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Kalas T, Newman A, Whyte J, Sharma A. Clinical utilization of microperimetry in ophthalmic surgery: A narrative review. Surv Ophthalmol 2023:S0039-6257(23)00142-X. [PMID: 37918576 DOI: 10.1016/j.survophthal.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Microperimetry is an emerging technology that provides concurrent analysis of retinal structure and function by combining retinal sensitivity and fixation analysis with fundus imaging. We summarize the substantial evidence validating the evolving role of microperimetry as an adjunctive assessment of visual function in the perioperative setting. We show that microperimetry provides useful complementary information to other established imaging and functional modalities in the perioperative setting for a wide range of vitreoretinal surgical procedures, as well as in cataract and refractive surgeries. This includes preoperative uses such as prognostication of visual and anatomical outcomes, timing of surgical intervention, and assessment of patient suitability for surgery-as well as postoperative uses including quantification of visual recovery, investigation of unexplained postoperative vision loss, and informing expected long term functional outcomes.
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Affiliation(s)
- Timothy Kalas
- Department of Ophthalmology, Queensland Children's Hospital, Queensland, Australia.
| | - Alexander Newman
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Jonathan Whyte
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Abhishek Sharma
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Queensland Eye Institute, South Brisbane, Queensland, Australia
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Boatin AA, Ngonzi J, Wylie BJ, Lugobe HM, Bebell LM, Mugyenyi G, Mohamed S, Martinez K, Musinguzi N, Psaros C, Metlay JP, Haberer JE. Wireless versus routine physiologic monitoring after cesarean delivery to reduce maternal morbidity and mortality in a resource-limited setting: protocol of type 2 hybrid effectiveness-implementation study. BMC Pregnancy Childbirth 2021; 21:124. [PMID: 33579213 PMCID: PMC7880025 DOI: 10.1186/s12884-021-03550-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/08/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Women in sub-Saharan Africa have the highest rates of morbidity and mortality during childbirth globally. Despite increases in facility-based childbirth, gaps in quality of care at facilities have limited reductions in maternal deaths. Infrequent physiologic monitoring of women around childbirth is a major gap in care that leads to delays in life-saving interventions for women experiencing complications. METHODS We will conduct a type-2 hybrid effectiveness-implementation study over 12 months to evaluate using a wireless physiologic monitoring system to detect and alert clinicians of abnormal vital signs in women for 24 h after undergoing emergency cesarean delivery at a tertiary care facility in Uganda. We will provide physiologic data (heart rate, respiratory rate, temperature and blood pressure) to clinicians via a smartphone-based application with alert notifications if monitored women develop predefined abnormalities in monitored physiologic signs. We will alternate two-week intervention and control time periods where women and clinicians use the wireless monitoring system during intervention periods and current standard of care (i.e., manual vital sign measurement when clinically indicated) during control periods. Our primary outcome for effectiveness is a composite of severe maternal outcomes per World Health Organization criteria (e.g. death, cardiac arrest, jaundice, shock, prolonged unconsciousness, paralysis, hysterectomy). Secondary outcomes include maternal mortality rate, and case fatality rates for postpartum hemorrhage, hypertensive disorders, and sepsis. We will use the RE-AIM implementation framework to measure implementation metrics of the wireless physiologic system including Reach (proportion of eligible women monitored, length of time women monitored), Efficacy (proportion of women with monitoring according to Uganda Ministry of Health guidelines, number of appropriate alerts sent), Adoption (proportion of clinicians utilizing physiologic data per shift, clinical actions in response to alerts), Implementation (fidelity to monitoring protocol), Maintenance (sustainability of implementation over time). We will also perform in-depth qualitative interviews with up to 30 women and 30 clinicians participating in the study. DISCUSSION This is the first hybrid-effectiveness study of wireless physiologic monitoring in an obstetric population. This study offers insights into use of wireless monitoring systems in low resource-settings, as well as normal and abnormal physiologic parameters among women delivering by cesarean. TRIAL REGISTRATION ClinicalTrials.gov , NCT04060667 . Registered on 08/01/2019.
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Affiliation(s)
- Adeline A Boatin
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Founders 5, Boston, MA, USA.
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, USA.
- Program for Global Surgery and Social Change, Boston, USA.
| | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Blair J Wylie
- Harvard Medical School, Boston, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Henry M Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lisa M Bebell
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Godfrey Mugyenyi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sudi Mohamed
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kenia Martinez
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nicholas Musinguzi
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christina Psaros
- Harvard Medical School, Boston, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua P Metlay
- Harvard Medical School, Boston, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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