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Biomedical subjects

W Thorburn

Publications and source records attributed to W Thorburn.

At least 19 recordsLinked to original sources
PubMed2002

Cataract surgery and quality of life in patients with age related macular degeneration.

BACKGROUND: The coexistence of cataract and age related macular degeneration (AMD) is not unusual, especially in the very elderly. The outcome of cataract surgery in these cases depends on the effect of AMD on vision. In this study the authors have compared the outcome of cataract patients with AMD to that of cataract patients with no vision threatening ocular comorbidity, and analysed possible predictors of good or poor outcome. METHODS: An observational prospective study on consecutive cases operated for cataract during 1 month at six surgical departments affiliated to the Swedish National Cataract Register (NCR). Data were collected according to the protocol of NCR and subjects completed the Catquest questionnaire before and 6 months after surgery. 90 subjects with AMD were compared to 335 subjects with no sight threatening ocular comorbidity. RESULTS: Difficulties in performing various daily life activities improved significantly for AMD subjects after surgery (p<0.001, Wilcoxon signed rank test). Satisfaction with vision also improved significantly after surgery (p<0.001, Wilcoxon signed rank test). Activity level and independence were unchanged. Subjects with no ocular comorbidity had a still better outcome. The most important variable related to a good self assessed functional outcome was postoperative visual acuity irrespective of the presence of AMD. AMD subjects scheduled for second eye surgery and AMD subjects dissatisfied with their vision before surgery had a poorer outcome. CONCLUSION: Subjects with various stages of dry AMD and cataract improved their self assessed visual function and satisfaction with vision significantly after cataract extraction.

Activities of Daily Living↗
PubMed2001

[Patient based care registries as a tool to follow up services].

The Federation of Swedish County Councils and six medical specialties are working together in a project aiming to support and stimulate the development of patient based case registers as a tool to follow up, evaluate, develop and manage medical units. The project is based on participation on the part of the medical professions in a process-oriented way. Each case register shall be based on the individual patient, and will integrate inpatient and outpatient care, all medical professions and important procedures. In hematology the project also seeks to merge case costing data with the patient based case registers in order to facilitate more comprehensive cost analysis and comparison. This episodic perspective is useful for providers per se as well as in discussions between purchasers and providers as a method for understanding and analyzing medical services. The six specialties are hematology, obstetrics and gynecology, ophthalmology, otorhinolaryngology, dermatology and sexually transmitted diseases, and lastly psychiatry.

Databases, Factual↗
PubMed2001

Quality of life after first- and second-eye cataract surgery: five-year data collected by the Swedish National Cataract Register.

PURPOSE: To study the benefits of surgery and satisfaction with vision after first- and second-eye cataract surgery in comparable groups of patients. SETTING: Clinics participating in the Swedish National Cataract Outcome Study from 1995 to 1999. METHODS: A prospective observational study evaluated patients' self-assessed visual function and satisfaction with vision before and 6 months after cataract extraction. Patients who had another cataract surgery in the fellow eye during the 6-month study were excluded. Data of 8595 patients having cataract extraction at participating clinics during the month of March for 1995 to 1999 were collected. Preoperative and intraoperative data were reported at the time of surgery. Final postoperative visual acuity was recorded. The Catquest questionnaire was completed before surgery and 6 months after surgery. RESULTS: First-eye surgery was performed in 5570 patients and second-eye surgery, in 3025. Patient-assessed benefits of surgery and satisfaction with vision as defined by the Catquest was higher after second-eye surgery (P <.001). The outcomes were studied in detail in patients with equal visual acuity in the fellow eye before and after surgery and without ocular comorbidity. The better outcome after second-eye surgery was most pronounced in patients with good or intermediate visual acuity in the fellow eye. CONCLUSION: The self-assessed visual outcomes and satisfaction with vision were better after second-eye surgery than after first-eye surgery in comparable groups of patients.

Aged↗
PubMed2001

Cataract surgery and effectiveness. 2. An index approach for the measurement of output and efficiency of cataract surgery at different surgery departments.

PURPOSE: To describe a model for comparing the performance of cataract surgery among ophthalmology departments in terms of economic efficiency. METHODS: An index approach for the measurement of outcome of cataract surgery is modeled. The index approach uses information about activities and difficulties in daily life as well as visual acuity and age. The change in activities and difficulties after surgery is expressed by changes in distances, and an overall index score is calculated as ratios of values to distances. Values to distances are estimated as solutions to linear programming problems. Index scores are calculated for two groups of patients, those with an ocular co-morbidity and those without. Economic efficiency is also estimated by use of an index approach. In the estimation of efficiency we use the calculated index scores of outcome of surgery as a measure of output of the ophthalmology department. Four different departments providing cataract surgery are compared. RESULTS: The studied departments showed differences to a great extent when traditional measures of cataract surgery outcomes were used. These differences changed when the outcomes were compared by use of index scores. When economic efficiency was calculated the difference between the departments was further reduced and only one department was considered inefficient according to the model. CONCLUSION: An index approach was used to study outcomes of cataract surgery and economic efficiency in four departments. This approach takes into account the complexity of cost in relation to feasible outcome. The ranking between the departments described by traditional methods turned out differently using the model.

Cataract Extraction↗
PubMed2001

Age-related utilisation of cataract surgery in Sweden during 1992-1999. A retrospective study of cataract surgery rate in one-year age groups based on the Swedish National Cataract Register.

PURPOSE: To study the utilisation and increase of first eye cataract surgery in one-year age groups between 60 and 90 years of age during 1992-1999. METHODS: Data was extracted from the National Swedish Cataract Register (NCR) that covers about 93.2% of all cataract extractions performed in Sweden during 1992-1999. The total number of living persons in each one-year age group was collected from the Year Book of Statistics in Sweden (1993-2000). RESULTS: The number of cataract extractions in Sweden increased by 54.8% from 1992 to 1999. The rates of first eye cataract surgery in one-year age groups between 60 and 90 years of age were different for females and males and this difference did not change during a 37% increase of the surgery volume from 1992 to 1999. The rate of first eye cataract surgery increased significantly both for females (+29.4%) and males (+27.2%) during 1992 to 1999 in Sweden. CONCLUSION: The rate of first eye cataract surgery increased significantly from 1992 to 1999 but the gender difference in age-related utilisation of surgery remained unchanged. The increase in rate was about the same in all age groups.

Age Distribution↗
PubMed2000

Impaired visual function after cataract surgery assessed using the Catquest questionnaire.

PURPOSE: To evaluate and explain why some patients report more difficulties performing everyday activities 6 months after a cataract extraction than they did before surgery. SETTING: Cataract surgeons from 4 departments of ophthalmology affiliated with the National Swedish Cataract Outcome Register. METHODS: Patients were recruited from those having cataract extraction during March 1995, 1996, or 1997 at the participating units. Only patients who completed Catquest questionnaires before and after surgery and were evaluated to have a "no-benefit" outcome were included. The no-benefit outcomes were analyzed by using medical records and surgeon opinions. Possible and/or probable reasons for the outcome were identified. RESULTS: Several possible and/or probable reasons were identified as a single reason or combined with other reasons. The 5 most frequent reasons were ocular co-morbidity in the operative eye, anisometropia after surgery, problems with the nonoperative eye during follow-up, low disability score sum before surgery (no difficulties), and postoperative complications. CONCLUSION: In about a third of the cases, the no-benefit outcome could probably have been avoided by better planning for both eyes; that is, both eyes should have surgery within a short time and waiting for second-eye surgery in cases with anisometropia should be avoided.

Activities of Daily Living↗
PubMed2000

Cataract surgery in the very elderly.

OBJECTIVE: To analyze the outcome of cataract extraction in patients aged 85 years and older (>/=85 group) and to compare their outcome with that of patients younger than 85 years (</=84 group). SETTING: Cataract surgeons participating in the Swedish National Cataract Outcome Study during 1995 to 1997. METHODS: A prospective observational study was performed that evaluated patients' self-assessed visual function before and 6 months after cataract extraction. Mean age of the 4819 patients having cataract extraction at participating clinics during March 1995, 1996, and 1997 with complete follow-up data was 75.6 years; 67. 5% were women. Preoperative and intraoperative data were reported at the time of surgery. Final postoperative visual acuity, refraction, and keratometry were recorded. Each study period closed 6 months after surgery. The Catquest questionnaire was completed before surgery and 6 months after surgery. RESULTS: Of those with complete data, 757 patients (15.7%) were in the >/=85 group. In this group, visual acuity in the operative eye improved in 84.3% and a visual acuity of 0.5 or better was achieved in 71.4%. A no-benefit outcome, as defined by the Catquest questionnaire, was found in 12.7% of the >/=85 group and 8.4% of the </=84 group. CONCLUSION: Elderly patients on average had a good outcome, although not as good as that in younger patients. Certain groups were identified as having an excellent result and others of having a high risk of an adverse outcome.

Aged↗
PubMed2000

Cataract surgery and effectiveness. 1. Variation in costs between different providers of cataract surgery.

PURPOSE: To describe and analyse the cost of cataract surgery in four community-run eye clinics in Sweden and also to analyse differences in cost between these clinics. METHODS: The average cost of a cataract surgery episode was calculated including one pre-operative visit, the surgery itself and the post-operative visits. Included in the analysis were the costs of disposables, personnel, rent, depreciation, general anaesthesia, bed days and education. Excluded were the costs of complications and overhead costs. RESULTS: The average cost for one cataract surgery episode was 5052/6915 SEK (1 Euro = 8.57 SEK) with a variation from 4436/6202 to 6130/8293 between the clinics. The lower sum represents a minimum cost of personnel, the higher sum a maximum cost. CONCLUSION: A large variation in costs of cataract surgery was found in four providers of cataract surgery. Nearly all clinics studied had one or more areas with much higher costs than average.

Cataract Extraction↗
PubMed2000

The cost of cataract patients awaiting surgery.

PURPOSE: To describe the cost for society services caused by the patients awaiting surgery for one year in Gothenburg, 1997. METHODS: From a waiting list of 1458 patients awaiting cataract surgery 250 randomly selected patients were interviewed. The structured questions focused on community services, such as home help, subsidised travel by taxi, medical treatment at home, visual aids, hospital stay and medical consultation, caused by the cataract symptoms. RESULTS: The total cost for the community for the 1458 patients awaiting surgery was an estimated SEK 5,200,000. Hospital stay and home help were the largest parts of this community expense. CONCLUSION: The direct costs for society for one year caused by 1458 patients awaiting cataract surgery with a mean waiting time of 9.8 months was approximately the same as operating 800 patients (eyes).

Cataract↗
PubMed1999

Gender and cataract surgery in Sweden 1992-1997. A retrospective observational study based on the Swedish National Cataract Register.

PURPOSE: To study the gender difference in total utilisation of cataract surgery in Sweden during the years 1992-1997. METHODS: The study is based on data from the National Swedish Cataract Register which covers about 95% of all cataract operations performed in Sweden during the study period. RESULTS: Utilisation of cataract surgery in Sweden was significantly higher in females than in males for all age groups between 50 and 89 years of age during the period 1992-1997. This gender difference was more pronounced for second eye surgery than first eye surgery in most age groups. The gender difference varied also depending on the pre-operative visual acuity. CONCLUSION: The cataract surgery rate was significantly higher for females compared to males during the study period. Three hypotheses to explain the gender difference are discussed.

Aged↗
PubMed1999

Outcome of cataract surgery considering the preoperative situation: a study of possible predictors of the functional outcome.

AIM: To analyse possible predictors of the self assessed functional outcome of a cataract extraction. METHODS: The patients' self assessed visual function was studied by use of a questionnaire, the "Catquest", before and 6 months after surgery. All patients (n=1933, mean age 75.5 years, 66.8% women) who were undergoing cataract surgery in March 1995, in 35 different departments of ophthalmology participating in the National Swedish Cataract Register, were included in the study. A routine ophthalmic examination was performed before and after surgery. The following preoperative variables were studied with regard to a possible relation to the outcome: age, sex, ocular comorbidity, best corrected preoperative vision (better eye), first or second eye surgery, other diseases with a need for long term medication, need for home help, need for subsidised travel by taxi. RESULTS: Ocular comorbidity was strongly related to a "no benefit" outcome after surgery (p= 0.005). Second eye surgery and young age was related to a "very good benefit" outcome after surgery (p=0.0001 and p<0.0001 respectively). CONCLUSIONS: Patients with an ocular comorbidity in the eye undergoing a cataract extraction were characterised by a significantly higher frequency of deteriorated self assessed visual function after surgery than patients with no ocular comorbidity. The highest degree of improvement was most frequently found in younger patients undergoing second eye surgery.

Adult↗
PubMed1998

Catquest questionnaire for use in cataract surgery care: assessment of surgical outcomes.

PURPOSE: To demonstrate the outcome for patients after cataract extraction using the Catquest cataract questionnaire and discuss the models validity in assessing outcome. SETTING: Thirty-five Swedish departments of ophthalmology. METHODS: Patients having cataract extraction performed by surgeons from 35 Swedish departments of opthalmology participated in the study. The questionnaire was given to 2970 consecutive patients having surgery during March 1995 at the participating surgical units. The questionnaire was sent by mail to patients and completed on a voluntary basis. It focuses on visual disabilities in daily life, activity level, cataract symptoms, and degree of independence. The results form the questionnaire are interpreted using a benefit matrix that credits not only a decrease in visual disabilities and cataract symptoms but also an improvement in or maintenance of a preoperative activity level. RESULTS: Complete surgical outcome data and completed preoperative and postoperative questionnaires were available in 1933 cases (65.1%). Benefit from surgery according to the model was achieved by 90.9% of the patients. Patients having their second cataract extraction had the highest frequency of the greatest benefit form surgery. There was good agreement between the different levels of benefit from surgery according to the model and the patient's global rating of his or her vision or achieved visual acuity after surgery, respectively. Patients with missing data (did not return postoperative questionnaire or had missing surgical result variables) were older and had a higher frequency of other diseases and handicaps. CONCLUSION: The Catquest cataract questionnaire allowed the outcome of cataract surgery to be graded by different levels of benefit. There seemed to be good agreement between this model of assessment and the patient's global rating of his or her vision. Missing data may be a problem when a postal questionnaire is used.

Activities of Daily Living↗
PubMed1997

An outcome study of cataract surgery based on a national register.

PURPOSE: To test the viability of performing a national cataract outcome study with a national cataract register as a reference base. METHODS: Seven Swedish eye clinics participated. All patients operated during the month of January 1994 were included. The total number of patients was 605. RESULTS: This outcome study is based on few, but well defined parameters. On the basis of these measurements quality indicators are suggested that makes comparison between surgeons/clinics possible. CONCLUSION: Outcome studies are different from controlled clinical trials. They are less time consuming and designed to describe the outcome of surgery in daily practise. An outcome study of cataract surgery does not replace the careful monitoring of each patient at the clinical level, which is necessary for the development of new surgical technics and medical treatments. However, an outcome study can provide an overall quality description of cataract surgery in the daily practise of any given surgical unit.

Aged↗
PubMed1996

Assessment of waiting time and priority setting by means of a national register.

To increase access to care for cataract patients in Sweden, it was decided, starting in 1992, that all cataract patients listed for surgery and with priority should have their cataract extraction performed within three months. To evaluate the effect of this waiting time guarantee, a National Cataract Register (NCR) was initiated in late 1991. In 1992, 81% of all cataract extractions performed in Sweden were reported to the NCR; in 1993 this figure was 92%. Reasons for this high participation ratio are discussed. In 1993, 74.4% (range between different clinics, 40-99%) of the patients with priority had their operation performed within three months. Great variation in visual acuity and age was found in patients with priority among the different surgical units.

Cataract Extraction↗
PubMed1995

A national Cataract Register. I. Description and epidemiology.

In 1992 a Swedish National Cataract Register was instituted. More than 90% of all cataract surgeries are performed at community run eye clinics. All community run eye clinics in the country participated and 89% of all cataracts performed are included in this register. In total 31,679 eyes were entered. All the pertinent preoperative information on these patients can be found in the register. As indicated in other studies two-thirds of the surgeries were performed on women and one-third of the surgeries was performed on second eyes. The number of surgeries equals 4.5 per 1000 inhabitants and this figure has steadily increased since 1980.

Adolescent↗
PubMed1989

Timolol-pilocarpine combined vs timolol and pilocarpine given separately.

In a controlled, double-observer, multicenter study, we compared the effect of a fixed combination of timolol 0.5%-pilocarpine 4% twice a day with that of timolol 0.5% twice a day plus pilocarpine 4% three times a day in 80 patients with open-angle glaucoma whose intraocular pressure was greater than 21 mm Hg on timolol 0.5% twice a day alone. Administered twice daily, the combination drug lowered intraocular pressure as effectively as concomitant treatment with timolol twice a day and pilocarpine three times a day. No statistically significant differences in reduction of intraocular pressure were found between the two groups nor were any unexpected side effects observed.

Blood Pressure↗