The influence of standards and clinical guidelines on prosthetic and orthotic service quality : a scoping review

OBJECTIVES: Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?" MATERIALS AND METHODS: A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. RESULTS: Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. DISCUSSION AND CONCLUSION: Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery

A five-year retrospective study of the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in a Mediterranean area

<p>Abstract</p> <p>Background</p> <p>To determine the epidemiological characteristics and visual outcome of ocular trauma in southern Italy.</p> <p>Methods</p> <p>All cases of ocular trauma admitted to Department of Ophthalmology of Palermo University, Italy, from January 2001–December 2005 were retrospectively reviewed for open- or closed-globe injury (OGI or CGI). Data extracted included age, sex, residence, initial and final visual acuity (VA), cause and treatment of injury, hospitalization. The injuries were classified by Ocular Trauma Classification System (OTCS) and Birmingham Eye Trauma Terminology (BETT). We also referred to the Ocular Trauma Score (OTS) in evaluating the final visual outcome.</p> <p>Results</p> <p>Of the 298 eyes, there were 146 OGI and 152 CGI. Fifty eyes (16.8%) had an intraocular foreign body (IOFB). The annual incidence of eye injuries was 4.9 per 100,000. Most injuries occurred in men (84.6%, p < 0.0005), with an average age of 33.0 vs. 49.9 for women (p = 0.005). Cause of injury differed significantly by gender (p = 0.001) and urban vs. rural location (p = 0.009). The most frequent causes in men were outdoor activities related injuries (30.9%), work-related (25.4%), and sport-related (17.5%), and in women were home-related (52.2%) and outdoor activities related injuries (30.4%). In urban areas, road accidents were more frequent; in rural areas, work-related injuries were more frequent with a greater rate of IOFBs than in urban areas (p = 0.002).</p> <p>The incidence of OGI and CGI differed in work-related injuries (p < 0.0005), sport-related injuries (p < 0.0005), and assaults (p = 0.033). The final visual acuity was 20/40 (6/12) or better in 144 eyes (48.3%), 20/40–20/200 (6/12–6/60) in 90 eyes (30.2%), and <20/200 (6/60) or less in 46 eyes (15.5%). Eighteen eyes (6%) had a final acuity of no light perception. Of those eyes that presented with hand motion vision or better, 220 (86.6%) had a final vision of better than 20/200 (6/60). Initial visual acuity was found to be correlated with final visual acuity (Spearman's correlation coefficient = 0.658; p < 0.001). The likelihood of the final visual acuities in the OTS categories was correlated to that of the OTS study group in 12 of 14 cases (85.7%).</p> <p>Conclusion</p> <p>This analysis provides insight into the epidemiology of patients hospitalized for ocular trauma. The findings indicate that ocular trauma is a significant cause of visual loss in this population.</p

Characteristics and causes of penetrating eye injuries reported to the National Eye Trauma System Registry, 1985-91.

Ocular trauma is one of the most important preventable causes of visual impairment. The National Eye Trauma System was developed to provide optimal clinical care for severe ocular injuries, to foster research on eye injury, and to increase awareness of ocular trauma as a public health problem. From 1985 through 1991, the National Eye Trauma System Registry collected data on 2,939 cases of penetrating eye injury reported by ophthalmologists at 48 collaborating eye trauma centers in 28 States and Washington, DC. Eighty-three percent of the cases involved men; the median age of the patients was 27 years, ranging from 1 to 92 years of age. Seventy-seven percent of the injuries were unintentional, 22 percent were the result of assault, and 1 percent were self-inflicted. In 62 percent of the cases studied, the injured person's initial best corrected visual acuity in the injured eye was the ability to perceive hand motion, or worse. The settings in which the injuries occurred included the home (28 percent), the worksite (21 percent), at recreation (11 percent), and in transportation (8 percent). At the time of the injury, 1.5 percent of the injured persons were wearing safety glasses and 2.9 percent were wearing nonsafety glasses. There was evidence of definite or possible alcohol use by at least 24 percent of the injured persons and illicit drug use by 8 percent. The most frequent types of tissue damage included corneal or scleral laceration, traumatic cataract, intraocular foreign body, vitreous hemorrhage, and prolapse of intraocular tissue.(ABSTRACT TRUNCATED AT 250 WORDS

Characteristics and causes of penetrating eye injuries reported to the National Eye Trauma System Registry, 1985-91

Ocular trauma is one of the most important preventable causes of visual impairment. The National Eye Trauma System was developed to provide optimal clinical care for severe ocular injuries, to foster research on eye injury, and to increase awareness of ocular trauma as a public health problem. From 1985 through 1991, the National Eye Trauma System Registry collected data on 2,939 cases of penetrating eye injury reported by ophthalmologists at 48 collaborating eye trauma centers in 28 States and Washington, DC. Eighty- three percent of the cases involved men; the median age of the patients was 27 years, ranging from 1 to 92 years of age. Seventy-seven percent of the injuries were unintentional, 22 percent were the result of assault, and 1 percent were self-inflicted. In 62 percent of the cases studied, the injured person\u27s initial best corrected visual acuity in the injured eye was the ability to perceive hand motion, or worse. The settings in which the injuries occurred included the home (28 percent), the worksite (21 percent), at recreation (11 percent), and in transportation (8 percent). At the time of the injury, 1.5 percent of the injured persons were wearing safety glasses and 2.9 percent were wearing nonsafety glasses. There was evidence of definite or possible alcohol use by at least 24 percent of the injured persons and illicit drug use by 8 percent. The most frequent types of tissue damage included corneal or scleral laceration, traumatic cataract, intraocular foreign body, vitreous hemorrhage, and prolapse of intraocular tissue. Analyses of the causes and characteristics of ocular injuries reported to the National Eye Trauma System Registry will help identify high risk settings for such injuries. Results will be used to develop and implement interventions that will reduce the incidence of eye trauma