Novel system for distant assessment of cataract surgical quality in rural China. (13th May 2015)

• Record Type: Journal Article
• Authors: Wang, Lanhua; Xu, Danping; Liu, Bin; Jin, Ling; Wang, Decai; He, Mingguang; Congdon, Nathan G; Huang, Wenyong
• Is Part Of: Clinical & experimental ophthalmology. Volume 43:Number 7(2015)
• Page Start: 621
• Page End: 628
• Publication Date: 2015-05-13
• Subjects: Ophthalmology -- Periodicals; 617.7
• DOI: 10.1111/ceo.12524
• Languages: English
• ISSNs: 1442-6404

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="ceo12524-sec-0001" sec-type="section"> <title>Background</title> <p>This study aims to assess the quality of various steps of manual small incision cataract surgery and predictors of quality, using video recordings.</p> </sec> <sec id="ceo12524-sec-0002" sec-type="section"> <title>Design</title> <p>This paper applies a retrospective study.</p> </sec> <sec id="ceo12524-sec-0003" sec-type="section"> <title>Participants</title> <p>Fifty‐two trainees participated in a hands‐on small incision cataract surgery training programme at rural Chinese hospitals.</p> </sec> <sec id="ceo12524-sec-0004" sec-type="section"> <title>Methods</title> <p>Trainees provided one video each recorded by a tripod‐mounted digital recorder after completing a one‐week theoretical course and hands‐on training monitored by expert trainers. Videos were graded by two different experts, using a 4‐point scale developed by the International Council of Ophthalmology for each of 12 surgical steps and six global factors. Grades ranged from 2 (worst) to 5 (best), with a score of 0 if the step was performed by trainers.</p> </sec> <sec id="ceo12524-sec-0005" sec-type="section"> <title>Main Outcome Measures</title> <p>Mean score for the performance of each cataract surgical step rated by trainers.</p> </sec> <sec id="ceo12524-sec-0006" sec-type="section"> <title>Results</title> <p>Videos and data were available for 49/52 trainees (94.2%, median age 38 years, 16.3% women and 77.5% completing > 50 training cases). The majority (53.1%, 26/49) had performed ≤ 50 cataract surgeries prior to training. Kappa was 0.57∼0.98 for the steps (mean 0.85). Poorest‐rated steps were draping the surgical field (mean ± standard deviation = 3.27 ± 0.78), hydro‐dissection (3.88 ± 1.22) and wound closure (3.92 ± 1.03), and top‐rated steps were insertion of viscoelastic (4.96 ± 0.20) and anterior chamber entry (4.69 ± 0.74). In linear regression models, higher total score was associated with younger age (<italic>P</italic> = 0.015) and having performed >50 independent manual small incision cases (<italic>P</italic> = 0.039).</p> </sec> <sec id="ceo12524-sec-0007" sec-type="section"> <title>Conclusions</title> <p>More training should be given to preoperative draping, which is poorly performed and crucial in preventing infection. Surgical experience improves ratings.</p> </sec> </abstract>