Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge...Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.展开更多
Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on d...Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.展开更多
BACKGROUND:Living donor liver transplantation (LDLT) has recently emerged as an effective therapeutic alternative for patients with end-stage liver disease.In the meantime,the health-related quality of life (HRQoL) of...BACKGROUND:Living donor liver transplantation (LDLT) has recently emerged as an effective therapeutic alternative for patients with end-stage liver disease.In the meantime,the health-related quality of life (HRQoL) of the donors is becoming better appreciated.Here we aimed to review the current literature and summarize the effects of liver donation on the long-term HRQoL of living donors.DATA SOURCES:A literature search of PubMed using "donors","living donor liver transplantation","health-related quality of life",and "donation" was performed,and all the information was collected.RESULTS:The varied postoperative outcomes of liver donors are attributive to the different evaluation instruments used.On the whole,donors experienced good long-term physical and mental well-being with a few complaining of compromised quality of life due to mild symptoms or psychiatric problems.The psychosocial dimension has received increasing attention with the vocational,interpersonal and financial impact of liver donation on donors mostly studied.CONCLUSIONS:Generally,donors have a good HRQoL after LDLT.Nevertheless,to achieve an ideal donor outcome,further work is necessary to minimize the negative effects as well as to incorporate recent progress in regenerative medicine.展开更多
AIM:To describe the design and clinical application of a corneal donor dehydrator which can quickly dehydrate corneas and keep its original shape.METHODS:The corneal donor material is placed on stainless steel beads w...AIM:To describe the design and clinical application of a corneal donor dehydrator which can quickly dehydrate corneas and keep its original shape.METHODS:The corneal donor material is placed on stainless steel beads with different diameters in the dehydrating box to make the cornea the same shape as the steel ball.Then,the cornea is placed inside the dehydrater for rapid dehydrating using the internal cleaning and ventilation system.Totally 83 eyes underwent deep anterior lamellar keratoplasty(DALK)using corneal donor tissue preserved with corneal dehydrater,and 60 patients(60 eyes)received DALK by the same surgeon using corneal donor tissue preserved with glycerol were included in the control group.The best corrected visual acuity(BCVA),the thickness and transparency of the corneal buttons were recorded.RESULTS:After the completion of dehydrating,all the donor corneas maintained a normal shape without any shrinkage or distortion,and the average intraoperative rehydration time was 43.3±12.1 s during operation.The mean BCVA of the dehydrater group was 0.30±0.18 at 1 wk and 0.32±0.16 at 1 mo,which were statistically better than that of the control group(P<0.001).The score of corneal buttons transparency were lower than that of the control group with statistical difference(P<0.001).The thickness of corneal buttons at 1 wk and at 1 mo in the dehydrater group was significantly better than that of the control group respectively(P<0.001).One week after operation,no corneal button turbidity or edema was observed in both groups.CONCLUSION:The dehydrater can quickly dehydrate the corneal material in a clean and airtight environment and maintain the original shape of the corneal donor during the dehydrating process.This dehydrater is recommended for long-term high-quality preservation in areas where corneal materials cannot be used within a reasonable time period.展开更多
AIM: To investigate the health related quality of life (HRQoL) and psychological outcome of donors after living donor liver transplantation. METHODS: Participants were 92 consecutive liver transplant donors who underw...AIM: To investigate the health related quality of life (HRQoL) and psychological outcome of donors after living donor liver transplantation. METHODS: Participants were 92 consecutive liver transplant donors who underwent hepatectomy with- out middle hepatic vein at West China Hospital of Sichuan University between January 2007 and Sep- tember 2010. HRQoL was measured using the Chinese version of the Medical Outcomes Study Short Form-36 (SF-36), and psychological symptoms were measured using the Symptom Checklist-90-Revised (SCL-90-R). Data collected from donors were compared to previ- ously published data from the general population. Clin- ical and demographic data were collected from medical records and questionnaires.RESULTS: The general health score of the SF-36 was significantly lower in females (59.78 ± 12.25) than in males (75.83 ± 22.09). Donors more than 40 years old scored higher in social functioning (85.71 ± 14.59) and mental health (82.61 ± 20.00) than those younger than 40 (75.00 ± 12.13, 68.89 ± 12.98; social func- tioning and mental health, respectively). Donors who had surgery more than two years prior to the study scored highest in physical functioning (P = 0.001) and bodily pain (P = 0.042) while those less than one year from surgery scored lowest. The health of the liver recipient significantly influenced the general health (P = 0.042), social functioning (P = 0.010), and role- emotional (P = 0.028) of donors. Donors with full-time employment scored highest in role-physical (P = 0.005), vitality (P = 0.001), social functioning (P = 0.016), mental health (P < 0.001), the physical component summary scale (P < 0.001), and the mental compo- nent summary scale (MCS) (P < 0.001). Psychological measures indicated that donors were healthier than the general population in obsessive-compulsive behav- ior, interpersonal sensitivity, phobic anxiety, and para- noid ideation. The MCS of the SF-36 was significantly correlated with most symptom scores of the SCL-90-R. CONCLUSION: HRQoL and psychological outcome were favorable in living liver transplant donors after donation. Specifically, gender, age, time since opera- tion, recipient health condition, and employment after donation, influenced postoperative quality of life.展开更多
AIM:To compare the subjective and objective visual quality between small incision lenticule extraction(SMILE)and transepithelial photorefractive keratectomy(t PRK)in patients with low and moderate myopia.METHODS:Patie...AIM:To compare the subjective and objective visual quality between small incision lenticule extraction(SMILE)and transepithelial photorefractive keratectomy(t PRK)in patients with low and moderate myopia.METHODS:Patients undertaking SMILE or t PRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period.Objective evaluation[visual acuity test,manifest refraction,wavefront aberrations,the total cut-off value of the total modulation transfer function(MTFcut-off),and Strehl ratio(SR)]and subjective evaluation of visual quality(quality-of-life questionnaire)were conducted before surgery and at days 1,7,30,and 90 after surgery.RESULTS:A total of 47 patients(94 eyes)with SMILE and 22 patients(22 eyes)with t PRK were enrolled.The uncorrected visual acuity(UCVA)was better in SMILE patients on day 7 after surgery(1.13±0.13 vs 0.99±0.17,t=4.85,P<0.001)but was comparable at days 30 and 90.At day 90,the SMILE group had a lower spherical equivalent(SE)than the t PRK group(0.04±0.31 vs 0.19±0.43,t=2.08,P=0.042).Total higher order aberrations(HOAs)were induced in both surgical types,which were more evident in the t PRK group with 3-mm pupil diameter(0.16±0.07 vs0.11±0.05,t=4.27,P<0.001)and 5-mm pupil diameter(0.39±0.17 vs 0.36±0.11,t=2.33,P=0.022).The MTFcut-offand SR showed a trend of improvement in both SMILE and t PRK patients but were statistically better in the SMILE group with both pupil diameters.There was a significant improvement of contrast sensitivity(CS)over baseline levels at the spatial frequency of 18 cycles/degree(c/d)in the SMILE group(F=2.72,P=0.033)and at 3 c/d(F=3.03,P=0.031),12 c/d(F=3.72,P=0.013),and 18 c/d(F=4.62,P=0.004)in the t PRK group.The subjective quality of life questionnaire showed a steady improvement in the SMILE group(F=8.31,P<0.001)but not the t PRK group.CONCLUSION:SMILE and t PRK are both safe and effective ways to correct low and moderate myopia.A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.展开更多
目的探讨心脏死亡器官捐献(donation after cardiac death,DCD)供体质量对肝移植术后受体生存率的影响。方法回顾性分析2018年1月至2021年1月解放军总医院第三医学中心DCD肝移植手术患者100例,移植术后进行为期1年的随访调查,观察肝移...目的探讨心脏死亡器官捐献(donation after cardiac death,DCD)供体质量对肝移植术后受体生存率的影响。方法回顾性分析2018年1月至2021年1月解放军总医院第三医学中心DCD肝移植手术患者100例,移植术后进行为期1年的随访调查,观察肝移植受者的生存状态,对相关危险因素加以分析。结果100例肝移植受者术后1年病死率为3%(3/100),其死亡因素与供体冷缺血时间、供体脂肪肝、术中出血量、供体白蛋白及总胆红素水平、肝细胞水肿密切相关(P<0.05)。多因素Logistic回归分析发现,供体冷缺血时间≥840 min、脂肪肝是影响肝移植受者生存状态的独立危险因素(P<0.05)。肝移植术后感染率为26%(26/100),其肝移植术后感染率与受体肝功能Child-Pugh评分、术前血红蛋白水平、血小板计数、术中输血量、术后重症监护病房(intensive care unit,ICU)留观时间密切相关(P<0.05)。结论DCD供体质量对肝移植术后受体生存率具有显著影响,供体冷缺血时间、供体脂肪肝对肝移植术后受体生存状态具有重要影响。展开更多
With the evolution of cataract surgery from visual rehabilitation to refractive surgery, aspheric intraocular lenses(IOLs) are being increasingly used in the field of ophthalmology. This increased use can be attribute...With the evolution of cataract surgery from visual rehabilitation to refractive surgery, aspheric intraocular lenses(IOLs) are being increasingly used in the field of ophthalmology. This increased use can be attributed to negative or zero spherical aberrations with unique optical designs, which counteract some of the positive spherical aberrations of the cornea. These alterations reduce the total spherical aberration of human eyes and improve the visual acuity in patients with cataract postoperatively. At present, various types of aspheric IOLs are used worldwide. Although the implantation of aspheric IOL is beneficial to the patients who need correction of spherical aberrations, much controversy is still associated with ocular residual spherical aberrations that facilitate the best visual quality for patients postoperatively. In order to provide reference for future clinical work and scientific research, this report reviews the relationship between the ocular residual spherical aberration of human eyes and visual quality.展开更多
AIM: To compare visual quality in cataract patients with low corneal astigmatism who underwent intraocular lens(IOL) implantation, and evaluate effects of low levels of astigmatism on visual outcomes in multifocal pse...AIM: To compare visual quality in cataract patients with low corneal astigmatism who underwent intraocular lens(IOL) implantation, and evaluate effects of low levels of astigmatism on visual outcomes in multifocal pseudophakic eyes.METHODS: This retrospective review of clinical records comprised patients with preoperative regular corneal astigmatism of 0.75-1.0 diopters(D) with-the-rule or 0.5-0.75 D against-the-rule who had uneventful cataract surgery and AcrySof IQ ReSTOR Toric-2 IOL(ART2) or AcrySof IQ ReSTOR IOL(ReSTOR) implantation. Retrospective data collection included postoperative ART2 axis rotation, uncorrected astigmatism, uncorrected entire visual acuities, distance corrected entire visual acuities, average modulation transfer function(aMTF), Strehl ratio(SR), spectacle independence, and patient satisfaction between groups.RESULTS: Mean ART2 axis rotation was 3.12°±0.70°. No secondary surgery was required to realign IOL axis. Residual astigmatism values were-0.18±0.07 D and-0.91±0.25 D in groups ART2 and ReSTOR(P<0.05). Three months postoperatively, the mean uncorrected distant, intermediate, and near visual acuities of group A were 0.01±0.05, 0.05±0.07, 0.02±0.07 logMAR, respectively; these were better than those of group R, which were 0.08±0.06, 0.15±0.12, and 0.09±0.08 logMAR, respectively(P<0.05). aMTF, SR, and spectacle independence rates were not significantly different. All patients were satisfied with postoperative results.CONCLUSION: ART2 is more suitable than ReSTOR for cataract patients with regular corneal astigmatism 0.75-1.0 D with-the-rule or 0.5-0.75 D against-the-rule.展开更多
To explore the lived experiences of patients undergoing acellular porcine corneal stroma(APCS)transplantation,a descriptive,qualitative design was performed.A purposive sample of 13 patients who underwent APCS transpl...To explore the lived experiences of patients undergoing acellular porcine corneal stroma(APCS)transplantation,a descriptive,qualitative design was performed.A purposive sample of 13 patients who underwent APCS transplantation to treat progressive infectious keratitis were enrolled in the semi-structured,open-ended interviews.The taped and transcribed interviews were analyzed using a thematic analysis approach.Alterations in the transparency of APCS grafts were accompanied by a gradual improved visual acuity(before surgery:1.38±0.91 logMAR;3mo postoperatively :0.40±0.24 logMAR, respectively).Accordingly,in terms of lived experiences,the patients generally reported"negative"experiences before the operation and during the early postoperative period,but this was greatly improved 3mo after surgery.Four main themes were derived:anxiety and fear,stigma,lifestyle change,and gratitude and insights. Conclusively,health care professionals should provide holistic care for patients,proactively promoting patients’physical and mental health.展开更多
AIM: To identify possible differences of efficacy, safety predictability, higher-order aberrations and cornea biomechnical parameters after small-incision lenticule extraction(SMILE) and femtosecond lenticule extracti...AIM: To identify possible differences of efficacy, safety predictability, higher-order aberrations and cornea biomechnical parameters after small-incision lenticule extraction(SMILE) and femtosecond lenticule extraction(FLEx).· METHODS: A systematic literature retrieval was conducted in Medline,Embase and the Cochrane Library up to October, 2015. The included studies were subject to a Meta-analysis. Comparison between SMILE and FLEx was measured as pooled odds ratio(OR) or weighted mean differences(WMD). Of 95% confidence intervals(CI) were used to analyze data.·RESULTS: A total of seven studies were included Firstly, there were no differences in uncorrected distance visual acuity(UDVA) 20/20 or better(OR, 1.37; 95% CI0.69 to 2.69; P =0.37) and log MAR UDVA(WMD,-0.02;95% CI,-0.05 to 0.01; P =0.17) after SMILE versus FLEx We found no differences in corrected distance visua acuity(CDVA) unchanged(OR, 0.98; 95% CI, 0.46 to 2.11;P =0.97) and log MAR CDVA(WMD,-0.00; 95% CI,-0.01 to 0.01; P =0.90) either. Secondly, we found no differences in refraction within ±1.00 D(OR, 0.98; 95% CI0.13 to 7.28; P =0.99) and ±0.50 D(OR, 1.62; 95% CI0.62 to 4.28; P =0.33) of target postoperatively. Thirdly for higher-order aberrations, we found no differences in the total higher-order aberrations(WMD,-0.04; 95%CI,-0.09 to 0.01;P =0.14), coma(WMD,-0.04; 95% CI,-0.09 to 0.01; P =0.11), spherical(WMD, 0.01; 95% CI,-0.02 to0.03; P =0.60) and trefoil(WMD,-0.00; 95% CI,-0.04 to0.03; P =0.76). Furthermore, for corneal biomechanica parameters, we also found no differences(WMD, 0.08;95% CI,-0.17 to 0.33; P =0.54) after SMILE versus FLEx.·CONCLUSION: There are no statistically differences in efficacy, safety, predictability, higher-order aberrations and corneal biomechnical parameters postoperative between SMILE and FLEx.展开更多
AIM: To evaluate the effect of rigid gas permeable contact lens(RGP-CL) on corneal morphological parameters and vision-related quality of life in keratoconus(KC) patients.METHODS: Totally 57 eyes of 30 KC patients who...AIM: To evaluate the effect of rigid gas permeable contact lens(RGP-CL) on corneal morphological parameters and vision-related quality of life in keratoconus(KC) patients.METHODS: Totally 57 eyes of 30 KC patients who were followed-up for more than two years, including 17 RGP wearers(32 eyes) and 13 non-wearers(25 eyes) were retrospectively analyzed. Initial medical history and corneal topography were collected at baseline. Corneal topography, corneal aberration, optical coherence tomography, and vision-related quality of life questionnaires were performed at the last follow-up.RESULTS: According to corneal topography, increase of the flattest keratometric values was higher in RGP wearers than in non-wearers(P=0.038). The morphological parameters, including symmetry index of front corneal curvature(P=0.004) and Baiocchi-Calossi-Versaci index front(P=0.047), were lower in RGP wearers than in nonwearers. Vertical coma was smaller in RGP wearers than non-wearers in 3.0, 5.0, 6.0, and 7.0 mm pupil diameters, respectively(P<0.05). The environmental triggering domain of ocular surface disease index was worse in RGP wearers as compared to non-wearers(P=0.003). At the last followup, there were no significant differences in constituent ratios of KC progression, corneal thickness topography, epithelial thickness topography, morphological parameters of corneal topography, and other questionnaire scores between the two groups(all P>0.05).CONCLUSION: Long-term use of RGP does not worsen KC but may cause corneal epithelial remodeling to increase symmetry of corneal anterior surface, reduce corneal vertical coma and improve visual quality. However, RGP wearing causes a slight decrease in vision-related quality of life. The occurrence of ocular surface symptoms is mainly associated with environmental triggering factors.展开更多
AIM:To investigate health-related quality of life(HRQoL) and psychological outcomes in 256 adults who had undergone liver transplantation(LT).METHODS:A stratified random sampling method was used in this follow-up mult...AIM:To investigate health-related quality of life(HRQoL) and psychological outcomes in 256 adults who had undergone liver transplantation(LT).METHODS:A stratified random sampling method was used in this follow-up multicenter study to select a representative sample of recipients undergoing either living donor liver transplantation(LDLT) or deceased donor liver transplantation(DDLT).HRQoL was measured by using the Chinese version of Medical Outcome Study Short Form-36(SF-36),and psychological outcomes by using the beck anxiety inventory(BAI) and the self-rating depression scale(SDS).Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via questionnaires.RESULTS:A total of 256 patients were sampled,including 66(25.8%) receiving LDLT and 190(74.2%) undergoing DDLT;15(5.9%) recipients had anxiety and four(1.6%) developed severe depression after the operation.Compared with LDLT recipients,DDLT patients had higher scores in general health(60.33 ± 16.97 vs 66.86 ± 18.42,P = 0.012),role-physical(63.64 ± 42.55 vs 74.47 ± 36.46,P = 0.048),roleemotional(61.11 ± 44.37 vs 78.95 ± 34.31,P = 0.001),social functioning(78.60 ± 22.76 vs 88.16 ± 21.85,P = 0.003),vitality(70.30 ± 15.76 vs 75.95 ± 16.40,P = 0.016),mental health(65.88 ± 12.94 vs 71.85 ± 15.45,P = 0.005),physical component summary scale(PCS,60.07 ± 7.36 vs 62.58 ± 6.88,P = 0.013) and mental component summary scale(MCS,52.65 ± 7.66 vs 55.95 ± 10.14,P = 0.016).Recipients > 45 years old at the time of transplant scored higher in vitality(77.33 ± 15.64 vs 72.52 ± 16.66,P = 0.020),mental health(73.64 ± 15.06 vs 68.00 ± 14.65,P = 0.003) and MCS(56.61 ± 10.00 vs 54.05 ± 9.30,P = 0.037) than those aged ≤ 45 years.MCS was poorer in recipients with than in those without complications(52.92 ± 12.21 vs 56.06 ± 8.16,P = 0.017).Regarding MCS(55.10 ± 9.66 vs 50.0 ± 10.0,P < 0.05) and PCS(61.93 ± 7.08 vs 50.0 ± 10.0,P < 0.05),recipients scored better than the Sichuan general and had improved overall QoL compared to patients with chronic diseases.MCS and PCS significantly correlated with scores of the BAI(P < 0.001) and the SDS(P < 0.001).CONCLUSION:Age > 45 years at time of transplant,DDLT,full-time working,no complications,anxiety and depression were possible factors influencing postoperative HRQoL in liver recipients.展开更多
Living kidney transplantation is now a widely accepted treatment for end stage renal disease(ESRD) because it provides excellent outcomes for recipients. However, long-term outcomes of living kidney donors have not be...Living kidney transplantation is now a widely accepted treatment for end stage renal disease(ESRD) because it provides excellent outcomes for recipients. However, long-term outcomes of living kidney donors have not been well understood. Because securing the safety of the donor is essential to the continued success of this procedure, we reviewed articles discussing long-term outcomes of living kidney donors. Most studies found no decrease in long-term survival or progressive renal dysfunction in previous kidney donors. Moreover, the prevalence of hypertension was comparable to that expected in the general population, although some did report otherwise. Urinary protein showed small increases in this population and was associated with hypertension and a lower glomerular filtration rate. Quality of life following living kidney donation seems to be better than the national norm. We also encountered several reports of ESRD in previous living kidney donors. Regular follow-up of kidney donors is recommended and future controlled, prospective studies will better delineate risk factors which cause health problems following living kidney donation.展开更多
文摘Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.
基金Supported by The Ophthalmic Research Center,Shahid Beheshti University of Medical Sciences,Tehran,Iran
文摘Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.
文摘BACKGROUND:Living donor liver transplantation (LDLT) has recently emerged as an effective therapeutic alternative for patients with end-stage liver disease.In the meantime,the health-related quality of life (HRQoL) of the donors is becoming better appreciated.Here we aimed to review the current literature and summarize the effects of liver donation on the long-term HRQoL of living donors.DATA SOURCES:A literature search of PubMed using "donors","living donor liver transplantation","health-related quality of life",and "donation" was performed,and all the information was collected.RESULTS:The varied postoperative outcomes of liver donors are attributive to the different evaluation instruments used.On the whole,donors experienced good long-term physical and mental well-being with a few complaining of compromised quality of life due to mild symptoms or psychiatric problems.The psychosocial dimension has received increasing attention with the vocational,interpersonal and financial impact of liver donation on donors mostly studied.CONCLUSIONS:Generally,donors have a good HRQoL after LDLT.Nevertheless,to achieve an ideal donor outcome,further work is necessary to minimize the negative effects as well as to incorporate recent progress in regenerative medicine.
基金National Natural Science Foundation of China(No.81870639,No.82070923,No.81900907)Taishan Scholar Program(No.tspd20150215,No.tsqn201812150)the Academic Promotion Program of Shandong First Medical University(No.2019RC009)。
文摘AIM:To describe the design and clinical application of a corneal donor dehydrator which can quickly dehydrate corneas and keep its original shape.METHODS:The corneal donor material is placed on stainless steel beads with different diameters in the dehydrating box to make the cornea the same shape as the steel ball.Then,the cornea is placed inside the dehydrater for rapid dehydrating using the internal cleaning and ventilation system.Totally 83 eyes underwent deep anterior lamellar keratoplasty(DALK)using corneal donor tissue preserved with corneal dehydrater,and 60 patients(60 eyes)received DALK by the same surgeon using corneal donor tissue preserved with glycerol were included in the control group.The best corrected visual acuity(BCVA),the thickness and transparency of the corneal buttons were recorded.RESULTS:After the completion of dehydrating,all the donor corneas maintained a normal shape without any shrinkage or distortion,and the average intraoperative rehydration time was 43.3±12.1 s during operation.The mean BCVA of the dehydrater group was 0.30±0.18 at 1 wk and 0.32±0.16 at 1 mo,which were statistically better than that of the control group(P<0.001).The score of corneal buttons transparency were lower than that of the control group with statistical difference(P<0.001).The thickness of corneal buttons at 1 wk and at 1 mo in the dehydrater group was significantly better than that of the control group respectively(P<0.001).One week after operation,no corneal button turbidity or edema was observed in both groups.CONCLUSION:The dehydrater can quickly dehydrate the corneal material in a clean and airtight environment and maintain the original shape of the corneal donor during the dehydrating process.This dehydrater is recommended for long-term high-quality preservation in areas where corneal materials cannot be used within a reasonable time period.
基金Supported by National Science and Technology Key Projects,No.2008ZX10002-026
文摘AIM: To investigate the health related quality of life (HRQoL) and psychological outcome of donors after living donor liver transplantation. METHODS: Participants were 92 consecutive liver transplant donors who underwent hepatectomy with- out middle hepatic vein at West China Hospital of Sichuan University between January 2007 and Sep- tember 2010. HRQoL was measured using the Chinese version of the Medical Outcomes Study Short Form-36 (SF-36), and psychological symptoms were measured using the Symptom Checklist-90-Revised (SCL-90-R). Data collected from donors were compared to previ- ously published data from the general population. Clin- ical and demographic data were collected from medical records and questionnaires.RESULTS: The general health score of the SF-36 was significantly lower in females (59.78 ± 12.25) than in males (75.83 ± 22.09). Donors more than 40 years old scored higher in social functioning (85.71 ± 14.59) and mental health (82.61 ± 20.00) than those younger than 40 (75.00 ± 12.13, 68.89 ± 12.98; social func- tioning and mental health, respectively). Donors who had surgery more than two years prior to the study scored highest in physical functioning (P = 0.001) and bodily pain (P = 0.042) while those less than one year from surgery scored lowest. The health of the liver recipient significantly influenced the general health (P = 0.042), social functioning (P = 0.010), and role- emotional (P = 0.028) of donors. Donors with full-time employment scored highest in role-physical (P = 0.005), vitality (P = 0.001), social functioning (P = 0.016), mental health (P < 0.001), the physical component summary scale (P < 0.001), and the mental compo- nent summary scale (MCS) (P < 0.001). Psychological measures indicated that donors were healthier than the general population in obsessive-compulsive behav- ior, interpersonal sensitivity, phobic anxiety, and para- noid ideation. The MCS of the SF-36 was significantly correlated with most symptom scores of the SCL-90-R. CONCLUSION: HRQoL and psychological outcome were favorable in living liver transplant donors after donation. Specifically, gender, age, time since opera- tion, recipient health condition, and employment after donation, influenced postoperative quality of life.
基金Supported by the Science&Technology Department of Sichuan Province (China)Funding Project (No.2021YFS0221)the Postdoctoral Research Funding of West China Hospital (No.2020HXBH044)1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University (No.2022HXFH032,ZYJC21058)。
文摘AIM:To compare the subjective and objective visual quality between small incision lenticule extraction(SMILE)and transepithelial photorefractive keratectomy(t PRK)in patients with low and moderate myopia.METHODS:Patients undertaking SMILE or t PRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period.Objective evaluation[visual acuity test,manifest refraction,wavefront aberrations,the total cut-off value of the total modulation transfer function(MTFcut-off),and Strehl ratio(SR)]and subjective evaluation of visual quality(quality-of-life questionnaire)were conducted before surgery and at days 1,7,30,and 90 after surgery.RESULTS:A total of 47 patients(94 eyes)with SMILE and 22 patients(22 eyes)with t PRK were enrolled.The uncorrected visual acuity(UCVA)was better in SMILE patients on day 7 after surgery(1.13±0.13 vs 0.99±0.17,t=4.85,P<0.001)but was comparable at days 30 and 90.At day 90,the SMILE group had a lower spherical equivalent(SE)than the t PRK group(0.04±0.31 vs 0.19±0.43,t=2.08,P=0.042).Total higher order aberrations(HOAs)were induced in both surgical types,which were more evident in the t PRK group with 3-mm pupil diameter(0.16±0.07 vs0.11±0.05,t=4.27,P<0.001)and 5-mm pupil diameter(0.39±0.17 vs 0.36±0.11,t=2.33,P=0.022).The MTFcut-offand SR showed a trend of improvement in both SMILE and t PRK patients but were statistically better in the SMILE group with both pupil diameters.There was a significant improvement of contrast sensitivity(CS)over baseline levels at the spatial frequency of 18 cycles/degree(c/d)in the SMILE group(F=2.72,P=0.033)and at 3 c/d(F=3.03,P=0.031),12 c/d(F=3.72,P=0.013),and 18 c/d(F=4.62,P=0.004)in the t PRK group.The subjective quality of life questionnaire showed a steady improvement in the SMILE group(F=8.31,P<0.001)but not the t PRK group.CONCLUSION:SMILE and t PRK are both safe and effective ways to correct low and moderate myopia.A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.
文摘目的探讨心脏死亡器官捐献(donation after cardiac death,DCD)供体质量对肝移植术后受体生存率的影响。方法回顾性分析2018年1月至2021年1月解放军总医院第三医学中心DCD肝移植手术患者100例,移植术后进行为期1年的随访调查,观察肝移植受者的生存状态,对相关危险因素加以分析。结果100例肝移植受者术后1年病死率为3%(3/100),其死亡因素与供体冷缺血时间、供体脂肪肝、术中出血量、供体白蛋白及总胆红素水平、肝细胞水肿密切相关(P<0.05)。多因素Logistic回归分析发现,供体冷缺血时间≥840 min、脂肪肝是影响肝移植受者生存状态的独立危险因素(P<0.05)。肝移植术后感染率为26%(26/100),其肝移植术后感染率与受体肝功能Child-Pugh评分、术前血红蛋白水平、血小板计数、术中输血量、术后重症监护病房(intensive care unit,ICU)留观时间密切相关(P<0.05)。结论DCD供体质量对肝移植术后受体生存率具有显著影响,供体冷缺血时间、供体脂肪肝对肝移植术后受体生存状态具有重要影响。
文摘With the evolution of cataract surgery from visual rehabilitation to refractive surgery, aspheric intraocular lenses(IOLs) are being increasingly used in the field of ophthalmology. This increased use can be attributed to negative or zero spherical aberrations with unique optical designs, which counteract some of the positive spherical aberrations of the cornea. These alterations reduce the total spherical aberration of human eyes and improve the visual acuity in patients with cataract postoperatively. At present, various types of aspheric IOLs are used worldwide. Although the implantation of aspheric IOL is beneficial to the patients who need correction of spherical aberrations, much controversy is still associated with ocular residual spherical aberrations that facilitate the best visual quality for patients postoperatively. In order to provide reference for future clinical work and scientific research, this report reviews the relationship between the ocular residual spherical aberration of human eyes and visual quality.
文摘AIM: To compare visual quality in cataract patients with low corneal astigmatism who underwent intraocular lens(IOL) implantation, and evaluate effects of low levels of astigmatism on visual outcomes in multifocal pseudophakic eyes.METHODS: This retrospective review of clinical records comprised patients with preoperative regular corneal astigmatism of 0.75-1.0 diopters(D) with-the-rule or 0.5-0.75 D against-the-rule who had uneventful cataract surgery and AcrySof IQ ReSTOR Toric-2 IOL(ART2) or AcrySof IQ ReSTOR IOL(ReSTOR) implantation. Retrospective data collection included postoperative ART2 axis rotation, uncorrected astigmatism, uncorrected entire visual acuities, distance corrected entire visual acuities, average modulation transfer function(aMTF), Strehl ratio(SR), spectacle independence, and patient satisfaction between groups.RESULTS: Mean ART2 axis rotation was 3.12°±0.70°. No secondary surgery was required to realign IOL axis. Residual astigmatism values were-0.18±0.07 D and-0.91±0.25 D in groups ART2 and ReSTOR(P<0.05). Three months postoperatively, the mean uncorrected distant, intermediate, and near visual acuities of group A were 0.01±0.05, 0.05±0.07, 0.02±0.07 logMAR, respectively; these were better than those of group R, which were 0.08±0.06, 0.15±0.12, and 0.09±0.08 logMAR, respectively(P<0.05). aMTF, SR, and spectacle independence rates were not significantly different. All patients were satisfied with postoperative results.CONCLUSION: ART2 is more suitable than ReSTOR for cataract patients with regular corneal astigmatism 0.75-1.0 D with-the-rule or 0.5-0.75 D against-the-rule.
基金Supported by National Natural Science Foundation of China(No.81670826No.81400423)the Science and Technology Planning Project of Guangdong Province(No.20160215)
文摘To explore the lived experiences of patients undergoing acellular porcine corneal stroma(APCS)transplantation,a descriptive,qualitative design was performed.A purposive sample of 13 patients who underwent APCS transplantation to treat progressive infectious keratitis were enrolled in the semi-structured,open-ended interviews.The taped and transcribed interviews were analyzed using a thematic analysis approach.Alterations in the transparency of APCS grafts were accompanied by a gradual improved visual acuity(before surgery:1.38±0.91 logMAR;3mo postoperatively :0.40±0.24 logMAR, respectively).Accordingly,in terms of lived experiences,the patients generally reported"negative"experiences before the operation and during the early postoperative period,but this was greatly improved 3mo after surgery.Four main themes were derived:anxiety and fear,stigma,lifestyle change,and gratitude and insights. Conclusively,health care professionals should provide holistic care for patients,proactively promoting patients’physical and mental health.
文摘AIM: To identify possible differences of efficacy, safety predictability, higher-order aberrations and cornea biomechnical parameters after small-incision lenticule extraction(SMILE) and femtosecond lenticule extraction(FLEx).· METHODS: A systematic literature retrieval was conducted in Medline,Embase and the Cochrane Library up to October, 2015. The included studies were subject to a Meta-analysis. Comparison between SMILE and FLEx was measured as pooled odds ratio(OR) or weighted mean differences(WMD). Of 95% confidence intervals(CI) were used to analyze data.·RESULTS: A total of seven studies were included Firstly, there were no differences in uncorrected distance visual acuity(UDVA) 20/20 or better(OR, 1.37; 95% CI0.69 to 2.69; P =0.37) and log MAR UDVA(WMD,-0.02;95% CI,-0.05 to 0.01; P =0.17) after SMILE versus FLEx We found no differences in corrected distance visua acuity(CDVA) unchanged(OR, 0.98; 95% CI, 0.46 to 2.11;P =0.97) and log MAR CDVA(WMD,-0.00; 95% CI,-0.01 to 0.01; P =0.90) either. Secondly, we found no differences in refraction within ±1.00 D(OR, 0.98; 95% CI0.13 to 7.28; P =0.99) and ±0.50 D(OR, 1.62; 95% CI0.62 to 4.28; P =0.33) of target postoperatively. Thirdly for higher-order aberrations, we found no differences in the total higher-order aberrations(WMD,-0.04; 95%CI,-0.09 to 0.01;P =0.14), coma(WMD,-0.04; 95% CI,-0.09 to 0.01; P =0.11), spherical(WMD, 0.01; 95% CI,-0.02 to0.03; P =0.60) and trefoil(WMD,-0.00; 95% CI,-0.04 to0.03; P =0.76). Furthermore, for corneal biomechanica parameters, we also found no differences(WMD, 0.08;95% CI,-0.17 to 0.33; P =0.54) after SMILE versus FLEx.·CONCLUSION: There are no statistically differences in efficacy, safety, predictability, higher-order aberrations and corneal biomechnical parameters postoperative between SMILE and FLEx.
文摘AIM: To evaluate the effect of rigid gas permeable contact lens(RGP-CL) on corneal morphological parameters and vision-related quality of life in keratoconus(KC) patients.METHODS: Totally 57 eyes of 30 KC patients who were followed-up for more than two years, including 17 RGP wearers(32 eyes) and 13 non-wearers(25 eyes) were retrospectively analyzed. Initial medical history and corneal topography were collected at baseline. Corneal topography, corneal aberration, optical coherence tomography, and vision-related quality of life questionnaires were performed at the last follow-up.RESULTS: According to corneal topography, increase of the flattest keratometric values was higher in RGP wearers than in non-wearers(P=0.038). The morphological parameters, including symmetry index of front corneal curvature(P=0.004) and Baiocchi-Calossi-Versaci index front(P=0.047), were lower in RGP wearers than in nonwearers. Vertical coma was smaller in RGP wearers than non-wearers in 3.0, 5.0, 6.0, and 7.0 mm pupil diameters, respectively(P<0.05). The environmental triggering domain of ocular surface disease index was worse in RGP wearers as compared to non-wearers(P=0.003). At the last followup, there were no significant differences in constituent ratios of KC progression, corneal thickness topography, epithelial thickness topography, morphological parameters of corneal topography, and other questionnaire scores between the two groups(all P>0.05).CONCLUSION: Long-term use of RGP does not worsen KC but may cause corneal epithelial remodeling to increase symmetry of corneal anterior surface, reduce corneal vertical coma and improve visual quality. However, RGP wearing causes a slight decrease in vision-related quality of life. The occurrence of ocular surface symptoms is mainly associated with environmental triggering factors.
基金Supported by A grant from the National Science and Technology Major Project of China,No.2008ZX10002-025, 2008ZX10002-026
文摘AIM:To investigate health-related quality of life(HRQoL) and psychological outcomes in 256 adults who had undergone liver transplantation(LT).METHODS:A stratified random sampling method was used in this follow-up multicenter study to select a representative sample of recipients undergoing either living donor liver transplantation(LDLT) or deceased donor liver transplantation(DDLT).HRQoL was measured by using the Chinese version of Medical Outcome Study Short Form-36(SF-36),and psychological outcomes by using the beck anxiety inventory(BAI) and the self-rating depression scale(SDS).Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via questionnaires.RESULTS:A total of 256 patients were sampled,including 66(25.8%) receiving LDLT and 190(74.2%) undergoing DDLT;15(5.9%) recipients had anxiety and four(1.6%) developed severe depression after the operation.Compared with LDLT recipients,DDLT patients had higher scores in general health(60.33 ± 16.97 vs 66.86 ± 18.42,P = 0.012),role-physical(63.64 ± 42.55 vs 74.47 ± 36.46,P = 0.048),roleemotional(61.11 ± 44.37 vs 78.95 ± 34.31,P = 0.001),social functioning(78.60 ± 22.76 vs 88.16 ± 21.85,P = 0.003),vitality(70.30 ± 15.76 vs 75.95 ± 16.40,P = 0.016),mental health(65.88 ± 12.94 vs 71.85 ± 15.45,P = 0.005),physical component summary scale(PCS,60.07 ± 7.36 vs 62.58 ± 6.88,P = 0.013) and mental component summary scale(MCS,52.65 ± 7.66 vs 55.95 ± 10.14,P = 0.016).Recipients > 45 years old at the time of transplant scored higher in vitality(77.33 ± 15.64 vs 72.52 ± 16.66,P = 0.020),mental health(73.64 ± 15.06 vs 68.00 ± 14.65,P = 0.003) and MCS(56.61 ± 10.00 vs 54.05 ± 9.30,P = 0.037) than those aged ≤ 45 years.MCS was poorer in recipients with than in those without complications(52.92 ± 12.21 vs 56.06 ± 8.16,P = 0.017).Regarding MCS(55.10 ± 9.66 vs 50.0 ± 10.0,P < 0.05) and PCS(61.93 ± 7.08 vs 50.0 ± 10.0,P < 0.05),recipients scored better than the Sichuan general and had improved overall QoL compared to patients with chronic diseases.MCS and PCS significantly correlated with scores of the BAI(P < 0.001) and the SDS(P < 0.001).CONCLUSION:Age > 45 years at time of transplant,DDLT,full-time working,no complications,anxiety and depression were possible factors influencing postoperative HRQoL in liver recipients.
文摘Living kidney transplantation is now a widely accepted treatment for end stage renal disease(ESRD) because it provides excellent outcomes for recipients. However, long-term outcomes of living kidney donors have not been well understood. Because securing the safety of the donor is essential to the continued success of this procedure, we reviewed articles discussing long-term outcomes of living kidney donors. Most studies found no decrease in long-term survival or progressive renal dysfunction in previous kidney donors. Moreover, the prevalence of hypertension was comparable to that expected in the general population, although some did report otherwise. Urinary protein showed small increases in this population and was associated with hypertension and a lower glomerular filtration rate. Quality of life following living kidney donation seems to be better than the national norm. We also encountered several reports of ESRD in previous living kidney donors. Regular follow-up of kidney donors is recommended and future controlled, prospective studies will better delineate risk factors which cause health problems following living kidney donation.
