4 research outputs found
Étude de l'efficacité et du workflow de la chirurgie de la cataracte assistée par laser femtoseconde dans un hôpital public espagnol
Background. – To assess the time-efficiency of a designated operating room (OR) workflow in the introduction of femtosecond laser-assisted cataract surgery (FLACS, LenSx, Alcon®). The study was carried out in a public hospital a with high-volume of procedures. Methods. – We performed this prospective, controlled, surgical intervention study in the ophthalmology department of a Spanish tertiary referral public hospital. A total of 167 eyes were enrolled, including 62 eyes undergoing conventional phacoemulsification surgery. In phase I, patients were assigned either to FLACS-I (n = 63) or conventional phacoemulsification surgery (n = 62). One surgeon operated the femtosecond laser, and another completed the procedure, while a third performed conventional phacoemulsification. In the second phase (FLACS-II), all the surgeries were FLACS (n = 42). One surgeon performed the FLACS procedure, and two different surgeons completed the surgeries in separate ORs. Surgical and turnover times of all the patients were recorded. Results. – Preparation time was statistically significantly lower in FLACS-I and FLACS-II (P < 0.001), whereas the duration of the cataract procedure per se was higher in FLACS-II compared to conventional phacoemulsification (P = 0.03). Phacoemulsification energy was higher in FLACS-II compared to FLACS-I (P = 0.01), whereas laser-related surgical time was lower (P = 0.001). Surgical complications and total surgical time showed no statistically significant differences between any of the three groups. Conclusions. – This study suggests a time-efficient and suitable workflow model for FLACS, considering the specific requirements and restrictions of a fully booked public hospital. Even so, we have shown that the FLACS procedure does not take longer than conventional phacoemulsification when following a detailed plan for OR workflow. In addition, our data reflect an improvement in FLACS surgical times with ongoing experience. Trial registration. – NCT03931629 (retrospectively registered).Contexte. – Évaluer le gain de temps d’un flux de travail en salle d’opĂ©ration dĂ©signĂ©e (RO) dans l’introduction de la chirurgie de la cataracte assistĂ©e par laser femtoseconde (FLACS, LenSx, Alcon®). L’étude a Ă©tĂ© rĂ©alisĂ©e dans un hĂ´pital public avec un volume Ă©levĂ© de procĂ©dures. MĂ©thodes. – Nous avons rĂ©alisĂ© cette Ă©tude d’intervention chirurgicale prospective et contrĂ´lĂ©e dans le service d’ophtalmologie d’un hĂ´pital public espagnol de rĂ©fĂ©rence tertiaire. Un total de 167 yeux ont Ă©tĂ© inclus, dont 62 yeux subissant une chirurgie conventionnelle de phacoĂ©mulsification. Dans la phase I, les patients ont Ă©tĂ© assignĂ©s soit Ă FLACS-I (n = 63) soit Ă une chirurgie de phacoĂ©mulsification conventionnelle (n = 62). Un chirurgien a opĂ©rĂ© le laser femto-seconde, un autre a terminĂ© l’intervention, tandis qu’un autre a rĂ©alisĂ© une phacoĂ©mulsification conventionnelle. Dans la deuxième phase (FLACS-II), toutes les chirurgies Ă©taient des FLACS (n = 42). Un chirurgien a effectuĂ© la procĂ©dure FLACS et deux chirurgiens diffĂ©rents ont effectuĂ© les chirurgies dans des salles d’opĂ©ration sĂ©parĂ©es. Les temps de chirurgie et de roll-over de tous les patients ont Ă©tĂ© enregistrĂ©s RĂ©sultats. – Le temps de prĂ©paration Ă©tait statistiquement significativement infĂ©rieur dans FLACS-I et FLACS-II (p <0,001) alors que le temps de la procĂ©dure de la cataracte en soi Ă©tait plus Ă©levĂ© dans FLACS-II par rapport Ă la phacoĂ©mulsification conventionnelle (p = 0,03). L'Ă©nergie de phacoĂ©mulsification Ă©tait plus Ă©levĂ©e dans FLACS-II par rapport Ă FLACS-I (p = 0,01) alors que le temps chirurgical liĂ© au laser Ă©tait plus faible (p = 0,001). Les complications chirurgicales et le temps chirurgical total n’ont montrĂ© aucune diffĂ©rence statistiquement significative entre les trois groupes. Conclusion. – Cette Ă©tude suggère un modèle de flux de travail efficace et appropriĂ© pour le FLACS compte tenu des exigences et des restrictions spĂ©cifiques d’un hĂ´pital public saturĂ©. MalgrĂ© cela, nous avons montrĂ© que la procĂ©dure FLACS ne prend pas plus de temps que la phacoĂ©mulsification conventionnelle après une planification dĂ©taillĂ©e du flux de travail de la salle d’opĂ©ration. De plus, nos donnĂ©es reflètent une amĂ©lioration des temps chirurgicaux dans les FLACS avec une expĂ©rience continue. Enregistrement de l’essai. – NCT03931629 (enregistrĂ© rĂ©trospectivement).Marina RodrĂguez-Calvo-de-Mora, Cristina PĂ©rez-Casaseca, Emilio Espejo-de-los-Riscos and Gustavo Fernández-Baca-Vaca G received an Investigator Initiatied Trial from Alcon
Efficacy of Anakinra in Refractory Adult-Onset Still's Disease: Multicenter Study of 41 Patients and Literature Review
Adult-onset Still's disease (AOSD) is often refractory to standard therapy. Anakinra (ANK), an interleukin-1 receptor antagonist, has demonstrated efficacy in single cases and small series of AOSD. We assessed the efficacy of ANK in a series of AOSD patients. Multicenter retrospective open-label study. ANK was used due to lack of efficacy to standard synthetic immunosuppressive drugs and in some cases also to at least 1 biologic agent. Forty-one patients (26 women/15 men) were recruited. They had a mean age of 34.4 ± 14 years and a median [interquartile range (IQR)] AOSD duration of 3.5 [2-6] years before ANK onset. At that time the most common clinical features were joint manifestations 87.8%, fever 78%, and cutaneous rash 58.5%. ANK yielded rapid and maintained clinical and laboratory improvement. After 1 year of therapy, the frequency of joint and cutaneous manifestations had decreased to 41.5% and to 7.3% respectively, fever from 78% to 14.6%, anemia from 56.1% to 9.8%, and lymphadenopathy from 26.8% to 4.9%. A dramatic improvement of laboratory parameters was also achieved. The median [IQR] prednisone dose was also reduced from 20 [11.3-47.5] mg/day at ANK onset to 5 [0-10] at 12 months. After a median [IQR] follow-up of 16 [5-50] months, the most important side effects were cutaneous manifestations (n = 8), mild leukopenia (n = 3), myopathy (n = 1), and infections (n = 5). ANK is associated with rapid and maintained clinical and laboratory improvement, even in nonresponders to other biologic agents. However, joint manifestations are more refractory than the systemic manifestations
Efficacy of Anakinra in Refractory Adult-Onset Still's Disease: Multicenter Study of 41 Patients and Literature Review.
Adult-onset Still's disease (AOSD) is often refractory to standard therapy. Anakinra (ANK), an interleukin-1 receptor antagonist, has demonstrated efficacy in single cases and small series of AOSD. We assessed the efficacy of ANK in a series of AOSD patients.Multicenter retrospective open-label study. ANK was used due to lack of efficacy to standard synthetic immunosuppressive drugs and in some cases also to at least 1 biologic agent.Forty-one patients (26women/15 men) were recruited. They had a mean age of 34.414 years and a median [interquartile range (IQR)] AOSD duration of 3.5 [2-6] years before ANK onset. At that time the most common clinical features were joint manifestations 87.8%, fever 78%, and cutaneous rash 58.5%. ANK yielded rapid and maintained clinical and laboratory improvement. After 1 year of therapy, the frequency of joint and cutaneous manifestations had decreased to 41.5% and to 7.3% respectively, fever from 78% to 14.6%, anemia from 56.1% to 9.8%, and lymphadenopathy from 26.8% to 4.9%. A dramatic improvement of laboratory parameters was also achieved. The median [IQR] prednisone dose was also reduced from 20 [11.3-47.5] mg/day at ANK onset to 5 [0-10] at 12 months. After a median [IQR] follow-up of 16 [5-50] months, the most important side effects were cutaneous manifestations (n=8), mild leukopenia (n=3), myopathy (n=1), and infections (n=5).ANK is associated with rapid and maintained clinical and laboratory improvement, even in nonresponders to other biologic agents. However, joint manifestations are more refractory than the systemic manifestations
Efficacy of Anakinra in Refractory Adult-Onset Still's Disease: Multicenter Study of 41 Patients and Literature Review.
Adult-onset Still's disease (AOSD) is often refractory to standard therapy. Anakinra (ANK), an interleukin-1 receptor antagonist, has demonstrated efficacy in single cases and small series of AOSD. We assessed the efficacy of ANK in a series of AOSD patients.Multicenter retrospective open-label study. ANK was used due to lack of efficacy to standard synthetic immunosuppressive drugs and in some cases also to at least 1 biologic agent.Forty-one patients (26women/15 men) were recruited. They had a mean age of 34.414 years and a median [interquartile range (IQR)] AOSD duration of 3.5 [2-6] years before ANK onset. At that time the most common clinical features were joint manifestations 87.8%, fever 78%, and cutaneous rash 58.5%. ANK yielded rapid and maintained clinical and laboratory improvement. After 1 year of therapy, the frequency of joint and cutaneous manifestations had decreased to 41.5% and to 7.3% respectively, fever from 78% to 14.6%, anemia from 56.1% to 9.8%, and lymphadenopathy from 26.8% to 4.9%. A dramatic improvement of laboratory parameters was also achieved. The median [IQR] prednisone dose was also reduced from 20 [11.3-47.5] mg/day at ANK onset to 5 [0-10] at 12 months. After a median [IQR] follow-up of 16 [5-50] months, the most important side effects were cutaneous manifestations (n=8), mild leukopenia (n=3), myopathy (n=1), and infections (n=5).ANK is associated with rapid and maintained clinical and laboratory improvement, even in nonresponders to other biologic agents. However, joint manifestations are more refractory than the systemic manifestations