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IMPORTANCE Sleep-disordered breathing (SDB) is common and associated with substantial adverse health consequences. Long wait times for SDB care are commonly reported; however, it is unclear whether wait times for care are associated with clinical outcomes. OBJECTIVE To evaluate the association of wait times for care with clinical outcomes for patients with severe SDB. DESIGN, SETTING, AND PARTICIPANTS This study is a secondary analysis of a randomized clinical noninferiority trial comparing management by alternative care practitioners (ACPs) with traditional sleep physician-led care between October 2014 and May 2017. The study took place at Foothills Medical Centre Sleep Centre, a tertiary care multidisciplinary sleep clinic at the University of Calgary. Patients with severe SDB (defined as a respiratory event index Ն30 events per hour during home sleep apnea testing, mean nocturnal oxygen saturation Յ85%, or suspected sleep hypoventilation syndrome) were recruited for the study. Patients were excluded if they were suspected of having a concomitant sleep disorder other than SDB or had previously been treated with positive airway pressure (PAP) therapy for SDB. Data were analyzed from October 2017 to January 2020. MAIN OUTCOMES AND MEASURES Outcomes were assessed 3 months after treatment initiation with adherence to PAP therapy as the primary outcome. Secondary outcomes included Epworth Sleepiness Scale score, health-related quality of life, and patient satisfaction measured using the Visit-Specific Satisfaction Instrument-9. Multiple regression models were used to assess the associations between wait times and each of the outcomes. t tests were used to compare wait times for patients who were adherent to PAP therapy (Ն4 hours per night for 70% of nights) with those for nonadherent patients. RESULTS One hundred fifty-six patients (112 [71.8%] men; mean [SD] age, 56 [12] years) were included in the analysis. The mean time from referral to initial visit was 88 days (95% CI, 79 to 96 days), and the mean time to treatment was 123 days (95% CI, 112 to 133 days). Shorter wait time to
IMPORTANCE Sleep-disordered breathing (SDB) is common and associated with substantial adverse health consequences. Long wait times for SDB care are commonly reported; however, it is unclear whether wait times for care are associated with clinical outcomes. OBJECTIVE To evaluate the association of wait times for care with clinical outcomes for patients with severe SDB. DESIGN, SETTING, AND PARTICIPANTS This study is a secondary analysis of a randomized clinical noninferiority trial comparing management by alternative care practitioners (ACPs) with traditional sleep physician-led care between October 2014 and May 2017. The study took place at Foothills Medical Centre Sleep Centre, a tertiary care multidisciplinary sleep clinic at the University of Calgary. Patients with severe SDB (defined as a respiratory event index Ն30 events per hour during home sleep apnea testing, mean nocturnal oxygen saturation Յ85%, or suspected sleep hypoventilation syndrome) were recruited for the study. Patients were excluded if they were suspected of having a concomitant sleep disorder other than SDB or had previously been treated with positive airway pressure (PAP) therapy for SDB. Data were analyzed from October 2017 to January 2020. MAIN OUTCOMES AND MEASURES Outcomes were assessed 3 months after treatment initiation with adherence to PAP therapy as the primary outcome. Secondary outcomes included Epworth Sleepiness Scale score, health-related quality of life, and patient satisfaction measured using the Visit-Specific Satisfaction Instrument-9. Multiple regression models were used to assess the associations between wait times and each of the outcomes. t tests were used to compare wait times for patients who were adherent to PAP therapy (Ն4 hours per night for 70% of nights) with those for nonadherent patients. RESULTS One hundred fifty-six patients (112 [71.8%] men; mean [SD] age, 56 [12] years) were included in the analysis. The mean time from referral to initial visit was 88 days (95% CI, 79 to 96 days), and the mean time to treatment was 123 days (95% CI, 112 to 133 days). Shorter wait time to
IMPORTANCETrustworthy clinical practice guidelines require reliable systematic reviews of the evidence to support recommendations. Since 2016, the American Academy of Ophthalmology (AAO) has partnered with Cochrane Eyes and Vision US Satellite to update their guidelines, the Preferred Practice Patterns (PPP).OBJECTIVE To describe experiences and findings related to identifying reliable systematic reviews that support topics likely to be addressed in the 2016 update of the 2011 AAO PPP guidelines on cataract in the adult eye.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study. Systematic reviews on the management of cataract were searched for in an established database. Each relevant systematic review was mapped to 1 or more of the 24 management categories listed under the Management section of the table of contents of the 2011 AAO PPP guidelines. Data were extracted to determine the reliability of each systematic review using prespecified criteria, and the reliable systematic reviews were examined to find whether they were referenced in the 2016 AAO PPP guidelines. For comparison, we assessed whether the reliable systematic reviews published before February 2010 the last search date of the 2011 AAO PPP guidelines were referenced in the 2011 AAO PPP guidelines. Cochrane Eyes and Vision US Satellite did not provide systematic reviews to the AAO during the development of the 2011 AAO PPP guidelines.MAIN OUTCOMES AND MEASURES Systematic review reliability was defined by reporting eligibility criteria, performing a comprehensive literature search, assessing methodologic quality of included studies, using appropriate methods for meta-analysis, and basing conclusions on review findings. RESULTSFrom 99 systematic reviews on management of cataract, 46 (46%) were classified as reliable. No evidence that a comprehensive search had been conducted was the most common reason a review was classified as unreliable. All 46 reliable systematic reviews were cited in the 2016 AAO PPP guidelines, and 8 of 15 available reliable reviews (53%) were cited in the 2011 PPP guidelines. CONCLUSIONS AND RELEVANCEThe partnership between Cochrane Eyes and Vision US Satellite and the AAO provides the AAO access to an evidence base of relevant and reliable systematic reviews, thereby supporting robust and efficient clinical practice guidelines development to improve the quality of eye care.
To the Editor Cataract is the leading cause of vision impairment in older adults in the United States and North America. The recent study by Tseng et al 1 found that cataract surgery was associated with a 60% reduced risk of death from all causes and a 37% to 69% reduced risk of death by pulmonary, unintentional, infectious, neurologic, and vascular diseases and cancer. These are important research findings and should contribute to meaningful policy debates. A comprehensive understanding of the benefits of cataract surgery is needed to inform policy and allocation of resources in a timely and appropriate manner to enhance access to this life-saving and cost-effective procedure.Furthermore, evidence from a systematic review 2 suggests that long waiting times for cataract surgery may be deleterious. Studies have shown that vision loss decreases quality of life and increases frequency of injuries, including injuries incurred in motor vehicle crashes, during protracted cataract surgery waiting times. Reducing patient waiting time for cataract surgery is an urgent health care need globally.Even though the study by Tseng et al 1 suggests that cataract surgery lowers the risk of falls in older members of the community, the literature shows somewhat mixed evidence of this. For example, a Cochrane systematic review 3 and a recent trial that examined interventions for preventing falls in elderly individuals 4 reported that the association of correction of visual deficiency through cataract surgery with reduced falls is unknown.Visual function is essential for safe driving. Even though motor vehicle crashes are the leading cause of death for persons aged 65 to 74 years, Tseng et al 1 did not mention driving improvements after cataract surgery or how improved vision could potentially enhance safe driving practices of the older adult population. Because this is supported in the literature, including a systematic review, we wonder if they can comment on whether their data provided clues to traffic fatality reductions associated with their findings. 5
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