Search results

The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains.

In a retrospective case study an in‐depth evaluation of the use of a quality cost model (QCM) and the applicability of Porter's care delivery value chain (CDVC) was performed in a specific care process: glaucoma care over the period 2001 to 2006 in the Rotterdam Eye Hospital in The Netherlands.

The case study shows a reduction of costs per product by increasing the number of outpatient visits and surgery combined with a higher patient satisfaction. Reduction of costs of non‐compliance by using the QCM is small, due to the absence of (external) financial incentives for both the hospital and individual physicians. For CDVC to be supportive to an integrated quality and cost management the notion “patient value” needs far more specification as mutually agreed on by the stakeholders involved and related reimbursement needs to depend on realised outcomes.

The case study just focused on one specific care process in one hospital. To determine effects in other areas of health care, it is important to study the use and applicability of the QCM and the CDVC in other care processes and settings.

QCM and a CDVC can be useful tools for hospital management to manage the outcomes on both quality and costs, but impact is dependent on the incentives in the context of the existing organisational and reimbursement system and asks for an agreed on operationalisation among the various stakeholders of the notion of patient value.

The purpose of this paper is to evaluate leadership training in the Sandwich Glaucoma Fellowship (SGF), a program in which fellows learn skills in a developed world institution and their home country to become leaders in glaucoma care.

This paper is a retrospective, qualitative and quantitative evaluation. Participants of the SGF between 2007 and 2019 were provided a survey eliciting demographic information, leadership training exposure, development of leadership competencies and feedback for the fellowship program.

Seven of nine alumni responded. The fellowship strongly impacted leadership competencies including integrity (8.8, 95% CI 7.8–9.8), work ethic (8.64, 95% CI 7.7–9.6) and empathy (8.6, 95% CI 7.7–9.5). A total of 85% of alumni indicated positive changes in their professional status and described an increasing role in mentorship of colleagues or residents as a result of new skills. Lack of formal leadership training was noted by three respondents. Informal mentorship equipped fellows practicing in regions of Sub Saharan Africa with competencies to rise in their own leadership and mentoring roles related to enhancing glaucoma management. Suggested higher-order learning objectives and a formal curriculum can be included to optimize leadership training catered to the individual fellow experience.

Leadership is necessary in health care and specifically in the context of low- and middle-income countries to bring about sustainable developments. The SGF contains a unique “Sandwich” design, focusing on the acquisition of medical and leadership skills. This evaluation outlines successes and challenges of this, and similar fellowship programs. Other programs can use a similar model to promote the development of skills in partnership with the fellows’ home country to strengthen health-care leaders.

The purpose of this study is to develop a domain independent, cost-effective, time-saving and semi-automated ontology generation framework that could extract taxonomic concepts from unstructured text corpus. In the human disease domain, ontologies are found to be extremely useful for managing the diversity of technical expressions in favour of information retrieval objectives. The boundaries of these domains are expanding so fast that it is essential to continuously develop new ontologies or upgrade available ones.

This paper proposes a semi-automated approach that extracts entities/relations via text mining of scientific publications. Text mining-based ontology (TmbOnt)-named code is generated to assist a user in capturing, processing and establishing ontology elements. This code takes a pile of unstructured text files as input and projects them into high-valued entities or relations as output. As a semi-automated approach, a user supervises the process, filters meaningful predecessor/successor phrases and finalizes the demanded ontology-taxonomy. To verify the practical capabilities of the scheme, a case study was performed to drive glaucoma ontology-taxonomy. For this purpose, text files containing 10,000 records were collected from PubMed.

The proposed approach processed over 3.8 million tokenized terms of those records and yielded the resultant glaucoma ontology-taxonomy. Compared with two famous disease ontologies, TmbOnt-driven taxonomy demonstrated a 60%–100% coverage ratio against famous medical thesauruses and ontology taxonomies, such as Human Disease Ontology, Medical Subject Headings and National Cancer Institute Thesaurus, with an average of 70% additional terms recommended for ontology development.

According to the literature, the proposed scheme demonstrated novel capability in expanding the ontology-taxonomy structure with a semi-automated text mining approach, aiming for future fully-automated approaches.

The purpose of this paper is to compare the fluid dynamic performance of two Aqueous Humor (AH) ocular drainage devices, the SOLX® Gold Micro Shunt (GMS) and the novel Silicon Shunt Device (SSD), implanted by surgeons in human eyes to reduce the IntraOcular Pressure towards physiological values, by draining the AH from the Anterior Chamber to the Suprachoroidal Space, to cure eyes with glaucoma.

The generalized porous medium model is solved to simulate the AH flow through the two ocular drainage devices and the surrounding porous tissues of the eye.

In the GMS, probable stagnation regions have been found, due to the very small AH velocity values inside the device and to the surrounding tissues, creating possible blockage and malfunction of the device. The simple microtubular geometry of the novel SSD allows to have a regular AH flow and to choose shunts with different diameters and/or with the presence of radial holes, based on patient needs, with consequent reduction of post-operative complications.

The present model will be further developed taking into account the insertion of the present drainage devices inside the anterior section of the eye. The present results show the comparative fluid dynamic performance of the two shunts considered, and can be useful for surgeons to choose the adequate shunt, based on the required AH flow rate for a specific patient.

The present numerical approach, employing the generalized porous medium model, represents a useful tool to study the fluid dynamics of ocular drainage devices and to design these shunts, to reduce post-operative complications.

The generalized porous medium model is here applied for the first time to simulate the interaction of ocular drainage devices with the surrounding porous tissues of the eye.

1. Introduction Probably the “hottest” topic in the LISA (Library and Information Systems) world in recent times is the idea of developing systems which can act “intelligently” by using the knowledge of a human expert (within our context, that of an intermediary or a librarian). Such knowledge‐based systems are popularly known as “expert systems”.

Glaucoma is a blinding disease which disproportionately affects some communities, particularly African‐Caribbeans. The ‘ReGAE’ project: Research into Glaucoma and Ethnicity was set up in 1999 and is based at the Birmingham and Midland Eye Centre. Among its aims are to provide ethnically‐sensitive evidence‐based information to help inform the future commissioning and training of glaucoma care with ethnic groups and to develop a national programme of glaucoma education.

The purpose of the paper is to report a case of bilateral inferior iridoschisis who underwent cataract surgery with intraocular lens implantation successfully with the help of iris hooks or pupillary expanders.

A 71-year-old male presented with inferior iridoschisis in both eyes, history of angle closure glaucoma (ACG), cataract and shallow anterior chamber (AC) angles inferiorly. A localized area of iris stroma is cleaved in two with anterior atrophic portion disintegrating into fibrils from the posterior stroma, and muscle layer is termed as iridoschisis. Iridoschisis is a rare condition associated with fibrillary iris degeneration, narrow drainage angles and cataract.

Preoperative and postoperative ocular examination, including visual acuity, intraocular pressure and degrees of iris damage, was evaluated. Cataract surgery was performed under topical anesthesia with flexible iris hooks. There were no intraoperative complications whereas marked corneal edema was shown at immediate postoperative period but subsided completely in two weeks’ time. Visual acuity improved from 20/60 to 20/25.

This case report demonstrates that while iridoschisis care during cataract surgery has been reported to be difficult, cataract extraction was managed using iris hooks.

This paper reports the successful management of cataract in a patient with bilateral inferior iridoschisis.