Surgery, like any other international development program, requires careful impact assessment. Monitoring and evaluation has several important benefits, including its ability to assess whether the program is having its desired effect. This information allows surgeons and administrators to identify and improve upon weaknesses in the healthcare delivery system, resulting in better patient care. This assessment also provides effectiveness data to stakeholders. With proper reporting, funders can be confident in the reach of their investment, governments can place their trust in the organization, and patients can rest assured that their doctors are delivering quality care.
While the importance of assessing program effectiveness is clear, the methodology of doing so is far more intricate. Measuring surgical outcomes is especially difﬁcult, “as intervention efﬁcacy is not always immediately apparent, complications are often delayed, and follow-up of patients is limited.” However, with thorough planning and careful execution, surgery providers can achieve high-quality program evaluation, thereby equipping themselves with an indispensable tool for patient care improvement.
This issue of Site News explores the Preoperative and Follow-up condition of Cataract surgical monitoring, Key Performance Indicators and Post-operative complications. It also brings to you Quality and outcome indicators, Surgical complications and details and Immediate postoperative findings.
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Cataract accounts for half of all blindness worldwide. Cataract surgery in the developed world has undergone a revolution over the last 20 years. An operation which required stay in hospital and long visual rehabilitation is now a simple day-care procedure with immediate benefits. It is now a highly effective intervention, restoring visual function and improving quality of life for patients. The very brief post-operative recovery period also is extremely beneficial to the patients. As with any surgery, this procedure also is not devoid of complications. Serious complications include retinal detachment and endophthalmitis. Monitoring the quality of cataract surgery largely depends on accurate assessment of visual outcomes. The quality of outcomes is important in maintaining and enhancing surgical uptake.
This issue of Sitenews reviews papers on several aspects of cataract surgery ranging from preoperative care to handling surgical complications. Childhood cataract and its incidence is also a subject of prime importance in this context. The importance of benchmarking in cataract surgery also has been a topic of several papers discussed here.
- PREOPERATIVE VISUAL ACUITY AMONG CATARACT SURGERY PATIENTS AND COUNTRIES’ STATE OF DEVELOPMENT: A GLOBAL STUDY
The purpose of the study was to assess variations in case mix by place and demographic characteristics, and to describe the relationship between preoperative VA, country development level and national CSRs.
- HOW TO IMPROVE THE OUTCOME OF CATARACT SURGERY
- DOES PROSPECTIVE MONITORING IMPROVE CATARACT SURGERY OUTCOMES IN AFRICA?
This study demonstrates improvement in visual outcome results after cataract surgery over a 1 year period. Monitoring of outcomes appears to be associated with a change in surgeons' attitudes, leading to greater emphasis on appropriate case selection, better management of surgical complications, and improved visual outcomes.
- MONITORING AND VISUAL OUTCOME OF CATARACT SURGERY IN INDIA
The visual outcome following cataract surgery could be monitored on a regular basis by ophthalmologists, using either of the methods evaluated, an exercise which in itself is likely to improve the outcome ofsurgery. When the proportion of poor outcomes is high (>10%) further investigation into the causes is warranted.
- ROUTINE MONITORING OF VISUAL OUTCOME OF CATARACT SURGERY. PART 2: RESULTS FROM EIGHT STUDY CENTRES
To determine whether monitoring of cataract outcome can be implemented as a routine activity in different hospital settings in Africa and Asia, and to assess the impact of routine monitoring.
- MONITORING CATARACT SURGICAL OUTCOME IN A PUBLIC HOSPITAL IN ORLU, SOUTH EAST NIGERIA
To determine the proportion and causes of poor visual outcome of cataract operations done in a public hospital in southeast Nigeria and propose actions to improve the cataract surgical outcome.
- MONITORING CATARACT OUTCOME WITH THE MANUAL TALLY SHEET SYSTEM
The purpose is to assist cataract surgeons and program managers to quantitatively monitor the result of their cataract surgery. Such monitoring is the key to improving the quality and results of our cataract surgery. It is quick, simple and user friendly.
- PREOPERATIVE ASSESSMENT OF A PATIENT WITH CATARACT
The preoperative assessment consists of an
i) ocular and a systemic history
ii) examination and
iii) suitable laboratory investigations
- PRE-OPERATIVE PSYCHIATRIC MORBIDITY IN PEOPLE UNDERGOING CATARACT SURGERY
To examine the impact of depressive symptomatology and cognitive impairment on visual function and symptoms in patients with cataract.
- FREQUENCY AND PREDICTING FACTORS OF SURGICAL COMPLICATIONS IN CATARACT SURGERY PERFORMED UNDER TOPICAL ANAESTHESIA
- THE ROLE OF TESTING IN THE PREOPERATIVE EVALUATION
- CATARACTS IN CHILDHOOD - POSTOPERATIVE MANAGEMENT OF PEDIATRIC CATARACT PATIENTS
This site focuses Postoperative Management of Pediatric Cataract Patients includes medications, refractive management and long-term postoperative conditions to monitor include: Amblyopia, Retinal complications Glaucoma etc.,
- DETERMINATION OF VALID BENCHMARKS FOR OUTCOME INDICATORS IN CATARACT SURGERY: A MULTICENTER, PROSPECTIVE COHORT TRIAL
Increasingly, institutions, third party payers, and the general public are requesting or requiring assessment of the quality of medical procedures and treatment. Payers want to ascertain what they are paying for and compare what they are receiving to established acceptable outcomes or normative "benchmarks." Providers likewise wish to market favorable results for competitive purposes.
- QUALITY AND OUTCOME INDICATORS FOR ACUTE HEALTHCARE SERVICES
The Project wished to: Identify key issues surrounding the use of quality and outcome indicators in a national context Identify key dimensions of quality of care for indicator development and implementation Assess the usefulness of existing indicators for application in the Australian context Advise on future directions for quality and outcome indicator developments
- GUIDELINES FOR QUALITY CATARACT MANAGEMENT
This manual focuses on best practice in managing cataract, is so important. It is extremely practical and will be considerable assistance for surgeons, other ophthalmic staff and programme managers involved in the delivery of cataract surgical centers.
- GUIDELINES FOR THE MANAGEMENT OF CATARACT IN INDIA
The manual deals with all the protocols necessary for preoperative assessment, intra operative procedures and postoperative care for cataract surgery. The manual also deals with the protocols for sterilization and care of instruments and other material required for cataract surgery. A complete section gives the check lists needed at various stages. The thoroughness of the manual in all the aspects shows the amount of hard work that has gone into producing the manual. The aspects of monitoring and surveillance of sterilization procedures and protocols for investigations and management of outbreaks of infection have also received attention.
- GUIDELINES FOR MANAGING POST-CATARACT SURGERY INFLAMMATION: CAN WE REACH A CONSENSUS
The purpose of the guidelines is to enhance the quality, safety, effectiveness and availability of cataract care for the citizens of the United States. The GUIDELINES are intended to establish acurrent consensus, which may be useful to ophthalmologists, other physicians, optometrists, nurses,and other health care practitioners to evaluate the effectiveness and appropriateness of techniques ofprevention, diagnosis, treatment and clinical management of the healthy adult patient with cataracts.
- COMPLICATIONS OF CATARACT SURGERY
In this article, the diagnosis, treatment and prevention of intraoperative and postoperative complications of cataract surgery are discussed. Early recognition and prompt treatment of these problems can minimize the risk of ocular morbidity.
- MEASURING THE VALUE OF CATARACT SURGERY
The standard analytic framework for constructing a cost-of-living index compares the change in expenditure between a base and a reference period needed to deliver a fixed level of utility.' This framework, which relies on a stable, well-defined function relating per period expenditure to prices and utility, has serious limitations for measuring how health-care expenditures affect the cost of living.
- MONITORING CATARACT SURGICAL OUTCOMES
The Cataract Surgery Record (CSR) has to be completed for each eye operated for cataract (if all patients are included in the monitoring of visual outcome) or for patients randomly selected for follow-up. If the same patient is operated at a later date for cataract in the second eye, a new form should be completed for the second operation. Each operated eye should be treated as a separate event.
- IMPORTANCE OF MONITORING CATARACT SURGICAL OUTCOMES
The fact that nearly 20 million persons are currently blind from cataract is a reflection of the lack of access to surgical services for a majority of these persons, even though the knowledge and skills required for applying the technology exist. For this reason intervention against cataract blindness has received priority attention in Vision 2020: The Right to Sight. In this context, the monitoring of the outcome of cataract services in general, and cataract surgery in particular, has become imperative.
- CUSUM: A DYNAMIC TOOL FOR MONITORING COMPETENCY INCATARACT SURGERY PERFORMANCE
A CUSUM analysis was applied to 80 phacoemulsification performed by three ophthalmic trainees and one consultant, for the occurrence of posterior capsular rupture and postoperative refracted vision of worse than 6/12 among patients without pre-existing ocular comorbidity. The CUSUM score of each consecutive procedure performed by an individual surgeon was calculated and charted on CUSUM chart. When trainees’ CUSUM charts showed an unacceptable level of performance, their supervisors would give feedback and impose closer monitoring of subsequent surgeries.
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