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PubMed2005

Representation of ophthalmology concepts by electronic systems: adequacy of controlled medical terminologies.

OBJECTIVE: To assess the adequacy of 5 controlled medical terminologies (International Classification of Diseases 9, Clinical Modification [ICD9-CM]; Current Procedural Terminology 4 [CPT-4]; Systematized Nomenclature of Medicine, Clinical Terms [SNOMED-CT]; Logical Identifiers, Names, and Codes [LOINC]; Medical Entities Dictionary [MED]) for representing concepts in ophthalmology. DESIGN: Noncomparative case series. PARTICIPANTS: Twenty complete ophthalmology case presentations were sequentially selected from a publicly available ophthalmology journal. METHODS: Each of the 20 cases was parsed into discrete concepts, and each concept was classified along 2 axes: (1) diagnosis, finding, or procedure and (2) ophthalmic or medical concept. Electronic or paper browsers were used to assign a code for every concept in each of the 5 terminologies. Adequacy of assignment for each concept was scored on a 3-point scale. Findings from all 20 case presentations were combined and compared based on a coverage score, which was the average score for all concepts in that terminology. MAIN OUTCOME MEASURES: Adequacy of assignment for concepts in each terminology, based on a 3-point Likert scale (0, no match; 1, partial match; 2, complete match). RESULTS: Cases were parsed into 1603 concepts. SNOMED-CT had the highest mean overall coverage score (1.625+/-0.667), followed by MED (0.974+/-0.764), LOINC (0.781+/-0.929), ICD9-CM (0.280+/-0.619), and CPT-4 (0.082+/-0.337). SNOMED-CT also had higher coverage scores than any of the other terminologies for concepts in the diagnosis, finding, and procedure categories. Average coverage scores for ophthalmic concepts were lower than those for medical concepts. CONCLUSIONS: Controlled terminologies are required for electronic representation of ophthalmology data. SNOMED-CT had significantly higher content coverage than any other terminology in this study.

Humans↗

PubMed2005

Assessment of ophthalmology resident on-call performance.

PURPOSE: To design and implement a valid tool for assessment of ophthalmology resident on-call performance. DESIGN: Retrospective chart audit. SETTING: Tertiary care academic ophthalmology programs. PARTICIPANTS: Ophthalmology faculty and residents at the University of Cincinnati and the University of Iowa. METHODS: A 1-page on-call assessment tool (OCAT) and scoring rubric were developed to evaluate ophthalmology resident on-call performance. A retrospective chart audit of consecutive resident on-call charts was performed at the University of Cincinnati and the University of Iowa, and resident performance was scored using the OCAT. RESULTS: A consensus of faculty comments established the face and content validity of the OCAT. One hundred ninety-one on-call consultations were assessed. Timeliness of consultation was the most common category receiving a borderline or unsatisfactory rating. Borderline ratings in knowledge-based categories (history, examination, assessment and plan, urgency rating) occurred more often for postgraduate year 2 (PGY2) residents than for PGY3 residents (P = 0.05, chi-square test). Incomplete differential diagnosis (n = 6) and lack of follow-up instruction (n = 5) were the most common deficiencies observed. CONCLUSIONS: The OCAT has face, content, and discriminative validity. It can be used to assess resident competence in patient care, professionalism, and medical knowledge. Interrater and intrarater reliability still need to be determined. The OCAT may prove to be an additional assessment tool for meeting the Accreditation Council for Graduate Medical Education competencies mandate.

Clinical Competence↗

PubMed2003

American ophthalmology graduate medical education and the web: current state of internet resource utilization.

PURPOSE: To evaluate the presence and accessibility of ophthalmology graduate medical education (GME) programs on the internet and the degree to which web-based resources are currently being utilized by American Ophthalmology training programs. DESIGN: Prospective sampling of internet postings of ophthalmology GME programs. METHODS: Ophthalmology residency programs listed in the American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA) online website (http://www.ama-assn.org/ama/pub/category/2997. html) were evaluated. Departmental websites were accessed either directly from the FREIDA website or from one of eight search engines or four metacrawlers utilized in the study. Each site was evaluated for the presence, extent, and type of postings in the following categories: residency, medical student resources, faculty, patient care, video utilization, and links. RESULTS: Departments with websites numbered 102 (83%). Specific posting rates were residency 84%; medical student resource 12%; faculty 72%; patient care 69%; video 2%; links 70%. CONCLUSIONS: Most departments have websites, but only a small number have postings in all categories.

Education, Medical, Graduate↗

PubMedDate not supplied

Japan's share of published research in ophthalmology.

PURPOSE: This study was conducted to determine Japan's share of published research in ophthalmology during the last decade. METHODS: Ophthalmology journals with higher impact factors were accessed through the Medline database to elicit the number of articles published in 1991-2000 that originated in various countries, including Japan. The proportion of articles with a higher grade of evidence (randomized controlled trials/clinical trials, cohort studies, and case-control studies) was determined for Japan and compared with the average values of the total articles published in these journals. In addition, the percentage of published research from the 20 top-ranking countries was calculated, showing the trend over time. RESULTS: Of the total articles (21,327), Japan's share in the selected ophthalmology journals was 6.5% (1,387 articles), ranking third in the world, following the USA (51.5%) and the UK (11.3%). The recent increase in the share was statistically significant for Japan (P =.01). However, the proportionate value of clinical research evidence was lower for Japan-originated articles than the average value for the total clinical research articles in these journals. CONCLUSIONS: Appropriate measures should be taken in the ophthalmology field in Japan to increase the number of clinical research papers with a higher grade of evidence.

Bibliometrics↗

PubMedDate not supplied

From four-bed clinic to modern eye hospital: ophthalmology in Leipzig, 1820-1996.

The opening of the "Heilanstalt für arme Augenkranke" by Friedrich Philipp Ritterich (1782-1866) in 1820 was an important landmark for ophthalmology in Leipzig and in all of Germany. The first chair of ophthalmology in Germany was taken by Christian Georg Theodor Ruete in 1852. In 1883 the clinic moved to a new domicile, a modern building in the Leipzig "medical quarter." In the ensuing years, the hospital developed into a well-known university center of ophthalmology with the scientific, clinical, and organizational work of ophthalmologists such as Hubert Sattler and Ernst Hertel. The extension of the old building in 1908-1911 and the rebuilding after the destruction in World War II created better opportunities for research, teaching, and patient treatment. Comprehensive expansion and reconstruction of the Eye Hospital since 1994 has created excellent conditions for both clinical and experimental ophthalmology as well as the training of students.

Education, Medical, Continuing↗

PubMedDate not supplied

A condensed history of ophthalmology in Cincinnati (1827-1999).

The history of ophthalmology in Cincinnati dates back to 1827, when Dr. Daniel Drake founded the Eye Institute of Cincinnati. Since that time, many other individuals have influenced the course of ophthalmology in the city and region. Included among these were Elkanah Williams, first chairman of the Department of Ophthalmology at Miami Medical College of Ohio (the forerunner of the University of Cincinnati), William Seeley, Robert Sattler, Christian Holmes, Derrick T. Vail and his illustrious son Derrick T. Vail, Jr., Clarence King, Karl Ascher, Donald Lyle, and Mary Knight Asbury. The author presents brief biographical summaries and interesting anecdotes about each of these individuals and several others of importance to Cincinnati ophthalmology.

History, 19th Century↗

PubMed2001

The quality of reporting of randomized clinical trials published in Ophthalmology.

PURPOSE: To evaluate the quality of reporting of all the new randomized clinical trials published during 1999 in OPHTHALMOLOGY: using the CONSORT statement parameters. DESIGN: Descriptive series of published studies. STUDIES INCLUDED: Randomized clinical trials. METHODS: Eligible studies were all randomized clinical trials published in Volume 106 (1999) of OPHTHALMOLOGY: that reported the results of prospectively conducted studies in humans comparing two or more therapeutic options with regard to their effect on one or various outcomes, in which the authors stated that a process of randomization or quasi-randomization was performed before the interventions. Each study was evaluated by two independent observers establishing the specific report in the published manuscript of 57 CONSORT statement descriptors, and consensus was obtained between evaluators. MAIN OUTCOME MEASURES: Overall presence of CONSORT statement descriptors in published reports. RESULTS: The mean number of positive CONSORT descriptors for the 24 eligible randomized clinical trials was 33.42 (standard error of the mean [SEM] 1.57) of 57 possible. This score was significantly different (P: < 0.001) from the score of 16.6 (standard error of the mean 0.6) reported for OPHTHALMOLOGY: in the 1991 to 1994 study by Scherer and Crawley. Of the nine descriptors measuring the quality of abstract reporting, a mean of 6.25 (SEM 0.3) was included in the 24 study abstracts evaluated, significantly different from the Scherer and Crawley score (5.2, SEM 0.2. P: < 0.001). Four and six descriptors increased and decreased, respectively, their reporting in more than 20%. Key descriptors such as hypothesis postulation, primary outcome determination, sample size calculations, and a discussion of the limitations of the study such as bias, imprecision, and internal validity are still reported in less than 42% of clinical trials. CONCLUSIONS: This study describes for the first time after the adoption of the CONSORT statement recommendations the status on the quality of reporting of recently published randomized clinical trials in OPHTHALMOLOGY: Although not a direct measure of the intrinsic quality of a study, reporting quality provides the reader with useful tools for the evaluation of its validity. The quality of reporting of randomized clinical trials shows an overall improvement when compared with the period between 1991 and 1994. However, there is still significant room for improvement, especially in descriptors essential for the validation of clinical trial results that are still widely underreported.

Guidelines as Topic↗

PubMed1981

Manpower requirements in ophthalmology.

Ophthalmology manpower requirements estimates presented to the Graduate Medical Education National Advisory Committee (GMENAC) are explained and compared to previous estimates published by the American Academy of Ophthalmology, Both studies used similar methods but reached different conclusions; the reasons for this are explored and shown to be due principally to (1) differences in projected hours per week spent in patients care by ophthalmologists, and (2) differences in the medical workload traceable to differences in estimated visit time and needs for care in the area of systemic ophthalmology. The manpower implications of the principal contributors to the ophthalmology workload are examined, and differences between the two studies regarding these conditions are documented. Areas for further research are suggested.

Forecasting↗

PubMed1989

Correlating factors to resident performance in an ophthalmology program.

To study the relationship between perceived clinical performance and objective measures of resident knowledge, the performance and records of 19 recent graduates of an ophthalmology training program were retrospectively reviewed. Six faculty members and six ancillary staff personnel independently ranked residents on the basis of dutiful performance of duties and quality of care provided by the end of residency. Clinical performance ranks were then compared with ranks of results on standardized tests of knowledge, and number of publications before and during residency. Additionally, a resident's ranking on clinical performance and knowledge-related criteria was compared with his or her ranking at the time of the ophthalmology match. The perceived clinical performance of residents was not related to their results on standardized examinations or their number of publications. Residents highly regarded at the time of the ophthalmology match were not the same as those so regarded at the end of residency. Using data available before the commencement of the residency, the only correlation to quality of care provided was the National Board of Medical Examiners (NBME) Part I scores. The scores on the NBME Part I did not, however, correlate with those of the Ophthalmology Knowledge Assessment Program (OKAP).

Clinical Competence↗

PubMed1994

Diagnostic management by gatekeepers is not cost effective for neuro-ophthalmology.

PURPOSE: To determine whether the "gatekeeper physician system" for evaluating neuro-ophthalmologic problems is cost effective. METHODS: The authors retrospectively reviewed the records of 588 patients referred for neuro-ophthalmologic evaluation between July and December 1989 to determine the frequency and cost of unnecessary diagnostic testing ordered by "gatekeeper physicians." Pre-referral diagnostic testing costs were compared with the cost of neurophthalmologic consultation for four common problems: (1) optic neuropathy; (2) diplopia; (3) ptosis; and (4) proptosis. RESULTS: Between 16% and 26% of patients in the first three diagnostic categories were subjected to overtesting, resulting in $57,900 of excessive costs, a 724% overcharge. Although the evaluation of proptosis was performed correctly, the quality of 10 of the 18 neuro-imaging procedures was substandard. CONCLUSIONS: The gatekeeper system managed by primary care physicians for these four neuro-ophthalmologic problems not only did not conserve healthcare dollars but also had a negative impact on cost control. For neuro-ophthalmologic disorders, prompt subspecialty evaluation and examination appear to be a cost-effective strategy.

Blepharoptosis↗

PubMed1998

The incidence of ophthalmologic interventions in children with birth weights less than 1251 grams. Results through 5 1/2 years. Cryotherapy for Retinopathy of Prematurity Cooperative Group.

OBJECTIVE: This study aimed to report the frequency of ophthalmologic surgical and medical therapies provided to children with birth weights less than 1251 g who had all stages of retinopathy of prematurity (ROP). In addition, this study aimed to report the initial age at which such procedures are provided and to report the frequency of cerebrospinal fluid shunts. DESIGN: Observational case series with prospective data collection. PARTICIPANTS: Children from the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) with birth weights less than 1251 g served as subjects. Group A included 257 children from all 23 CRYO-ROP study centers who had threshold ROP, who had participated in the randomized trial of cryotherapy, and who had survived to age 1 year. Group B included 1208 children from 5 of the 23 study centers who had varying severity of ROP (69 had threshold ROP) and who had participated in a 5 1/2-year study of the natural history of ROP. MAIN OUTCOME MEASURES: Investigators documented medical and surgical ophthalmologic interventions through age 5 1/2 years as well as cerebrospinal fluid shunting surgery for hydrocephalus through age 2 years. RESULTS: Group A was composed of 257 children with threshold ROP who underwent 226 ocular interventions in addition to cryotherapy (0.9 intervention per child). The most common treatments performed on the randomized cohort of children were vitrectomy (26% of patients), lensectomy (18%), amblyopia therapy (20%), and strabismus surgery (10%). Cataract surgery not associated with vitrectomy was performed infrequently (2%) and was performed equally often in treated and control eyes. Amblyopia therapy was prescribed as often for treated as for control eyes. Cerebrospinal fluid shunts were placed in 11% of these children. Group B was composed of 1208 natural history patients who underwent 239 ophthalmologic interventions (0.4 intervention per child). Strabismus surgery was the most commonly performed procedure for the natural history cohort of children (6% of the children). Amblyopia therapy was prescribed for 7% of the natural history patients. Cerebrospinal fluid shunts were required by 3% of the natural history infants, more often in children with more severe ROP. CONCLUSIONS: These premature infants underwent a large number of ophthalmologic treatments during the first 5 1/2 years of life. The long-term costs of both extreme prematurity and ROP include not only the initial ablative therapy for ROP and societal loss due to blindness that still occurs in some cases, but also the ongoing costs of caring for eye problems.

Amblyopia↗

PubMed1991

Ophthalmology in the Oxford region: analysis of time trends from linked statistics.

OBJECTIVES: to report on trends in ophthalmology workload using linked statistical data; DESIGN: analysis of linked abstracts of hospital inpatient and day case records for ophthalmology; SETTING: six districts in Southern England covered by the Oxford record linkage study; SUBJECTS: records for hospital admissions to ophthalmology from 1975 to 1985; MEASUREMENTS AND MAIN RESULTS: Over the period of study, the number of episodes of inpatient and day case care increased by 16.3%. Notable increases in age-specific admission rates were seen among the elderly. An increase in the number of individuals treated contributed about 67% and an increase in multiple admissions per individual contributed about 33% to the increase in admission rates. Both average length of stay per episode and total time in hospital per individual decreased consistently during the 11 years; and there was no increase in emergency readmissions over time. No significant changes over time were found in admission rates for retinal detachments and defects or for glaucoma. There was a statistically significant increase averaging 4.8% per annum in admission rates for cataract, and a significant decrease averaging 5.2% per annum in admission rates for strabismus and other disorders of binocular eye movement between 1975 and 1985. CONCLUSIONS: Age-specific admission rates in ophthalmology are much higher in the very young and old than in other age groups. Patterns of work in the specialty are therefore particularly affected by variation in the age distribution of the population. The increase in cataract surgery reflected both the increase in numbers of old people in the population and an increase in age-specific operation rates for cataract. Attempts to alter attitudes and behaviour of the elderly regarding eye diseases, disability, and facilities for treatment may have had a positive impact on the use of services. The decrease in admissions for children probably reflects the impact made by child health surveillance programmes. As the child screening programme has expanded, the admission rates for strabismus have decreased.

Adolescent↗

PubMed1980

[Postgraduate training in ophthalmology (author's transl)].

Legal stipulations covering postgraduate training in medical specialties are expected to be introduced in the near future. A committee set up by the Austrian Ophthalmological Society is working on a postgraduate training scheme, including clinical training and recommended literature, with the aim of achieving the greatest possible degree of coordination with ophthalmological societies in other German-speaking countries. Surgical training in ophthalmology, and the need to update recommended literature constantly, require special consideration. However, the standard of postgraduate medical training will not depend solely on the provision of a satisfactory legal framework; in ophthalmology it will depend to a large extent on the example set by teachers and their assistants, as well as on the individual efforts of the trainers themselves. A final examination should be introduced, in spite of the objections still being raised in Austria.

Austria↗

PubMed2000

A survey of eye trauma and diseases at a teaching hospital: implications for training in occupational ophthalmology in Nigeria.

This study explores the amount of occupational ophthalmology that it is possible to encounter within an existing teaching hospital system, as this offers the primary training facilities for resident doctors who expect to specialize in occupational medicine. The study was based on an analysis of ophthalmology patient records available at the University College Hospital, Ibadan, which is Nigeria's largest teaching hospital. One thousand, three hundred and thirty-four patients with eye disease were seen during the 1-year study. Of these, 1052 (78.9%) did not have their occupations recorded. Accidents were the only occupational diagnoses recorded, and this occurred in 75 (5.6%) of cases. The findings indicate that doctors who train in this specialty should gain experience in industries that have sizeable occupational health services, in addition to their formal ophthalmology training, in order to acquire experience in primary and occupational eye care. It is suggested that greater emphasis be placed on occupational ophthalmology in teaching hospitals and that there is a general improvement in completing patients' records: in particular, a patient's occupation should be recorded.

Adolescent↗

PubMed2006

Atrophy and anarchy: Third national survey of nursing skill-mix and advanced nursing practice in ophthalmology.

AIMS AND OBJECTIVES: The aims of the study were to investigate the advanced nursing practice and the skill-mix of nurses working in ophthalmology. BACKGROUND: The expansion of new nursing roles in the United Kingdom in the past decade is set against the background of a nursing shortage. The plan to modernize the National Health Service and improve the efficiency and delivery of healthcare services as well as to reduce junior doctors' hours contributes towards a profusion of new and more specialized and advanced nursing roles in various areas of nursing including ophthalmology. DESIGN: A self-reporting quantitative questionnaire was employed. The study used comparative and descriptive statistical tests. METHOD: The questionnaires were distributed to all ophthalmic hospitals and units in the United Kingdom. Hospital and unit managers were responsible for completing the questionnaires. RESULTS: Out of a total 181 questionnaires 117 were returned. There is a downward trend in the total number of nurses working in ophthalmology. The results demonstrate more nurses working at an advanced level. However, there is a general confusion regarding role interpretation at the advanced level of practice, evident through the wide range of job titles being used. There was inconsistency in the qualifications expected of these nurses. CONCLUSION: Whilst there are more nurses working at an advanced level this is set against an ageing workforce and an overall decline in the number of nurses in ophthalmology. There is inconsistency in job titles, grades, roles and qualifications for nurses who work at an advanced or higher level of practice. The Agenda for Change with its new structure for grading jobs in the United Kingdom may offer protection and consistency in job titles, pay and qualifications for National Health Service nurse specialists. The Nursing and Midwifery Council needs to provide clear guidelines to the practitioners on educational and professional requirements, to protect patients and nurses. RELEVANCE TO CLINICAL PRACTICE: The findings indicate that there is a need for better regulations for nurses working at advanced nursing practice.

Adult↗

PubMed2004

Research agenda-setting program for geriatric ophthalmology.

The healthcare needs of an aging population of "baby boomers" (persons born between 1946 and 1964) will disproportionately affect ophthalmology. To meet this emerging need, the American Geriatrics Society and the John A. Hartford Foundation developed a research agenda-setting process for geriatric ophthalmology. A systematic literature search was performed using Medline from the years 1990 to 2000. The literature review (168 papers) was performed to determine the current state of information regarding selected issues in geriatric ophthalmology. A needs assessment for each of the identified topics was performed, gaps in the existing knowledge base were identified, and key questions for future research were proposed. A research agenda-setting process for geriatric ophthalmology might provide a structural framework for future research efforts in the field.

Accidental Falls↗

PubMed2004

The state of basic surgical training in the UK: ophthalmology as a case example.

Concern is being expressed about the state of basic surgical training in the context of growing demands to improve service provision in the National Health Service. Taking ophthalmology as a case example, we sent questionnaires to all 466 senior house officers (SHOs) in recognized surgical training posts in England, Wales, Scotland and Northern Ireland. The main outcome measures were intraocular surgery performed in the previous two weeks and since starting as an SHO in ophthalmology; access to protected teaching time or cases on theatre lists; and supervision during surgery. Phakoemulsification, the most common type of cataract surgery, was used as a generic indicator of intraocular procedures. 314 (67%) of the SHOs responded. Of those working in the hospital in the previous two weeks, 50% had performed at least one component part of a phakoemulsification (phako) operation and 44% had performed at least one full phako operation. The average number of full phako operations done per week was 0.741. 77% reported some protected surgical teaching time over the two weeks and those with protected teaching time reported more full phako operations per week. Of those who had performed at least one surgical procedure in the previous two weeks, 79% had been supervised by a consultant. Of those who had completed two or more years' training as an SHO, only 42% met the Royal College of Ophthalmologists minimum requirement of 50 complete intraocular operations performed under supervision. Women were less likely than men, and SHOs in district general hospitals were less likely than those in teaching hospitals, to have achieved this target. As many as half the SHOs in ophthalmology are not receiving an adequate basic surgical training. If this continues it may prove difficult to train sufficient new surgeons to an acceptable standard to meet the increasing demands of an ageing population. This is not an issue for ophthalmology alone but for all surgical specialties.

Adult↗

PubMed1998

The use of telemedicine to treat ophthalmological emergencies in rural Australia.

A retrospective analysis was made of a cohort of patients who presented sequentially with acute ophthalmological conditions which were managed by telemedicine consultation. Twenty-four patients presented with acute problems requiring specialist ophthalmological advice to the emergency department of a remote hospital in Mt Isa, Queensland, between December 1996 and February 1997. Tele-ophthalmology consultations were carried out with three ophthalmologists working in a specialist eye clinic in Townsville, 900 km away. Patients and doctors were extremely positive about the telemedicine facility. Tele-ophthalmology was an effective means of providing acute specialist consultation in a remote emergency department. By reducing the need for acute transfers to the tertiary hospital in Townsville, significant benefits can be anticipated--both financial and in terms of convenience for the patient. Benefits for medical staff in skills acquisition and education were also evident.

Australia↗