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Biomedical subjects

L Bellan

Publications and source records attributed to L Bellan.

16 recordsLinked to original sources
PubMed2001

The Manitoba Cataract Waiting List Program.

This article describes the Manitoba Cataract Waiting List Program. This program uses a centralized database to track and prioritize all patients waiting for cataract surgery. It provides an objective and reliable measure of the length of the wait, and patients on the waiting list are treated in a more equitable fashion through application of a uniform method of prioritization. The program will allow for long-term tracking of quality of care through monitoring of the average length of wait for patients with comparable functional impairment. It will also allow for long-term monitoring of thresholds for surgery. It has brought to light previously undocumented issues, such as the simultaneous booking of both eyes for cataract surgery and variations in waiting time between surgeons.

Cataract Extraction↗
PubMed1999

Intraoperative clinical practice and risk of early complications after cataract extraction in the United States, Canada, Denmark, and Spain.

OBJECTIVE: To examine variation in intraoperative clinical practice and rates of adverse events after cataract surgery across four different healthcare systems. DESIGN: Multicenter cohort study. PARTICIPANTS: Patients were recruited from ophthalmic clinics in the United States (n = 75); in the Province of Manitoba, Canada (n = 12); in Denmark (n = 17); and the City of Barcelona, Spain (n = 10). In all, 1420 patients undergoing first eye cataract surgery were enrolled, with preoperative, perioperative, and postoperative clinical data collected on 1344 patients (95%). MAIN OUTCOME MEASURES: Occurrence of 23 specified intraoperative and early postoperative adverse events was measured. Four-month postoperative visual acuity outcome also was measured. RESULTS: Phacoemulsification was performed in two thirds of the extractions in the United States and Manitoba, in one third in Denmark, and in 3% in Barcelona (P < 0.001). More than 96% of extractions in North America and Denmark were performed with the patient under local anesthesia, whereas general anesthesia was used for 38% of extractions in Barcelona (P < 0.001). Rates of intraoperative adverse events were 11% to 12.8% in Manitoba, Denmark, and Barcelona and significantly lower in the United States (6%), mainly because of a lower rate of capsular rupture (P < 0.01). Significantly higher rates of early postoperative events were seen in the United States (18.8%) and Manitoba (20.4%) compared to Denmark (7.9%) and Barcelona (5%) (P < 0.001). The differences among sites in rates of events could not be explained by differences in recorded patient characteristics or surgical techniques. The occurrence of perioperative events was significantly associated with a worse 4-month visual outcome. CONCLUSION: The observed variation in clinical practice might represent a general trend of a slower diffusion of new medical technology in Europe compared with that of North America. Rates of intraoperative and early postoperative events varied significantly across sites.

Aged↗
PubMed1998

Visual outcomes of cataract surgery in the United States, Canada, Denmark, and Spain. Report From the International Cataract Surgery Outcomes Study.

OBJECTIVE: To compare visual outcomes obtained following cataract surgery in 4 sites in North America and Europe where considerable differences in the organization of care and patterns of clinical practice have been previously described. METHODS: Patients scheduled for first eye-cataract surgery and aged 50 years or older were enrolled consecutively in a prospective multicenter study that collected clinical and patient interview data preoperatively and postoperatively. From the United States, 772 patients were enrolled; from the Province of Manitoba (Canada), 159; from Denmark, 291; and from the City of Barcelona (Spain), 200. Preoperative and 4-month postoperative visual acuity was obtained for 92% of the patients (n = 1291). RESULTS: The mean 4-month postoperative visual acuity of eyes operated on varied significantly across the 4 sites (P < .001) and had the following Snellen decimal fraction measurements: 0.49 in Barcelona, 0.65 in Denmark, 0.66 in Manitoba, and 0.74 in the United States. However, while crude visual acuity outcome figures varied significantly, no significant difference was observed across the 4 sites regarding the risk of poorer visual outcome after controlling for differences in age, preoperative visual acuity, and general health status for patients with no ocular comorbidity. Older age, poorer preoperative visual acuity, poorer preoperative general health status, and coexisting ocular comorbidity were predictors of a poorer visual outcome. CONCLUSION: A previously identified variation in treatment modalities across the 4 sites did not seem to affect patients' visual acuity outcomes.

Aged↗
PubMed1998

Variation in indications for cataract surgery in the United States, Denmark, Canada, and Spain: results from the International Cataract Surgery Outcomes Study.

BACKGROUND/AIMS: International comparisons of clinical practice may help in assessing the magnitude and possible causes of variation in cross national healthcare utilisation. With this aim, the indications for cataract surgery in the United States, Denmark, the province of Manitoba (Canada), and the city of Barcelona (Spain) were compared. METHODS: In a prospective multicentre study, patients scheduled for first eye cataract surgery and aged 50 years or older were enrolled consecutively. From the United States 766 patients were enrolled; from Denmark 291; from Manitoba 152; and from Barcelona 200. Indication for surgery was measured as preoperative visual status of patients enlisted for cataract surgery. Main variables were preoperative visual acuity in operative eye, the VF-14 score (an index of functional impairment in patients with cataract) and ocular comorbidity. RESULTS: Mean visual acuity were 0.23 (USA), 0.17 (Denmark), 0.15 (Manitoba), and 0.07 (Barcelona) (p < 0.001). When restricting the sample to eyes with normal retina and macula, no significant difference between United States and Denmark was observed (p > 0.05). Mean VF-14 scores were 76 (USA), 76 (Denmark), 71 (Manitoba), and 64 (Barcelona) (p < 0.001). CONCLUSION: Similar indications for cataract surgery were found in the United States and Denmark. Significantly more restricted indications were observed in Manitoba and Barcelona. Possible explanations for the results are discussed, including differences in sociodemographic characteristics, access to care, surgeons' willingness to operate, and patient demand.

Aged↗
PubMed1998

Ophthalmology undergraduate education in Canada.

OBJECTIVE: To compile a database recording components of undergraduate education in ophthalmology in Canada. DESIGN: Mailed questionnaire survey. SETTING: The 16 Canadian medical schools. PARTICIPANTS: All ophthalmology undergraduate program directors. OUTCOME MEASURES: Teaching hours, subjects and clinical skills taught, examination methods. RESULTS: Almost all schools covered a similar curriculum and used multiple-choice examinations. The number of hours devoted to preclerkship teaching was similar, but only seven schools had a mandatory clerkship rotation. Overall, 69% of the annual graduating medical school class receive clinical exposure to ophthalmology during their clerkship. Almost all schools provided electives that were similar in structure. CONCLUSIONS: There was great similarity in the curricula for medical student teaching in Canada. Efforts should be undertaken to increase the proportion of medical students receiving clinical teaching in ophthalmology. Increased coordination and collaboration in undergraduate teaching can be achieved in specific areas with future data sharing.

Canada↗
PubMed1997

International variation in ophthalmologic management of patients with cataracts. Results from the International Cataract Surgery Outcomes Study.

OBJECTIVES: To describe international variation in the management of patients with cataacts in 4 health care systems and to discuss the potential implications for cost and utilization of services. DESIGN: To characterize current clinical practice on patients with no coexisting medical or ocular conditions, a standardized questionnaire was sent to random samples of ophthalmologists in the United States (response rate, 82.5%), Canada (66.9%), and Barcelona, Spain (70.4%), and to all ophthalmologists in Denmark (80.1%). From the United States, 526 ophthalmologists who performed cataract surgery participated in the study; there were 276 from Canada, 89 from Barcelona, and 82 from Denmark. RESULTS: Although in all 4 sites most surgeons reported that they performed A-scanning, fundus examination, and refraction routinely before surgery, significant crossnational variation was observed in preoperative ophthalmic and medical testing. While preoperative medical tests were virtually unused in Denmark, they were widely used in the other sites. A significantly higher proportion of the surgeons in the United States and Barcelona reported that they performed less than 100 extractions per year compared with surgeons in Canada and Denmark (P < .001). A significantly higher proportion of the surgeons in the United States and Canada were performing predominantly phacoextraction compared with surgeons in Denmark and Barcelona (P < .001). Both within and across sites, considerable variation in number of follow-up visits and postoperative tests was observed. CONCLUSIONS: Significant international variation in the management of healthy patients with cataracts has been observed. If less intensive care is not associated with poorer outcomes, there is the potential for less costly care of patients with cataracts. Further research identifying the most cost-effective practices is needed.

Adult↗
PubMed1997

International variation in anesthesia care during cataract surgery: results from the International Cataract Surgery Outcomes Study.

OBJECTIVES: To describe international variation in anesthesia care and monitoring during cataract surgery and to discuss its implications for cost and safety. METHODS: A standardized questionnaire was sent to random samples of ophthalmologists in the United States, Canada, and Barcelona, Spain, and to all ophthalmologists in Denmark. The survey was conducted in 1993 and 1994. Certified ophthalmologists who had performed 1 or more cataract extractions in the previous year were eligible for enrollment. RESULTS: The response rates were 62% in the United States (n=148), 67% in Canada (n=276), 70% in Barcelona (n=89), and 80% in Denmark (n=82). The anesthetic technique for cataract surgery varied significantly between sites (P<.001). Surgeons reported that retrobulbar blocks were used for 46% of the cataract extractions in the United States, 70% in Canada, 66% in Denmark, and 31% in Barcelona. In Barcelona, general anesthesia was used for 23% of the cataract extractions; it was used for less than 3% of the extractions at the other 3 sites. Peribulbar blocks or topical anesthesia was used for the remaining extractions. In the United States, Canada, and Barcelona, surgeons reported that vital functions were monitored during more than 97% of the extractions and anesthesia surveillance was used during more than 78% of the extractions. In Denmark, ophthalmologists reported that vital functions were monitored and anesthesia surveillance was used for 1% of the cataract extractions (P<.001). CONCLUSIONS: Substantial international variation in anesthesia care and monitoring during cataract surgery was observed. The findings suggest a need for further research to determine whether less intensive monitoring is cost-effective.

Anesthesia↗
PubMed1997

Practices associated with cataract surgery in Canada: results of a national survey.

OBJECTIVE: To examine Canadian ophthalmologists' reported practices related to cataract surgery. DESIGN: Mailed questionnaire survey. SETTING: Canada. PARTICIPANTS: Random sample of 698 ophthalmologists from the mailing list of the Canadian Ophthalmological Society. Of the 528 eligible ophthalmologists 353 completed the questionnaire (response rate 67%). A total of 276 respondents were classified as cataract surgeons (performed at least one cataract operation in the preceding year [1992]) and were included in the study. OUTCOME MEASURES: Reported use of preoperative ophthalmic tests, surgical technique, cataract anesthesia (including type of block and who administers it) and postoperative care. RESULTS: Most of the preoperative tests examined either were so routine as to be done in almost all cases or were rarely done at all. A total of 52% of the respondents were identified as predominantly extracapsular cataract extraction surgeons (ECCE), 46% as predominantly phacoemulsification surgeons and 2% as predominantly intracapsular cataract extraction surgeons. Overall, 57% of the respondents reported high use of retrobulbar anesthesia, 18% reported high use of peribulbar anesthesia, and 0.7% reported high use of general anesthesia. The mean number of postoperative visits in the first 4 months after surgery was 4.25. The mean rate of Nd:YAG laser capsulotomy in the first year after cataract surgery was 17.9%; 91% of the respondents reported a rate less than 40%. CONCLUSIONS: There seems to be limited use of nonessential preoperative ocular testing by Canadian cataract surgeons. Although ECCE remains the most common type of surgery performed, there appears to be a substantial number of surgeons trying phacoemulsification, and this will likely become the predominant technique in the near future. The self-reported practices of Canadian surgeons with relation to preoperative testing and postoperative follow-up appear to be consistent with the Clinical Practice Guideline for cataract surgery set by the US Agency for Health Care Policy and Research. However, variations in the number of postoperative visits and Nd:YAG capsulotomy rates merit further investigation.

Anesthesia, Local↗
PubMed1994

Preoperative testing for cataract surgery.

A survey was carried out to examine variation in preoperative testing of healthy patients scheduled to undergo cataract surgery in Canada. The results showed significant variations in which investigations are mandatory and in how close to the time of surgery the tests had to be done. A literature review questioning the value of routine preoperative testing is presented. Eliminating low-yield pre-operative screening tests is a safe way to reduce expenditures on cataract surgery without compromising patient care.

Canada↗
PubMed1990

The "O" sign--clue to a lost lens.

The authors describe two patients who lost a hard contact lens beneath the upper lid. After a year they presented with mass lesions as the lens eroded into the lid. There were no external features to point to the correct diagnosis. In both cases a round hole in the conjunctiva over the embedded lens was noted, and the authors also noted this finding in clinical photographs from other case reports in the literature. This finding, the "O" sign, should suggest the possibility of a lost hard contact lens embedded in the upper lid.

Adolescent↗
PubMed1988

Sarcoidosis as a cause of linitis plastica.

We report a patient with gastric sarcoidosis. After initial pulmonary sarcoidosis, which responded to corticosteroids, the patient developed linitis plastica of the stomach which was treated by partial gastrectomy and steroids.

Adenocarcinoma, Scirrhous↗
PubMed1988

Lecithin:cholesterol acyltransferase deficiency.

Lecithin:cholesterol acyltransferase (LCAT) deficiency is a rare familial disease inherited in an autosomal recessive pattern. It is characterized by a combination of plasma lipoprotein, corneal, erythrocyte and, in most patients, renal changes. The corneal changes consist of scattered stromal dots that are lipid deposits. Their composition is unique and suggests an intrinsic corneal metabolic defect. The corneal clouding is usually asymptomatic. Patients with the condition must be followed closely because renal failure may develop. We describe a patient with LCAT deficiency.

Adult↗
PubMed1982

[Value and significance of CEA in the monitoring of patients with neoplasms and in the evaluation of their cure].

An assessment was made of the determination of carcinoembryonic antigen (CEA) in patients with tumours and non-neoplastic diseases. Positivity in relation to hepatic cirrhosis and stasis was noted in only 3.9% of non-oncological patients, whereas this figure rose to 28.8% in those with tumors, with higher frequencies in forms involving the intestine, lung, liver, and stomach. Variations in the result of the examination were noted in relation to the progress of the disease, and also in relation to chemotherapy in some cases. The results of the investigation indicate that CEA is of little use as an early diagnosis test. Its importance lies in its indication of the effectiveness of treatment, and as an early sign of the approach of recurrences.

Carcinoembryonic Antigen↗