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Carlisle A, Patterson T, Bonnar J. A quality analysis of internet patient information for immediate, sequential, bilateral cataract surgery (ISBCS). Eur J Ophthalmol 2024; 34:754-758. [PMID: 37792539 DOI: 10.1177/11206721231204828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Due to surgical capacity pressures, induced by the COVID-19 pandemic, immediate bilateral simultaneous cataract surgery (ISBCS) has been utilised increasingly throughout the U.K. This surgical method comes with both novel risks and benefits, so the consent process must be modified. Prior randomised trials have demonstrated that appropriate online information may act as an adjunct to the surgical consent process. This study aims to assess the quality of available internet information for ISBCS. METHODS Terms searched were 'bilateral cataract surgery patient information', 'double cataract surgery patient information', and 'immediate sequential bilateral cataract surgery patient information'. The Google search engine was used. The DISCERN instrument and JAMA benchmarks were used to assess healthcare information for quality. The Flesch Reading Ease Score (FRE), Flesch Kincaid Grade (FKG) Level and Gunning Fog Score (GFS) were used to assess for readability. HONcode certification was used to assess transparency and quality. RESULTS Forty-six websites were found. The average DISCERN score was 41.3, meaning a "fair" quality which is below what many patients would anticipate discovering when trying to find information. National Healthcare Service websites had higher DISCERN scores than private healthcare-provided websites (p < 0.01; 95% CI: 1.13-1.88.). CONCLUSIONS Fair patient information for ISBCS has been demonstrated. Specific internet information sources with appropriate information should be further developed, with cited sources, and patients signposted to them if felt appropriate.
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Affiliation(s)
- Aaron Carlisle
- Department of Ophthalmology, Royal Victoria Hospital, Belfast Trust, Belfast, UK
| | - Timothy Patterson
- Department of Ophthalmology, Royal Victoria Hospital, Belfast Trust, Belfast, UK
| | - Jonathan Bonnar
- Department of Ophthalmology, Royal Victoria Hospital, Belfast Trust, Belfast, UK
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Keel S, Müller A, Block S, Bourne R, Burton MJ, Chatterji S, He M, Lansingh VC, Mathenge W, Mariotti S, Muirhead D, Rabiu MM, Ravilla TD, Resnikoff S, Silva JC, Tapply I, Vos T, Wang N, Cieza A. Keeping an eye on eye care: monitoring progress towards effective coverage. Lancet Glob Health 2021; 9:e1460-e1464. [PMID: 34237266 PMCID: PMC8440222 DOI: 10.1016/s2214-109x(21)00212-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 12/02/2022]
Abstract
The eye care sector is well positioned to contribute to the advancement of universal health coverage within countries. Given the large unmet need for care associated with cataract and refractive error, coupled with the fact that highly cost-effective interventions exist, we propose that effective cataract surgery coverage (eCSC) and effective refractive error coverage (eREC) serve as ideal indicators to track progress in the uptake and quality of eye care services at the global level, and to monitor progress towards universal health coverage in general. Global targets for 2030 for these two indicators were endorsed by WHO Member States at the 74th World Health Assembly in May, 2021. To develop consensus on the data requirements and methods of calculating eCSC and eREC, WHO convened a series of expert consultations to make recommendations for standardising the definitions and measurement approaches for eCSC and eREC and to identify areas in which future work is required.
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Affiliation(s)
- Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
| | - Andreas Müller
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Rupert Bourne
- Cambridge University Hospitals, Cambridge, UK; Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Moorfields Eye Hospital, London, UK
| | - Somnath Chatterji
- Data and Analytics Department, World Health Organization, Geneva, Switzerland
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China; Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia
| | - Van C Lansingh
- Retina Department, Instituto Mexicano de Oftalmología IAP, Santiago De Querétaro, Querétaro, Mexico; HelpMeSee, New York, NY, USA
| | | | - Silvio Mariotti
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Debbie Muirhead
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; The Fred Hollows Foundation, Melbourne, VIC, Australia
| | - M Mansur Rabiu
- Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia; Brien Holden Vision Institute, Sydney, NSW, Australia; Organisation pour la Prévention de la Cécité, Paris, France
| | - Juan Carlos Silva
- Division of Blindness Prevention, Pan American Health Organization, Bogota, Colombia
| | - Ian Tapply
- Cambridge University Hospitals, Cambridge, UK
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Alarcos Cieza
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Argay A, Vamosi P. The assessment of the impact of glistening on visual performance in relation to tear film quality. PLoS One 2020; 15:e0240440. [PMID: 33044979 PMCID: PMC7549795 DOI: 10.1371/journal.pone.0240440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022] Open
Abstract
Background The aim of our case control study was to evaluate the impact of glistening and tear film quality on visual performance after implantation of two different hydrophobic acrylic intraocular lenses (IOLs). Materials and methods In our retrospective study we included cataract patients operated between January 1, 2011 and December 31, 2012, with follow-up controls between January 2016 and December 2019. Z-Flex 860FAB (Medicontur) and AcrySof IQ SN60WF (Alcon) monofocal IOLs were implanted during standard phacoemulsification. Best corrected distance visual acuity (BCDVA) and contrast sensitivity were monitored over the post-operative period of up to 6 years. Glistening was evaluated semi-quantitatively with slit-lamp biomicroscopy and quantitatively using Pentacam HR (Oculus). Using HD Analyzer OQAS (Visiometrics), total intraocular light diffusion was interpreted with the objective scatter index (OSI) and tear film quality was evaluated with the tear film related objective scatter index (TF-OSI). Results 26 eyes implanted with the Z-Flex and 25 eyes with the AcrySof IQ IOLs were included in the analysis. The slit-lamp evaluation of patients with the Z-Flex IOL (0.57 ± 0.60) revealed significantly less glistening (p<0.0001), compared to the AcrySof IQ group (1.82 ± 0.90), and these observations were confirmed by the Pentacam HR analyses, as well (Z-Flex group: 35.1 ± 1.63, Acrysof IQ: 39.6 ± 3.69, p<0.0001). TF-OSI differed between the two sets of patients remarkably (1.53 ± 1.03 vs. 2.51 ± 1.76 for AcrySof IQ and Z-Flex groups, respectively, p = 0.043). Both groups of patients provided similar results of BCDVA and contrast sensitivity. Conclusion Glistening and tear film quality both contribute to visual performance outcomes after cataract surgery. In our study the advantage of less glistening in the Z-Flex IOL might have been masked by the adverse effects of the more pronounced tear film insufficiency of these patients, compared to the AcrySof IQ group. Among other factors, tear film quality should also be taken into consideration when comparing the impact of glistening on visual quality of patients implanted with different IOLs.
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Affiliation(s)
- Amanda Argay
- Department of Ophthalmology, Péterfy Sándor Hospital and Traumatology Center, Budapest, Hungary
| | - Peter Vamosi
- Department of Ophthalmology, Péterfy Sándor Hospital and Traumatology Center, Budapest, Hungary
- * E-mail:
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Abstract
Construct: Authors investigated the perspectives of stakeholders on feasibility elements of workplace-based assessments (WBA) with varying designs. Background: In the transition to competency-based medical education, WBA are taking a more prominent role in assessment programs. However, the increased demand for WBA leads to new challenges for implementing suitable WBA tools with published validity evidence, while also being feasible and useful in practice. Despite the availability of published WBA tools, implementation does not necessarily occur; a more fulsome understanding of the perspectives of stakeholders who are ultimately the end-users of these tools, as well as the system factors that both deter or support their use, could help to explain why evidence-based assessment tools may not be incorporated into residency programs. Approach: We examined the perspectives of two groups of stakeholders, surgical teachers and resident learners, during an assessment intervention that varied the assessment tools while keeping the assessment process constant. We chose diverse exemplars from published assessment tools that each represented a different response format: global rating scales, step-by-step surgical rubrics, and an entrustability scale. The primary purpose was to investigate how stakeholders are impacted by WBA tools with varying response formats to better understand their feasibility for assessment of cataract surgery. Secondarily, we were able to explore the culture of assessment in cataract surgery education including stakeholders' perceptions of WBA unrelated to assessment form design. Semi-structured interviews with teachers and a focus group with the residents enabled discussion of their perspectives on dimensions of the tools such as acceptability, demand, implementation, practicality, adaptation, and integration. Findings: Three themes summarize teachers' and residents' experiences with the assessment tools: (1) Feedback is the priority; (2) Forms informing coaching; and (3) Forcing the conversation. The tools helped to facilitate the feedback conversation by serving as a reminder to initiate the conversation, a framework to structure the conversation, and a memory aid for providing detailed feedback. Surgical teachers preferred the assessment tool with a design that best aligned with their approach to teaching and how they wanted to provide feedback. Orientation to the tools, combined with established remediation pathways, may help preceptors to better use assessment tools and improve their ability to give critical feedback. Conclusions: Feedback, more so than assessment, dominated the comments provided by both teachers and residents after using the various WBA tools. Our typical assessment design efforts focus on the creation or selection of a robust assessment tool according to good design and measurement principles, but the current findings would encourage us to also prioritize the coaching relationship and include efforts to design WBA tools to function as a mediator to augment teaching, learning, and feedback exchange within that relationship in the workplace.
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Affiliation(s)
- Nawaaz A Nathoo
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Ravi Sidhu
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Andrea Gingerich
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
- Northern Medical Program, University of Northern British Columbia, Prince George, Canada
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Reddy JC, Vaddavalli PK, Sharma N, Sachdev MS, Rajashekar YL, Sinha R, Agarwal A, Porwal A, Chakrabarti A, Nayak BK, Jain BK, Chandrasekhar D, Ramamurthy C, Mehta CK, Bhattacharya D, Luthra G, Aravind H, Bhattacharjee H, Mehta HR, Titiyal JS, Ram J, Bhalla JS, Dasari KK, Mehta KR, Kudlu KP, Prasad RK, Murugesan K, Singh MJ, Rajan M, Rohit OP, Gogate P, Biswas P, Padmanabhan P, Parekh RH, Khanna R, Honavar SG, Murthy SI, Goel S, Ganesh S, Arora VK. A new normal with cataract surgery during COVID-19 pandemic. Indian J Ophthalmol 2020; 68:1269-1276. [PMID: 32587150 PMCID: PMC7574133 DOI: 10.4103/ijo.ijo_1528_20] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022] Open
Abstract
Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI.
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Affiliation(s)
- Jagadesh C Reddy
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pravin K Vaddavalli
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Namrata Sharma
- Secretary, All India Ophthalmological Society, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mahipal S Sachdev
- President, All India Ophthalmological Society, Chairman, Centre for Sight, New Delhi, India
| | | | - Rajesh Sinha
- Treasurer, All India Ophthalmological Society, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amar Agarwal
- Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
| | - Amit Porwal
- Choithram Netralaya, Indore, Madhya Pradesh, India
| | | | | | | | | | | | | | | | | | | | | | | | - J S Titiyal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jagat Ram
- Postgraduate Institute of Medical Education and Research Chandigarh, India
| | | | | | - Keiki R Mehta
- Mehta International Eye Institute, Mumbai, Maharashtra, India
| | | | | | | | | | - Mohan Rajan
- Rajan Eye Care Hospiral, Chennai, Tamil Nadu, India
| | | | | | | | | | | | - Rohit Khanna
- LV Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Somasheila I Murthy
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sonu Goel
- Anand Eye Hospital, Jaipur, Rajasthan, India
| | - Sri Ganesh
- Nethradhama Hospital Pvt. Ltd., Bengaluru, Karnataka, India
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Zhu AY, Kraus CL. Practice Patterns in the Surgical Management of Pediatric Traumatic Cataracts. J Pediatr Ophthalmol Strabismus 2020; 57:190-198. [PMID: 32453853 DOI: 10.3928/01913913-20200304-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/17/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To facilitate the development of standardized guidelines for the surgical management of patients with pediatric traumatic cataracts by assessing current ophthalmologists' practice patterns. METHODS This was a cross-sectional, observational, and retrospective study. A 24-question electronic survey of current practices pertaining to the surgical management of pediatric traumatic cataracts was sent to pediatric ophthalmologists worldwide. Preferences for pre-operative evaluation, surgical timing and techniques, and postoperative management were analyzed. RESULTS Of the 56 respondents, 62.5% practiced in academic settings. Of the 49 respondents (87.5%) who performed pediatric ruptured globe repair, 41.7% would perform simultaneous cataract extraction if anterior capsular violation existed, whereas 4.1% would do so without capsular violation (P < .001). Most respondents (50.9%) would remove visually significant cataracts within 4 weeks in patients within the amblyogenic age range (P = .02), whereas 63.6% would wait longer outside the amblyogenic range. Preferences for intraocular lens selection, primary posterior capsulotomy, and timing of amblyopia therapy differed. CONCLUSIONS Individual management practices regarding pediatric traumatic cataracts vary depending on associated globe injuries and patient age. Trends exist in surgical planning, intraoperative techniques, and visual rehabilitation methods, but no single approach has achieved complete unanimity. Therefore, further investigation into optimal timing and the extent of surgical intervention, refractive correction, and postoperative care is necessary prior to developing evidence-based guidelines for enhancing visual outcomes in this population. [J Pediatr Ophthalmol Strabismus. 2020;57(3):190-198.].
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Guedes RAP, Gravina DM, Lake JC, Guedes VMP, Chaoubah A. One-Year Comparative Evaluation of iStent or iStent inject Implantation Combined with Cataract Surgery in a Single Center. Adv Ther 2019; 36:2797-2810. [PMID: 31440981 PMCID: PMC6822971 DOI: 10.1007/s12325-019-01067-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This retrospective consecutive case series assessed 12-month effectiveness and safety of iStent® or iStent inject® trabecular micro-bypass implants with cataract surgery in patients with open-angle glaucoma (OAG) in a real-world clinical setting. METHODS Effectiveness outcomes consisted of intraocular pressure (IOP) reduction; glaucoma medication reduction; proportions of eyes achieving IOP < 18, < 15, or < 12 mmHg; and proportional analysis of medication usage. Safety outcomes included adverse events, secondary surgeries, and best-corrected visual acuity (BCVA). RESULTS This evaluation included 58 eyes with OAG (35 iStent, 23 iStent inject), with 96.6% of eyes having mild or moderate glaucoma. Diagnoses included primary open-angle glaucoma (the majority; 72.4%), pseudoexfoliative glaucoma, and pigmentary glaucoma. Baseline mean IOP and medications were statistically comparable between groups: 16.1 ± 3.6 mmHg on a mean of 1.8 ± 0.8 medications in the iStent group, and 16.2 ± 3.1 mmHg on a mean of 1.7 ± 0.8 medications in the iStent inject group. Twelve months after stent-cataract surgery, mean IOP was significantly lower in the iStent inject group than in the iStent group (13.1 mmHg vs. 15.4 mmHg, respectively; p < 0.001), and the percent reduction in IOP from baseline was significantly greater in iStent inject eyes than in iStent eyes (19.1% vs. 4.3% reduction, respectively; p < 0.001). At 12 months postoperative, significantly greater proportions of iStent inject eyes than iStent eyes achieved IOP < 18 mmHg (100% vs. 80.0% of eyes, respectively; p = 0.035), IOP < 15 mmHg (73.9% vs. 34.3% of eyes, respectively; p = 0.003), and IOP < 12 mmHg (26.1% vs. 0% of eyes, respectively; p = 0.002). Meanwhile, both groups achieved significant medication reductions at 12 months vs. baseline (94.1% reduction in iStent inject eyes, p < 0.0001; and 72.2% reduction in iStent eyes, p < 0.0001), with the percent reduction being significantly greater in iStent inject eyes than in iStent eyes (p = 0.023). At 12 months, mean number of medications was significantly lower in iStent inject eyes than iStent eyes (0.1 vs. 0.5 medications, respectively; p = 0.021), and significantly more iStent inject eyes (95.7%) than iStent eyes (71.4%) were off medications entirely (p = 0.021). A similarly high safety profile was observed in both groups. CONCLUSION iStent or iStent inject implantation with cataract surgery resulted in substantial and safe reductions in IOP and medications through 12 months postoperative. Consistent with prior observations, greater efficacy was observed with iStent inject than with iStent. FUNDING The Rapid Service Fees were funded by Glaukos Corporation.
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Affiliation(s)
- Ricardo Augusto Paletta Guedes
- Paletta Guedes Eye Institute, Juiz de Fora, Minas Gerais, Brazil.
- Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
| | | | | | | | - Alfredo Chaoubah
- Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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Kumar CM, Seet E, Koh SL, Lai FW. Outcomes of nurse vs. anesthesiologist monitoring during cataract surgery under topical anesthesia. J Fr Ophtalmol 2018; 41:e491-e492. [PMID: 30449640 DOI: 10.1016/j.jfo.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 11/19/2022]
MESH Headings
- Anesthesia, Local/methods
- Anesthesia, Local/nursing
- Anesthesia, Local/standards
- Anesthesiologists/standards
- Anesthetics, Local/administration & dosage
- Anxiety/etiology
- Anxiety/nursing
- Anxiety/therapy
- Cataract/diagnosis
- Cataract/nursing
- Cataract/therapy
- Cataract Extraction/methods
- Cataract Extraction/nursing
- Cataract Extraction/standards
- Female
- Humans
- Hypertension/etiology
- Hypertension/nursing
- Hypertension/therapy
- Male
- Monitoring, Intraoperative/methods
- Monitoring, Intraoperative/nursing
- Monitoring, Intraoperative/standards
- Nurse Anesthetists/standards
- Phacoemulsification/methods
- Phacoemulsification/nursing
- Phacoemulsification/standards
- Postoperative Complications/etiology
- Postoperative Complications/nursing
- Postoperative Complications/therapy
- Practice Patterns, Nurses'/standards
- Practice Patterns, Nurses'/statistics & numerical data
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/statistics & numerical data
- Prognosis
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- C M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, 768828 Singapore.
| | - E Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, 768828 Singapore
| | - S L Koh
- Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, 768828 Singapore
| | - F W Lai
- Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, 768828 Singapore
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Affiliation(s)
- Jorge L Alio
- Department of Ophthalmology, University Miguel Hernandez de Elche, Alicante, Spain
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10
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Wiemuth M, Junger D, Leitritz MA, Neumann J, Neumuth T, Burgert O. Application fields for the new Object Management Group (OMG) Standards Case Management Model and Notation (CMMN) and Decision Management Notation (DMN) in the perioperative field. Int J Comput Assist Radiol Surg 2017; 12:1439-1449. [PMID: 28516301 DOI: 10.1007/s11548-017-1608-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/04/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Medical processes can be modeled using different methods and notations. Currently used modeling systems like Business Process Model and Notation (BPMN) are not capable of describing the highly flexible and variable medical processes in sufficient detail. METHODS We combined two modeling systems, Business Process Management (BPM) and Adaptive Case Management (ACM), to be able to model non-deterministic medical processes. We used the new Standards Case Management Model and Notation (CMMN) and Decision Management Notation (DMN). RESULTS First, we explain how CMMN, DMN and BPMN could be used to model non-deterministic medical processes. We applied this methodology to model 79 cataract operations provided by University Hospital Leipzig, Germany, and four cataract operations provided by University Eye Hospital Tuebingen, Germany. Our model consists of 85 tasks and about 20 decisions in BPMN. We were able to expand the system with more complex situations that might appear during an intervention. CONCLUSION An effective modeling of the cataract intervention is possible using the combination of BPM and ACM. The combination gives the possibility to depict complex processes with complex decisions. This combination allows a significant advantage for modeling perioperative processes.
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Affiliation(s)
- M Wiemuth
- School of Informatics, Research Group Computer Assisted Medicine (CaMed) Reutlingen, Reutlingen University, Reutlingen, Germany.
| | - D Junger
- School of Informatics, Research Group Computer Assisted Medicine (CaMed) Reutlingen, Reutlingen University, Reutlingen, Germany
| | - M A Leitritz
- Centre for Ophthalmology, University Eye Hospital Tuebingen, Tuebingen, Germany
| | - J Neumann
- Innovation Center for Computer Assisted Surgery (ICCAS), Leipzig University, Leipzig, Germany
| | - T Neumuth
- Innovation Center for Computer Assisted Surgery (ICCAS), Leipzig University, Leipzig, Germany
| | - O Burgert
- School of Informatics, Research Group Computer Assisted Medicine (CaMed) Reutlingen, Reutlingen University, Reutlingen, Germany.
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Abstract
OBJECTIVES To describe the initial outcomes following installation of a cataract surgery laser system. SETTING National Health Service cataract surgery day care unit in North London, UK. PARTICIPANTS 158 eyes of 150 patients undergoing laser-assisted cataract surgery. INTERVENTIONS Laser cataract surgery using the AMO Catalys femtosecond laser platform. PRIMARY OUTCOME MEASURE intraoperative complications including anterior and posterior capsule tears. SECONDARY OUTCOME MEASURES docking to the laser platform, successful treatment delivery, postoperative visual acuities. RESULTS Mean case age was 67.7±10.8 years (range 29-88 years). Docking was successful in 94% (148/158 cases), and in 4% (6/148 cases) of these, the laser delivery was aborted part way during delivery due to patient movement. A total of 32 surgeons, of grades from junior trainee to consultant, performed the surgeries. Median case number per surgeon was 3 (range from 1-20). The anterior capsulotomy was complete in 99.3% of cases, there were no anterior capsule tears (0%). There were 3 cases with posterior capsule rupture requiring anterior vitrectomy, and 1 with zonular dialysis requiring anterior vitrectomy (4/148 eyes, 2.7%). These 4 cases were performed by trainee surgeons, and were either their first laser cataract surgery (2 surgeons) or their first and second laser cataract surgeries (1 surgeon). CONCLUSIONS Despite the learning curve, docking and laser delivery were successfully performed in almost all cases, and surgical complication rates and visual outcomes were similar to those expected based on national data. Complications were predominately confined to trainee surgeons, and with the exception of intraoperative pupil constriction appeared unrelated to the laser-performed steps.
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Affiliation(s)
- Alexander C Day
- The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Cataract Service, Moorfields Eye Hospital, London, UK
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Connell B, Ward T. Leveraging the EHR to Facilitate Efficient Surgical Audit: A Case Study from a Ophthalmic Private Practice. Stud Health Technol Inform 2016; 227:14-20. [PMID: 27440283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Surgeons agree over the importance of surgical audit associated with their practice especially given the benefits to patient care. Medical registration also requires audit as part of their requirements. Concerns over inefficiencies that can arise from duplication in data entry, led Eye Surgery Associates, a 16 doctor practice over 3 locations in Melbourne, to develop a new data entry and analysis system to facilitate audit as well as to maintain the practice's health records system in a way that addresses these inefficiencies. They did this in conjunction with IT professionals. Surgeons in our practice are highly positive about the new system which has attracted interest and likely future participation from the broader surgeon community.
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Affiliation(s)
- Ben Connell
- Eye Surgery Associates, Melbourne, Australia
| | - Trevor Ward
- Eye Surgery Associates, Melbourne, Australia
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Ahmad K, Zwi AB, Tarantola DJM, Soomro AQ, Baig R, Azam SI. Gendered Disparities in Quality of Cataract Surgery in a Marginalised Population in Pakistan: The Karachi Marine Fishing Communities Eye and General Health Survey. PLoS One 2015; 10:e0131774. [PMID: 26186605 PMCID: PMC4506126 DOI: 10.1371/journal.pone.0131774] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/06/2015] [Indexed: 11/18/2022] Open
Abstract
Background Marine fishing communities are among the most marginalised and hard-to-reach groups and have been largely neglected in health research. We examined the quality of cataract surgery and its determinants, with an emphasis on gender, in marine fishing communities in Karachi, Pakistan, using multiple indicators of performance. Methods and Findings The Karachi Marine Fishing Communities Eye and General Health Survey was a door-to-door, cross-sectional study conducted between March 2009 and April 2010 in fishing communities living on 7 islands and in coastal areas in Keamari, Karachi, located on the Arabian Sea. A population-based sample of 638 adults, aged ≥ 50 years, was studied. A total of 145 eyes (of 97 persons) had undergone cataract surgery in this sample. Cataract surgical outcomes assessed included vision (presenting and best-corrected with a reduced logMAR chart), satisfaction with surgery, astigmatism, and pupil shape. Overall, 65.5% of the operated eyes had some form of visual loss (presenting visual acuity [PVA] < 6/12). 55.2%, 29.0%, and 15.9% of these had good, borderline, and poor visual outcomes based on presenting vision; with best correction, these values were: 68.3 %, 18.6%, and 13.1%, respectively. Of 7 covariates evaluated in the multivariable generalized estimating equations (GEE) analyses, gender was the only significant independent predictor of visual outcome. Women’s eyes were nearly 4.38 times more likely to have suboptimal visual outcome (PVA<6/18) compared with men’s eyes (adjusted odds ratio 4.38, 95% CI 1.96-9.79; P<0.001) after adjusting for the effect of household financial status. A higher proportion of women’s than men’s eyes had an irregular pupil (26.5% vs. 14.8%) or severe/very severe astigmatism (27.5% vs. 18.2%). However, these differences did not reach statistical significance. Overall, more than one fourth (44/144) of cataract surgeries resulted in dissatisfaction. The only significant predictor of satisfaction was visual outcome (P <0.001). Conclusions The quality of cataract surgery in this marginalised population, especially among women, falls well below the WHO recommended standards. Gender disparities, in particular, deserve proactive attention in policy, service delivery, research and evaluation.
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Affiliation(s)
- Khabir Ahmad
- School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales, Sydney, NSW, Australia
- Section of Ophthalmology, Department of Surgery, Aga Khan University, Karachi, Pakistan
- Office of Surgical Research, Department of Surgery, Aga Khan University, Karachi, Pakistan
- * E-mail:
| | - Anthony B. Zwi
- School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales, Sydney, NSW, Australia
| | - Daniel J. M. Tarantola
- School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Abdul Qadeem Soomro
- Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Malir, Karachi, Pakistan
| | - Rashid Baig
- Section of Ophthalmology, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Syed Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Cunha-Vaz JG. Evaluation of quality of cataract microsurgery. Dev Ophthalmol 2015; 22:108-12. [PMID: 1936434 DOI: 10.1159/000419912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J G Cunha-Vaz
- Centro de Oftalmologia, Hospitais da Universidade de Coimbra, Portugal
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Haastrup OOO, Buchan JC, Cassels-Brown A, Cook C. Are we monitoring the quality of cataract surgery services? A qualitative situation analysis of attitudes and practices in a large city in South Africa. Middle East Afr J Ophthalmol 2015; 22:220-5. [PMID: 25949081 PMCID: PMC4411620 DOI: 10.4103/0974-9233.151878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To evaluate the current quality "assurance" and "improvement" mechanisms, the knowledge, attitudes and practices of cataract surgeons in a large South African city. METHODOLOGY A total of 17 in-depth semi-structured interviews were conducted with ophthalmologists in June 2012 at 2 tertiary institutions in the Republic of South Africa. Recruitment of the purposive sample was supplemented by snowball sampling. The study participants were 5 general ophthalmologists and 2 pediatric ophthalmologists; 4 senior and 4 junior registrars and a medical officer. Participants were interviewed by a trained qualitative interviewer. The interview lasted between 20 and 60 min. The interviews were recorded, transcribed verbatim and analyzed for thematic content. RESULTS Mechanisms for quality assurance were trainee logbooks and subjective senior staff observation. Clinicians were encouraged, but not obliged to self-audit. Quality improvement is incentivized by personal integrity and ambition. Poorly performing departments are inconspicuous, especially nationally, and ophthalmologists rely on the impression to gauge the quality of service provided by colleagues. Currently, word of mouth is the method for determining the better cataract surgical centers. CONCLUSION The quality assurance mechanisms were dependent on insight and integrity of the individual surgeons. No structures were described that would ensure the detection of surgeons with higher than expected complication rates. Currently, audits are not enforced, and surgical outcomes are not well monitored due to concerns that this may lead to lack of openness among ophthalmologists.
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Affiliation(s)
| | - John C. Buchan
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Andy Cassels-Brown
- Academic Unit of Public Health, Nuffield Institute for International Health, Leeds Institute for Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Colin Cook
- Department of Ophthalmology, Grootes Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Mörchen M, Langdon T, Ormsby GM, Meng N, Seiha D, Piseth K, Keeffe JE. Prevalence of blindness and cataract surgical outcomes in Takeo Province, Cambodia. Asia Pac J Ophthalmol (Phila) 2015; 4:25-31. [PMID: 26068610 DOI: 10.1097/apo.0000000000000061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To estimate the prevalence of blindness and cataract surgical outcomes in persons 50 years or older above in Takeo Province, Cambodia. DESIGN A population based survey. METHODS A total of 93 villages were selected through probability proportionate to size using the Rapid Assessment of Avoidable Blindness methodology. Households from 93 villages were selected using compact segment sampling. Visual acuity (VA) of 4650 people 50 years or older was tested and lens status and cause of visual impairment were assessed. RESULTS The response rate was 96.2%. The age- and sex-adjusted prevalence of bilateral blindness [presenting visual acuity (PVA) <3/60 in the better eye] was 3.4% (95% confidence interval, 2.8%-4.0%), resulting in an estimated 4187 people blind in Takeo Province. The age- and sex-adjusted prevalence of low vision (PVA <6/18 to 3/60) was 21.1%, an estimated 25,900 people. Cataract surgical coverage in the bilaterally blind was 64.7% (female 59.5%, male 78.1%). Cataract surgical outcome was poor (best-corrected visual acuity <6/60) in only 7.7% and good in 88.7% (best-corrected visual acuity ≥6/18) of eyes operated in the last 5 years before the survey. CONCLUSIONS The cataract surgical coverage for women is less than that for men. The increased life expectancy in Cambodia and the fact that women constitute 60.6% of the population (aged ≥50 years) at Takeo Province could have had an impact on cataract workload and high prevalence of blindness. A repeated survey using the same methodology after 8-12 years might be helpful in proving genuine change over time.
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Affiliation(s)
- Manfred Mörchen
- From the *CARITAS Takeo Eye Hospital, Takeo, Cambodia; †Christian Blind Mission, Bensheim, Germany; ‡Center for Eye Research Australia, East Melbourne, Victoria, Australia; §Faculty of Education and Science, Avondale College of Higher Education, Cooranbong, New South Wales, Australia; ¶National Program for Eye Health, Ministry of Health; and ∥Department of Ophthalmology, Preah Ang Duong Hospital, Phnom Penh, Cambodia; and **LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
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Böhringer D, Vach W, Hagenlocher K, Eberwein P, Maier P, Reinhard T. Are entry criteria for cataract surgery justified? PLoS One 2014; 9:e112819. [PMID: 25401738 PMCID: PMC4234514 DOI: 10.1371/journal.pone.0112819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 10/15/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The German Ophthalmological Society (GOS) recently proposed surgical entry criteria, i.e. 300 cataract surgeries. We herein correlate the surgical hands-on experience with the risk of posterior capsule ruptures in order to assess whether this number is appropriate. METHODS We identified all cataract operations that had been performed at the University Eye Hospital Freiburg since 1995. For each surgeon, we assigned a running number to his/her procedures in the order they had been performed. Thereafter, we excluded all combined procedures and the second eyes. We then selected the 5475 surgical reports between November 2008 and November 2012 for detailed review. We additionally classified each surgery into low- vs. high- à priori risk for posterior capsule ruptures. We fitted a multifactorial logistic regression model to assess the GOS recommendation of 300 surgeries under supervision. In the low-risk group, we additionally visualized the 'typical' learning curve by plotting the posterior capsule ruptures against the respective rank numbers. RESULTS The odds ratio for posterior capsule ruptures of 'learning-mode' (one of the respective surgeon's 300 first procedures) vs. the non-learning-mode was 3.8 (p<0.0001). By contrast, classification into the low-risk group lowered the risk of posterior capsule ruptures three fold (p<0.0001). According to the low-risk plot, the surgeons started with a complication rate of 4% and continuously improved towards 0.5% after 1500 operations. Thereafter, the rate increased again and stabilized around one percent. CONCLUSION The learning curve with respect to posterior capsule ruptures is surprisingly flat. The GOS entry criterion of 300 cataract procedures is therefore most likely justified. Careful selection of low-risk patients for the training surgeons may help in reducing the rate of posterior capsule ruptures during training.
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Affiliation(s)
| | - Werner Vach
- Center for Medical Biometry and Medical Informatics, Medical Center - University of Freiburg, Freiburg, Germany
| | | | | | - Philip Maier
- Eye Center, University Hospital, Freiburg, Germany
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Hahn U, Neuhann I, Schmickler S, Krummenauer F. A methodological approach to identify external factors for indicator-based risk adjustment illustrated by a cataract surgery register. BMC Health Serv Res 2014; 14:279. [PMID: 24965949 PMCID: PMC4082622 DOI: 10.1186/1472-6963-14-279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 06/18/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Risk adjustment is crucial for comparison of outcome in medical care. Knowledge of the external factors that impact measured outcome but that cannot be influenced by the physician is a prerequisite for this adjustment. To date, a universal and reproducible method for identification of the relevant external factors has not been published. The selection of external factors in current quality assurance programmes is mainly based on expert opinion. We propose and demonstrate a methodology for identification of external factors requiring risk adjustment of outcome indicators and we apply it to a cataract surgery register. METHODS Defined test criteria to determine the relevance for risk adjustment are "clinical relevance" and "statistical significance". Clinical relevance of the association is presumed when observed success rates of the indicator in the presence and absence of the external factor exceed a pre-specified range of 10%. Statistical significance of the association between the external factor and outcome indicators is assessed by univariate stratification and multivariate logistic regression adjustment.The cataract surgery register was set up as part of a German multi-centre register trial for out-patient cataract surgery in three high-volume surgical sites. A total of 14,924 patient follow-ups have been documented since 2005. Eight external factors potentially relevant for risk adjustment were related to the outcome indicators "refractive accuracy" and "visual rehabilitation" 2-5 weeks after surgery. RESULTS The clinical relevance criterion confirmed 2 ("refractive accuracy") and 5 ("visual rehabilitation") external factors. The significance criterion was verified in two ways. Univariate and multivariate analyses revealed almost identical external factors: 4 were related to "refractive accuracy" and 7 (6) to "visual rehabilitation". Two ("refractive accuracy") and 5 ("visual rehabilitation") factors conformed to both criteria and were therefore relevant for risk adjustment. CONCLUSION In a practical application, the proposed method to identify relevant external factors for risk adjustment for comparison of outcome in healthcare proved to be feasible and comprehensive. The method can also be adapted to other quality assurance programmes. However, the cut-off score for clinical relevance needs to be individually assessed when applying the proposed method to other indications or indicators.
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Affiliation(s)
- Ursula Hahn
- Institut für Medizinische Biometrie und Epidemiologie, Fakultät für Gesundheit der Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
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Abstract
PURPOSE To evaluate waiting times for first-eye cataract surgery in Sweden following widespread adoption of the Nationell Indikationsmodell for Kataraktextraktion (NIKE) tool for prioritizing patients for cataract surgery. METHODS Waiting times for all first-eye cataract surgeries in Sweden in 2009-2011 were identified from the Swedish National Cataract Register. Waiting times were compared according to demographic, clinical and NIKE indication group for surgery. Multivariate logistic regression modelling was used to determine factors associated with waiting times less than the 3-month Government guarantee period. RESULTS There were 141,070 first-eye cataract surgeries in 2009 to 2011; an annual increase of around 6%. Over the study period, mean waiting times decreased across all NIKE groups. The proportion waiting <3 months for surgery also increased across all NIKE groups. Surgery within 3 months of waitlisting was more likely for patients with a NIKE 1 indication classification (most need for surgery), in later years, male patients, younger patients and patients with a preoperative visual acuity in the better eye worse than 6/24. CONCLUSIONS Prioritizing patients for cataract surgery using NIKE reduces waiting times for those with the greatest need.
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Affiliation(s)
- Jonathon Q Ng
- Eye and Vision Epidemiology Research Group, Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, WA, AustraliaEyeNet Sweden, Blekinge Hospital, Karlskrona, SwedenDepartment of Clinical Sciences and Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
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Jiang H, Lin H, Qu B, Chen W. Exploration of management workflow of cataract surgery in an impoverished population in urban China. Eye Sci 2014; 29:116-120. [PMID: 26011963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To explore and establish a rational management workflow for a free cataract surgery program for the poor population in urban China, aiming to improve surgical efficiency. METHODS Establishment of a management workflow mainly includes system design and an auxiliary facility. System design procedures consist of outpatient screening, outpatient physical examination, surgical procedures, and postoperative clinic visits. After establishing the management workflow of cataract surgery, a free cataract surgery program was conducted for 15 months. RESULTS Based upon the established management mode, 9003 patients received preoperative screening and 2358 underwent cataract surgery. During the 15-month investigation, each procedure was successfully conducted, the efficiency of screening and operation attained the highest standards in China, and no surgical malpractice occurred intraoperatively. CONCLUSION In this study, a management workflow for cataract surgery was designed for a poverty relief project in urban China. During the 15-month project, the degree of patient satisfaction was enhanced without disrupting the normal practice and safety of the sponsor hospital.
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Lundström M, Barry P, Brocato L, Fitzpatrick C, Henry Y, Rosen P, Stenevi U. European registry for quality improvement in cataract surgery. Int J Health Care Qual Assur 2014; 27:140-51. [PMID: 24745139 DOI: 10.1108/ijhcqa-10-2012-0101] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A project aimed at creating a multi-national database for cataract and refractive surgery was initiated in 2008. The database was intended for learning and clinical improvement, not supervision. The project was co-funded by the European Union, under the Executive Agency for Health and Consumers and the European Society of Cataract and Refractive Surgeons (ESCRS) and supported by 11 national societies for cataract and refractive surgery. The purpose of this article is to describe the setup of the database and the ensuing achievements within cataract surgery after four years. DESIGN/METHODOLOGY/APPROACH A web-based system was created for input and output of data, with a software interface to two databases, one for cataract surgery and one for refractive surgery. Data can be put in either manually through web forms or by transfer of data from existing national registries or large electronic medical record systems. Output of reports from the system or export of one's own data is available on the web. The data are anonymous to all users, with the sole exception that reporting surgeons and clinics have access to their own data. The system does not include any patient identification. FINDINGS After four years, data from 16 countries have been entered into the system, including reports of more than 900,000 cataract extractions. The database has been used by individual clinics for benchmarking and clinical improvement work, and has also served as the basis for new clinical guidelines for cataract surgery. The ESCRS has guaranteed the sustainability of the database after the project period. ORIGINALITY/VALUE A European quality registry with data input from surgeons and clinics in 16 European countries has been established. Close to one million surgeries have been entered into the system during the first four years. Evidence-based guidelines have been published based on data in the registry. The system is used for benchmarking by both experienced surgeons and trainees.
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Carlisle D. A new vision for cataract surgery. Health Serv J 2014; 123:30-33. [PMID: 24956740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Iribarren R, Iribarren G. Prevalence of myopic shifts among patients seeking cataract surgery. Medicina (B Aires) 2013; 73:207-212. [PMID: 23732195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.
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Affiliation(s)
- Rafael Iribarren
- Departamento de Oftalmología, Centro Médico San Luis, Buenos Aires, Argentina.
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Puliyel A, Puliyel J. CUSUM for monitoring competency: computer software is useful for bootstrapping and real-time CUSUM plotting. Br J Ophthalmol 2011; 95:295-6. [PMID: 21258032 DOI: 10.1136/bjo.2010.188805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lundström M, Albrecht S, Wendel E, Hanning M. [More equal care of patients with cataract. Results after implementation of national surgical indicators]. Lakartidningen 2009; 106:1733-1736. [PMID: 19731734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Niemiec ES, Anderson KL, Scott IU, Greenberg PB. Evidence-based management of resident-performed cataract surgery: an investigation of compliance with a preferred practice pattern. Ophthalmology 2009; 116:678-84. [PMID: 19268367 DOI: 10.1016/j.ophtha.2008.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 11/14/2008] [Accepted: 11/14/2008] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate compliance with the American Academy of Ophthalmology (AAO) Cataract in the Adult Eye Preferred Practice Pattern (PPP) in a resident ophthalmology clinic. DESIGN Retrospective chart review. PARTICIPANTS All patients undergoing first-eye cataract surgery by ophthalmology residents with attending supervision at a Veterans Affairs Medical Center between January 1, 2006, and July 31, 2007. METHODS Electronic medical records (EMRs) were reviewed for compliance with the AAO Cataract in the Adult Eye PPP. MAIN OUTCOME MEASURES Frequency of resident compliance with all 39 elements of the AAO Cataract in the Adult Eye PPP. RESULTS A total of 129 patients met the inclusion criteria. The mean compliance with the PPP was 81%, with 62% of the elements having 90% or greater compliance. Compliance was below the mean for those PPP elements requiring patient input or assessment, including 0% for considering patient preference in the determination of anesthesia management, 73% for patient assessment of preoperative functional status, and 66% for patient assessment of postoperative vision. CONCLUSIONS Compliance with the AAO Cataract in the Adult Eye PPP in this resident ophthalmology clinic can be improved by increasing the documentation of patient input about their visual function both preoperatively and postoperatively. Further study of compliance with evidence-based guidelines is needed in ophthalmology, particularly in teaching hospitals where new providers are developing their approach to care.
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Affiliation(s)
- Elizabeth S Niemiec
- Ophthalmology Section, VA Medical Center, Providence, Rhode Island 02908-4799, USA
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Román R, Comas M, Mar J, Bernal E, Jiménez-Puente A, Gutiérrez-Moreno S, Castells X. Geographical variations in the benefit of applying a prioritization system for cataract surgery in different regions of Spain. BMC Health Serv Res 2008; 8:32. [PMID: 18248668 PMCID: PMC2277390 DOI: 10.1186/1472-6963-8-32] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 02/04/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Spain, there are substantial variations in the utilization of health resources among regions. Because the need for surgery differs in patients with appropriate surgical indication, introducing a prioritization system might be beneficial. Our objective was to assess geographical variations in the impact of applying a prioritization system in patients on the waiting list for cataract surgery in different regions of Spain by using a discrete-event simulation model. METHODS A discrete-event simulation model to evaluate demand and waiting time for cataract surgery was constructed. The model was reproduced and validated in five regions of Spain and was fed administrative data (population census, surgery rates, waiting list information) and data from research studies (incidence of cataract). The benefit of introducing a prioritization system was contrasted with the usual first-in, first-out (FIFO) discipline. The prioritization system included clinical, functional and social criteria. Priority scores ranged between 0 and 100, with greater values indicating higher priority. The measure of results was the waiting time weighted by the priority score of each patient who had passed through the waiting list. Benefit was calculated as the difference in time weighted by priority score between operating according to waiting time or to priority. RESULTS The mean waiting time for patients undergoing surgery according to the FIFO discipline varied from 1.97 months (95% CI 1.85; 2.09) in the Basque Country to 10.02 months (95% CI 9.91; 10.12) in the Canary Islands. When the prioritization system was applied, the mean waiting time was reduced to a minimum of 0.73 months weighted by priority score (95% CI 0.68; 0.78) in the Basque Country and a maximum of 5.63 months (95% CI 5.57; 5.69) in the Canary Islands. The waiting time weighted by priority score saved by the prioritization system varied from 1.12 months (95% CI 1.07; 1.16) in Andalusia to 2.73 months (95% CI 2.67; 2.80) in Aragon. CONCLUSION The prioritization system reduced the impact of the variations found among the regions studied, thus improving equity. Prioritization allocates the available resources within each region more efficiently and reduces the waiting time of patients with greater need. Prioritization was more beneficial than allocating surgery by waiting time alone.
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Affiliation(s)
- Rubén Román
- Evaluation and Clinical Epidemiology Department, Institut Municipal d'Assistència Sanitària (IMAS), Passeig Marítim, 25-29, 08003, Barcelona, Spain
| | - Mercè Comas
- Evaluation and Clinical Epidemiology Department, Institut Municipal d'Assistència Sanitària (IMAS), Passeig Marítim, 25-29, 08003, Barcelona, Spain
| | - Javier Mar
- Health Management Department, Hospital Alto Deba (Osakidetza), Avenida Navarra 16, 20500, Mondragón, Spain
| | - Enrique Bernal
- Health Services Research Department, Instituto Aragonés de Ciencias de la Salud, Gómez Laguna 25, 50009, Zaragoza, Spain
| | - Alberto Jiménez-Puente
- Evaluation Department, Hospital Costa del Sol, Ctra. Nacional 340 Km 187, 29600, Marbella, Spain
| | - Santiago Gutiérrez-Moreno
- Evaluation and Planification Department, Canarian Health Department, Pérez de Rozas 5, 38004 Santa Cruz de Tenerife, Canary Islands, Spain
| | - Xavier Castells
- Evaluation and Clinical Epidemiology Department, Institut Municipal d'Assistència Sanitària (IMAS), Passeig Marítim, 25-29, 08003, Barcelona, Spain
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Abstract
Purpose To compare the outcomes after phacoemulsification performed with the AquaLase® and phacoemulsification in MicroFlow® system, including surgically induced astigmatism (SIA), corneal endothelial cell damage and postoperative recovery of visual acuity. Methods The cataracts of Lens Opacities Classification System, version III (LOCS III) nuclear grade below 2 were subjected in this study. Nineteen eyes underwent cataract operation using AquaLase® (Alcon Laboratories, Fort Worth, Texas, U.S.A.). A control group (19 eyes) used the MicroFlow® system (Millenium, Stortz, U.S.A.) and was selected by matching age, sex, systemic disease, corneal astigmatism and corneal endothelial cell density. All the surgeries were performed by the same operator. SIA, corneal endothelial cell loss, visual acuity, and corneal thickness were evaluated postoperatively. Results SIA in the group using AquaLase® was less than that of the group using MicroFlow® system (P=0.022) at 2 months postoperatively. Evaluation of corneal endothelial cell loss, recovery of visual acuity and corneal thickness found no statistically significant differences between the two groups. Conclusions Cataract surgery using AquaLase® induces less surgically induced astigmatism in mild to moderate cataracts.
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Affiliation(s)
- Hyun-Wook Ryu
- Department of Ophthalmology and Visual Science, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shin-Hae Park
- Department of Ophthalmology and Visual Science, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Korean Eye Tissue and Gene Bank Related to Blindness, Seoul, Korea
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Maehara S, Itoh N, Wakaiki S, Yamasaki A, Tsuzuki K, Izumisawa Y. The effects of cataract stage, lens-induced uveitis and cataract removal on ERG in dogs with cataract. Vet Ophthalmol 2007; 10:308-12. [PMID: 17760711 DOI: 10.1111/j.1463-5224.2007.00559.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effects of cataract stage, lens-induced uveitis and cataract removal on the electroretinogram (ERG) of dogs with cataract. ANIMALS STUDIED Fifty-seven dogs diagnosed with unilateral or bilateral cataract whose ERG was recorded at Rakuno Gakuen University Teaching Animal Hospital from 2001 to 2004. PROCEDURES Four responses were recorded during the ERG: rod ERG, standard combined ERG, single-flash cone ERG and 30-Hz flicker ERG. Cataracts were divided into four stages: incipient, immature, mature and hypermature, and with or without lens induced uveitis (LIU). Noncataractous eyes of dogs with unilateral cataract were used as the control. We compared ERG amplitude, implicit time, and the b- to a-wave amplitude ratio of cataractous vs. noncataractous eyes, preoperative vs. postoperative cataractous eyes, and cataractous eyes with and without LIU. RESULTS No significant difference was found in ERG amplitude between incipient, immature and hypermature cataractous eyes, while in mature cataractous eyes decreased amplitude was confirmed in all responses compared with control eyes. However, no significant difference in b/a ratio was found at any stage of cataract. In postoperative eyes, increased amplitude was recorded in all responses compared to preoperative values. In eyes with LIU a decreased amplitude in the rod ERG and b-wave of standard combined ERG was recorded and, furthermore, a significant decline was confirmed in b/a ratio. CONCLUSION ERG values were influenced by cataract stage and LIU. LIU was associated with a reduction in the b/a ratio.
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Affiliation(s)
- Seiya Maehara
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan.
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Hibino T, Shimomura Y, Matsumoto C, Fukuda M, Uno N, Usui M, Takeuchi M, Asatani T, Minoda H. Clinical evaluation of blue-light blocker foldable acrylic IOL (HMY). Ann Ophthalmol (Skokie) 2007; 38:311-6. [PMID: 17726218 DOI: 10.1007/bf02697213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 11/30/1999] [Accepted: 09/08/2006] [Indexed: 11/30/2022]
Abstract
Efficacy and safety of blue-light-filtering acrylic IOL (HMY) were assessed and proven from 3 months to 1 year of postoperative follow-up in a clinical study performed on 80 eyes of 45 patients. Postoperative corrected visual acuity of all the eyes was 6/12 or better and 78.8% of them achieved higher than 6/6. The rate of mean corneal endothelial cell density decrease stood at 5.0%. Mild complications were observed, but none were serious.
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Affiliation(s)
- Tsuyoshi Hibino
- Department of Ophthalmology, Kinki University School of Medicine, Osaka, Japan.
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Chang MA, Congdon NG, Baker SK, Bloem MW, Savage H, Sommer A. The surgical management of cataract: barriers, best practices and outcomes. Int Ophthalmol 2007; 28:247-60. [PMID: 17712529 DOI: 10.1007/s10792-007-9121-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 06/11/2007] [Indexed: 10/22/2022]
Abstract
Cataract is the leading cause of blindness in the world. Cataract surgery has been shown by multiple studies to be one of the most cost-effective health interventions, and leads to a dramatic increase in quality of life and productivity for many patients. Though there has been marked improvement in the last several decades, surgical delivery services in developing nations are still suboptimal, and a large backlog in cataract cases continues to grow. To decrease this backlog, barriers to surgery, such as direct and indirect patient costs, geographic access to surgical facilities and surgeons, cultural factors, and patient education, must be addressed. In particular, access to services by women and rural patients needs to be improved. It is clear that extracapsular techniques are cost-effective and lead to better post-operative outcomes than intracapsular cataract extraction with aphakic correction. In addition, monitoring surgical outcomes is essential for improving the quality of surgical services. However, other issues regarding the delivery of cataract surgical services, including the role of average power intraocular lenses and the role of non-physician surgeons, are yet unresolved. Information about the true cost of surgery, including costs of surgeon training, equipment, and patient outreach programs, is needed so that the goal of self-sustaining programs may be obtained.
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Affiliation(s)
- Margaret A Chang
- The Johns Hopkins University Schools of Medicine and Public Health, 600 N. Wolfe Street, Wilmer 120, Baltimore, MD 21287, USA.
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Fernando B, Bhojwani R, Skarmoustas P, Aralikatti D, Mohan M. Standards in consent for cataract surgery. J Cataract Refract Surg 2007; 33:1464-8. [PMID: 17662443 DOI: 10.1016/j.jcrs.2007.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 04/16/2007] [Indexed: 10/23/2022]
Abstract
Consent forms for cataract surgery performed at Burnley General Hospital (BGH) and Blackburn Royal Infirmary (BRI) from October 4 to December 7, 2004, were prospectively reviewed to ensure that the East Lancashire Hospital's National Health Service (NHS) Trust Policy on consent to treatment and Department of Health (DoH) guidelines were being followed when seeking consent for cataract surgery. A set of 22 criteria derived as standards were formulated from the reference guide published by the DoH and from the East Lancashire trust policy document for consent to treatment. Each consent form was measured against these standards. Cases were randomly selected between BRI and BGH prospectively. All consent forms completed by physicians involved in formulating the standards were excluded. The review showed the NHS Trust Policy and DoH guidelines were largely followed when seeking consent for cataract surgery. However, certain areas were found to be deficient. If a health professional fails to obtain proper consent and the patient suffers harm as a result of treatment, it may be a factor in a claim of negligence against that health professional. Subsequent recommendations may include simple solutions that can be implemented to improve clinical practice when obtaining informed consent.
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Affiliation(s)
- Bertie Fernando
- East Lancashire NHS Trust, Burnley General Hospital, Burnley, United Kingdom
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Blanco-Rivera C, García-Caeiro AL, Rey-Liste T. [Assessment of clinical practice guidelines about cataract management]. Arch Soc Esp Oftalmol 2007; 82:429-35. [PMID: 17647118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE To evaluate the quality of clinical practice guidelines (CPG) about the management of cataract in adults. MATERIAL AND METHOD A bibliographic search was carried out selecting the CPG based on the evidence or on the expert consensus, published since the year 2000. The guidelines selected were assessed with the AGREE Instrument. RESULTS Six guidelines were assessed. Three were classified as "recommend with provisos or alterations" and the others "would not be recommended". In accordance with the AGREE Instrument criteria, no guidelines can be recommended for their use in the clinical practice if they were not modified previously.
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Affiliation(s)
- C Blanco-Rivera
- Complejo Hospitalario Universitario de Vigo, Servicio de Oftalmología y Axencia de Avaliación de Tecnoloxías Sanitarias de Galicia (avalia-t) Vigo, Galicia, España.
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Eusebio C, Kuper H, Polack S, Enconado J, Tongson N, Dionio D, Dumdum A, Limburg H, Foster A. Rapid assessment of avoidable blindness in Negros Island and Antique District, Philippines. Br J Ophthalmol 2007; 91:1588-92. [PMID: 17567662 PMCID: PMC2095536 DOI: 10.1136/bjo.2007.119123] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To conduct rapid assessments of avoidable blindness to estimate the magnitude and causes of blindness in people aged >/=50 years in Negros Island and Antique district, Philippines. METHODS Clusters of 50 people aged >/=50 years were sampled with probability proportionate to size. Households within clusters were selected through compact segment sampling. Visual acuity (VA) was measured with a tumbling "E" chart. Ophthalmologists examined people with VA<6/18 in either eye. RESULTS In Negros, 2774 of 3649 enumerated subjects were examined (76.0%) and 3177 of 3842 enumerated subjects in Antique (82.7%). The prevalence of blindness (presenting VA<3/60 in better eye) was 2.6% (95% CI = 2.0 to 3.2%) in Negros and 3.0% (2.4 to 3.6%) in Antique. The leading cause of blindness was untreated cataract, and was refractive error for visual impairment (VA<6/18 to >/=6/60). Most of the cases of blindness (67% in Negros, 82% in Antique) and visual impairment (94% in Negros, 95% in Antique) were avoidable (ie, operated and unoperated cataract, refractive error and corneal scar). In Negros, 23% of eyes had a poor outcome after cataract surgery, and 13% in Antique. CONCLUSIONS The prevalence of blindness in two areas in the Philippines was relatively low. Since most cases were avoidable, further reductions are possible.
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Affiliation(s)
- Cristina Eusebio
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Courtright P, Ndegwa L, Msosa J, Banzi J. Use of our existing eye care human resources: assessment of the productivity of cataract surgeons trained in eastern Africa. ACTA ACUST UNITED AC 2007; 125:684-7. [PMID: 17502509 DOI: 10.1001/archopht.125.5.684] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To measure the productivity of cataract surgeons in Africa and assess the factors that predict high productivity. METHODS A questionnaire on productivity and working environments was sent to all cataract surgeons trained in Malawi, Uganda, Tanzania, and Kenya. In addition, 2 meetings and in-depth discussions were held to elicit information on strategies to improve productivity among surgeons in general. RESULTS More than 77 000 cataract surgeries were performed in the years 2000 through 2004, resulting in an annual productivity rate of 243 surgeries per surgeon. Higher productivity was associated with having 2 or more cataract surgical sets, a well-functioning operating microscope, 3 or more nursing support staff, and a community program that includes transporting patients to the hospital. CONCLUSION Strategies for training, supporting, and supervising cataract surgeons in Africa need to be revised to create conditions amenable to greater productivity.
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Affiliation(s)
- Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Tumaini University/KCMC, Moshi, Tanzania
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Barsam A, Heatley CJ, Sundaram V, Toma NMG. A retrospective analysis to determine the effect of independent treatment centres on the case mix for microsurgical training. Eye (Lond) 2007; 22:687-90. [PMID: 17277752 DOI: 10.1038/sj.eye.6702718] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To determine the effect of Independent Sector Treatment Centres (ISTC) on microsurgical training. METHODS A novel scoring protocol for stratification of cases suitable for microsurgical training was devised. This scoring protocol was applied to all patients who underwent cataract surgery on a single consultant dedicated training list between September and November 2004. These patients are representative of patients remaining on the waiting list after ISTC selection, that is, the residual case mix. Patients who underwent cataract surgery on the same consultant list in the same period in 2003 were also analysed when there was no ISTC or other waiting list initiative in operation. RESULTS Data was available for 129 patients. Seventy three patients underwent cataract surgery between September and November 2003 and 56 patients underwent cataract surgery in the same period in 2004. Using the devised scoring protocol, the mean score in the 2003 group was 1.08 +/-1.75 (range, 0.0-10.5) and for the 2004 group the mean score was 2.31 +/-2.65 (range, 0.0-4.5). A Mann-Whitney test showed that there was a statistically significant difference between the scores in the two groups (P=0.0009). With Independent Sector Treatment Centre implementation the percentage of cases suitable only for consultants increased fourfold. CONCLUSION The decrease in suitable cases for training as shown in this study is likely to have serious consequences on microsurgical training in the UK. We recommend that the results of this study are considered in any current or future plans for ISTC continuation and expansion.
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Affiliation(s)
- A Barsam
- Department of Ophthalmology, Queen Elizabeth II Hospital, Howlands, Welwyn Garden City, UK.
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Abstract
PROBLEM A Scottish national health service ophthalmic facility was unable to cope with increasing demand for cataract surgery. DESIGN Multifaceted approach to redesign hospital space to accommodate a cataract unit; to invest in cataract nursing staff to allow more operations under local anaesthesia and as day cases; and to enhance input by general practitioners and optometrists to streamline and reduce false positive cataract referrals. A prospective audit for productivity was undertaken in 2004 (two years after the redesign) and compared against the national cataract surgery audit data for Fife from 1997. SETTING District general hospital serving a population of 400,000 in south east Scotland. KEY MEASURES FOR IMPROVEMENT Increasing throughput of cataract surgery while assessing quality of care provided against predefined evidence and Royal College of Ophthalmologists' guidelines, and evaluating training standards for ophthalmic surgical trainees against higher surgical training requirements. STRATEGIES FOR CHANGE Cataract services were redesigned to increase throughput and to reduce waiting times while preserving the quality of patient care. A secondary end point was to maintain surgical case load mix thus allowing trainees to continue to fulfil the number of operations required to acquire higher surgical training standards. EFFECTS OF CHANGE In the same three month period 237 cataract operations were carried out in 1997 and 374 in 2004, representing an increase of productivity by 60%. The waiting time for surgery decreased from more than one year to three months. The redesign resulted in almost complete preoperative and postoperative assessment by nursing staff, thus freeing medical time and allowing for more operations. Optometrists' referrals with reports increased significantly (P<0.0001). The number of operations carried out as day cases under local anaesthesia increased, with fewer intraoperative complications and postoperative visits (P<0.0001). The number of operations carried out by trainees more than doubled, from 43 to 100 cases, thus improving training opportunities. LESSONS LEARNT Modest capital investment in rebuilding space and in staff for cataract services can improve the quality and volume of cataract surgery. Enhancing existing NHS services provides for future need while maintaining training standards, thus potentially obviating the need for independent treatment centres. This model could be used throughout the United Kingdom.
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Affiliation(s)
- Adrian Tey
- Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee DD1 9SY.
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Abstract
Reorganisation of in-house services is an efficient way to improve quality and increase volume
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Pahau D, Melengas S, Garap J, Brian G. Monitoring cataract surgery outcomes in Papua New Guinea. Clin Exp Ophthalmol 2006; 34:900-2. [PMID: 17181629 DOI: 10.1111/j.1442-9071.2006.01382.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fine IH, Hoffman RS, Packer M. The new challenge for cataract surgeons. Curr Opin Ophthalmol 2006; 18:1-3. [PMID: 17159438 DOI: 10.1097/icu.0b013e3280124976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bourne R, Dineen B, Jadoon Z, Lee PS, Khan A, Johnson GJ, Foster A, Khan D. Outcomes of cataract surgery in Pakistan: results from The Pakistan National Blindness and Visual Impairment Survey. Br J Ophthalmol 2006; 91:420-6. [PMID: 17151060 PMCID: PMC1994747 DOI: 10.1136/bjo.2006.106724] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To evaluate the outcomes of cataract surgery in Pakistan. METHODS Cross-sectional, nationally representative sample of 16 507 adults (aged >or=30 years). Each underwent interview, logarithm of the minimum angle of resolution visual acuity (VA), autorefraction, examination of optic disc. Those with <6/12 VA on presentation underwent best-corrected VA and dilated biomicroscopic ocular examination. RESULTS 1317 subjects (633 men) had undergone surgery in one or both eyes. Of the 1788 operated eyes, 1099 (61%) had undergone intracapsular cataract extraction (ICCE) and 607 (34%) extracapsular surgery with an intraocular lens (ECCE+IOL). Presenting VA: 275 (15.4%) eyes: 6/12 or better; 253 (14.1) <6/12 >or=6/18; 632 (35.3%) 6/18 to 6/60; 85 (4.8%): 6/60 to 3/60; 528 (29.5%): <3/60. With "best" refractive correction, these values were: 563 (31.5%), 332 (18.6%), 492 (27.5%), 61 (3.4%), 334 (18.7%), respectively. Of the 1498 eyes with VA <or=6/12 on presentation, 352 (23.5%) were the result of coincident disease, 800 (53.4%) refractive error and 320 (21.4%) operative complications. Eye camp surgery (OR 1.72, p = 0.002), ICCE (OR 3.78; p<0.001), rural residence (OR 1.36, p = 0.01), female gender (OR 1.55, p<0.001) and illiteracy (OR 2.44, p<0.001) were associated with VA of <6/18. More recent ICCE surgeries were associated with a poorer outcome. The ratio of ECCE+IOL:ICCE in the last 3 years was 1.2:1, compared with 1:3.3 >or=4 years before the survey. CONCLUSION Almost a third of cataract operations result in a presenting VA of <6/60, which could be halved by appropriate refractive correction. This study highlights the need for an improvement in quality of surgery with a more balanced distribution of services.
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Affiliation(s)
- Rupert Bourne
- Department of Ophthalmology, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, England.
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Mathenge W, Kuper H, Limburg H, Polack S, Onyango O, Nyaga G, Foster A. Rapid assessment of avoidable blindness in Nakuru district, Kenya. Ophthalmology 2006; 114:599-605. [PMID: 17141319 DOI: 10.1016/j.ophtha.2006.06.057] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 06/01/2006] [Accepted: 06/01/2006] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of avoidable blindness in > or =50-year-olds in Nakuru district, Kenya, and to evaluate the Rapid Assessment for Avoidable Blindness (RAAB), a new methodology to measure the magnitude and causes of blindness. DESIGN Cross-sectional population-based survey. PARTICIPANTS Seventy-six clusters of 50 people 50 years or older were selected by probability proportionate to size sampling of clusters. Households within clusters were selected through compact segment sampling. Three thousand seven hundred eighty-four eligible subjects were selected, of whom 3503 (92.6%) were examined. METHODS Participants underwent a comprehensive ophthalmic examination in their homes by an ophthalmologist, including measurement of visual acuity (VA) with a tumbling-E chart and the diagnosis of the principal cause of visual impairment. Those who had undergone cataract surgery were questioned about the details of the operation and their satisfaction with surgery. Those who were visually impaired from cataract were asked why they had not gone for surgery. MAIN OUTCOME MEASURES Visual acuity and principal cause of VA<6/18. RESULTS The prevalence of bilateral blindness (presenting VA < 3/60) was 2.0% (95% confidence interval [CI], 1.5%-2.4%), and prevalence of bilateral visual impairment (VA of <6/18-> or =6/60) was 5.8% (95% CI, 4.8%-6.8%) in the sample. Definite avoidable causes of blindness (i.e., cataract, refractive error, trachoma, and corneal scarring) were responsible for 69.6% of bilateral blindness and 74.9% of bilateral visual impairment. Cataract was the major cause of blindness (42.0%) and visual impairment (36.0%). The cataract surgical coverage was high, with 78% of those with bilateral cataract who needed surgery having had surgery at VA<3/60. The quality of surgery was of concern because 22% of the 222 eyes that had undergone cataract surgery had VA<6/60 with best correction. The main barriers to surgery were lack of awareness and cost. The RAAB methodology was easy to use, and each team could visit one cluster per day. CONCLUSIONS The prevalence of blindness in > or =50-year-olds in Nakuru district was low, in part due to the high cataract surgical coverage. The RAAB is easy to use and inexpensive and provides information about the magnitude and causes of avoidable blindness that can be used for planning and monitoring eye care services.
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Bellan L. Cataract surgery in Canada. Can J Ophthalmol 2006; 41:539-41. [PMID: 17016523 DOI: 10.1016/s0008-4182(06)80021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lundström M, Montan P, Stenevi U, Thorburn W, Wejde G. [Reduced incidence of endophthalmitis following cataract extraction. National registration has found the risk factors]. Lakartidningen 2006; 103:2868-70. [PMID: 17128921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Mats Lundström
- Lunds Universitet samt Eyenet Sweden, Blekingesjukhuset, Karlskrona.
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Abstract
PURPOSE The recent focus on healthcare errors and safety suggest that practitioners and policy makers might appraise their cataract surgical care from a patient safety perspective. This paper reviews patient safety issues relevant to cataract care. Causation and consequences of incidents in cataract surgery, with implications for policy, are discussed. METHODS Models of accident causation from other domains were drawn on and empirically applied to cataract care. Consultation was undertaken with experts in cataract surgery, patient safety, and in risk management. Feedback on patient safety was included from presentations made to staff and patients and from personal insights. RESULTS Ophthalmology teams should embrace steps to improve patient safety. The role of incident reporting is advanced, including the provision of a prompt menu of cataract patient safety incidents as suggested by the Royal College of Ophthalmologists. CONCLUSIONS Strict attention to detail, risk assessment, and careful consideration of the patient pathway is needed to enhance cataract care. Clinical errors, near misses and complications happen, and may provide an opportunity for learning to reduce the risk of similar events in the future. Investment in staffing and training, appropriate equipment, and development of a safety culture with patient involvement are key elements of safe cataract surgical care. Patients and the public expect that safe cataract care should be commissioned for them. Critical patient safety incidents, including incidents that have led to permanent harm, require careful analysis of underlying systems and/or root causes.
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Lundström M, Albrecht S, Håkansson I, Lorefors R, Ohlsson S, Polland W, Schmid A, Svensson G, Wendel E. NIKE: a new clinical tool for establishing levels of indications for cataract surgery. ACTA ACUST UNITED AC 2006; 84:495-501. [PMID: 16879570 DOI: 10.1111/j.1600-0420.2006.00707.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to construct a new clinical tool for establishing levels of indications for cataract surgery, and to validate this tool. METHODS Teams from nine eye clinics reached an agreement about the need to develop a clinical tool for setting levels of indications for cataract surgery and about the items that should be included in the tool. The tool was to be called 'NIKE' (Nationell Indikationsmodell för Kataraktextraktion). The Canadian Cataract Priority Criteria Tool served as a model for the NIKE tool, which was modified for Swedish conditions. Items included in the tool were visual acuity of both eyes, patients' perceived difficulties in day-to-day life, cataract symptoms, the ability to live independently, and medical/ophthalmic reasons for surgery. The tool was validated and tested in 343 cataract surgery patients. Validity, stability and reliability were tested and the outcome of surgery was studied in relation to the indication setting. RESULTS Four indication groups (IGs) were suggested. The group with the greatest indications for surgery was named group 1 and that with the lowest, group 4. Validity was proved to be good. Surgery had the greatest impact on the group with the highest indications for surgery. Test-retest reliability test and interexaminer tests of indication settings showed statistically significant intraclass correlations (intraclass correlation coefficients [ICCs] 0.526 and 0.923, respectively). CONCLUSIONS A new clinical tool for indication setting in cataract surgery is presented. This tool, the NIKE, takes into account both visual acuity and the patient's perceived problems in day-to-day life because of cataract. The tool seems to be stable and reliable and neutral towards different examiners.
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Au L, Saha K, Fernando B, Ataullah S, Spencer F. 'Fast-track' cataract services and diagnostic and treatment centre: impact on surgical training. Eye (Lond) 2006; 22:55-9. [PMID: 16858438 DOI: 10.1038/sj.eye.6702512] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS To evaluate the impact of 'Action on Cataracts' and the development of Diagnostic and Treatment Centre (DTC) on cataract surgery training in the Central Manchester and Manchester Children's University Hospital's Trust. METHODS We compared all cataract extractions undertaken from April to September 2005 with the same 6-month time period over the preceding 5 years. Surgery was performed on one of four types of lists: Manchester Royal Eye Hospital standard lists (MREH), Cataract Services list, Waiting List Initiative list (WLI), and Diagnostic and Treatment Centre list (DTC). Surgeons were identified by their specific codes and divided into grades. RESULTS The total number of cataract operations undertaken on the standard MREH lists has declined significantly over the years (P<0.001 chi(2) test for trend). The number of cataract operations performed by both Specialist Registrars (SpRs) and Senior House Officers (SHOs) demonstrated a statistically significant decline over the years (P<0.001 for both cases, chi(2) test for trend), with the SHOs number dropping dramatically over the last 2 years. When comparing the number of operations performed by junior SpRs and senior SpRs, shift in the balance can be seen towards the senior surgeons. The proportion of operations performed by junior SpRs declined from 50% in 2000 to 28.2% in 2005. CONCLUSION Recent changes in cataract care provision have had a significant impact on training. Our results document for the first time that both higher and basic surgical trainees were affected. Future care of our patients could be comprised owing to lack of training.
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Affiliation(s)
- L Au
- Manchester Royal Eye Hospital, Manchester, UK.
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Accreditation Association of Ambulatory Health Care, Inc. Fact sheet: non-clinical performance measures for cataract surgery. Insight 2006; 31:13-4. [PMID: 17253020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Wong D. Auditing cataract surgery nationwide. Br J Ophthalmol 2006; 90:817. [PMID: 16782948 PMCID: PMC1857165 DOI: 10.1136/bjo.2006.095489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D Wong
- Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK,
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