Visual outcome of penetrating keratoplasty, deep anterior lamellar keratoplasty and Descemet membrane endothelial keratoplasty

Purpose: A single-center, cross-sectional study was designed to assess and compare objective and subjective quality of vision of patients intervened with penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). Methods: Forty-six patients previously intervened with PK (22 eyes), DALK (7 eyes) and DMEK (17 eyes) were recruited. Visual evaluation included spherical and cylindrical refraction, distance corrected visual acuity (DCVA), photopic contrast sensitivity (CS), optical quality, measured with the HD Analyzer (objective scattering index [OSI], MTF cut-off and Strehl ratio), and ocular and corneal aberrometry, measured with the KR-1W Wavefront Analyzer. Results: Statistically significant between-group differences were found in age (p = 0.006, DMEK patients were older) and time since surgery (p <. 0.001, longest time for PK patients). No statistically significant differences were found in DCVA between the techniques. Between-group differences were encountered in CS at 12 (p = 0.007) and 18 (p <. 0.001) cycles per degree, with DMEK and DALK obtaining the best and worst outcomes, respectively. Differences in optical quality were found between the techniques (OSI, p = 0.004; MTF cut-off, p = 0.048; Strehl ratio p = 0.022), with DMEK displaying the best outcomes. Highest and lowest values in ocular and corneal aberrations were for DALK and DMEK patients, respectively. Between-group differences were found in corneal astigmatism (p <. 0.001; -3.31. ±. 2.00 D in PK; -2.68. ±. 0.94 D in DALK; -1.09. ±. 0.62 D in DMEK). Conclusion: Overall, DMEK proved superior over PK and DALK in terms of quality of vision, with PK offering slightly better outcomes than DALK in most visual function parameters under evaluation.Preprin

Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease

<p>Abstract</p> <p>Background</p> <p>The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients.</p> <p>Methods/Design</p> <p>A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts.</p> <p>Discussion</p> <p>The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases.</p

Visual outcome of penetrating keratoplasty, deep anterior lamellar keratoplasty and Descemet membrane endothelial keratoplasty

A single-center, cross-sectional study was designed to assess and compare objective and subjective quality of vision of patients intervened with penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). Forty-six patients previously intervened with PK (22 eyes), DALK (7 eyes) and DMEK (17 eyes) were recruited. Visual evaluation included spherical and cylindrical refraction, distance corrected visual acuity (DCVA), photopic contrast sensitivity (CS), optical quality, measured with the HD Analyzer (objective scattering index [OSI], MTF cut-off and Strehl ratio), and ocular and corneal aberrometry, measured with the KR-1W Wavefront Analyzer. Statistically significant between-group differences were found in age (p = 0.006, DMEK patients were older) and time since surgery (p < 0.001, longest time for PK patients). No statistically significant differences were found in DCVA between the techniques. Between-group differences were encountered in CS at 12 (p = 0.007) and 18 (p < 0.001) cycles per degree, with DMEK and DALK obtaining the best and worst outcomes, respectively. Differences in optical quality were found between the techniques (OSI, p = 0.004; MTF cut-off, p = 0.048; Strehl ratio p = 0.022), with DMEK displaying the best outcomes. Highest and lowest values in ocular and corneal aberrations were for DALK and DMEK patients, respectively. Between-group differences were found in corneal astigmatism (p < 0.001; −3.31 ± 2.00 D in PK; −2.68 ± 0.94 D in DALK; −1.09 ± 0.62 D in DMEK). Overall, DMEK proved superior over PK and DALK in terms of quality of vision, with PK offering slightly better outcomes than DALK in most visual function parameters under evaluation

Visual outcome of penetrating keratoplasty, deep anterior lamellar keratoplasty and Descemet membrane endothelial keratoplasty

Purpose: A single-center, cross-sectional study was designed to assess and compare objective and subjective quality of vision of patients intervened with penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). Methods: Forty-six patients previously intervened with PK (22 eyes), DALK (7 eyes) and DMEK (17 eyes) were recruited. Visual evaluation included spherical and cylindrical refraction, distance corrected visual acuity (DCVA), photopic contrast sensitivity (CS), optical quality, measured with the HD Analyzer (objective scattering index [OSI], MTF cut-off and Strehl ratio), and ocular and corneal aberrometry, measured with the KR-1W Wavefront Analyzer. Results: Statistically significant between-group differences were found in age (p = 0.006, DMEK patients were older) and time since surgery (p <. 0.001, longest time for PK patients). No statistically significant differences were found in DCVA between the techniques. Between-group differences were encountered in CS at 12 (p = 0.007) and 18 (p <. 0.001) cycles per degree, with DMEK and DALK obtaining the best and worst outcomes, respectively. Differences in optical quality were found between the techniques (OSI, p = 0.004; MTF cut-off, p = 0.048; Strehl ratio p = 0.022), with DMEK displaying the best outcomes. Highest and lowest values in ocular and corneal aberrations were for DALK and DMEK patients, respectively. Between-group differences were found in corneal astigmatism (p <. 0.001; -3.31. ±. 2.00 D in PK; -2.68. ±. 0.94 D in DALK; -1.09. ±. 0.62 D in DMEK). Conclusion: Overall, DMEK proved superior over PK and DALK in terms of quality of vision, with PK offering slightly better outcomes than DALK in most visual function parameters under evaluation

Informe sobre bon govern i transparència administrativa

El Departament de Justícia ha proveït el Grup de Treball amb el suport necessari per a la realització de les seves funcion