Outcome of corneal transplantation: can a prioritisation system predict outcome?

Saunders, P. P. R.; Sibley, Lyn M.; Richards, J. Scott; Holland, Simon; Chow, Debbie L.; Courtright, Paul

doi:10.1136/bjo.86.1.57

Cited by 14 publications

(7 citation statements)

References 9 publications

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“…They showed no obvious signs of ocular pain, in keeping with relatively low experience of pain among human transplant recipients. 4 We considered whether postoperative stress (Table 1) was linked to operative variables. However, it was not significantly linked to any variables routinely monitored during the operation (level of sedation after premedication before placement of an intravenous catheter, amount of propofol administered before anaesthesia, mean isoflurane concentration during anaesthesia, duration of anaesthesia, mean heart rate, mean arterial blood pressure, maximum or minimum mean arterial blood pressure or temperature at end of anaesthesia) (P ¼ 0.57 for the overall model).…”

Section: Postoperative Behaviourmentioning

confidence: 99%

Perioperative socialization, care and monitoring of National Institutes of Health miniature swine undergoing ocular surgery and sampling of peripheral blood

et al. 2012

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Swine are a frequent species of choice for testing new surgical procedures and for transplantation studies. However, information concerning best practice to prepare pigs for surgery and postoperative treatment and monitoring is limited, despite a perception that preoperative socialization is beneficial. Therefore we examined the effect of preoperative visits by project personnel on compliance of 26 National Institutes of Health (NIH) minipigs subject to corneal transplantation. We briefly describe sedation and anaesthesia protocols developed for surgery and multiple postoperative interventions in order to facilitate interpretation of data relating to pig compliance. Preoperative visit variables and measures of preoperative socialization were correlated with postoperative outcome. Principal component analysis (PCA) of postoperative outcome variables identified a factor accounting for 53.5% of the variance that was significantly associated with two factors derived from PCA of preoperative factors (accounting, respectively, for 54.7% and 26.0% of the variance; P = 0.019 for the overall model, P = 0.041 and 0.040 for factors 1 and 2, respectively), such that more time spent with pigs before surgery and higher socialization scores were associated with less postoperative stress and difficulty of eye medication. Moreover, two of the preoperative visit variables, time spent with only one person in the pen and time spent with two or more people in the pen, contributed predominantly to PCA factors 1 and 2, respectively, indicating that they were fulfilling two qualitatively different requirements for socialization. We conclude that NIH minipigs are fully compliant with anaesthetic and postoperative experimental procedures provided they are well-socialized to project personnel before surgery.

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Section: Postoperative Behaviourmentioning

confidence: 99%

Perioperative socialization, care and monitoring of National Institutes of Health miniature swine undergoing ocular surgery and sampling of peripheral blood

et al. 2012

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“…Other important studies of the validity of VF-14 have been carried out by Steinberg et al (1994b), Cassard et al (1995), Damiano et al (1995) and Tielsch et al (1995). The validity of the instrument for eye diseases other than cataract has also been examined, and preliminary results indicate it to be acceptable for research on corneal diseases (Musch et al 1997;Courtright et al 1998;Boisjoly et al 1999;Fontaine et al 2000;Brahma et al 2000;Saunders et al 2002), refractive surgery (Brunette et al 2000), glaucoma (Gutierrez et al 1997;Parrish et al 1997;Lee et al 1998;Montemayer et al 2001), cataract surgery (Uusitalo & Tarkkanen 1998;Crabtree et al 1999;Rose et al 1999;Brydon et al 2000;Lee et al 2000;Lum et al 2000;Saw et al 2002), second-eye cataract surgery (Javitt et al 1995b;Desai et al 1996;Castells et al 1999), retinal diseases (Linder et al 1999;Sharma et al 2002), myopia (Rose et al 2000), low vision aid (Brown 1999;Scott et al 1999), uveitis (Schiffman et al 2001), and agerelated macular degeneration (AMD) (Mackenzie et al 2002). Since its introduction, the VF-14 has been used in more than 40 studies (reference list available from JCN).…”

Section: Vf-14 Indexmentioning

confidence: 99%

Results from the International Cataract Surgery Outcomes Study

Nørregaard

2007

Acta Ophthalmologica Scandinavica

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It is widely accepted that cataract extraction with intraocular lens implantation is a highly effective and successful procedure. However, quality assessments and studies of effectiveness should still be undertaken. As with any surgical treatment modality, complications may occur, leading to suboptimal outcomes, additional health costs and deterioration in patients' functional capacity. International variation in clinical practice patterns and outcomes can serve as important pointers in the attempt to identify areas amenable to improvements in quality and cost-effectiveness. Once demonstrated, similar clinical results obtained in different health care systems can improve the level of confidence in a clinical standard against which the quality of care can be evaluated.The International Cataract Surgery Outcomes Study was established in 1992. The objective of this international comparative research project was to compare cataract management, outcomes of surgery and quality of care in four international sites. The study was conducted in the 1990s, since when many developments and refinements have emerged within cataract surgery. The actual figures reported in this thesis may no longer be of specific relevance as a decade has passed since their collection. However, the research questions and methods used in the study are still highly important and justify the publication of this report. The report deals with problems related to quality assessment, benchmarking, and the establishment and design of nationwide clinical databases ) issues that are currently the focus of much attention. Moreover, the problems related to cross-national comparisons are increasingly relevant as more international databases are established. The study makes suggestions on how to report and compare objective as well as subjective criteria for surgery. The issue of how to report subjective criteria is a particular subject of current discussion.Four sites with high-quality health care systems were examined in this study: the USA, Denmark, the Province of Manitoba (Canada), and Barcelona (Spain). The design of the international research programme was based on methods developed by the US National Cataract Surgery Outcomes Study conducted by the US Cataract Patients Outcomes Research Team. The International Cataract Surgery Outcomes Study comprised three separate studies: a survey of ophthalmologists; a prospective cohort study, and a retrospective register-based cohort study.The survey study was based on data generated by a self-administered questionnaire completed by ophthalmologists in the four study areas. The questionnaire examined routine clinical practice involving patients considered for cataract surgery, and included questions on anaesthesia, monitoring and surgical techniques. Acta Ophthalmologica Scandinavica 2007 5The prospective cohort study was a large-scale, longitudinal observational study of patients undergoing first-eye cataract surgery in each study site. Patients were sampled consecutively from multiple clinics and follo...

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“…The limited postimplementation evaluation data available for some of the NZ CPAC tools showed little correlation with expert clinical judgement, 17,18 no more than slight correlation between health outcomes following surgery and prior CPAC score 3 and failure to prioritize patients at risk of adverse events while waiting 19,20 . However, assessment of a prioritization system developed for corneal transplants in British Columbia found a significant association between high preoperative score and improvement in visual outcome following surgery 13 . The outcome and evaluation assessment of the current tool will be conducted on a prospective cohort of patients waiting for elective TURP.…”

Section: Discussionmentioning

confidence: 99%

“…7 In our analysis, age did not influence patient priority whereas the NZ clinical priority assessment criteria (CPAC) studies incorporated age in the tool developed for the prioritization of coronary artery bypass grafting. 8 There is similar disagreement about the incorporation of time already spent waiting for surgery [12][13][14] and the existence of dependents. 11,15 This divergence in views exists among health professionals and in the wider community and the ethical implications of using such criteria need further examination.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 However, assessment of a prioritization system developed for corneal transplants in British Columbia found a significant association between high preoperative score and improvement in visual outcome following surgery. 13 The outcome and evaluation assessment of the current tool will be conducted on a prospective cohort of patients waiting for elective TURP. Outcomes measured will include severity of BPH symptoms and quality of life at the time of entry into the waiting list, as well as before and after surgery.…”

Section: Discussionmentioning

confidence: 99%

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Prioritizing Patients for Prostatectomy: Balancing Clinical and Psychosocial Factors

Curtis

Wolfe

Russell

et al. 2007

ANZ Journal of Surgery

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Outcome of corneal transplantation: can a prioritisation system predict outcome?

Cited by 14 publications

References 9 publications

Perioperative socialization, care and monitoring of National Institutes of Health miniature swine undergoing ocular surgery and sampling of peripheral blood

Perioperative socialization, care and monitoring of National Institutes of Health miniature swine undergoing ocular surgery and sampling of peripheral blood

Results from the International Cataract Surgery Outcomes Study

Prioritizing Patients for Prostatectomy: Balancing Clinical and Psychosocial Factors

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