Determinants of surgery related anxiety in cataract patients.

BACKGROUND/AIMS: Not much is known about the relative importance of different determinants of anxiety in cataract patients. This study analysed the predictive value of factors related to surgery induced anxiety. METHODS: In 128 cataract patients, recruited from two hospitals (Medical Centre Maastricht Annadal (MCMA) and Rotterdam Eye Hospital (REH)), state anxiety was assessed at four different time points using the State-Trait Anxiety Inventory (STAI). The following predictive factors of anxiety were measured: trait anxiety, outcome expectancies, doctor-patient relationship, coping strategy, social support, information supply, sociodemographic variables, and previous cataract surgery. Repeated measures ANOVA, t tests, multiple regression analysis, and correlations were used to analyse data. RESULTS: In general patients reported little anxiety. The level of anxiety (scale 1-4) was the highest before surgery, decreased immediately after surgery, and increased again after the postoperative visit. Patients with higher trait anxiety levels (r = 0.41; p<0.01), and women (r = 0.30; p<0.01) reported more anxiety. The REH patients showed lower anxiety scores than the MCMA patients. CONCLUSION: Women and patients with higher trait anxiety were more likely to experience higher levels of state anxiety. Positive outcome expectancies and social support may decrease anxiety.

Quality of care from the perspective of the cataract patient: the reliability and validity of the QUOTE-cataract.

BACKGROUND/AIMS: To assess reliability and validity of the QUOTE-cataract, a questionnaire that measures the quality of care from the perspective of cataract patients. METHODS: The QUOTE-cataract was tested in a multicentre study among 540 cataract patients in three different hospitals. Reliability was represented by internal consistency (Cronbach's alpha), and repeatability (intraclass correlation coefficient (ICC)). Validity was evaluated qualitatively and by factor analyses. RESULTS: A strong internal consistency coefficient (0.89), and high repeatability (ICC = 0.76) demonstrated good reliability. Content validity was assured by involvement of patients in the development of the questionnaire. Factor analysis confirmed an underlying taxonomy of generic and disease specific items. CONCLUSION: The QUOTE-cataract has good reliability and provides a valid assessment of quality of care in cataract surgery.

Meeting patients' needs with patient information systems: potential benefits of qualitative research methods.

This article reports on our pilot evaluation of an electronic patient information system for children with amblyopia and their parents. The aim was to investigate whether the information system would be able to improve the quality of care, as indicated by an improvement in the effectiveness and efficiency of care, and in an increase in patient satisfaction. In the pilot evaluation, we used qualitative research methods, exploring the impact of the information system on children and their parents, with the aim to find suitable indicators for a potential further, quantitative study. Yet we found that the system was little used and had marginal effects on the quality of care for children with amblyopia and their parents. It appeared that the main problem underlying this patient information system was that the needs of those people who actually would be using the system had never really been investigated. The designers had built their assumptions about these needs into the system. These appeared to be mistaken at so many levels that the system could not become a success. As a result of this pilot evaluation, the patient information project was thoroughly transformed. This study makes clear that a thorough exploration of user needs before building the system, using qualitative research methods, may be crucial because it can prevent mismatches and maximizes the chance that the eventual information system meets its most important aim: to enhance patient empowerment and improve the quality of care.

Detection of lens proteins in phaco tips after phacoemulsification.

PURPOSE: To determine the efficacy of cleaning procedures to remove water-soluble and water-insoluble lens proteins from phaco tips after phacoemulsification. SETTING: Academic Hospital Maastricht, Department of Ophthalmology, University Eye Clinic, and Rotterdam Hospital, Rotterdam, The Netherlands. METHODS: Detection of alpha A-crystallins, cytoskeletal lens proteins (vimentin), and lens-cell membranes (MP26) was performed on new and reused phaco tips with specific markers. To detect antibodies, sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting techniques were used. RESULTS: Threshold detection levels for alpha A-crystallins, vimentin, and MP26 were 100, 43, and 108 ng, respectively. No detectable residues of water-soluble or water-insoluble lens proteins were found in outflow samples of routinely cleaned phaco tips or in outflow samples of phaco tips that were not cleaned after phacoemulsification. Urea effectively eliminated water-insoluble lens proteins from contaminated phaco tips. CONCLUSION: After regular cleaning of phaco tips, no detectable lens protein residues were found in the outflow samples. Moreover, omitting the cleaning of phaco tips after phacoemulsification did not lead to detectable lens proteins in the outflow samples.