Search results
1 – 10 of 58Peter Shah, Freda Sii and Vinette Cross
Glaucoma is a blinding disease which disproportionately affects some communities, particularly African‐Caribbeans. The ‘ReGAE’ project: Research into Glaucoma and Ethnicity was…
Abstract
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.
Details
Keywords
Dirk F. de Korne, Kees (J.C.A.) Sol, Thomas Custers, Esther van Sprundel, B. Martin van Ineveld, Hans G. Lemij and Niek S. Klazinga
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.
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Research limitations/implications
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.
Originality/value
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.
Details
Keywords
Alessandro Mauro, Mario R. Romano, Vito Romano and P. Nithiarasu
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…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Research limitations/implications
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.
Practical implications
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.
Originality/value
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.
Details
Keywords
This case, “One Mission, Multiple Roads: Aravind Eyecare System in 2009” is a sequel to the earlier case, “Aravind Eyecare System: Giving Them the Most Precious Gift” (BP 0299)…
Abstract
This case, “One Mission, Multiple Roads: Aravind Eyecare System in 2009” is a sequel to the earlier case, “Aravind Eyecare System: Giving Them the Most Precious Gift” (BP 0299). It describes the new challenges facing AECS in 2009. It presents the strategic choices facing a mission driven organization like AECS. For its future growth it had the option of several paths. Following any of these paths would not dilute its mission and yet it could not pursue all of them at the same time. It would have to prioritize them. The case encourages participants to develop criteria for this prioritization.
Details
Keywords
Petrina Tan, Fong Yee Foo, Stephen C. Teoh and Hon Tym Wong
The purpose of this paper is to determine the safety of substituting the first day post-operative review after routine cataract surgery (phacoemulsification) with a telephone…
Abstract
Purpose
The purpose of this paper is to determine the safety of substituting the first day post-operative review after routine cataract surgery (phacoemulsification) with a telephone survey.
Design/methodology/approach
Prospective non-randomised cohort study. A standardised questionnaire of five common ocular symptoms (general condition, vision, eye pain, headache, nausea or vomiting) was administered by a trained nurse on the first post-operative day. The patients were reviewed in clinic two to 14 days later. Patient charts were retrospectively reviewed for complications (endophthalmitis, raised intra-ocular pressure, wound leaks and uveitis) requiring deviation from standard treatment.
Findings
Over 13 months, 256 eyes of 238 patients underwent uncomplicated phacoemulsification by four consultant surgeons. Only one patient reported poor general condition, blurred vision and eye pain. She was subsequently found to have corneal oedema and raised intra-ocular pressure when recalled for an earlier review. Best corrected visual acuity better than 20/40 was achieved in 80.5 per cent of patients. There were no other post-operative complications noted from medical records review.
Research limitations/implications
Non-randomised nature, skewed surgical expertise, lack of a control group and patient experience data. In all, 22 patients (9.2 per cent) were also uncontactable for the telephone interview.
Practical implications
A nurse-administered telephone survey seemed to be a safe and effective alternative to first day post-operative review after routine phacoemulsification. The survey also enabled the detection of serious post-operative complications. The first day post-operative hospital visit may be safely substituted in a selected patient population with greater patient convenience achieved and liberation of clinic resources.
Originality/value
This is the first study which utilises a standardised questionnaire as a form of post-operative review in an Asian population.
Details
Keywords
A variety of enabling technologies such as synthetic speech, print enlargement on CRT screens, braille printers and displays, and communications technology has made library…
Abstract
A variety of enabling technologies such as synthetic speech, print enlargement on CRT screens, braille printers and displays, and communications technology has made library operations at the American Foundation for the Blind accessible to persons who are blind or visually impaired. INMAGIC software, a versatile database management system, has automated many library functions and has been integrated with other adaptive technologies. In addition to other applications, INMAGIC is used to update and create bibliographies and accession lists in inkprint, large print, or braille formats (with tape cassette versions available on request). Sidebars discuss the Xerox/Kurzweil Personal Reader (KPR); closed circuit television (CCTV); computers with speech; large print enhancements; Inmagic, Inc.—the company; and, in some depth, the functionality of INMAGIC.
Abbas Heydari, Rana Amiri, Nahid Dehghan Nayeri and Vedadhir AboAli
– The purpose of this paper is to explore experiences of Afghan refugees from health service delivery in Mashhad, Iran.
Abstract
Purpose
The purpose of this paper is to explore experiences of Afghan refugees from health service delivery in Mashhad, Iran.
Design/methodology/approach
This is a descriptive study with contextual and qualitative design. Semi-structured interview conducted with 19 Afghan refugees and their caregivers and a focus group session were held with Afghan medical science students. Purposive sampling technique was used to select participants. Data were analysed by qualitative content analysis of Graneheim and Lundman. Lincoln and Guba’s criteria were implemented to ensure trustworthiness.
Findings
The results with the core concept of “position of immigrants in the health system” were presented at four themes of “perceived discrimination”, “snowed with loneliness”, “feeling inferior”, and “gratitude”.
Research limitations/implications
This study has some implications for researchers and practitioners. The present study is the first study that was done on the health of Afghan refugees in Iran, therefore it can be a ground for further research. In addition, it has valuable results regarding the Afghan immigrants’ experience of health care system of Iran.
Practical implications
It can be useful for improving the condition of immigrants in Iran and for improving Iran’s health system. In order to improve the health system in Iran, authorities should pay much attention to transcultural caring and needs of minorities. Furthermore, health workers should be trained to appropriately take care of all patients, without prejudice.
Originality/value
Overall the study revealed that there is inequity in access to health services among Afghan refugees in Iran. The findings, although not generalized, offer important insights into health care providers in Iran which should be delivering health service without prejudice. The authors recommended that policies of public medical insurance and assistance programme should be implemented for providing affordable health care services for Afghan refugees.
Details
Keywords
Arja Juntunen, Tuulevi Ovaska, Jarmo Saarti and Liisa Salmi
To present the process of creating the quality management system of the Kuopio University Library (Finland) and its auditing.
Abstract
Purpose
To present the process of creating the quality management system of the Kuopio University Library (Finland) and its auditing.
Design/methodology/approach
Case study of the Library's quality management system's building process, with some survey‐based material.
Findings
The European Union has decided that some kind of quality management system should be established in its higher education institutions. This sets new challenges for the university libraries. The paper presents the fact that quality management can be used as a tool for leadership within the Library, improving the Library's processes and marketing the Library within the University.
Research limitations/implications
The paper is based on conditions in Finland.
Practical implications
The paper gives an example of what implications national and international higher‐education policies have on a university library.
Originality/value
The paper provides a model for quality management and quality system documentation.
Details
Keywords
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…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Practical implications
This case report demonstrates that while iridoschisis care during cataract surgery has been reported to be difficult, cataract extraction was managed using iris hooks.
Originality/value
This paper reports the successful management of cataract in a patient with bilateral inferior iridoschisis.
Details
Keywords
Navin K. Dev, Ravi Shankar and Kamal Arvind
The aim of this study is to highlight the value of the success rate performance of a surgery while planning patient flow within a supply chain of a health care…
Abstract
Purpose
The aim of this study is to highlight the value of the success rate performance of a surgery while planning patient flow within a supply chain of a health care organization/hospital.
Design/methodology/approach
The paper has considered one of the common surgeries, cataract, and the complications that subsequently result from this surgery. The study employs interpretive structural modeling (ISM) approach to draw a roadmap to study various complications causing cataract that subsequently help in planning and coordination of patient flow.
Findings
The study finds that there is a hierarchy of causes and certain complications, the persistence of which gives a higher success rate performance in cataract surgery as compared to others.
Practical implications
The paper provides leverage to the decision maker while organizing the patient flow depending upon the information of hierarchy of complication of a disease, and accordingly ensures the availability of resources to the patient.
Originality/value
The study is of value in identifying the degree of complications from cataract surgery. Given the degree of complication, the patient logistics can be planned myopically in a health care organization which largely depends upon the degree of success rate. The paper attempts to suggest that the hierarchy obtained through ISM can be implemented in the modules of an enterprise resource planning (ERP) set up.
Details