3 research outputs found
The Importance Of Ocular Ultrasonography In The Preoperative Evaluation Of Patients With Mature Cataract [importância Da Ultra-sonografia Ocular Na Avaliação Pré-operatória De Pacientes Com Catarata Total]
With the new techniques of cataract surgery visual success has increased and it became necessary to foresee undesirable postoperative results regarding visual acuity. Purpose: To verify the role of ocular ultrasonography in the preoperative evaluation of patients with mature cataract searching for posterior segment pathologies that may affect surgical results, their prevalence and the main associated risk factors. Methods: A retrospective study was performed analyzing records of 262 patients indicated for ocular ultrasonography because the presence of mature cataract, thus preventing fundoscopic evaluation of the posterior segment. It was also tried to associate the presence of those changes with sex, age, race, history of ocular trauma, systemic and ocular diseases and the presence of cataract in the contralateral eye. Results: Ecographic changes were found in 24.8% of the examinations performed between 1996 and 2001, of which retinal detachment and vitreous condensations were the most common, with 9.9% of the findings for each. Conclusions: Among the risk factors pointed out as predisposing to findings in ocular ultrasonography, uveitis was the only statistically significant element. It was not possible to correlate positively the described posterior segment pathology to ocular trauma using obtained data.6713336Anteb II, Y., Blumenthal, E.Z., Zamir, E., Waindim, P., The role of preoperative ultrasonography for patients with dense cataract: A retrospective study of 509 cases (1998) Ophthalmic Surg Lasers, 29, pp. 114-118Datiles, M.B., Lasa, M.S., Freidlin, V., A longitudinal study of cortical cataracts using retroillumination photographs (1996) Curr Eye Res, 15, pp. 53-61Barret, B.T., Davison, P.A., Eustace, P., Clinical comparison of three techniques for evaluating visual function behind cataract (1995) Eye, 9 (PART. 6), pp. 722-727Haile, M., Mengistu, Z., B-scan ultrasonography in ophthalmic diseases (1996) East Afr Med, 73, pp. 703-707Hurst, M.A., Douthwaite, W.A., Assessing vision behind cataract: A review of methods (1993) Optom Vis Sci, 70, pp. 903-913Fielding, J.A., Imaging the eye with ultrasound (1992) Br J Hosp Med, 47, pp. 805-815Conover, W.J., (1971) Practical Nonparametric Statistics, , New York: John Wiley & SonsFleis, J.L., (1981) Statistical Methods for Rates and Proportions, , 2aed. New YorkJohn Wiley &SonsHosmer, D.W., Lemeshow, S., (1988) Applied Logistic Regression, , New York: John Wiley & SonsCorrêa, Z.M.S., Goldhardt, R., Marcon, A.S., Marcon, I.M., Achados ecográficos em pacientes com catarata total (2002) Arq Bras Oftalmol, 65, pp. 609-61
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 < 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)