Cataract surgery redesign : meeting increasing demand, training, audit and patient-centered care

Objective: The demand for cataract surgery in Fife (a well-defined region in southeast Scotland) was steadily increasing over 15 years. Cataract surgery was therefore being outsourced to meet demand with consequences on list mix, training needs, patient experience and staff morale. We aimed to redesign our services to meet local demand, retain a patient-centered service and continue to fulfil training needs. Methods: We quantified cataract surgery delivery over an 18-month period: before, during and after redesign of services. We studied numbers of operations, trainee cases and number of outsourced cases. We also considered the economic implications of the redesign. Results: We studied three periods (each of six months duration): before redesign (BR), redesign period (RP) and post-redesign (PR). Data were collected on total operation numbers, number of cases performed by trainees, and numbers performed out with normal working hours (weekend lists) and external providers. An economic analysis examined the cost of outsourcing cataracts during BR and RP and the costs of the redesign, including building, equipment and additional nursing staff. Conclusion: Regional fulfilment of cataract surgery provision remains a continuous challenge within the NHS. We show that with minimal investment, smart redesign process and collaborative working, increased local provision is possible while fulfilling trainee needs and achieving the necessary clinical audits and national standards.Publisher PDFPeer reviewe

Caracterización de la fibrilación auricular y riesgo tromboembólico en pacientes del Hospital León Cuervo Rubio

Introduction: among cardiac pathologies, atrial fibrillation is related to a high incidence of thromboembolic diseases. Objective: to clinically and epidemiologically characterize atrial fibrillation and thromboembolic risk in patients attended at the León Cuervo Rubio Hospital in Pinar del Río between 2017 and 2019. Methods: an observational, descriptive, cross-sectional, descriptive study was conducted on patients with atrial fibrillation attended at the León Cuervo Rubio Hospital in Pinar del Río from 2017 to 2019. The study universe consisted of 198 patients diagnosed with atrial arrhythmias in that hospital, the sample was constituted by 68 patients who met the inclusion and exclusion criteria. Results: female sex predominated (58.8%). The most representative age group was 75 to 85 years old (45.5 %). Some type of heart disease associated with atrial fibrillation was present in 69.1% of patients. Persistent atrial fibrillation predominated (35.2%). Palpitations predominated as symptoms of atrial fibrillation (91.1%). Most patients with atrial fibrillation were in the moderate thromboembolic risk category (66.1%). Conclusions: the predominant sex was female, the most affected age group was over 85 years, ischemic heart disease was the most prevalent history, persistent atrial fibrillation was the most frequent, palpitations were the main symptom, and according to the thromboembolic risk category, most patients were at moderate risk.Introducción: dentro de las patologías cardiacas, la fibrilación auricular se relaciona con una alta incidencia de enfermedades tromboembólicas. Objetivo: caracterizar clínica y epidemiológicamente la fibrilación auricular y el riesgo tromboembólico en pacientes atendidos en el Hospital León Cuervo Rubio de Pinar del Río entre 2017 y 2019. Método: se realizó un estudio observacional, descriptivo, de corte transversal a pacientes con fibrilación auricular atendidos en el Hospital León Cuervo Rubio de Pinar del Río de 2017 a 2019. El universo de estudio estuvo conformado por 198 pacientes con diagnóstico de arritmias auriculares en dicho hospital, la muestra quedó constituida por 68 pacientes que cumplieron con los criterios de inclusión y exclusión. Resultados: predominó el sexo femenino (58,8 %). El grupo etario más representativo fue el de 75 a 85 años (45,5 %). El 69,1 % presentaban algún tipo de cardiopatía asociada a la fibrilación auricular. Predominó la fibrilación auricular de tipo persistente (35,2 %). Predominaron las palpitaciones como síntomas de la fibrilación auricular (91,1 %). La mayoría de los pacientes con fibrilación auricular estaban en la categoría de riesgo tromboembólico moderado (66,1 %). Conclusiones: el sexo que predominó fue el femenino, el grupo etáreo más afectado fue el de más de 85 años, la cardiopatía isquémica fue el antecedente de mayor prevalencia, la fibrilación auricular de tipo persistente fue la más frecuente, las palpitaciones constituyeron el síntoma principal y según la categoría de riesgo tromboembólico la mayoría de los pacientes presentaban riesgo moderado

Ophthalmology research in the UK’s National Health Service: the structure and performance of the NIHR’s Ophthalmology research portfolio

Purpose- To report on the composition and performance of the portfolio of Ophthalmology research studies in the United Kingdom’s National Institute for Health Research (NIHR) Clinical Research Network (UK CRN). Methods- Ophthalmology studies open to recruitment between 1 April 2010 and 31 March 2018 were classified by: sub-specialty, participant age, gender of Chief Investigator, involvement of genetic investigations, commercial/ non-commercial, interventional/observational design. Frequency distributions for each covariate and temporal variation in recruitment to time and target were analysed. Results- Over 8 years, 137,377 participants were recruited (average of 15,457 participants/year; range: 5485–32,573) with growth by year in proportion of commercial studies and hospital participation in England (76% in 2017/18). Fourteen percent of studies had a genetic component and most studies (82%) included only adults. The majority of studies (41%) enrolled patients with retinal diseases, followed by glaucoma (17%), anterior segment and cataract (13%), and ocular inflammation (6%). Overall, 68% of non-commercial studies and 55% of commercial studies recruited within the anticipated time set by the study and also recruited to or exceeded the target number of participants. Conclusions- High levels of clinical research activity, growth and improved performance have been observed in Ophthalmology in UK over the past 8 years. Some sub-specialties that carry substantial morbidity and a very high burden on NHS services are underrepresented and deserve more patient-centred research. Yet the NIHR and its CRN Ophthalmology National Specialty Group has enabled key steps in achieving the goal of embedding research into every day clinical care