The IRIS® Registry : Purpose and perspectives.

The American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) launched about 2 years ago and has already become the largest national clinical specialty data registry with nearly 50 million patient visits and over 14 million unique patients. The purpose of the registry is to support and promote continued improvement in the delivery of eye care. The perspectives that "big data" encompass are the key issues facing ophthalmology and eye care, including public health and public policy concerning disease incidence and prevalence, utilization of eye care services, natural history of disease, disease surveillance, comparative effectiveness, safety and adverse event monitoring, compliance with "best practices" and clinical guidelines, etc. The valuable real-world and current-day insights provided by the IRIS Registry and other registries like it will accelerate scientific learning and improvements in care delivery, particularly in a cost-constrained environment.

[The IRIS® Registry : Purpose and perspectives. German Version]. / Das IRIS®-Register : Ziele und Perspektiven.

The American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) launched about 2 years ago and has already become the largest national clinical specialty data registry with nearly 50 million patient visits and over 14 million unique patients. The purpose of the registry is to support and promote continued improvement in the delivery of eye care. The perspectives that "big data" encompass are the key issues facing ophthalmology and eye care, including public health and public policy concerning disease incidence and prevalence, utilization of eye care services, natural history of disease, disease surveillance, comparative effectiveness, safety and adverse event monitoring, compliance with "best practices" and clinical guidelines, etc. The valuable real-world and current-day insights provided by the IRIS Registry and other registries like it will accelerate scientific learning and improvements in care delivery, particularly in a cost-constrained environment.

Neuropsychological effects associated with temporal lobectomy and amygdalohippocampectomy depending on Wada test failure.

OBJECTIVE: To compare the neuropsychological effects of temporal lobectomy (TL) and amygdalohippocampectomy (AH), depending on whether the patients had passed or failed the Wada test. METHODS: We compared changes in neuropsychological scores in patients who underwent TL (n = 91) or AH (n = 15), and had passed or failed the Wada test. Comparisons were carried out in all 106 patients and among the 20 patients who failed the Wada test (12 who had TL and 8 who had AH). RESULTS: No patient became globally amnesic after surgery. Among all patients, no differences were found in pre-surgical or change scores (percentage of change after surgery compared with preoperative values) of neuropsychological tests between patients who underwent TL or AH. Among patients who failed the Wada test, those in the TL group showed higher visual memory impairment (p<0.05). There was a strong trend suggesting that TL is associated with higher verbal memory deficits than AH (p = 0.07). Of those TL patients who failed the Wada test, the contralateral Wada score correlated with change scores in verbal intelligence quotient (p<0.01), and there was a strong trend towards a correlation with the logical memory immediate recall version subtest of the Wechsler Memory Scale (p = 0.06). CONCLUSIONS: No profound changes in intelligence quotient or memory scores were found after TL or AH. Nevertheless, patients who underwent TL and failed the Wada test showed more deficits than those who passed the test or those who had AH. The presence of a correlation between contralateral Wada scores and verbal deficits in TL patients who failed the Wada test but not among AH patients suggests that, if temporal surgery is required, AH might be preferred to TL in patients who fail the Wada test.

Initial two years of experience with the AAO National Eyecare Outcomes Network (NEON) cataract surgery database.

PURPOSE: To report the results of the first 2 years of experience with an American Academy of Ophthalmology (AAO) cataract surgery registry; to compare patient characteristics, operative procedures, and patient outcomes observed in the registry to those observed in the Cataract PORT study; and to discuss the current shortcomings and potential benefits of a national cataract surgery registry. DESIGN: Observational study of episodes of cataract surgery reported by a self-selected sample of 249 ophthalmologists. PARTICIPANTS: Seven thousand six hundred twenty-six patients undergoing cataract surgery during 1996 and 1997. METHODS: Beginning in January 1996, participation in the AAO cataract surgery registry was offered to all ophthalmologists. Participants could use software or paper data collection forms to submit a common set of data regarding patients' demographics, preoperative ophthalmologic history, physical examination and test results, functional status and symptoms, intraoperative procedures and events, and postoperative outcomes for all patients undergoing first or second eye cataract surgery. Data were transmitted to a central database, where they were aggregated and analyzed. Findings were compared with those observed in the Cataract PORT study, which was conducted in 1991 and 1992. RESULTS: Between January 1, 1996, and February 28, 1998, 249 ophthalmologists submitted data on at least one patient who underwent cataract surgery. A total of 7626 patients undergoing first or second eye surgery were enrolled, with all preoperative, intraoperative, and postoperative data forms submitted for 3342 patients (44%). The preoperative characteristics of patients reported to National Eyecare Outcomes Network (NEON) were similar to those of patients enrolled in the Cataract PORT study except for a higher reported prevalence of ocular comorbidity in NEON patients. Use of retrobulbar anesthesia was reported far less commonly, and use of topical anesthesia, phacoemulsification, and foldable intraocular lenses was reported far more often for NEON than for Cataract PORT study patients. Patient outcomes reported to NEON were similar to those observed in the Cataract PORT study. MAIN OUTCOME MEASURES: Visual acuity, VF-14, Cataract Symptom Score, surgical complications. CONCLUSIONS: During the first 2 years of NEON, ophthalmologist participation in the NEON cataract surgery database was low and consisted of a self-selected and likely nonrepresentative sample of ophthalmologists. The representativeness of patients for whom data were reported is unknown. In addition, complete data were submitted on only a minority of patients who were enrolled. Even so, the preoperative characteristics of patients on whom data were submitted to NEON were similar to those of patients enrolled in the Cataract PORT study. The initial experience with NEON demonstrates that it is technically possible to collect clinical data from, and report aggregated results to, practicing clinicians' offices. In addition, at least some practicing clinicians are willing to spend the time required to participate in the NEON registry. The NEON cataract surgery database thus has the potential to provide a practical means for tracking practice patterns and patient outcomes in real time. If a representative sample of physicians was willing to contribute data systematically and accurately over time, initiatives such as NEON could provide a means for professional societies and physicians to play a leadership role in defining and monitoring quality of care.

Gradual withdrawal of long-term anticholinergic antiparkinson medication in Chinese patients with chronic schizophrenia.

Previous antiparkinson drug withdrawal studies involving white subjects have yielded inconclusive findings, whereas there is a paucity of data concerning Asian patients. A double-blind, placebo-controlled, randomized trial using gradual withdrawal of antiparkinson medication was conducted to evaluate the need for maintenance antiparkinson therapy for clinically stable Chinese patients with chronic schizophrenia. Seventy-five schizophrenic subjects who had received a diagnosis according to DSM-IV who had been ill for at least 5 years and on antipsychotic and antiparkinson medication for a minimum of 2 years entered the study. After baseline assessment, 58 subjects were matched according to age, sex, age at onset, length of illness, dose and length of antipsychotic and antiparkinson medication, and the presence of various extrapyramidal side effects. Randomly assigned dose-reduction and control groups were formed consisting of 29 subjects each. Trihexyphenidyl (THP), the only oral antiparkinson drug used in the study, was reduced by 1 mg every 2 weeks, whereas other psychotropic medication remained unchanged. Monthly assessment was performed using the Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, Abnormal Involuntary Movement Scale, Simpson-Angus Scale, Barnes Akathisia Rating Scale, and the Nursing Observation Scale for Inpatient Evaluation-30. Complete withdrawal of THP was possible in 25 (90%) of the 28 subjects who completed the study, whereas considerable dose reduction was achieved in the remaining 3 subjects. There were no significant differences between dose reduction and control groups on any of the rating scales at the completion of the study. Our results suggest that long-term prophylactic administration of antiparkinson medication is unnecessary in the treatment of the majority of Chinese patients with chronic schizophrenia because withdrawal was accomplished without adverse mental or motor effects.

Characteristics of dropouts from a child psychiatry clinic in Hong Kong.

There is, to date, no study on the pattern of dropping out from child and adolescent psychiatry clinics in a non-western setting. This study aims to investigate this phenomenon in Hong Kong. The database and medical charts of 235 new cases were reviewed 1 year after the initial assessments. The clinical, demographic and family data of the dropout and non-dropout groups were compared. An overall dropout rate of 27.2% was found. Boys and children with attention deficit hyperkinetic disorder and infantile autism were less likely to drop out. No interaction with gender was found. Compared with western literature, there are some important differences in the factors associated with dropping out of treatment. Our study highlights the importance of socio-cultural influences on the characteristics of clinic drop-outs.

Psychotropic drug prescription in rehabilitation. A survey in Hong Kong.

Rational pharmacotherapy helping chronic psychiatric patients in the difficult process of reintegration into the community is an important prerequisite of successful rehabilitation. Results of a survey conducted at the opening of a rehabilitation facility in Hong Kong revealed a number of illogicalities in prescription patterns. Frequently encountered faulty treatment decisions incompatible with the recommendations of modern literature included polypharmacy, higher than necessary doses of anticholinergic antiparkinsonian agents and giving psychotropic drugs in inconveniently divided doses. With the newly emerging subspecialty of rehabilitation-community psychiatry in Hong Kong, it is expected that large numbers of chronically hospitalized patients will enter rehabilitation programmes. The present survey indicated that it is imperative to pay continued attention to their medication status.

A prospective outcome study of patients missing regular psychiatric outpatient appointments.

This paper describes a prospective follow-up study of defaulters of regular psychiatric outpatient appointments in Hong Kong. To establish outcome, 258 patients were traced 6 months after their non-attendance at a follow-up clinic. Results showed that 50% returned while the rest dropped out of treatment. The clinical and demographic variables, including employment, marriage, being seen by faculty rather than resident staff, a past history of default and shorter length of contact at the clinic studied (within a year), were all significant in predicting drop-out. There was a trend for those who reattended to have received a telephone reminder, to be a student and to be single. Out of the 129 drop-out patients, 84 were traced, 23 were admitted to hospital and 5 died. There were no deaths and only 5 patients required hospitalisation among the attenders. We concluded that active reengagement of psychiatric outpatient defaulters is required.

Querulous paranoia in Chinese patients: a cultural paradox.

OBJECTIVE: There has been no reported case of querulous paranoia from the Asian population. A prospective study was undertaken to identify patients with querulous paranoia in an outpatient clinic. METHOD: One thousand, five hundred and fifty-one new referrals to a university-affiliated psychiatric outpatient clinic in Hong Kong were screened for querulous paranoia during routine clinical work. RESULTS: Three patients with querulous paranoia (0.19%) were identified during 1 year. The case histories of these three patients are reported. CONCLUSION: Possible reasons for the low reporting rate are discussed and the importance of sociocultural traditions in the development and recognition of querulous paranoia is emphasised.