scholarly journals Cataract Surgery Outcomes and Postoperative Patient Compliance in Limited English Proficiency Patients at a County Hospital

2021 ◽  
Author(s):  
Colleen C Yard ◽  
Kayla R Walter ◽  
Ning O Zhao ◽  
Alice Z Chuang ◽  
Kimberly A Mankiewicz ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Limited English Proficiency ◽  
Intraoperative Complications ◽  
Language Barriers ◽  
Retrospective Chart Review ◽  
County Hospital ◽  
Poor Vision ◽  
Hospital Patients ◽  
Surgery Outcomes

Background/Aims: Investigate the role of language barriers in cataract surgery outcomes at a county hospital. Methods: Retrospective chart review of patients who underwent cataract surgery March 2018-February 2019 at Lyndon B. Johnson Hospital. Patients who underwent cataract surgery combined with another procedure or had severe glaucoma or proliferative diabetic retinopathy were excluded. Patients were classified into limited English proficient (LEP) or English proficient (non-LEP) groups based on language preferences. Demographics, baseline ocular characteristics, intraoperative complications, postoperative BCVA (best-corrected visual acuity), complications, and compliance were recorded. The primary outcome was incidence of poor visual outcomes (BCVA<20/40) at the postoperative 1-month visit. Results: 354 patients (199 [56%] LEP and 155 [44%] non-LEP) with 125 (35%) males and a mean age 66.1 (+/- 10.9) years were included. LEP patients were about 5 years older than non-LEP patients (P<0.001) and were mostly Hispanic (172 [86%] LEP vs. 36 [26%] non-LEP, P<0.001). The baseline ocular characteristics were similar (P >0.05), except severity of cataract (125 [63%] NSC grade >2+ for LEP vs 70 [51%] for non-LEP, P =0.03). No significant differences in intraoperative complications (P =0.18), incidence of poor vision (P =0.59), postoperative cystoid macular edema (P =0.32), and compliance with the postoperative drop regimen (P =0.11) were noted. Conclusion: There were no statistically significant differences in incidence of poor vision, complications, or compliance. However, there was a trend toward significance, showing that language barriers may lead to more advanced disease and compliance issues with postoperative medications.

scholarly journals A retrospective observational study to estimate use of biomarkers to predict severity of community acquired pneumonia in children

2021 ◽  
Author(s):  
Anam Bashir ◽  
Raheel Khan ◽  
Stephanie Thompson ◽  
Manuel Caceres
Keyword(s):  
Area Under The Curve ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Community Acquired Pneumonia ◽  
Pneumonia Severity ◽  
Neutrophil Lymphocyte Ratio ◽  
Reactive Protein ◽  
Hospital Patients ◽  
Minimal Research

Purpose: Multiple studies have investigated the role of biomarkers in predicting pneumonia severity in adults but minimal research exists for children. The aim of this study was to determine if the following biomarkers: white blood cell count (WBC), platelet count, C-reactive protein (CRP), procalcitonin (PCT), neutrophil-lymphocyte ratio, neutrophil count, or band count predict community associated pneumonia (CAP) severity in children. Methods: A retrospective chart review was conducted on pediatric patients (aged 60 days to 18 years) diagnosed with CAP, admitted to a regional, tertiary hospital. Patients were stratified into two severity cohorts, mild (no ICU care), and moderate /severe (required ICU care). Biomarker values were then compared between the severity cohorts and area under the curve (AUC), cut-off values, performance characteristics were calculated. Results: A total of 108 patients met inclusion criteria. Among the biomarkers examined, elevated levels of CRP (51.7 mg/L in mild vs. 104.8 mg/L in moderate/severe, p = 0.003, PCT (0.29 ng/ml in mild vs. 4.02 ng/ml in moderate/severe, p = 0.001) and band counts (8% in mild vs. 15% moderate/severe, p = 0.009) were associated with increased pneumonia severity. In predicting moderate/severe CAP, PCT had the highest AUC of 0.77 (p = 0.001) followed by bands AUC of 0.69 (p = 0.009) and CRP AUC of 0.67 (p = 0.003). The cut-off for PCT of 0.55ng/ml had a sensitivity of 83% and a specificity of 65%. A cut-off level of 53.1 mg/L for CRP had a sensitivity of 79% and specificity of 52%. A cut off level of 12.5% bands had a sensitivity of 61% and specificity of 71%. Conclusion: Biomarkers, in particular PCT, obtained early in hospitalization appear to perform as predictors for CAP severity in children and may be beneficial in guiding CAP management

scholarly journals Learning Curve of a Surgical Educator: Resident Cataract Surgery Outcomes under the Supervision of One Attending Surgeon over 5 Years

2020 ◽  
Vol 12 (01) ◽  
pp. e15-e19
Author(s):  
Sidra Zafar ◽  
Ariel Chen ◽  
Seung Yeon Seo ◽  
Xinyi Chen ◽  
Jing Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Learning Curve ◽  
Cataract Surgery ◽  
Intraoperative Complications ◽  
Retrospective Chart Review ◽  
Estimating Equation ◽  
Fellowship Training ◽  
Preoperative Risk ◽  
Preoperative Risk Factors ◽  
Vitreous Loss

Abstract Background The main purpose of this article is to determine the trend of intraoperative complications of resident-performed cataract surgery under the supervision of one attending surgeon during the initial 5 years of surgical teaching. Methods A retrospective chart review was conducted at the Wilmer Eye Institute for all postgraduate year 4 resident-performed cataract surgeries between July 2013 and June 2018 that were supervised by one attending surgeon who was directly out of fellowship training. Recorded data included patient demographics, presence of preoperative risk factors (small pupil, dense cataract, history of ocular trauma, pseudoexfoliation syndrome, postvitrectomy, pre-existing zonular weakness, and high myopia), and intraoperative complications (posterior capsule tear resulting in vitreous loss and zonular dehiscence resulting in vitreous loss and/or loss of sulcus support). A generalized estimating equation model was constructed to determine factors associated with intraoperative complications. Results A total of 1,253 resident cataract surgeries involving 988 patients were included. The overall complication rate was 3.6% (n = 45/1253), with a decreasing trend observed in the rate of intraoperative complications across the study years. Multivariate analysis found that complications during cataract surgery were more likely to occur in earlier years of the supervising surgeon's career (p = 0.01), at the beginning of the academic year (p = 0.03), in eyes with preoperative risk factors (p < 0.001), black patients (p = 0.02), and left eyes (p = 0.02). Conclusion A learning curve exists for novice attending surgeons during their initial years of resident cataract surgery supervision. Residency programs should consider resources to educate novice surgical educators, especially on how to effectively supervise resident-performed complex cases.

scholarly journals Outcomes of Femtosecond Laser Assisted Cataract Surgery Performed by Resident and Attending Surgeons

2021 ◽  
Vol 13 (01) ◽  
pp. e26-e31
Author(s):  
Spencer C. Cleland ◽  
Daniel W. Knoch ◽  
Jennifer C. Larson
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Cataract Surgery ◽  
Retrospective Chart Review ◽  
Dissipated Energy ◽  
Independent Practice ◽  
Postoperative Visual Acuity ◽  
Included Patient ◽  
Duration Of Surgery ◽  
The Difference

Abstract Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS). Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications. Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared with attending FLACS cases (13.6 ± 4.4 minutes; p < 0.001). There was higher CDE in resident FLACS and resident manual cases compared with attending FLACS cases, but the difference was not statistically significant (p = 0.06). Postoperative visual acuity was not statistically different at 1-day and 1-month after surgery among the three groups. Resident FLACS complications, which included one case requiring an intraoperative suture to close the wound, two cases with intraoperative corneal abrasions, two cases with postoperative ocular hypertension, and one case with cystoid macular edema, were not significantly greater than attending FLACS complications (p = 0.30). Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to FLACS performed by attending surgeons, and to manual cataract surgery performed by resident surgeons. However, resident FLACS cases took significantly longer time to complete, and they were associated with a higher CDE and minor complication rate compared with attending FLACS cases. Introducing advanced technologies into surgical training curricula improves resident preparedness for independent practice, and this study suggests FLACS can be incorporated safely and effectively into resident education.

scholarly journals The Role of Skin-to-Skin Contact and Breastfeeding on Atonic Postpartum Hemorrhage

2020 ◽  
Vol 11 (1) ◽  
pp. 1-11
Author(s):  
Wedad M. Almutairi ◽  
Susan M. Ludington ◽  
Mary T. Quinn Griffin ◽  
Christopher J. Burant ◽  
Ahlam E. Al-Zahrani ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Retrospective Chart Review ◽  
Skin Contact ◽  
Labor Duration ◽  
Third Stage Of Labor ◽  
Estimated Blood Loss ◽  
Third Stage ◽  
Skin To Skin ◽  
Increasing Trends

Objectives: were to (a) determine incidence of postpartum hemorrhage (PPH) in all women delivering between 2009 and 2015, and (b) determine the amount of Estimated Blood Loss (EBL) and duration of the third stage of labor in each subgroup for women with or without PPH, and (c) compare EBL and duration of 3rd stage of labor between subgroups in groups of women with or without PPH. Design: A retrospective chart review conducted using codes for atonic PPH. Setting: Records from a University based tertiary setting, 264 charts were reviewed and data from 154 charts were analyzed. One-way ANOVAs followed with post-hocs and a 2-way ANOVA were conducted. Results: PPH rate increased by 47.50% from 2009–2015. For women with PPH, EBL was lower in skin to skin contact (SSC) + Breastfeeding (BF) subgroup. For women without PPH, EBL was lower in SSC only subgroup. Third stage of labor duration was longer in women with PPH. Conclusions: Study confirmed the increasing trends of PPH due to uterine atony and proposed role of SSC and BF in decreasing EBL and shorten the duration of the 3rd stage of labor for PPH women, usefulness of SSC and BF as physiologic practices merit further study.

scholarly journals Usefulness of Surgical Media Center as a Cataract Surgery Educational Tool

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Tomoichiro Ogawa ◽  
Takuya Shiba ◽  
Hiroshi Tsuneoka
Keyword(s):  
Cataract Surgery ◽  
Surgical Procedures ◽  
Intraoperative Complications ◽  
Recording Device ◽  
Educational Tool ◽  
Intraoperative Complication ◽  
Vacuum Level ◽  
Media Center ◽  
Medical Optics ◽  
Education Tool

Purpose.This study retrospectively analyzed cataract surgeries to examine the usefulness of Surgical Media Center (SMC) (Abbott Medical Optics Inc.), a new cataract surgery recording device, for training of cataract surgery.Methods.We studied five hundred cataract surgeries conducted with a phacoemulsification system connected to the SMC. After surgery, the surgical procedures were reviewed, with changes in aspiration rate, vacuum level, and phaco power displayed as graphs superimposed on the surgical video. We examined whether use of SMC is able to demonstrate the differences in technique between experienced and trainee operators, to identify inappropriate phacoemulsification techniques from analyzing the graphs, and to elucidate the cause of intraoperative complications.Results. Significant differences in the time taken to reach maximum vacuum and the speed of increase in vacuum during irrigation and aspiration were observed between experienced and trainee operators. Analysis of the graphs displayed by SMC detected inappropriate phacoemulsification techniques mostly in cases operated by trainee operators.Conclusions. Using SMC, it was possible to capture details of cataract surgery objectively. This recording device allows surgeons to review cataract surgery techniques and identify the cause of intraoperative complication and is a useful education tool for cataract surgery.

scholarly journals Risk of retinal detachment following cataract extraction: results from the International Cataract Surgery Outcomes Study.

1996 ◽  
Vol 80 (8) ◽  
pp. 689-693 ◽  
Author(s):  
J C Norregaard ◽  
H Thoning ◽  
T F Andersen ◽  
P Bernth-Petersen ◽  
J C Javitt ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Cataract Surgery ◽  
Cataract Extraction ◽  
Outcomes Study ◽  
Surgery Outcomes

scholarly journals The Effect of Perioperative Administration of Probiotics on Colorectal Cancer Surgery Outcomes

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1451
Author(s):  
Louise Pitsillides ◽  
Gianluca Pellino ◽  
Paris Tekkis ◽  
Christos Kontovounisios
Keyword(s):  
Colorectal Cancer ◽  
Perioperative Management ◽  
Single Species ◽  
Infectious Complications ◽  
Mucosal Permeability ◽  
Colorectal Cancer Surgery ◽  
Rate Analysis ◽  
Surgery Outcomes ◽  
Randomised Controlled

The perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and disruption of the microbiome. Probiotics can maintain the microbiome’s balance postoperatively by maintaining intestinal mucosal integrity and reducing bacterial translocation (BT). This review aims to assess the role of probiotics in the perioperative management of CRC patients. The outcomes were categorised into: postoperative infectious and non-infectious complications, BT rate analysis, and intestinal permeability assessment. Fifteen randomised controlled trials (RCTs) were included. There was a trend towards lower rates of postoperative infectious and non-infectious complications with probiotics versus placebo. Probiotics reduced BT, maintained intestinal mucosal permeability, and provided a better balance of beneficial to pathogenic microorganisms. Heterogeneity among RCTs was high. Factors that influence the effect of probiotics include the species used, using a combination vs. single species, the duration of administration, and the location of the bowel resection. Although this review provided evidence for how probiotics possibly operate and reported notable evidence that probiotics can lower rates of infections, heterogeneity was observed. In order to corroborate the findings, future RCTs should keep the aforementioned factors constant.

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