Looking at outcomes important to patients may improve results of cataract surgery

Public release date: 29-Jul-2013
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Contact: Connie Hughes
Connie.Hughes@wolterskluwer.com
646-674-6348
Wolters Kluwer Health

Special issue of Optometry and Vision Science focuses on patient-reported outcome measures

Philadelphia, Pa. (August 29, 2013) - Cataract surgery can lead to good results from a clinical standpoint yet have poor outcomes from the patient's point of view, reports a study, "Analyzing Patient-Reported Outcomes to Improve Cataract Care", appearing in the August issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Using well-designed and validated tools to assess patient-reported outcomes can lead to new insights for improving the results of cataract care, suggests the study by Mats Lundstrm, MD, PhD, of Lund University and Ulf Stenevi, MD, PhD, of Sahlgren's University Hospital, Sweden. Their paper is part of a special theme issue on "Measuring the Patient's Perspective" in optometry research and clinical practice.

Study Compares Clinical and Patient-Reported Outcomes of Cataract Surgery

Using a nationwide registry, Drs Lundstrm and Stenevi evaluated clinical and patient-reported outcome measures in nearly 10,000 cataract surgeries performed in Sweden between 2001 and 2011. For example, a major clinical outcome measure after cataract surgery is visual acuity. But improved visual acuity may not always reflect patient ratings of change in vision from before to after the procedureespecially in performing everyday functional tasks.

Not surprisingly, a comparison of the two sets of outcomes found that patient-reported measures were affected by clinical measures. Factors affecting patient-reported outcomes included visual acuity in both the operated and nonoperated eyes, change in visual acuity in the operated eye, and any other eye-related conditions ("ocular comorbidity").

However, more useful information was gained by looking at factors related to better or worse patient-reported outcomes. For example, patients who reported better visual function before surgery or who had poor visual acuity in the nonoperated eye were more likely to have poorer patient-reported outcomes after cataract surgery.

Implications for Decisions about Cataract Care

Ocular comorbidity was also related to worse patient-reported outcomes. These findings may indicate that, as in other chronic diseases, "some patients are too healthy and some too sick to benefit" from cataract surgery, Drs Lundstrm and Stenevi write. "It is possible that patients who are very satisfied with their vision and have no problems in performing daily life activities should not have cataract surgery at present."

The study also looked at situations where the clinical outcomes were good but patient-reported outcomes were poorwhich happened in about seven percent of cataract surgeries. In many of these cases, poor near vision after the procedure was a major contributor to patient dissatisfaction.

There's a growing emphasis on patient-reported outcomes and quality of life in assessing various medical or surgical treatments. But there's been little attention to linking patient-reported outcomes to clinical outcomes in an attempt to improve health care. Age-related cataract is a good model for quality outcome studies: it is a very common, progressive condition that affects daily life and activities, and one for which surgical treatment is effective.

The new study helps vision care professionals in understanding how patient-reported outcome measures might be used to improve on the results of cataract surgery from the patient's perspective. For example, Drs Lundstrm and Stenevi suggest that surgery could be delayed or not performed in patients who feel they aren't having a lot of problems with daily activitiesperhaps especially if they have good near vision.

The special theme issue presents 20 papers on topics related to the use of patient-reported outcomes in vision care. "These papers focus on new tools that are being increasingly used to assess the patient's perspective on a wide range of important conditions, problems, and outcomes," comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science. "These measures allow us to rigorously measure the outcomes important to patients, and to do so in a very meaningful way."

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To read the article, "Analyzing Patient-Reported Outcomes to Improve Cataract Care", please visit http://journals.lww.com/optvissci/Fulltext/2013/08000/Analyzing_Patient_Reported_Outcomes_to_Improve.6.aspx

About Optometry and Vision Science

Optometry and Vision Science, official journal of the American Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 75 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide.

About the American Academy of Optometry

Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning. All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.

About Wolters Kluwer Health

Wolters Kluwer Health is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health's customers include professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands include Health Language, Lexicomp, Lippincott Williams & Wilkins, Medicom, Medknow, Ovid, Pharmacy OneSource, ProVation Medical and UpToDate.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2012 annual revenues of 3.6 billion ($4.6 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Follow our official Twitter handle: @WKHealth.

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Public release date: 29-Jul-2013
[ | E-mail | Share ]

Contact: Connie Hughes
Connie.Hughes@wolterskluwer.com
646-674-6348
Wolters Kluwer Health

Special issue of Optometry and Vision Science focuses on patient-reported outcome measures

Philadelphia, Pa. (August 29, 2013) - Cataract surgery can lead to good results from a clinical standpoint yet have poor outcomes from the patient's point of view, reports a study, "Analyzing Patient-Reported Outcomes to Improve Cataract Care", appearing in the August issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Using well-designed and validated tools to assess patient-reported outcomes can lead to new insights for improving the results of cataract care, suggests the study by Mats Lundstrm, MD, PhD, of Lund University and Ulf Stenevi, MD, PhD, of Sahlgren's University Hospital, Sweden. Their paper is part of a special theme issue on "Measuring the Patient's Perspective" in optometry research and clinical practice.

Study Compares Clinical and Patient-Reported Outcomes of Cataract Surgery

Using a nationwide registry, Drs Lundstrm and Stenevi evaluated clinical and patient-reported outcome measures in nearly 10,000 cataract surgeries performed in Sweden between 2001 and 2011. For example, a major clinical outcome measure after cataract surgery is visual acuity. But improved visual acuity may not always reflect patient ratings of change in vision from before to after the procedureespecially in performing everyday functional tasks.

Not surprisingly, a comparison of the two sets of outcomes found that patient-reported measures were affected by clinical measures. Factors affecting patient-reported outcomes included visual acuity in both the operated and nonoperated eyes, change in visual acuity in the operated eye, and any other eye-related conditions ("ocular comorbidity").

However, more useful information was gained by looking at factors related to better or worse patient-reported outcomes. For example, patients who reported better visual function before surgery or who had poor visual acuity in the nonoperated eye were more likely to have poorer patient-reported outcomes after cataract surgery.

Implications for Decisions about Cataract Care

Ocular comorbidity was also related to worse patient-reported outcomes. These findings may indicate that, as in other chronic diseases, "some patients are too healthy and some too sick to benefit" from cataract surgery, Drs Lundstrm and Stenevi write. "It is possible that patients who are very satisfied with their vision and have no problems in performing daily life activities should not have cataract surgery at present."

The study also looked at situations where the clinical outcomes were good but patient-reported outcomes were poorwhich happened in about seven percent of cataract surgeries. In many of these cases, poor near vision after the procedure was a major contributor to patient dissatisfaction.

There's a growing emphasis on patient-reported outcomes and quality of life in assessing various medical or surgical treatments. But there's been little attention to linking patient-reported outcomes to clinical outcomes in an attempt to improve health care. Age-related cataract is a good model for quality outcome studies: it is a very common, progressive condition that affects daily life and activities, and one for which surgical treatment is effective.

The new study helps vision care professionals in understanding how patient-reported outcome measures might be used to improve on the results of cataract surgery from the patient's perspective. For example, Drs Lundstrm and Stenevi suggest that surgery could be delayed or not performed in patients who feel they aren't having a lot of problems with daily activitiesperhaps especially if they have good near vision.

The special theme issue presents 20 papers on topics related to the use of patient-reported outcomes in vision care. "These papers focus on new tools that are being increasingly used to assess the patient's perspective on a wide range of important conditions, problems, and outcomes," comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science. "These measures allow us to rigorously measure the outcomes important to patients, and to do so in a very meaningful way."

###

To read the article, "Analyzing Patient-Reported Outcomes to Improve Cataract Care", please visit http://journals.lww.com/optvissci/Fulltext/2013/08000/Analyzing_Patient_Reported_Outcomes_to_Improve.6.aspx

About Optometry and Vision Science

Optometry and Vision Science, official journal of the American Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 75 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide.

About the American Academy of Optometry

Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning. All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.

About Wolters Kluwer Health

Wolters Kluwer Health is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health's customers include professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands include Health Language, Lexicomp, Lippincott Williams & Wilkins, Medicom, Medknow, Ovid, Pharmacy OneSource, ProVation Medical and UpToDate.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2012 annual revenues of 3.6 billion ($4.6 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Follow our official Twitter handle: @WKHealth.

---

[ | E-mail | Share ]

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2013-07/wkh-lao072913.php

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Review: ?Red 2? ? Nerdist

by Kyle Anderson on July 19, 2013

I?m not going to beat around the bush; I never saw the first Red. I worried for a few minutes prior to the start of Red 2 that I might have a bit of trouble being brought up to speed on who everybody was and where the events of the first film had brought them. I needn?t have worried. Red 2 does a good job of not hampering itself with the events of the first film. In fact, it doesn?t really hamper itself with anything save the exact thing we?re watching at that exact moment. It?s a movie that feels like edited highlights of some other movie, and at nearly 2 hours long, that larger movie would probably have to be Lawrence of Arabian.

Red 2 begins with Frank Moses (Bruce Willis), a retired and extremely dangerous CIA operative, who is attempting to live in peace and obscurity in suburban America with his girlfriend Sarah (Mary-Louise Parker). So committed is he to this new Costco (product placement) lifestyle that Sarah is getting incredibly bored. Luckily, she doesn?t have to worry too long, as Frank?s former partner and best friend Marvin (John Malkovich) shows up to warn Frank that they?re being targeted by someone. Of course, Marvin gets incapacitated, Frank gets apprehended, and the whole thing gets up and running. Eventually, he and Marvin are believed to have knowledge of an experimental and monumentally deadly explosive device that uses red mercury. They, and Sarah, who wants to join in the fun, begin a globetrotting adventure to find the location of the device, release the man who invented it (Anthony Hopkins) from the loony bin, and not be killed by Han (Byung-hun Lee) or their former associate Victoria (Helen Mirren).

This movie is all plot, action, and funny dialogue. There?s a thread about Willis and Parker?s relationship being put to the test, but it?s the thinnest of strands. Catherine Zeta-Jones plays a Russian agent and is described as ?Frank Moses Kryptonite,? and one might assume that there will be a tug of war for his affections between his former flame and his new love, but there isn?t, really. Zeta-Jones is quite superfluous. We get exactly who the characters are at the very beginning, and they?re more or less the same at the end; really, no internal struggle to speak of. It?s a lot of fighting, shooting, exploding, infiltrating, visiting glamorous locations (Paris! Moscow! London!), and getting in and out of scrapes. It?s a mission movie, and in that it?s a lot fun, but there?s really no meat. I will say that it was refreshing to have an action movie with older characters where they aren?t forever griping about how old they are. Clearly, everyone is still at the top of their game, especially Mirren?s character, who is easily the most badass of the bunch.

But this is also the problem. This doesn?t seem particularly momentous to any of the characters. They are attempting to save the world, but there?s really no show of the stakes. There?s a mention of how many people will die should the bomb go off, but that might as well be someone saying ?The world will crack in two and be engulfed in aphids? and then we never see it. It?s a vague threat, and like any good (or not so good) MacGuffin, it?s simply there to start the action.

Red 2 is a moderately enjoyable 116 minutes, but it?s really no more than that. If you like funny dialogue, quirky John Malkovich line readings, adorable Mary-Louise Parker, and lots and lots of bullets being fired, then Red 2 will be a welcome brain-relaxing escape.

Source: http://www.nerdist.com/2013/07/review-red-2/

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Cryptex vaults to make gift-giving more fun ? for you!

Remember the cryptex from The Da Vinci Code book and movies – the small, but complicated vault that would destroy the contents unless opened with the proper code? ?A company called?4Thought Products?is offering two cryptex-like enclosures to make your friends work for their gifts. ?The Vino Vault Wine Cryptex fits over a wine bottle and [...]

Source: http://the-gadgeteer.com/2013/07/19/cryptex-vaults-to-make-gift-giving-more-fun-for-you/

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'Armageddon year' for Dallas coach Jason Garrett? Jerry Jones says no

Published Saturday, Jul 20, 2013 at 10:10 pm EDT Last updated 3 hours and 43 minutes ago

OXNARD, Calif.?Jerry Jones opened his 25th training camp as owner of the Dallas Cowboys sounding as if coach Jason Garrett would be around for 25 more.

The first vote of confidence came even before someone could ask Saturday in the annual "State of the Cowboys" address that Jones gives on the eve of camp.

The words got stronger after the questions started. Jones said it was a "mistake" to consider this a make-or-break year for Garrett, who missed the playoffs with 8-8 records in each of his two full seasons. Both ended with losses in finales to NFC East rivals with a playoff berth on the line.

The owner and his coach shared a concert-like stage for nearly 40 minutes in what has become something of a summer tradition for Jones since he bought the team in 1989. Garrett had to duck out for the first team meeting of camp, and as he was walking off the stage, Jones was asked if it was fair to say Garrett's job was on the line.

Jones leaned into the microphone, said "no" in several ways and even suggested that he was looking beyond the two years remaining on Garrett's contract.

"I look to the future with Jason and not just through his contract that we're sitting here with right now," Jones said. "But it is not what is implied when you say, 'Well, this is an Armageddon year for him.' It is not that with me."

The questions started as soon as the Cowboys overhauled their defensive staff a few weeks into the offseason, and not long after Jones said he was going to make things "uncomfortable" at team headquarters.

Fueled by the comment, speculation centered on Garrett being a rubber stamp for the firing of defensive coordinator Rob Ryan, the hiring of replacement Monte Kiffin and the decision to move play-calling duties from Garrett to Bill Callahan.

Kiffin might not have helped things when he said his first phone calls were from the owner and his son, executive vice president Stephen Jones.

Garrett had a stock answer for the "hot seat" issue all offseason: Everyone in the NFL is on it. The question for him Saturday was getting out of his personal .500 rut?and the team's. The Cowboys are 128-128 going back to the start of the 1997 season.

"We are what we are to this point," Garrett said. "But at some point in your life, you have to let the past go, whether it's been great, good, mediocre or not so good. And you focus on learning from those experiences and getting better and take advantage of the opportunity in front of you."

Garrett and Jones think the Cowboys are better because they're healthier than they were after a 28-18 loss to Washington that kept them out of the playoffs.

The optimism has mostly to do with a defense that was missing six key players by the end of the season: linebackers Sean Lee and Bruce Carter, linemen Jay Ratliff and Kenyon Coleman, safety Barry Church and cornerback Orlando Scandrick.

DeMarcus Ware didn't miss any games but had offseason surgery on a shoulder that limited him late in the year.

Tony Romo has been cleared for today's opening practice after missing offseason workouts to have a cyst removed from his back.

"That was a pretty tough hand," Jones said of last season's injury issues on defense. "I said the other day that we are a better team. I probably should have said the better team now than when we finished up last year. We had a healthy Romo, but apart from that, we were pretty banged up."

The newcomers with the strongest chance to start are first-round pick Travis Frederick, who will get most of his work at center, and 10-year veteran Will Allen at safety. Second-year player Matt Johnson, who missed last season with a hamstring injury, is competing with Allen.

"I like how we worked in the offseason," Garrett said. "I like our personnel. I like how our staff has come together. I think we've done a good job as an organization getting younger. We feel good about the decisions we made from a personnel standpoint the last couple of years."

And as Jones reiterated Saturday, he feels good about his head coach.

Source: http://www.sportingnews.com/nfl/story/2013-07-20/dallas-cowboys-jason-garrett-jerry-jones-football-nfl-training-camp-tony-romo-nf

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Vets reeling from military sexual assault describe gaps in accessing VA health care

WASHINGTON ? Former Marine Tara Johnson says that when she finally got medical care after being sexually assaulted in the military, the Veterans Affairs doctor asked whether she really thought she had been raped.

She left the session so dismayed and discouraged that she hasn't been back to a VA facility. She now gets treatment outside of the VA through her private insurance coverage, she told a congressional committee Friday.

Navy veteran Brian Lewis spoke of the isolation that comes from being a male victim of military sexual assault. He said he was denied access to a support group for military sexual trauma at the Baltimore VA because it was reserved for women. He also felt ostracized when joining a group of combat veterans suffering from post-traumatic stress disorder.

"Men don't have anywhere to go," Lewis said. "Men are emasculated when they talk about this."

Johnson and Lewis, along with other victims of military sexual assault, described for members of Congress the myriad barriers to care that they experienced as they sought help for the emotional problems they still stuffer as a result of being assaulted.

More than 85,000 veterans were treated through the VA last year for injuries or illness linked to sexual abuse. The chief complaints Friday focused on a lack of access to care and a general lack of sensitivity toward their suffering, which they viewed as another betrayal by the government they had tried to serve.

Rep. Dan Benishek, R-Mich., said it was clear that the federal government was not doing enough to help veterans suffering from military sexual trauma.

"It's so frightening, frankly, the testimony we've heard this morning. I know there is great bipartisan support to make this better," said Benishek, the chairman of the House Committee on Veteran's Affairs panel that deals with health issues.

The Pentagon estimated that as many as 26,000 military members may have been sexually assaulted last year. Much of the attention on the problem has focused on whether prosecutions should be moved outside the military chain of command to an independent group. But lawmakers are also looking at ways to ease access to health care as well as disability benefits for victims once they enter the civilian world.

Air Force veteran Lisa Wilken told lawmakers that she still deals on a daily basis with being raped 20 years ago. She said part of the reason the health problems are so longstanding is that most victims are already far behind in their recovery by the time they get to the VA. She also said that some victims simply don't trust the VA enough to seek care because their medical facilities remind them so much of the military. She recommended that the VA make greater use of mental health providers in the private sector.

Source: http://www.startribune.com/lifestyle/health/216205171.html

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AAU boys basketball report: Florida Elite Black rolls through 11th Grade pool

Grandview Prep beats Orlando Christian Prep 51-40 in Class 2A championship game.

Florida Elite Black (3-0), with Dmitri Thompson and Brandon Maxwell of Orlando Christian Prep and Ocoee?s David Efianyi, rolled through its AAU 11th Grade Silver Showcase boys basketball pool with wins by 28, 28 and 13.

The team, directed by Olympia coach Mark Griseck, plays its championship bracket opener Sunday at 12:15 p.m. on the main court at Disney?s ESPN Wide World of Sports and with a win would stay there for a round of 16 game at 7:30.

Florida Tarheels 17U Lubin, a team comprised solely of players form Orange and Lake County schools, also went 3-0 to advance to a 12:15 bracket play game on Sunday.

Quarterfinals and semifinals are Monday, leading to the championship game on Tuesday at 12:15 p.m.

Buddy Collings is a senior sports writer covering high schools for the Orlando Sentinel. You can reach him at bcollings@orlandosentinel.com.

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Source: http://www.orlandosentinel.com/sports/highschool/os-hs-florida-elite-black-aau-11th-showcase-20130720,0,1465535.post?track=rss

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