Cataract surgical outcome at the Vancouver Eye Care Centre: can it be predicted using current data?

BACKGROUND: Patients selected for cataract surgery have an increasingly wider range of coexisting ocular and systemic diseases. The aim of this study was to determine whether preoperative patient characteristics can assist surgeons in identifying patients who are at increased risk of having little or no improvement in visual outcome after cataract surgery. METHODS: We prospectively studied a randomly selected subset (20%) of patients with cataract undergoing cataract extraction at a tertiary centre in Vancouver. There were no patient exclusion criteria. Pre-, intra- and postoperative clinical data were collected from medical records. RESULTS: We studied 1329 cataract surgical procedures from March 1999 to December 2000. Of the 1329, 851 had complete pre- and postoperative visual acuity data. The mean age of the 851 patients was 73.2 (standard deviation 10.6) years, 575 (67.6%) were women, and 472 procedures (55.5%) were first-eye procedures. Preoperatively, the best-corrected visual acuity was 20/40 or better in 146 eyes (17.2%), 20/50 in 173 (20.3%), 20/60 to 20/70 in 248 (29.1%), and 20/80 or worse in 284 (33.4%). Almost half of the patients (419 [49.2%]) had at least one coexisting eye disease in the operated eye. At about 3 months postoperatively, the best-corrected visual acuity had improved in 786 eyes (92.4%), remained the same in 42 (4.9%) and had worsened in 23 (2.7%). Of the 23 eyes with worse visual acuity, half had preoperative visual acuity of 20/40 or better; most of the remaining eyes had preoperative vision of 20/50 to 20/70. Of the 42 eyes with unchanged vision, 22 (52%) had preoperative visual acuity worse than 20/100; the remaining eyes were distributed across the visual acuity range. An increase of 1 year of age increased the odds of having a poor visual acuity outcome by 2% to 4%. Worse preoperative visual acuity predicted an increased likelihood of a poor outcome; this effect increased sharply for eyes with preoperative visual acuity of 20/80 or worse. After adjustment for age and preoperative visual acuity, patients with three or more coexisting eye diseases in the operated eye were 10 to 24 times more likely to have the worst postoperative visual acuity. INTERPRETATION: The presence and number of coexisting ocular diseases, increased age and poor preoperative visual acuity predicted an unchanged or worse visual acuity after cataract surgery.     

Influence of peripheral iridectomy on intravitreous penetration of topical nipradilol

PURPOSE: Penetration of drug from the anterior chamber to the vitreous is substantial in aphakic eyes, but negligible in normal phakic eyes. The purpose of this study is to investigate the effect of the presence of peripheral iridectomy (PI) which bypasses iris-lens diaphragm on the drug penetration from the anterior chamber to the vitreous. METHODS: Twelve Japanese White rabbits underwent PI in a randomly chosen eye and the same procedures except removal of the peripheral iris in the contralateral eye. Nine weeks after the procedure, topical instillation of 20 microl of 1% nipradilol into the both eyes was repeated three times at five-minute intervals, and two hours later the animals were sacrificed and the both eyes were enucleated. Concentrations of nipradilol in the aqueous and vitreous were determined using a high-performance liquid chromatography. RESULTS: The concentrations of nipradilol were significantly greater in the eyes with PI than those in the contralateral control eyes in the aqueous (5636 +/- 1688 vs 2835 +/- 663 ng/g, mean +/- standard error, n = 12, p = 0.0028) and in the anterior vitreous (11.9 +/- 2.5 vs 5.6 +/- 1.0 ng/g, p = 0.0047), while not in the posterior vitreous or in the posterior retina-choroid. The ratios of the nipradilol concentrations in the anterior or posterior vitreous to that in the aqueous were not significantly different between the both eyes. CONCLUSIONS: The presence of PI had little effect on the penetration of topically instilled nipradilol from the anterior chamber to vitreous.     

Comparison of the effects of prophylactic antibiotic therapy and cost-effectiveness between cefazolin (CEZ) and Sulbactam/Ampicillin (SBT/ABPC) in gastric cancer surgery employing clinical pathway

The present study was designed to investigate the effects of prophylactic antibiotic therapy and the cost-effectiveness of Cefazolin (CEZ) and Sulbactam/Ampicillin (SBT/ABPC) in gastric cancer surgery employing clinical pathway. 157 patients (62 in the CEZ group and 95 in the SBT/ABPC group), who underwent surgery for gastric cancer at the First Department of Surgery of our hospital, were investigated. There was no significant difference between the groups with regard to sex, age, incidence of complication, stage of cancer, surgical method, operative time and blood loss, length of hospitalization, the appearance of systemic inflammatory response syndrome (SIRS), changes body temperature, white blood cell count (WBC), C-reactive protein (CRP), or clinical outcome of postoperative care by a nurse during post-operation for 7 days. The prophylactic effect of infection was also no different between the CEZ (69.4%) and SBT/ABPC (69.5%) groups. In contrast, decision analysis strongly indicated that the anticipate cost of antibiotics was higher in the latter group (yen 20402) than in the CEZ group (yen 15556), suggesting that the prophylactic effect of CEZ may be more cost-effective. Thus, evaluations of pharmacotherapy from the aspect of cost may be one of the important responsibility of hospital pharmacists in the future.     

Policy formation in gamete donation and egg sharing in the UK--a critical appraisal

This article considers two key policy documents concerning donor-assisted conception in the UK, The British Fertility Society's Recommendations for Good Practice on the Screening of Egg and Embryo Donors and the Human Fertilisation and Embryology Authority's Guidance for Egg Sharing Arrangements. It discusses both the process and the evidence used in formulating those sections of the documents which relate to donor anonymity. The paper concludes that psycho-social policy developments in assisted conception, such as those relating to donor anonymity, should be subjected to comparable levels of rigour and scrutiny to those that are applied in the formulation of medical and scientific policies.     

The National Rural Faculty Bursary Essay--to promote remote: a positive approach to rural general practice

Australian Family Physician is proud to publish the winning essay in the inaugural National Rural Faculty Bursary, an award offered by the National Rural Faculty (NRF) of The Royal Australian College of General Practitioners to a medical student who is a member of a Rural Health Students Club at an Australian University.     

Tumor-promoting activity and mutagenicity of 5 termiticide compounds

The tumor-promoting activities of 5 commercial compounds used in termiticides were measured by a cell-transformation assay employing Bhas 42 cells. Their initiating activities were also measured by the microsuspension assay employing S. typhimurium TA98 and TA100 strains. The results of the transformation assay confirmed the tumor-promoting activities of fenitrothion, silafluofen and bifenthrin. Furthermore, the mutagenicity of S-421 and fenitrothion were also confirmed. Consideration of 2-stage carcinogenesis suggests that concurrent use of and long-term exposure to these compounds that have tumor-promoting and initiator activity, and compounds exhibiting either type of activity individually should be avoided as much as possible.     

Measuring adolescent drug abuse and psychosocial factors in four ethnic groups of drug-abusing boys

There is an absence of empirical work on the measurement of adolescent drug abuse among non-White ethnic youths. The field would benefit from psychometrically sound measures for ethnic groups. The psychometric properties of a multi-scale assessment tool for adolescent drug abuse, the Personal Experience Inventory (PEI), have been examined largely in White samples. The current study reports reliability and validity data for the PEI across four samples of boys (White, African American, Native American, and Hispanic). The results provide general psychometric support for the non-White groups. The use and limitations of the PEI in different ethnic/racial groups are discussed.