Strategies for improving quality and safety in global health:Lessons from nontechnical skills for surgery implementation in rwanda

The Non-Technical Skills for Surgeons (NOTSS) framework is a taxonomy of cognitive and social skills that foster expertise and medical knowledge in the operating room. This framework can be used as a method to improve the quality of surgical care in global efforts to improve access to affordable surgery

Transient Electroretinographic Changes during Light-Induced Amaurosis in Severe Carotid Artery Stenosis Measured with a Novel Portable Handheld Device

Purpose Light-induced amaurosis is a symptom suggestive of reduced oxygenation of the RPE-outer retina resulting mostly from severe ipsilateral internal carotid artery stenosis or occlusion. We report the transient electroretinographic changes following light exposure in a patient with unilateral chronic ocular ischemic syndrome due to severe carotid artery stenosis using a novel portable hand-held electroretinography (ERG) device. Methods A 67 year old man complained of light-induced amaurosis. Ocular examination revealed extensive peripheral retinal ischemia and a severe ipsilateral internal carotid artery stenosis was found. Due to the extent of retinal ischemia, laser photocoagulation was planned. Photopic ERG (RETeval, LKC Technologies, Gaithersburg, MD) was recorded before and after 3-minute laser photocoagulation, as well as 15 minutes after photocoagulation. The interocular variation of amplitudes and implicit times of the flicker photopic b wave was examined. Electroretinographic changes were measured using a novel handheld ERG diagnostic instrument that makes it possible to record ERGs rapidly and less invasively than the conventional ERG, using adhesive skin electrodes. Results Before light exposure, visual acuity was 0.6 in the right and 0.4 in the left eye, and there was an interocular asymmetry in the photopic ERG. Following 3 minute of light exposure (photocoagulation), left eye vision was absent (absolute scotoma) and left photopic ERG was significantly reduced. Vision slowly recovered in the left eye over 15 minutes, at which time both vision and photopic ERG had recovered to pre-illumination values. Otherwise, slit lamp examination, intraocular pressure and fundus examination showed no changes following light exposure. Conclusion Conventional full-field ERG may be cumbersome, due to the equipment size and the use of either contact lens or corneal wire electrodes. The availability of a handheld portable stimulator and the use of adhesive skin electrodes allow the clinician to perform rapid ERG assessment, when conventional ERG would be difficult to perform. Our case demonstrated for the first time that the light-induced transient visual loss in a patient with a chronic ocular ischemic syndrome was correlated to a transient reduction of ERG activity

Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up

Aim To report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with pseudoexfoliative glaucoma (PXG). Methods Prospective, interventional, non-comparative case series. A total of 103 eyes from 84 patients with PXG were enrolled to undergo a 360-degree ab interno trabeculotomy with gonioscopic assistance using either a 5.0 polypropylene suture or an illuminated microcatheter with up to 24 months of follow-up. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥20% from baseline or IOP between 6 and 21 mm Hg, without further glaucoma surgery) and complication rate. Results Mean preoperative IOP was 27.1 mm Hg (95% CI 25.5 to 28.7) using 2.9 (SD 1.1) glaucoma medications which decreased postoperatively to 13.0 mm Hg (95% CI 11.5 to 14.4) and 1.0 (SD 1.1) medications at 24 months (p\u3c0.001). Success rate was 89.2% at 24 months of follow-up, and complication rate was 2.9%. Conclusion At 24 months of follow-up, our results for GATT in PXG demonstrate that this conjunctival sparing procedure effectively lowers IOP and reduces the medications with a low complication rate, in this relatively aggressive glaucoma subtype