Systematic review of the agreement of tonometers with goldmann applanation tonometry

This review was part of the Surveillance for Ocular Hypertension study funded by the UK National Institute for Health Research Health Technology Assessment Programme (Project No. 07/46/02). J.C. held a Medical Research Council UK fellowship (G0601938). AA-B was a grantholder on an AstraZeneca (London, UK) funded study of a new medication for glaucoma. The Health Services Research Unit receives core funding from the Chief Scientist Office of the Scottish Government Health Directorates. Views and opinions expressed are those of the authors and do not necessarily reflect those of the Chief Scientist Office, National Institute for Health Research Health Technology Assessment Programme, or the Department of Health. None of the funders had a role in the design or conduct of this researchPeer reviewedPostprin

Autoclinimetría aplicada colectivamente en pacientes Latinoamericanos con Artritis Reumatoide

Para aplicar esquemas terapéuticos como la terapia de control estrecho en pacientes con Artritis Reumatoide (AR), Es necesario contar con mediciones objetivas de la actividad de la enfermedad. Para esto se han creado las herramientas de clinimetría. Las hay desarrollados con mediciones hechas por el médico, como elDAS28, el SDAI y el CDAI ó realizadas mediante cuestionario auto administrados, como los RAPID, producto del cuestionario R808-NP2-Spanish, ó el esquema SAI para auto conteo articular. Existen dudas respecto a la validez del cuestionario R808-NP2-Spanish, en pacientes de origen hispánico.\ud Objetivo: Estipular el grado de asociación existente, entre las medidas de actividad de la Artritis reumatoide (AR), producidas mediante las herramientas de clinimetria auto-administradas, (cuestionario R808 - Np2- Spanish y esquema SAI), con las mediciones de clinimetria producidas mediante las mediciones realizadas por el personal médico entrenado y marcadores inflamatorios(DAS28 PCR, CDAI, SDAI), cuando dichas herramientas se aplican de forma colectiva a un grupo de pacientes latinoamericanos con AR.\ud Métodos y Resultados: Este fue un estudio de corte trasversal en el que se analizaron 130 pacientes con AR, mediante los RAPID, el DAS28PCR el CDAI y el SDAI. Se encontraron variabilidades compartidaentre los RAPID y el CDAI y SDAI mayor al 50% (p<0,0001) y un kappa de 0,76; 0,74 y 0,61 entre DAS28 PCR 4V y los RAPID 3, 4 y 5 (p<0,000); un kappa de 0,54; 0,57 y 0,69 entre el CDAI y los RAPID 3, 4 y 5 (p<0,000) y un kappa de 0,49; 0,50 y 0,63 entre el SDAI y los RAPID 3, 4 y 5 (p<0,000).\ud Conclusión: El origen hispanoamericano no parece afectar la validez de los RAPID ni de los auto-conteos articulares por el esquema SAI.To apply therapeutic regimens such as tight control therapy in patients with rheumatoid arthritis (RA), is necessary to have objective measures of disease activity. For this reason clinimetry tools have created. Some of them are developed with measurements made by the doctor, like the DAS28, SDAI and the CDAI. Other trough self-administered questionnaire as the RAPID index, from the questionnaire R808-NP2 Spanish, or the self-assessment joint count using the SAI-form. There are some doubts about the validity of the questionnaire R808-NP2-Spanish, in patients of Hispanic origin.\ud Objective: To evaluate the degree of association between the Rheumatoid Arthritis activity measures developed through self-assessment tools (R808 - Np2- Spanish questionnaire and SAI scheme), with those developed depending on physician and laboratory measures (DAS28 CRP 3V, 4V DAS 28 CRP, SDAI and CDAI), when those tools are applied collectively to a group of Latin American patients with Rheumatoid Arthritis. \ud Methods and Results: This was a cross sectional study. 130 patients with RA were analyzed, using the RAPID, the DAS28PCR the CDAI and SDAI. Shared variability were greater than 50% between RAPID and SDAI and CDAI (p <0.0001); a kappa index of 0.76, 0.74 and 0.61 between DAS28 and RAPID PCR 4V 3, 4 and 5 (p <0.000), a kappa of 0.54, 0.57 and 0.69 between the CDAI and RAPID 3, 4 and 5 (p <0.000) and a kappa of 0.49, 0.50 and 0, 63 between the SDAI and RAPID 3, 4 and 5 (p <0.000).\ud Conclusion Hispanic origin does not seem to impair the validity of the RAPIDs to evaluate RA disease activity index

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)