika Aggarwal
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha (Hisar), Haryana, India
| | - Priyanka Chodhary
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha (Hisar), Haryana, India
| | - Aparna Singhal
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha (Hisar), Haryana, India
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Assi L, Chamseddine F, Ibrahim P, Sabbagh H, Rosman L, Congdon N, Evans J, Ramke J, Kuper H, Burton MJ, Ehrlich JR, Swenor BK. A Global Assessment of Eye Health and Quality of Life: A Systematic Review of Systematic Reviews. JAMA Ophthalmol 2021; 139:526-541. [PMID: 33576772 PMCID: PMC7881366 DOI: 10.1001/jamaophthalmol.2021.0146] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Question What is the association between vision impairment, eye diseases, or ophthalmic interventions and quality of life? Findings In this cross-sectional study, vision impairment and eye diseases were associated with lower quality of life. More than half of the ophthalmic interventions included had a positive association with quality of life. Meaning The associations of quality of life with vision impairment and the improvements in quality of life with ophthalmic interventions support efforts to improve access to ophthalmic treatments globally to reach the millions of people affected by eye disease each year. Importance More than 1 billion people worldwide have vision impairment or blindness from potentially preventable or correctable causes. Quality of life, an important measure of physical, emotional, and social well-being, appears to be negatively associated with vision impairment, and increasingly, ophthalmic interventions are being assessed for their association with quality of life. Objective To examine the association between vision impairment or eye disease and quality of life, and the outcome of ophthalmic interventions on quality of life globally and across the life span, through an umbrella review or systematic review of systematic reviews. Evidence Review The electronic databases MEDLINE, Ovid, Embase, Cochrane Database of Systematic Reviews, Proquest Dissertations, and Theses Global were searched from inception through June 29, 2020, using a comprehensive search strategy. Systematic reviews addressing vision impairment, eye disease, or ophthalmic interventions and quantitatively or qualitatively assessing health-related, vision-related, or disease-specific quality of life were included. Article screening, quality appraisal, and data extraction were performed by 4 reviewers working independently and in duplicate. The Joanna Briggs Institute critical appraisal and data extraction forms for umbrella reviews were used. Findings Nine systematic reviews evaluated the association between quality of life and vision impairment, age-related macular degeneration, glaucoma, diabetic retinopathy, or mendelian eye conditions (including retinitis pigmentosa). Of these, 5 were reviews of quantitative observational studies, 3 were reviews of qualitative studies, and 1 was a review of qualitative and quantitative studies. All found an association between vision impairment and lower quality of life. Sixty systematic reviews addressed at least 1 ophthalmic intervention in association with quality of life. Overall, 33 unique interventions were investigated, of which 25 were found to improve quality of life compared with baseline measurements or a group receiving no intervention. These interventions included timely cataract surgery, anti–vascular endothelial growth factor therapy for age-related macular degeneration, and macular edema. Conclusions and Relevance There is a consistent association between vision impairment, eye diseases, and reduced quality of life. These findings support pursuing ophthalmic interventions, such as timely cataract surgery and anti–vascular endothelial growth factor therapy, for common retinal diseases, where indicated, to improve quality of life for millions of people globally each year.
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Affiliation(s)
- Lama Assi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fatimah Chamseddine
- Clinical Research Institute, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Perla Ibrahim
- Department of Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Hadi Sabbagh
- Department of Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Lori Rosman
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, United Kingdom.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jennifer Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Moorfields Eye Hospital, London, United Kingdom
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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20
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Spekreijse LS, Simons RWP, Winkens B, van den Biggelaar FJHM, Dirksen CD, Nuijts RMMA. Cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (the BICAT-NL study): study design of a prospective multicenter randomised controlled trial. BMC Ophthalmol 2020; 20:257. [PMID: 32600295 PMCID: PMC7323372 DOI: 10.1186/s12886-020-01521-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/17/2020] [Indexed: 12/04/2022] Open
Abstract
Background Cataract surgery is one of the most frequently performed types of surgery. Most patients suffer from bilateral cataract and while cataract surgery of only one eye is effective in restoring functional vision, second-eye surgery leads to further improvements in health-related quality of life, and is cost-effective. At present, most patients undergo cataract surgery in both eyes on separate days as recommended in national guidelines, referred to as delayed sequential bilateral cataract surgery (DSBCS). An alternative procedure involves operating both eyes on the same day, but as separate procedures, known as immediately sequential bilateral cataract surgery (ISBCS). The aim of this study is to evaluate the effectiveness and costs of ISBCS compared to DSBCS, in order to test the hypothesis that ISBCS is non-inferior to DSBCS in terms of effectiveness and superior to ISBCS in terms of cost-effectiveness. Methods/design Multicenter non-inferiority randomised controlled clinical trial. Patients (18 years or older) with bilateral cataract and an indication for bilateral cataract surgery with an expected uncomplicated intraoperative and postoperative course are included in the study. Patients are randomly assigned to either ISBCS or DSBCS. The primary endpoint is the proportion of patients with a refractive outcome in the second eye within 1.0 dioptre from the target refraction, at 4 weeks after surgery. Secondary outcomes include corrected and uncorrected distance visual acuity, complications, patient reported outcomes (PROMs), cost-effectiveness, and budget impact. Follow-up visits are planned at 1 week after first-eye surgery and 4 weeks after second-eye surgery. At 3 months after first-eye surgery, the occurrence of complications is checked and patients fill in a final questionnaire. Discussion This study protocol describes the design of a multicenter non-inferiority randomised controlled trial. Current studies on ISBCS often lack information on safety regarding refractive outcomes. In addition, there is a lack of well-designed cost-effectiveness studies using established methods. The BICAT-NL study will provide more insight in refractive and cost-effectiveness outcomes for ISBCS compared to DSBCS. Trial registration This study was prospectively registered at Clinicaltrials.gov on January 17th 2018. (Identifier: NCT03400124.
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Affiliation(s)
- L S Spekreijse
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. .,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
| | - R W P Simons
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - B Winkens
- Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - F J H M van den Biggelaar
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - C D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - R M M A Nuijts
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.,Department of Ophthalmology, Zuyderland Medical Center, Heerlen, the Netherlands
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21
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Frampton GK, Shepherd J, Pickett K, Griffiths G, Wyatt JC. Digital tools for the recruitment and retention of participants in randomised controlled trials: a systematic map. Trials 2020; 21:478. [PMID: 32498690 PMCID: PMC7273688 DOI: 10.1186/s13063-020-04358-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 04/28/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recruiting and retaining participants in randomised controlled trials (RCTs) is challenging. Digital tools, such as social media, data mining, email or text-messaging, could improve recruitment or retention, but an overview of this research area is lacking. We aimed to systematically map the characteristics of digital recruitment and retention tools for RCTs, and the features of the comparative studies that have evaluated the effectiveness of these tools during the past 10 years. METHODS We searched Medline, Embase, other databases, the Internet, and relevant web sites in July 2018 to identify comparative studies of digital tools for recruiting and/or retaining participants in health RCTs. Two reviewers independently screened references against protocol-specified eligibility criteria. Included studies were coded by one reviewer with 20% checked by a second reviewer, using pre-defined keywords to describe characteristics of the studies, populations and digital tools evaluated. RESULTS We identified 9163 potentially relevant references, of which 104 articles reporting 105 comparative studies were included in the systematic map. The number of published studies on digital tools has doubled in the past decade, but most studies evaluated digital tools for recruitment rather than retention. The key health areas investigated were health promotion, cancers, circulatory system diseases and mental health. Few studies focussed on minority or under-served populations, and most studies were observational. The most frequently-studied digital tools were social media, Internet sites, email and tv/radio for recruitment; and email and text-messaging for retention. One quarter of the studies measured efficiency (cost per recruited or retained participant) but few studies have evaluated people's attitudes towards the use of digital tools. CONCLUSIONS This systematic map highlights a number of evidence gaps and may help stakeholders to identify and prioritise further research needs. In particular, there is a need for rigorous research on the efficiency of the digital tools and their impact on RCT participants and investigators, perhaps as studies-within-a-trial (SWAT) research. There is also a need for research into how digital tools may improve participant retention in RCTs which is currently underrepresented relative to recruitment research. REGISTRATION Not registered; based on a pre-specified protocol, peer-reviewed by the project's Advisory Board.
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Affiliation(s)
- Geoff K. Frampton
- Southampton Health Technology Assessments Centre (SHTAC), Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
- Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
- Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
| | - Karen Pickett
- Southampton Health Technology Assessments Centre (SHTAC), Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
- Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and Southampton University Hospital NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Jeremy C. Wyatt
- Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
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22
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Levy ER, Hutchins KA, Schears GJ, Rodriguez V, Huskins WC. How We Approach Central Venous Catheter Safety: A Multidisciplinary Perspective. J Pediatric Infect Dis Soc 2020; 9:87-91. [PMID: 31886510 DOI: 10.1093/jpids/piz096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Emily R Levy
- Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn A Hutchins
- Quality Management Services, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory J Schears
- Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pediatric Anesthesia, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - W Charles Huskins
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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23
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Kristianslund O, Dalby M, Moe MC, Drolsum L. Cost-effectiveness analysis in a randomized trial of late in-the-bag intraocular lens dislocation surgery: repositioning versus exchange. Acta Ophthalmol 2019; 97:771-777. [PMID: 30968572 DOI: 10.1111/aos.14108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare the cost-effectiveness of two operation methods for late in-the-bag intraocular lens (IOL) dislocation. METHODS In this randomized clinical trial, 104 patients were randomly assigned to IOL repositioning by scleral suturing (n = 54) or IOL exchange with a retropupillary iris-claw lens (n = 50). A cost-effectiveness analysis (CEA) was performed in conjunction with previously published 6-month efficacy and safety results. An incremental cost-effectiveness ratio was calculated as the cost difference between the operation groups relative to their difference in postoperative corrected distance visual acuity (CDVA) (mean and 95% confidence interval: minimum and maximum), reported as the cost difference in United States Dollars ($) per logMAR difference. RESULTS Exchange surgery was $281.20 ± 17.66 more expensive than repositioning, mainly explained by the new IOL and the frequent use of anterior vitrectomy. A previous trial publication revealed no significant difference in the 6-month postoperative CDVA between the groups. In the CEA, the mean group difference yielded an incremental cost-effectiveness ratio of -$281.20 per -0.11 logMAR (-$1108/QALY) in favour of repositioning, ranging from -$281.20 per -0.29 logMAR (-$406/QALY) in favour of repositioning to +$281.20 per -0.08 logMAR (+$1522/QALY) in favour of exchange. The CEA did not include the mean 9.5 min shorter operation time for exchange. CONCLUSION Repositioning tended to be more cost-effective than exchange; however, this is modified if also considering the operation time. Overall, it seems the cost-effectiveness is not alone sufficiently different to recommend one of the operation methods over the other for late in-the-bag IOL dislocation.
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Affiliation(s)
- Olav Kristianslund
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Marius Dalby
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Morten C. Moe
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Liv Drolsum
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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24
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Golozar A, Chen Y, Lindsley K, Rouse B, Musch DC, Lum F, Hawkins BS, Li T. Identification and Description of Reliable Evidence for 2016 American Academy of Ophthalmology Preferred Practice Pattern Guidelines for Cataract in the Adult Eye. JAMA Ophthalmol 2019; 136:514-523. [PMID: 29800249 DOI: 10.1001/jamaophthalmol.2018.0786] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Trustworthy clinical practice guidelines require reliable systematic reviews of the evidence to support recommendations. Since 2016, the American Academy of Ophthalmology (AAO) has partnered with Cochrane Eyes and Vision US Satellite to update their guidelines, the Preferred Practice Patterns (PPP). Objective To describe experiences and findings related to identifying reliable systematic reviews that support topics likely to be addressed in the 2016 update of the 2011 AAO PPP guidelines on cataract in the adult eye. Design, Setting, and Participants Cross-sectional study. Systematic reviews on the management of cataract were searched for in an established database. Each relevant systematic review was mapped to 1 or more of the 24 management categories listed under the Management section of the table of contents of the 2011 AAO PPP guidelines. Data were extracted to determine the reliability of each systematic review using prespecified criteria, and the reliable systematic reviews were examined to find whether they were referenced in the 2016 AAO PPP guidelines. For comparison, we assessed whether the reliable systematic reviews published before February 2010 the last search date of the 2011 AAO PPP guidelines were referenced in the 2011 AAO PPP guidelines. Cochrane Eyes and Vision US Satellite did not provide systematic reviews to the AAO during the development of the 2011 AAO PPP guidelines. Main Outcomes and Measures Systematic review reliability was defined by reporting eligibility criteria, performing a comprehensive literature search, assessing methodologic quality of included studies, using appropriate methods for meta-analysis, and basing conclusions on review findings. Results From 99 systematic reviews on management of cataract, 46 (46%) were classified as reliable. No evidence that a comprehensive search had been conducted was the most common reason a review was classified as unreliable. All 46 reliable systematic reviews were cited in the 2016 AAO PPP guidelines, and 8 of 15 available reliable reviews (53%) were cited in the 2011 PPP guidelines. Conclusions and Relevance The partnership between Cochrane Eyes and Vision US Satellite and the AAO provides the AAO access to an evidence base of relevant and reliable systematic reviews, thereby supporting robust and efficient clinical practice guidelines development to improve the quality of eye care.
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Affiliation(s)
- Asieh Golozar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yujiang Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kristina Lindsley
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Benjamin Rouse
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.,Department of Epidemiology, University of Michigan, Ann Arbor
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Barbara S Hawkins
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Tianjing Li
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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25
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Moureau NL, Carr PJ. Vessel Health and Preservation: a model and clinical pathway for using vascular access devices. ACTA ACUST UNITED AC 2019; 27:S28-S35. [PMID: 29683752 DOI: 10.12968/bjon.2018.27.8.s28] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of intravenous devices for the delivery of medical treatment spans all healthcare facilities ranging from hospitals to clinics and home care. Clinical pathways are processes used by healthcare providers to integrate and illustrate the best evidence and approach to care for a specific area of practice. The Vessel Health and Preservation (VHP) model is a framework and pathway process, consisting of four quadrants, to guide initiation and management of treatment requiring intravenous access. The pathway is designed to promote preservation of the vasculature of patients from admission through discharge with a focus on acute care. This article describes the model and pathway process. Moving through the quadrants of assessment/selection, insertion, management and evaluation of outcomes the clinician receives vascular access education to establish an understanding of the key principles and is then better able to provide care to the patient. Research on the VHP model has found that patients, clinicians and healthcare facilities benefit from the evidence integrated within the VHP model for improved outcomes, greater success with insertion, time saved through improved efficiency, risk reduced through appropriate device discontinuation, and greater patient satisfaction.
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Affiliation(s)
- Nancy L Moureau
- Chief Executive Officer, PICC Excellence Inc, Hartwell, Georgia, and Vascular Access Specialist, Greenville Memorial Hospital, South Carolina, USA, and Adjunct Associate Professor and member of Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia
| | - Peter J Carr
- Lecturer/Researcher, Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Australia
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26
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Sramka M, Slovak M, Tuckova J, Stodulka P. Improving clinical refractive results of cataract surgery by machine learning. PeerJ 2019; 7:e7202. [PMID: 31304064 PMCID: PMC6611496 DOI: 10.7717/peerj.7202] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/27/2019] [Indexed: 11/20/2022] Open
Abstract
AIM To evaluate the potential of the Support Vector Machine Regression model (SVM-RM) and Multilayer Neural Network Ensemble model (MLNN-EM) to improve the intraocular lens (IOL) power calculation for clinical workflow. BACKGROUND Current IOL power calculation methods are limited in their accuracy with the possibility of decreased accuracy especially in eyes with an unusual ocular dimension. In case of an improperly calculated power of the IOL in cataract or refractive lens replacement surgery there is a risk of re-operation or further refractive correction. This may create potential complications and discomfort for the patient. METHODS A dataset containing information about 2,194 eyes was obtained using data mining process from the Electronic Health Record (EHR) system database of the Gemini Eye Clinic. The dataset was optimized and split into the selection set (used in the design for models and training), and the verification set (used in the evaluation). The set of mean prediction errors (PEs) and the distribution of predicted refractive errors were evaluated for both models and clinical results (CR). RESULTS Both models performed significantly better for the majority of the evaluated parameters compared with the CR. There was no significant difference between both evaluated models. In the ±0.50 D PE category both SVM-RM and MLNN-EM were slightly better than the Barrett Universal II formula, which is often presented as the most accurate calculation formula. CONCLUSION In comparison to the current clinical method, both SVM-RM and MLNN-EM have achieved significantly better results in IOL calculations and therefore have a strong potential to improve clinical cataract refractive outcomes.
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Affiliation(s)
- Martin Sramka
- Department of Circuit Theory/Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
- Research and Development Department, Gemini Eye Clinic, Zlin, Czech Republic
| | - Martin Slovak
- Research and Development Department, Gemini Eye Clinic, Zlin, Czech Republic
| | - Jana Tuckova
- Department of Circuit Theory/Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Pavel Stodulka
- Research and Development Department, Gemini Eye Clinic, Zlin, Czech Republic
- Department of Ophthalmology/Third Faculty of Medicine, Charles University, Prague, Czech Republic
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27
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Bauer A, Taggart L, Rasmussen J, Hatton C, Owen L, Knapp M. Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks. BMC Public Health 2019; 19:706. [PMID: 31174506 PMCID: PMC6556058 DOI: 10.1186/s12889-019-6912-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/29/2019] [Indexed: 01/09/2023] Open
Abstract
Background Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. Methods Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. Results Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. Conclusion Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions. Electronic supplementary material The online version of this article (10.1186/s12889-019-6912-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annette Bauer
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK.
| | - Laurence Taggart
- Institute of Nursing & Health Research, Ulster University, N Ireland, Newtownabbey, BT37 0QB, UK
| | - Jill Rasmussen
- Royal College of General Practitioners (RCGP), 30 Euston Square, London, England, NW1 2FB, UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Lancaster University, Lancaster, England, LA1 4YG, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, England, SW1A 2BU, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK
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28
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Dickman MM, Spekreijse LS, Winkens B, Schouten JSAG, Simons RWP, Dirksen CD, Nuijts RMMA. Immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts. Hippokratia 2019. [DOI: 10.1002/14651858.cd013270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Mor M Dickman
- Maastricht University Medical Centre; University Eye Clinic Maastricht; P. Debyelaan 25 Maastricht Netherlands 6229 HX
| | - Lindsay S Spekreijse
- Maastricht University Medical Centre; University Eye Clinic Maastricht; P. Debyelaan 25 Maastricht Netherlands 6229 HX
| | - Bjorn Winkens
- Maastricht University; Department of Methodology and Statistics, Faculty of Health Medicine and Life Sciences (FHML); Debyeplein 1 Maastricht Netherlands 6200 MD
| | - Johannes SAG Schouten
- Maastricht University Medical Centre; University Eye Clinic Maastricht; P. Debyelaan 25 Maastricht Netherlands 6229 HX
| | - Rob WP Simons
- Maastricht University Medical Centre; University Eye Clinic Maastricht; P. Debyelaan 25 Maastricht Netherlands 6229 HX
| | - Carmen D Dirksen
- Maastricht University (CAPHRI); Clinical Epidemiology and Medical Technology Assessment Department; Maastricht Netherlands
| | - Rudy MMA Nuijts
- Maastricht University Medical Centre; University Eye Clinic Maastricht; P. Debyelaan 25 Maastricht Netherlands 6229 HX
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Consecutive case series of 244 age-related macular degeneration patients undergoing implantation with an extended macular vision IOL. Eur J Ophthalmol 2017; 28:198-203. [DOI: 10.5301/ejo.5001052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: To determine safety and visual outcomes in eyes with age-related macular degeneration (AMD) implanted with a novel intraocular lens (IOL) that delivers an optimized retinal image to all macular areas within 10 degrees of retinal eccentricity. Methods: This was a consecutive case series of 244 eyes with dry/stable wet AMD and logMAR visual acuity ≥0.3 implanted with iolAMD Eyemax monoTM (London Eye Hospital Pharma), a single-piece, injectable, hydrophobic acrylic IOL sited in the capsular bag. Primary outcome was safety. Secondary outcomes were changes in corrected distance visual acuity (CDVA) and corrected near visual acuity (CNVA) (logMAR). Results: Mean age at surgery was 80 years. Mean duration of follow-up was 3 months (range 1-16 months). No eyes had worsening of CDVA. Frequency of perioperative complications was equivalent to standard IOL implantation. Postoperative refractive outcomes were within ±1 D of the target refraction in 88% of cases. Mean preoperative CDVA improved from 1.06 to 0.71 postoperatively (mean of differences -0.35; 95% confidence interval [CI] -0.3886 to -0.3223; p<0.0001), equating to an approximate Early Treatment Diabetic Retinopathy Study gain of 18 letters. Mean preoperative CNVA (N-point; logMAR conversion) improved from 1.36 to 0.88 postoperatively (mean of differences -0.48; 95% CI -0.53 to -0.44; p<0.0001). Conclusions: This novel IOL appears safe in the short to medium term. Improvements in postoperative CDVA and CNVA exceed those observed with standard implants.
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Gominet M, Compain F, Beloin C, Lebeaux D. Central venous catheters and biofilms: where do we stand in 2017? APMIS 2017; 125:365-375. [PMID: 28407421 DOI: 10.1111/apm.12665] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/29/2016] [Indexed: 12/28/2022]
Abstract
The use of central venous catheters (CVC) is associated with a risk of microbial colonization and subsequent potentially severe infection. Microbial contamination of the catheter leads to the development of a microbial consortia associated with the CVC surface and embedded in an extracellular matrix, named biofilm. This biofilm provides bacterial cells the ability to survive antimicrobial agents and the host immune system and to disseminate to other sites of the body. The best preventive strategy is to avoid any unnecessary catheterization or to reduce indwelling duration when a CVC is required. Beside aseptic care and antibiotic-impregnated catheters (like minocycline/rifampin), preventive locks can be proposed in some cases, whereas non-biocidal approaches are under active research like anti-adhesive or competitive interactions strategies. When the diagnosis of catheter-related bloodstream infection (CRBSI) is suspected on clinical symptoms, it requires a microbiological confirmation by paired blood cultures in order to avoid unnecessary catheter removal. The treatment of CRBSI relies on catheter removal and systemic antimicrobials. However, antibiotic lock technique (ALT) can be used as an attempt to eradicate biofilm formed on the inside lumen of the catheter in case of uncomplicated long-term catheter-related BSI caused by coagulase-negative staphylococci (CoNS) or Enterobacteriaceae. Recently, promising strategies have been developed to improve biofilm eradication; they rely on matrix degradation or destabilization or the development of anti-persister compounds, targeting the most tolerant bacterial cells inside the biofilm. Understanding biofilm formation at the molecular level may help us to develop new approaches to prevent or treat these frequent infections.
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Affiliation(s)
- Marie Gominet
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Paris, France
| | - Fabrice Compain
- Université Paris Descartes, Paris, France.,Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Christophe Beloin
- Unité de Génétique des Biofilms, Département de Microbiologie, Institut Pasteur, Paris, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Paris, France
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Zhang L, Cao S, Marsh N, Ray-Barruel G, Flynn J, Larsen E, Rickard CM. Infection risks associated with peripheral vascular catheters. J Infect Prev 2016; 17:207-213. [PMID: 28989482 DOI: 10.1177/1757177416655472] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/18/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Peripheral vascular catheters (PVC) are the most frequently used invasive medical devices in hospitals, with 330 million sold each year in the USA alone. One in three UK inpatients at any one time has at least one PVC in situ according to the Scottish National Prevalence survey. METHOD A narrative review of studies describing the infection risks associated with PVCs. RESULTS It is estimated that 30-80% of hospitalised patients receive at least one PVC during their hospital stay. Despite their prevalence, PVCs are not benign devices, and the high number of PVCs inserted annually has resulted in serious catheter-related bloodstream infections and significant morbidity, prolonged hospital stay and increased healthcare system costs. To date, PVC infections have been under-evaluated. Most studies focus on central venous catheter rather than PVC-associated bloodstream infections. Risks associated with PVC infection must be addressed to reduce patient morbidity and associated costs of prolonged hospital admission and treatment. DISCUSSION This article discusses the sources and routes of PVC-associated infection and outlines known effective prevention and intervention strategies.
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Affiliation(s)
- Li Zhang
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Siyu Cao
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Nicole Marsh
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Gillian Ray-Barruel
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Julie Flynn
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Emily Larsen
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Claire M Rickard
- AVATAR Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
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Miake-Lye IM, Hempel S, Shanman R, Shekelle PG. What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products. Syst Rev 2016; 5:28. [PMID: 26864942 PMCID: PMC4750281 DOI: 10.1186/s13643-016-0204-x] [Citation(s) in RCA: 303] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 02/02/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The need for systematic methods for reviewing evidence is continuously increasing. Evidence mapping is one emerging method. There are no authoritative recommendations for what constitutes an evidence map or what methods should be used, and anecdotal evidence suggests heterogeneity in both. Our objectives are to identify published evidence maps and to compare and contrast the presented definitions of evidence mapping, the domains used to classify data in evidence maps, and the form the evidence map takes. METHODS We conducted a systematic review of publications that presented results with a process termed "evidence mapping" or included a figure called an "evidence map." We identified publications from searches of ten databases through 8/21/2015, reference mining, and consulting topic experts. We abstracted the research question, the unit of analysis, the search methods and search period covered, and the country of origin. Data were narratively synthesized. RESULTS Thirty-nine publications met inclusion criteria. Published evidence maps varied in their definition and the form of the evidence map. Of the 31 definitions provided, 67 % described the purpose as identification of gaps and 58 % referenced a stakeholder engagement process or user-friendly product. All evidence maps explicitly used a systematic approach to evidence synthesis. Twenty-six publications referred to a figure or table explicitly called an "evidence map," eight referred to an online database as the evidence map, and five stated they used a mapping methodology but did not present a visual depiction of the evidence. CONCLUSIONS The principal conclusion of our evaluation of studies that call themselves "evidence maps" is that the implied definition of what constitutes an evidence map is a systematic search of a broad field to identify gaps in knowledge and/or future research needs that presents results in a user-friendly format, often a visual figure or graph, or a searchable database. Foundational work is needed to better standardize the methods and products of an evidence map so that researchers and policymakers will know what to expect of this new type of evidence review. SYSTEMATIC REVIEW REGISTRATION Although an a priori protocol was developed, no registration was completed; this review did not fit the PROSPERO format.
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Affiliation(s)
- Isomi M. Miake-Lye
- />Evidence-based Synthesis Program (ESP) Center, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
- />Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 640 Charles E Young Dr S, Los Angeles, CA USA
| | - Susanne Hempel
- />Southern California Evidence-based Practice Center, RAND Corporation, 1776 Main St, Santa Monica, CA 90401 USA
| | - Roberta Shanman
- />Southern California Evidence-based Practice Center, RAND Corporation, 1776 Main St, Santa Monica, CA 90401 USA
| | - Paul G. Shekelle
- />Evidence-based Synthesis Program (ESP) Center, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
- />Southern California Evidence-based Practice Center, RAND Corporation, 1776 Main St, Santa Monica, CA 90401 USA
- />Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
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Day AC, Wormald R, Coronini-Cronberg S, Smith R. The Royal College of Ophthalmologists' Cataract Surgery Commissioning Guidance: executive summary. Eye (Lond) 2016; 30:498-502. [PMID: 26795408 DOI: 10.1038/eye.2015.271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- A C Day
- Moorfields Eye Hospital, London, UK.,The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - R Wormald
- Moorfields Eye Hospital, London, UK.,The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - S Coronini-Cronberg
- Department of Primary Care and Public Health, Faculty of Medicine, Imperial College, London, UK.,Public Health, and Head of Clinical Effectiveness, BUPA, London, UK
| | - R Smith
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
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O'Mahony JF, Coughlan D. The Irish Cost-Effectiveness Threshold: Does it Support Rational Rationing or Might it Lead to Unintended Harm to Ireland's Health System? PHARMACOECONOMICS 2016; 34:5-11. [PMID: 26497002 DOI: 10.1007/s40273-015-0336-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Ireland is one of the few countries worldwide to have an explicit cost-effectiveness threshold. In 2012, an agreement between government and the pharmaceutical industry that provided substantial savings on existing medications set the threshold at €45,000/quality-adjusted life-year (QALY). This replaced a previously unofficial threshold of €20,000/QALY. According to the agreement, drugs within the threshold will be granted reimbursement, whereas those exceeding it may still be approved following further negotiation. A number of drugs far exceeding the threshold have been approved recently. The agreement only applies to pharmaceuticals. There are four reasons for concern regarding Ireland's threshold. The absence of an explicit threshold for non-drug interventions leaves it unclear if there is parity in willingness to pay across all interventions. As the threshold resembles a price floor rather than a ceiling, in principle it only offers a weak barrier to cost-ineffective interventions. It has no empirical basis. Finally, it is probably too high given recent estimates of a threshold for the UK based on the cost effectiveness of services forgone of approximately £13,000/QALY. An excessive threshold risks causing the Irish health system unintended harm. The lack of an empirically informed threshold means the policy recommendations of cost-effectiveness analysis cannot be considered as fully evidence- based rational rationing. Policy makers should consider these issues and recent Irish legislation that defined cost effectiveness in terms of the opportunity cost of services forgone when choosing what threshold to apply once the current industry agreement expires at the end of 2015
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Ma Y, Gao W, Wu K, Bao Y. Flavonoid intake and the risk of age-related cataract in China's Heilongjiang Province. Food Nutr Res 2015; 59:29564. [PMID: 26652740 PMCID: PMC4677276 DOI: 10.3402/fnr.v59.29564] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 12/16/2022] Open
Abstract
Background/objectives Epidemiological evidence suggests that diets rich in flavonoids may reduce the risk of developing age-related cataract (ARC). Flavonoids are widely distributed in foods of plant origin, and the objective of this study was to evaluate retrospectively the association between the intakes of the five flavonoid subclasses and the risk of ARC. Subjects/methods A population-based case-control study (249 cases and 66 controls) was carried out in Heilongjiang province, which is located in the northeast of China, and where intakes and availability of fresh vegetables and fruits can be limited. Dietary data gathered by food-frequency questionnaire (FFQ) were used to calculate flavonoid intake. Adjusted odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression. Results No linear associations between risk of developing ARC and intakes of total dietary flavonoids, anthocyanidins, flavon-3-ol, flavanone, total flavones or total flavonols were found, but quercetin and isorhamnetin intake was inversely associated with ARC risk (OR 11.78, 95% CI: 1.62–85.84, p<0.05, and OR 6.99, 95% CI: 1.12–43.44, p<0.05, quartile 4 vs. quartile 1, respectively). Conclusion As quercetin is contained in many plant foods and isorhamnetin in very few foods, we concluded that higher quercetin intake may be an important dietary factor in the reduction of the risk of ARC.
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Affiliation(s)
- Yingna Ma
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China.,The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Weiqi Gao
- The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Kun Wu
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China;
| | - Yongping Bao
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China.,Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK;
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Olk RJ, Peralta E, Gierhart DL, Brown GC, Brown MM. Triple combination therapy and zeaxanthin for the treatment of neovascular age-related macular degeneration: an interventional comparative study and cost-effectiveness analysis. Int J Retina Vitreous 2015; 1:22. [PMID: 27847615 PMCID: PMC5088486 DOI: 10.1186/s40942-015-0019-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/27/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Reports of triple combination therapy for neovascular age-related macular degeneration (AMD) suggest a benefit, as do reports for zeaxanthin. An interventional comparative study was thus undertaken to evaluate the efficacy of triple combination therapy with and without zeaxanthin, as well as the economic viability of the therapies. METHODS The cases of 543 consecutive eyes of 424 patients with subfoveal choroidal neovascularization (CNV) secondary to AMD were reviewed. All eyes were treated with triple combination therapy (triple therapy) consisting of: (1) reduced-fluence photodynamic therapy with verteporfin, (2) intravitreal bevacizumab and (3) intravitreal dexamethasone. Therapy was repeated as necessary. One cohort of patients was also given supplementation with 20 mg of oral zeaxanthin (Zx) daily. RESULTS The triple therapy group without Zx received a mean of 2.8 treatment cycles and 87 % of patients had stable or improved vision at 24 months. In the triple therapy group with Zx, the mean number of treatment cycles was 2.1, with 83 % of patients having stable or improved vision at 24 months. At 24 months, CNV developed in 12.5 % of fellow eyes treated with triple therapy alone; CNV developed in 6.25 % of eyes treated with triple therapy with Zx (p = 0.03). An average cost-utility analysis revealed that triple therapy was cost-effective with a cost-utility ratio of $26,574/QALY, while triple therapy with Zx was more cost-effective with an average cost-utility ratio of $19,962/QALY. The incremental cost-utility analysis assessing the addition of Zx to triple therapy disclosed Zx supplementation was very cost-effective at $5302/QALY. When it was assumed that triple therapy with Zx reduced fellow eye CNV development by 30.3 %, the incremental cost-utility dropped to (-$6332/QALY), indicating that adding Zx to triple therapy yielded greater patient value, and was also less expensive than using triple therapy alone. CONCLUSIONS Triple therapy is comparatively effective and cost-effective. Considerably less treatment is needed than reported in monotherapy studies. The addition of oral Zx appears to further reduce the treatment cycles required, and possibly reduce the risk of CNV development in the fellow eye.
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Affiliation(s)
- R. Joseph Olk
- The Center for Value-Based Medicine®, Box 335, Flourtown, PA 19031 USA
- The Retina Center of St. Louis County, St. Louis, MO USA
| | - Enrique Peralta
- The Center for Value-Based Medicine®, Box 335, Flourtown, PA 19031 USA
- The Retina Center of St. Louis County, St. Louis, MO USA
| | - Dennis L. Gierhart
- The Center for Value-Based Medicine®, Box 335, Flourtown, PA 19031 USA
- ZeaVision, 680F Crown Industrial Court, Chesterfield, MO 63005 USA
| | - Gary C. Brown
- The Center for Value-Based Medicine®, Box 335, Flourtown, PA 19031 USA
- Retina Service, Wills Eye Hospital, Jefferson Medical College, philadelphia, PA USA
| | - Melissa M. Brown
- The Center for Value-Based Medicine®, Box 335, Flourtown, PA 19031 USA
- Research Department, Wills Eye Hospital, Jefferson Medical College, philadelphia, PA USA
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Cooper K, Shepherd J, Frampton G, Harris P, Lotery A. The cost-effectiveness of second-eye cataract surgery in the UK. Age Ageing 2015; 44:1026-31. [PMID: 26410365 DOI: 10.1093/ageing/afv126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 07/27/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Elective cataract surgery is the most commonly performed surgical procedure in developed countries. However, it is unclear whether cataract surgery on the second eye provides enough incremental benefit to be considered cost-effective. This study conducted a cost-effectiveness analysis of second-eye cataract surgery in the U.K. DESIGN A cost-effectiveness analysis. METHODS A decision-analytical model was developed to estimate the cost-effectiveness of second-eye cataract surgery, based on a comprehensive epidemiological and economic review to develop the parameters for the model. The model followed the clinical pathway of cohorts of patients receiving second-eye cataract surgery and included costs and health benefits associated with post-surgical complications. RESULTS In the model, second-eye surgery generated 0.68 additional quality-adjusted life years (QALY) with an incremental cost-effectiveness ratio of £1,964 per QALY gained. In sensitivity analyses, model results were most sensitive to changes in the health-related quality of life (HRQoL) gain associated with second-eye surgery, but otherwise robust to changes in parameter values. The probability that second-eye surgery is cost-effective at willingness to pay thresholds of £10,000 and £20,000 was 100%. CONCLUSION Second-eye cataract surgery is generally cost-effective based on the best available data and under most assumptions. However, there are only a small number of clinical trials for second-eye cataract surgery, and these have not been conducted in recent years.
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Affiliation(s)
- Keith Cooper
- SHTAC, University of Southampton, Southampton, Hampshire SO16 7NS, UK
| | - Jonathan Shepherd
- SHTAC, University of Southampton, Southampton, Hampshire SO16 7NS, UK
| | - Geoff Frampton
- SHTAC, University of Southampton, Southampton, Hampshire SO16 7NS, UK
| | - Petra Harris
- SHTAC, University of Southampton, Southampton, Hampshire SO16 7NS, UK
| | - Andrew Lotery
- Clinical and Experimental Sciences, University of Southampton, Southampton, Hampshire, UK
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Johnson MJ, May CR. Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. BMJ Open 2015; 5:e008592. [PMID: 26423853 PMCID: PMC4593167 DOI: 10.1136/bmjopen-2015-008592] [Citation(s) in RCA: 263] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/27/2015] [Accepted: 09/04/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Translating research evidence into routine clinical practice is notoriously difficult. Behavioural interventions are often used to change practice, although their success is variable and the characteristics of more successful interventions are unclear. We aimed to establish the characteristics of successful behaviour change interventions in healthcare. DESIGN We carried out a systematic overview of systematic reviews on the effectiveness of behaviour change interventions with a theory-led analysis using the constructs of normalisation process theory (NPT). MEDLINE, CINAHL, PsychINFO and the Cochrane Library were searched electronically from inception to July 2015. SETTING Primary and secondary care. PARTICIPANTS Participants were any patients and healthcare professionals in systematic reviews who met the inclusion criteria of having examined the effectiveness of professional interventions in improving professional practice and/or patient outcomes. INTERVENTIONS Professional interventions as defined by the Cochrane Effective Practice and Organisation of Care Review Group. PRIMARY AND SECONDARY OUTCOME MEASURES Success of each intervention in changing practice or patient outcomes, and their mechanisms of action. Reviews were coded as to the interventions included, how successful they had been and which NPT constructs its component interventions covered. RESULTS Searches identified 4724 articles, 67 of which met the inclusion criteria. Interventions fell into three main categories: persuasive; educational and informational; and action and monitoring. Interventions focusing on action or education (eg, Audit and Feedback, Reminders, Educational Outreach) acted on the NPT constructs of Collective Action and Reflexive Monitoring, and reviews using them tended to report more positive outcomes. CONCLUSIONS This theory-led analysis suggests that interventions which contribute to normative restructuring of practice, modifying peer group norms and expectations (eg, educational outreach) and relational restructuring, reinforcing modified peer group norms by emphasising the expectations of an external reference group (eg, Reminders, Audit and Feedback), offer the best chances of success. Combining such interventions is most likely to change behaviour.
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Affiliation(s)
- Mark J Johnson
- National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carl R May
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Sabharwal S, Carter A, Darzi LA, Reilly P, Gupte CM. The methodological quality of health economic evaluations for the management of hip fractures: A systematic review of the literature. Surgeon 2015; 13:170-6. [DOI: 10.1016/j.surge.2014.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/30/2014] [Accepted: 10/16/2014] [Indexed: 12/21/2022]
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Affiliation(s)
- Nancy L Moureau
- Chief Executive Officer of PICC Excellence; Vascular Access Specialist at Greenville Memorial University Medical Center; Adjunct Associate Professor at Griffith University Health Institute Centre for Health Practice Innovation; Member of the Alliance for Vascular Access Teaching and Research Group (AVATAR), Queensland at Griffith University
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