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Toomey M, Gyawali R, Ho KC, Stapleton F, Keay L, Jalbert I. Developing realistic benchmarks for glaucoma care delivery. Clin Exp Optom 2024; 107:196-203. [PMID: 37952255 DOI: 10.1080/08164622.2023.2275748] [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: 03/23/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
CLINICAL RELEVANCE Realistic benchmarks can serve as comparators for optometrists wishing to engage in clinical practice audits of their glaucoma care. BACKGROUND The iCareTrack study established the appropriateness of glaucoma care delivery through clinical record audits of Australian optometry practices. Benchmarks required for monitoring and improving glaucoma care delivery do not exist. This study developed realistic benchmarks for glaucoma care and then benchmarked the performance of practices from the iCareTrack study to establish aspects of care that warrant attention from quality improvement initiatives. METHODS Benchmarks were developed from the pre-existing iCareTrack dataset using the Achievable Benchmarks of Care (ABC) method. The iCareTrack study had audited the appropriateness of glaucoma care delivery against 37 clinical indicators for 420 randomly sampled glaucoma patient records from 42 Australian optometry practices. The four-step ABC method calculates benchmarks based on the top 10% of best-performing practices adjusted for low patient encounter numbers. iCareTrack results were compared to the benchmarks to explore the distribution of practices that were at, above or below benchmark. RESULTS Benchmarks were developed for 34 of 37 iCareTrack indicators. For 26 (of 34) indicators, the benchmarks were at or above 90% appropriateness. The benchmarks for 14 (of 34) iCareTrack indicators were met by more than 80% of eligible practices, indicating excellent performance. Some aspects of glaucoma care such as peripheral anterior angle assessment, applanation tonometry, and visual field assessment appeared to be delivered sub-optimally by optometrists when compared to the benchmarks. CONCLUSION This study established benchmarks for glaucoma care delivery in optometry practices that reflect realistic and top achievable performance. The large number of indicators with benchmarks above 90% confirmed that glaucoma care can and should be delivered by optometrists at very high levels of appropriateness. Benchmarking identified pockets of sub-optimal performance that can now be targeted by quality improvement initiatives.
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Affiliation(s)
- Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Rajendra Gyawali
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Discipline of Optometry and Vision Science, University of Canberra, Canberra, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Gyawali R, Ho KC, Toomey M, Stapleton F, Keay L, Hibbert P, Wiles L, Jalbert I. Level of appropriate primary diabetic eyecare delivered and achievable in optometry practices in Australia. Clin Exp Optom 2022; 106:276-282. [PMID: 35125062 DOI: 10.1080/08164622.2022.2033107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE Current levels of appropriateness for primary diabetic eyecare delivered by Australian optometrists are presented along with realistic targets (benchmarks) for quality improvement. The demonstrated methods can be used in practice evaluation and benchmarking of other clinical practice areas and settings. BACKGROUND To examine the appropriateness of diabetic eye-care delivery and establish achievable benchmarks of care (ABCs) for optometry practices in Australia. METHOD In a retrospective audit, clinical records of patients with type-II diabetes obtained from a randomly selected nationally representative sample of optometry practices were assessed against evidence-based clinical indicators. Appropriate care is defined as care delivered in compliance with the indicators. The ABC for each indicator was calculated as the average performance for the top 10% of optometry practices after Bayesian adjustment to account for a low number of eligible records. RESULTS The audit of 420 randomly selected patient records from 42 practices against 12 clinical indicators showed an overall appropriateness of 69% (95% confidence interval (CI) 66%, 73%) for overall diabetic eye care. While a high level of appropriateness was identified for recall period (93%, 95% CI 85%, 100%) and referral (100%, 95% CI 38%, 100%), larger gaps existed in history taking (46%, 95% CI 44%, 52%), dilated fundus examination (80%, 95% CI 76%, 84%) and iris examination (0%, 95% CI 0%, 56%). The ABCs for 8 of 12 indicators were 100%, and the remaining three indicators had ABCs above 80%. An ABC for the iris examination indicator could not be calculated owing to the low number of eligible patient record cards. CONCLUSIONS This study demonstrated a systematic process of practice evaluation and benchmarking in optometry practices. The diabetic eye care delivered by Australian optometrists was largely appropriate; however, improvement opportunities exist for history taking and physical examination. The ABCs demonstrate that excellence in primary diabetic eye care is attainable and will serve as an important tool in future initiatives to reduce the identified evidence-to-practice gaps.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia.,Better Vision Foundation Nepal, Kathmandu, Nepal
| | - Kam Chun Ho
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia.,Discipline of Optometry and Vision Science, University of Canberra, Canberra, Australia
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Peter Hibbert
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise Wiles
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
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Toomey M, Ho KC, Gyawali R, Stapleton F, Wiles L, Hibbert P, Keay L, Jalbert I. The appropriateness of and barriers to glaucoma care delivery by Australian optometrists. Clin Exp Optom 2022; 105:593-601. [PMID: 35037600 DOI: 10.1080/08164622.2021.2004861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE Establishing the level of appropriateness and barriers to glaucoma care delivery by Australian optometrists are important first steps in developing tailored interventions aimed at improving glaucoma care delivery. BACKGROUND To determine the appropriateness of and barriers to glaucoma care by optometrists. METHODS A mixed method study was conducted. Phase I was a retrospective cross-sectional medical record audit that assessed glaucoma care appropriateness against 37 clinical indicators from a nationally representative sample of 42 optometry practices. In Phase II, focus groups and interviews involving 31 optometrists explored audit findings to identify barriers to appropriate glaucoma care. Barriers were analysed by deductive and inductive qualitative analysis. Saliency analysis was used to identify key domains that influence glaucoma care. RESULTS Appropriate glaucoma care was delivered for 63% (95% CI 61%, 64%) of the 420 patient encounters audited. Appropriate care was delivered above 80% for most (57%) indicators, while 14 (38%) indicators were delivered below 60% appropriateness. Good compliance to appropriate care was noted for key indicators of intraocular pressure measurement (90%, 95% CI 87%, 93%) and optic nerve head/retinal nerve fibre layer imaging (78%, 95% CI 74%, 82%). Important barriers identified were beliefs about expected outcomes, lack of perceived relevancy, time constraints, poor organisational culture, knowledge gaps, focusing on some aspects of glaucoma care to the detriment of others, the complexity of glaucoma care, information recall, and social norms. CONCLUSION Glaucoma care was appropriate in most patient encounters, with opportunity to improve some aspects of history taking and physical examinations. Barriers to glaucoma care were diverse, existing at both the practitioner and organisational levels. These findings provide direction for the development of a tailored improvement intervention.
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Affiliation(s)
- Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Population Health Research Unit, Singapore Eye Research Institute, Singapore, Singapore
| | - Rajendra Gyawali
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Louise Wiles
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Iimpact in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Peter Hibbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Iimpact in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Valero-Vello M, Peris-Martínez C, García-Medina JJ, Sanz-González SM, Ramírez AI, Fernández-Albarral JA, Galarreta-Mira D, Zanón-Moreno V, Casaroli-Marano RP, Pinazo-Duran MD. Searching for the Antioxidant, Anti-Inflammatory, and Neuroprotective Potential of Natural Food and Nutritional Supplements for Ocular Health in the Mediterranean Population. Foods 2021; 10:1231. [PMID: 34071459 PMCID: PMC8229954 DOI: 10.3390/foods10061231] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022] Open
Abstract
Adherence to a healthy diet offers a valuable intervention to compete against the increasing cases of ocular diseases worldwide, such as dry eye disorders, myopia progression, cataracts, glaucoma, diabetic retinopathy, or age macular degeneration. Certain amounts of micronutrients must be daily provided for proper functioning of the visual system, such as vitamins, carotenoids, trace metals and omega-3 fatty acids. Among natural foods, the following have to be considered for boosting eye/vision health: fish, meat, eggs, nuts, legumes, citrus fruits, nuts, leafy green vegetables, orange-colored fruits/vegetables, olives-olive oil, and dairy products. Nutritional supplements have received much attention as potential tools for managing chronic-degenerative ocular diseases. A systematic search of PubMed, Web of Science, hand-searched publications and historical archives were performed by the professionals involved in this study, to include peer-reviewed articles in which natural food, nutrient content, and its potential relationship with ocular health. Five ophthalmologists and two researchers collected the characteristics, quality and suitability of the above studies. Finally, 177 publications from 1983 to 2021 were enclosed, mainly related to natural food, Mediterranean diet (MedDiet) and nutraceutic supplementation. For the first time, original studies with broccoli and tigernut (chufa de Valencia) regarding the ocular surface dysfunction, macular degeneration, diabetic retinopathy and glaucoma were enclosed. These can add value to the diet, counteract nutritional defects, and help in the early stages, as well as in the course of ophthalmic pathologies. The main purpose of this review, enclosed in the Special Issue "Health Benefits and Nutritional Quality of Fruits, Nuts and Vegetables," is to identify directions for further research on the role of diet and nutrition in the eyes and vision, and the potential antioxidant, anti-inflammatory and neuroprotective effects of natural food (broccoli, saffron, tigernuts and walnuts), the Mediterranean Diet, and nutraceutic supplements that may supply a promising and highly affordable scenario for patients at risk of vision loss. This review work was designed and carried out by a multidisciplinary group involved in ophthalmology and ophthalmic research and especially in nutritional ophthalmology.
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Affiliation(s)
- Mar Valero-Vello
- Ophthalmic Research Unit “Santiago Grisolía” Foundation for the Promotion of Health and Biomedical Research of Valencia FISABIO, 46017 Valencia, Spain; (M.V.-V.); (J.J.G.-M.); (S.M.S.-G.); (M.D.P.-D.)
| | - Cristina Peris-Martínez
- Ophthalmic Medical Center (FOM), Foundation for the Promotion of Health and Biomedical Research of Valencia (FISABIO), 46015 Valencia, Spain;
- Department of Surgery, University of Valencia, 46019 Valencia, Spain
- Spanish Net of Ophthalmic Research “OFTARED” RD16/0008/0022, Institute of Health Carlos III, 28029 Madrid, Spain; (A.I.R.); (D.G.-M.); (R.P.C.-M.)
| | - José J. García-Medina
- Ophthalmic Research Unit “Santiago Grisolía” Foundation for the Promotion of Health and Biomedical Research of Valencia FISABIO, 46017 Valencia, Spain; (M.V.-V.); (J.J.G.-M.); (S.M.S.-G.); (M.D.P.-D.)
- Spanish Net of Ophthalmic Research “OFTARED” RD16/0008/0022, Institute of Health Carlos III, 28029 Madrid, Spain; (A.I.R.); (D.G.-M.); (R.P.C.-M.)
- Department of Ophthalmology, General University Hospital “Morales Meseguer”, 30007 Murcia, Spain
- Department of Ophthalmology and Optometry, University of Murcia, 30120 Murcia, Spain
| | - Silvia M. Sanz-González
- Ophthalmic Research Unit “Santiago Grisolía” Foundation for the Promotion of Health and Biomedical Research of Valencia FISABIO, 46017 Valencia, Spain; (M.V.-V.); (J.J.G.-M.); (S.M.S.-G.); (M.D.P.-D.)
- Spanish Net of Ophthalmic Research “OFTARED” RD16/0008/0022, Institute of Health Carlos III, 28029 Madrid, Spain; (A.I.R.); (D.G.-M.); (R.P.C.-M.)
- Cellular and Molecular Ophthalmobiology Group, Department of Surgery, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
| | - Ana I. Ramírez
- Spanish Net of Ophthalmic Research “OFTARED” RD16/0008/0022, Institute of Health Carlos III, 28029 Madrid, Spain; (A.I.R.); (D.G.-M.); (R.P.C.-M.)
- Department of Immunology, Ophthalmology and Otorrinolaringology, Institute of Ophthalmic Research “Ramón Castroviejo”, Complutense University of Madrid, 28040 Madrid, Spain;
| | - José A. Fernández-Albarral
- Department of Immunology, Ophthalmology and Otorrinolaringology, Institute of Ophthalmic Research “Ramón Castroviejo”, Complutense University of Madrid, 28040 Madrid, Spain;
| | - David Galarreta-Mira
- Spanish Net of Ophthalmic Research “OFTARED” RD16/0008/0022, Institute of Health Carlos III, 28029 Madrid, Spain; (A.I.R.); (D.G.-M.); (R.P.C.-M.)
- Department of Ophthalmology. University Clinic Hospital of Valladolid, 47003 Valladolid, Spain
| | - Vicente Zanón-Moreno
- Ophthalmic Research Unit “Santiago Grisolía” Foundation for the Promotion of Health and Biomedical Research of Valencia FISABIO, 46017 Valencia, Spain; (M.V.-V.); (J.J.G.-M.); (S.M.S.-G.); (M.D.P.-D.)
- Spanish Net of Ophthalmic Research “OFTARED” RD16/0008/0022, Institute of Health Carlos III, 28029 Madrid, Spain; (A.I.R.); (D.G.-M.); (R.P.C.-M.)
- Faculty of Health Sciences, International University of Valencia, 46002 Valencia, Spain
| | - Ricardo P. Casaroli-Marano
- Spanish Net of Ophthalmic Research “OFTARED” RD16/0008/0022, Institute of Health Carlos III, 28029 Madrid, Spain; (A.I.R.); (D.G.-M.); (R.P.C.-M.)
- Departament of Surgery, School of Medicine and Health Sciences, Clinic Hospital of Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - María D. Pinazo-Duran
- Ophthalmic Research Unit “Santiago Grisolía” Foundation for the Promotion of Health and Biomedical Research of Valencia FISABIO, 46017 Valencia, Spain; (M.V.-V.); (J.J.G.-M.); (S.M.S.-G.); (M.D.P.-D.)
- Spanish Net of Ophthalmic Research “OFTARED” RD16/0008/0022, Institute of Health Carlos III, 28029 Madrid, Spain; (A.I.R.); (D.G.-M.); (R.P.C.-M.)
- Cellular and Molecular Ophthalmobiology Group, Department of Surgery, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
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Iorio-Aranha F, Peleteiro B, Rocha-Sousa A, Azevedo A, Barbosa-Breda J. A Scoping Review of Process Indicators for Measuring Quality of Care in Glaucoma. J Glaucoma 2021; 30:e198-e204. [PMID: 33675335 DOI: 10.1097/ijg.0000000000001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/13/2021] [Indexed: 11/26/2022]
Abstract
PRCIS There are no standardized process quality indicators (QIs) in glaucoma care. Although they can be inferred from guidelines and trials, they should be designed and standardized to allow better assessment of the quality of care. PURPOSE QIs are crucial for assessing the performance of any health care system. To allow efficiency, effectiveness, and patient-centeredness, there is a need for prompt acquisition of up-to-date information. Among the available QIs, process indicators have the highest sensitivity to frequent changes and could better reflect the implementation outcomes of novel ideas and technology. This study aimed to map the available information regarding process QIs in glaucoma care, identify the current development stage of these indicators, and systematically synthesize them. MATERIALS AND METHODS We performed a scoping review of 4 electronic bibliographic databases for studies reporting on process QIs in glaucoma. We retrieved 7502 references and created a domain list reflecting the core idea underlying each indicator. RESULTS We summarized information from 18 documents and listed 20 domains. The most mentioned domains were follow-up, optic nerve head assessment, visual field test, and intraocular pressure. Indicators regarding the quality of life assessment, patient assistance, or presence of written protocols were less frequently mentioned. CONCLUSIONS There are notable variations among process QIs in glaucoma and significant heterogeneity in their descriptions in published studies. Although novel indicators can be inferred from guidelines and trials, they should be designed and standardized for better assessment of performance in health systems to improve their quality.
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Affiliation(s)
- Flavio Iorio-Aranha
- EPIUnit, Institute of Public Health, Universidade do Porto
- Department of Ophthalmology, Faculty of Medicine, Universidade de Brasilia, Brasilia, Brasil
| | - Bárbara Peleteiro
- EPIUnit, Institute of Public Health, Universidade do Porto
- Departments of Public Health and Forensic Sciences and Medical Education
- Hospital Epidemiology Center
| | - Amândio Rocha-Sousa
- Surgery and Physiology and Cardiovascular R&D Center, Faculty of Medicine, Universidade do Porto
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ana Azevedo
- EPIUnit, Institute of Public Health, Universidade do Porto
- Departments of Public Health and Forensic Sciences and Medical Education
- Hospital Epidemiology Center
| | - João Barbosa-Breda
- Surgery and Physiology and Cardiovascular R&D Center, Faculty of Medicine, Universidade do Porto
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Neurosciences, Research Group Ophthalmology, KULeuven, Leuven, Belgium
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Alagöz N, Tellioglu A, Bektasoglu DL, Yasar T, Basgil Pasaoglu I, Altan AC, Solmaz B, Basarır B. Do We Conform with European Glaucoma Society Guidelines in the Medical Treatment of Primary Open-Angle Glaucoma/Ocular Hypertension? Data from a Real-Life Practice. J Ocul Pharmacol Ther 2020; 36:747-753. [PMID: 33326338 DOI: 10.1089/jop.2020.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To evaluate the prescribing habits of glaucoma specialists and of general ophthalmologists, and reveal the conformance with European Glaucoma Society (EGS) guidelines in the medical treatment of primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Methods: Patients receiving medical treatment for POAG/OHT in the glaucoma clinic comprised the "naive group." Patients having a diagnosis and a treatment for POAG/OHT initiated in another center before presentation comprised the second group and were named as "treatment initiated elsewhere" (TIEW). All patients were retrospectively evaluated from the patients' charts. The outcome measures included the percentage of eyes treated with monotherapy, the molecule groups preferred, and the change in prescription trends over the years in both groups. Results: Seventy-two subjects were included in the naive group and 135 subjects in TIEW group. The rate of monotherapy was 76% and 36% in both groups, respectively. The molecule number was significantly higher in the TIEW group compared with naive group (1.98 ± 0.89 vs. 1.28 ± 0.56, P < 0.001). Until 2003, beta blockers, and in the 2003-2008 period, prostaglandin analogs (PGAs) were the mostly prescribed drugs in glaucoma clinic. From 2009, the rate of PGAs declined, with PGAs being replaced by combination drugs and alfa-2 agonists. Conclusions: Overtreatment rate was high among patients receiving a diagnosis and a treatment by general ophthalmologists, whereas glaucoma specialists were found to conform with EGS guidelines. A shift toward polypharmacy was observed from 2000 to 2017. The common guidelines to evaluate and treat glaucoma need to be adopted by the general ophthalmologists in their real-life practice.
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Affiliation(s)
- Neşe Alagöz
- Beyoğlu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Adem Tellioglu
- Beyoğlu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Damla Leman Bektasoglu
- Beyoğlu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tekin Yasar
- Beyoğlu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Isıl Basgil Pasaoglu
- Beyoğlu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ayse Cigdem Altan
- Beyoğlu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Banu Solmaz
- Beyoğlu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Berna Basarır
- Beyoğlu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Russolillo N, Aldrighetti L, Cillo U, Guglielmi A, Ettorre GM, Giuliante F, Mazzaferro V, Dalla Valle R, De Carlis L, Jovine E, Ferrero A, Ratti F, Lo Tesoriere R, Gringeri E, Ruzzenente A, Levi Sandri GB, Ardito F, Virdis M, Iaria M, Ferla F, Lombardi R, Di Benedetto F, Gruttadauria S, Boggi U, Torzilli G, Rossi E, Vincenti L, Berti S, Ceccarelli G, Belli G, Zamboni F, Calise F, Coratti A, Santambrogio R, Brolese A, Navarra G, Mezzatesta P, Zimmitti G, Ravaioli M. Risk-adjusted benchmarks in laparoscopic liver surgery in a national cohort. Br J Surg 2020; 107:845-853. [DOI: 10.1002/bjs.11404] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 12/07/2022]
Abstract
Abstract
Background
This study aimed to assess the best achievable outcomes in laparoscopic liver resection (LLR) after risk adjustment based on surgical technical difficulty using a national registry.
Methods
LLRs registered in the Italian Group of Minimally Invasive Liver Surgery registry from November 2014 to March 2018 were considered. Benchmarks were calculated according to the Achievable Benchmark of Care (ABC™). LLRs at each centre were divided into three clusters (groups I, II and III) based on the Kawaguchi classification. ABCs for overall and major morbidity were calculated in each cluster. Multivariable analysis was used to identify independent risk factors for overall and major morbidity. Significant variables were used in further risk adjustment.
Results
A total of 1752 of 2263 patients fulfilled the inclusion criteria: 1096 (62·6 per cent) in group I, 435 (24·8 per cent) in group II and 221 (12·6 per cent) in group III. The ABCs for overall morbidity (7·8, 14·2 and 26·4 per cent for grades I, II and II respectively) and major morbidity (1·4, 2·2 and 5·7 per cent) increased with the difficulty of LLR. Multivariable analysis showed an increased risk of overall morbidity associated with multiple LLRs (odds ratio (OR) 1·35), simultaneous intestinal resection (OR 3·76) and cirrhosis (OR 1·83), and an increased risk of major morbidity with intestinal resection (OR 4·61). ABCs for overall and major morbidity were 14·4 and 3·2 per cent respectively for multiple LLRs, 30 and 11·1 per cent for intestinal resection, and 14·9 and 4·8 per cent for cirrhosis.
Conclusion
Overall morbidity benchmarks for LLR ranged from 7·8 to 26·4 per cent, and those for major morbidity from 1·4 to 5·7 per cent, depending on complexity. Benchmark values should be adjusted according to multiple LLRs or simultaneous intestinal resection and cirrhosis.
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Affiliation(s)
- N Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - L Aldrighetti
- Hepatobiliary Surgery, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy
| | - U Cillo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - A Guglielmi
- Department of Hepatobiliary Surgery, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | - G M Ettorre
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - F Giuliante
- Unit of Hepato-Biliary Surgery, Foundation ‘Policlinico Universitario A. Gemelli’, Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Mazzaferro
- Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Milan, Milan, Italy
| | - R Dalla Valle
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - L De Carlis
- Surgical and Transplant Department, Aziende Socio Sanitarie Territoriali Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E Jovine
- Department of Surgery, Ospedale Maggiore di Bologna, Bologna, Italy
| | - A Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
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9
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Woiski MD, van Vugt HC, Dijkman A, Grol RP, Marcus A, Middeldorp JM, Mol BW, Mols F, Oudijk MA, Porath M, Scheepers HJ, Hermens RP. From Postpartum Haemorrhage Guideline to Local Protocol: A Study of Protocol Quality. Matern Child Health J 2017; 20:2160-8. [PMID: 27395381 PMCID: PMC5025494 DOI: 10.1007/s10995-016-2050-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking. The objective of this study was to evaluate the quality of PPH-protocols on structure and content in the Netherlands. Methods We performed an observational multicenter study. Eighteen PPH-protocols from 3 University Hospitals (UH), 8 Teaching Hospitals (TH) and 7 Non-Teaching hospitals (NTH) throughout the Netherlands were acquired. The structure of the PPH-protocols was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) Instrument. The content was appraised using previously developed quality indicators, based on international guidelines and Advance-Trauma-Life-Support (ATLS)-based course instructions. Results The quality of the protocols for postpartum hemorrhage for both structure and content varied widely between different hospitals, but all of them showed room for improvement. The protocols scored mainly below average on the different items of the AGREE-II instrument (8 of the 10 items scored <4 on a 1–7 scale). Regarding the content, adoption of guideline recommendations in protocols was 46 %. In addition, a timely indication of ‘when to perform’ a recommendation was lacking in three-fourths of the items. Conclusion This study shows that the quality of the PPH-protocols for both structure and content in the Netherlands is suboptimal. This makes adherence to the guideline and ATLS-based course instructions difficult.
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Affiliation(s)
- Mallory D Woiski
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Geert Grootplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Helena C van Vugt
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Geert Grootplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Anneke Dijkman
- Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, P.O. Box 5011, 2600 GA, Delft, The Netherlands
| | - Richard P Grol
- Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Abraham Marcus
- Department of Anesthesiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Johanna M Middeldorp
- Department of Obstetrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre (AMC), P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Femke Mols
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Geert Grootplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Martina Porath
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, P.O. Box 90052, 5600 PD, Veldhoven, The Netherlands
| | - Hubertina J Scheepers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Rosella P Hermens
- Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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10
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Bentayeb M, Norback D, Bednarek M, Bernard A, Cai G, Cerrai S, Eleftheriou KK, Gratziou C, Holst GJ, Lavaud F, Nasilowski J, Sestini P, Sarno G, Sigsgaard T, Wieslander G, Zielinski J, Viegi G, Annesi-Maesano I. Indoor air quality, ventilation and respiratory health in elderly residents living in nursing homes in Europe. Eur Respir J 2015; 45:1228-38. [PMID: 25766977 DOI: 10.1183/09031936.00082414] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 11/11/2014] [Indexed: 11/05/2022]
Abstract
Few data exist on respiratory effects of indoor air quality and comfort parameters in the elderly. In the context of the GERIE study, we investigated for the first time the relationships of these factors to respiratory morbidity among elderly people permanently living in nursing homes in seven European countries. 600 elderly people from 50 nursing homes underwent a medical examination and completed a standardised questionnaire. Air quality and comfort parameters were objectively assessed in situ in the nursing home. Mean concentrations of air pollutants did not exceed the existing standards. Forced expiratory volume in 1 s/forced vital capacity ratio was highly significantly related to elevated levels of particles with a 50% cut-off aerodynamic diameter of <0.1 µm (PM0.1) (adjusted OR 8.16, 95% CI 2.24-29.3) and nitrogen dioxide (aOR 3.74, 95% CI 1.06-13.1). Excess risks for usual breathlessness and cough were found with elevated PM10 (aOR 1.53 (95% CI 1.15-2.07) and aOR 1.73 (95% CI 1.17-10.3), respectively) and nitrogen dioxide (aOR 1.58 (95% CI 1.15-2.20) and aOR 1.56 (95% CI 1.03-2.41), respectively). Excess risks for wheeze in the past year were found with PM0.1 (aOR 2.82, 95% CI 1.15-7.02) and for chronic obstructive pulmonary disease and exhaled carbon monoxide with formaldehyde (aOR 3.49 (95% CI 1.17-10.3) and aOR 1.25 (95% CI 1.02-1.55), respectively). Breathlessness and cough were associated with higher carbon dioxide. Relative humidity was inversely related to wheeze in the past year and usual cough. Elderly subjects aged ≥80 years were at higher risk. Pollutant effects were more pronounced in the case of poor ventilation. Even at low levels, indoor air quality affected respiratory health in elderly people permanently living in nursing homes, with frailty increasing with age. The effects were modulated by ventilation.
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Affiliation(s)
- Malek Bentayeb
- INSERM, U1136 IPLESP EPAR, Paris, France Université Pierre et Marie Curie - Sorbonne Universités, UMR S 1136 IPLESP EPAR, Paris, France
| | - Dan Norback
- Dept of Medical Science, Occupational and Environmental Medicine, Uppsala University, University Hospital, Uppsala, Sweden
| | - Micha Bednarek
- 2nd Dept of Respiratory Medicine, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Alfred Bernard
- Dept of Public Health, Catholic University of Louvain, Brussels, Belgium
| | - Guihong Cai
- Dept of Medical Science, Occupational and Environmental Medicine, Uppsala University, University Hospital, Uppsala, Sweden
| | - Sonia Cerrai
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | | | - Christina Gratziou
- Pulmonary and Critical Care Dept, Asthma Centre, Athens University, Athens, Greece
| | - Gitte Juel Holst
- Section of Environment, Occupation and Health, Dept of Public Health, University of Aarhus, Aarhus, Denmark
| | - François Lavaud
- Service de Pneumologie et Allergologie CHU Reims, Reims, France
| | - Jacek Nasilowski
- 2nd Dept of Respiratory Medicine, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | | | - Giuseppe Sarno
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Torben Sigsgaard
- Section of Environment, Occupation and Health, Dept of Public Health, University of Aarhus, Aarhus, Denmark
| | - Gunilla Wieslander
- Dept of Medical Science, Occupational and Environmental Medicine, Uppsala University, University Hospital, Uppsala, Sweden
| | - Jan Zielinski
- 2nd Dept of Respiratory Medicine, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Isabella Annesi-Maesano
- INSERM, U1136 IPLESP EPAR, Paris, France Université Pierre et Marie Curie - Sorbonne Universités, UMR S 1136 IPLESP EPAR, Paris, France
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