[Training of Medical Assistants in Ophthalmology: Survey of a Sample of Large Ophthalmic Centers]. / Ausbildung von MFA in der Ophthalmologie. Ergebnisse einer Stichprobe von großen augenmedizinischen Zentren.

The shortage of specialists in SHI-accredited medical care is increasingly affecting medical assistants (MFA) in medical practices and Medical Care Center (MVZ). Training can mitigate the associated problems in the future, but currently only 42% of practices provide training. A survey of a sample of large ophthalmic centers was conducted to test the hypothesis that larger practices and MVZs provide disproportionate training. In addition, an interaction between ownership (physician-owned (äE); third-party owned (F)) and training engagement was evaluated. In a questionnaire-based complete survey (2022) of large ophthalmic centers of different ownerships organized in a network, the training rate by main operating site (HBS), the number of MFA trainees (MFA-A) per HBS, staffing problems and planned change in training commitment were collected. The distribution measures of the quantitative data were analyzed overall and separately by sponsoring organization and tested for significance.Results were compared to data from a representative survey (2020/2021) of all practices and MVZs. In order to determine the proportion of all ophthalmic MFA-A accounted for by the sample, their total number was determined in an extrapolation. The training rate of the total of 100 HBS of the 14 surveyed centers (11 äE, 3 F) of the sample was 82% (äE: 93%, F: 79%), which was higher than the representative survey (41%). In the sample, there were on average 5.9 MFA-A per HBS (äE: 5.6, F: 7.1), in the comparative survey 1.5. 50% of the centers in the sample reported staffing problems, 25% wanted to expand their training commitment; the comparative values of the representative survey were 11% for both parameters. Stratified by sponsorship, neither training rate nor MFA-A per HBS showed significant differences. According to projections, there were nearly 1,966 MFA-A working in ophthalmology in 2021, of which 19.5% were at centers in the study population. Of all the MFA-A in the sample, 71% were at the significantly larger centers by number of HBS owned by third-party. The survey confirms the positive correlation between the size of practices and MVZ and commitment to training. There are no significant differences according to the ownership of organization.

Surgical Care in Specialist Ophthalmology Departments: Structure and Impact of the COVID-19 Pandemic.

BACKGROUND: Specialist ophthalmology departments contribute to the surgical care of German patients. Outpatient and inpatient surgeries were restricted during the COVID-19 pandemic and led to a sharp decline in the number of cases in ophthalmological care. The aim of this analysis was to improve the understanding of the logistic structures of medical facilities as well as the effects of the pandemic. MATERIAL AND METHOD: Based on reported process data, a sample of the specialist ophthalmological departments were examined based on operation and procedure codes (OPS) and data submitted between 01.01.2017 and 31.05.2021 according to the benchmarking programmes of the Professional Association of German Anaesthetists (BDA), the Professional Association of German Surgeons (BDC), and the Association for Operating Theatre Management (VOPM). RESULTS: Eighteen ophthalmology departments from Germany were analysed. After the decline in the number of cases (by temporarily up to 48%) during the first wave of the pandemic, the case numbers of all interventions assessed as nonurgent continued to be reduced. While intravitreal injections hardly decreased during the first wave (- 16%), significant drops in the coverage of cataract surgery (- 79%), vitrectomies (- 35%), glaucoma surgery (- 59%), strabismus surgery (- 95%), and eyelid surgery (- 52%) were found. One exception was intravitreal injection, which stabilised at a lower level early on during the pandemic. Overall, the number of cases during the later phases of the pandemic were significantly reduced below the level of previous years, despite the maintenance of emergency care. The underuse was variable for different interventions. CONCLUSION: In addition to self-reported figures, the analysed process data demonstrates the effect that various factors had on elective as well as urgent operations within hospital care during the pandemic. Despite partial stabilisation of some services, a relevant supply gap for outpatient and inpatient interventions was identified, with corresponding effects on the eye health of the population, while compensation or performance enhancement have not taken place to date. Facing the growing preload and the demographic development, future structures must therefore allow for an increase in the performance of specialist ophthalmological departments.

[Structures of Outpatient Medical Care: Germany and Other Decentrally Organized Healthcare Systems]. / Angebotsstrukturen der ambulanten vertragsärztlichen Versorgung: Deutschland und andere dezentral organisierte Gesundheitssysteme.

BACKGROUND: The image of outpatient medical care is physician-centered; little attention is paid to the (potential) influence of health organizations and their characteristics on medical care dimensions. AIM: Description of the structures of outpatient medical care stratified by legal forms, comparison with those of other decentralized health systems and discussion of the potential effect of legal form on different dimensions of medical care. METHODS: The frequencies of solo practice, group practice and Medical Care Centers for both primary and specialist medical care, the average team size of practices and the proportion of interdisciplinary health organizations are described over time based on secondary data sources (mainly provided by the National Association of Statutory Health Insurance Physicians). RESULTS: The structures of outpatient medical care are characterized by high fragmentation (2018:>80,000 health organizations), high proportion of small organizations (73% of all health organizations are solo practices), low average team size (1.7 physicians on average) and low proportion of interdisciplinary health organizations (17% of all group practices and Medical Care Centers). Overall, there is little indication that family and specialist care facilities tend to merge with each other. CONCLUSIONS: The fragmentation of the German health care structure is more pronounced and lasting than in other decentralized health systems. Legal forms and average values do not adequately capture the heterogeneity of organizations in outpatient health care. In order to improve organization of medical care, a broader database including more organizational characteristics would be desirable.

[Does the Foveal Avascular Zone Change in Glaucoma?] / Verändert sich die foveale avaskuläre Zone beim Glaukom?

BACKGROUND: The foveal avascular zone (FAZ) - with perimeter and acircularity index (AI) and surrounding vessel density - are measured in glaucomatous eyes in comparison to healthy eyes - with additional subdivision into visual field defects in different locations (central vs. peripheral). MATERIALS AND METHODS: The data from 128 eyes were evaluated. Firstly, glaucomatous eyes (n = 74) were compared with healthy eyes (n = 54). In addition, glaucomatous eyes with a central visual field defect (ZGD, n = 19) and eyes with peripheral visual field defect (PGD, n = 34) were differentiated. The FAZ area, its perimeter and roundness, as well as the parafoveal vessel density (VD), were calculated by means of optical coherence tomography angiography in the superficial and deep vascular plexus. RESULTS: Glaucomatous eyes have no significant change in FAZ, its perimeter or the AI compared to healthy eyes. However, dividing the glaucomatous eye by visual field defect reveals that the eyes with a central defect have a significantly larger FAZ than those with a peripheral defect and the perimeter is also significantly larger. The AI shows no significant difference depending on the localisation of visual field defects. The macular/foveal VD is significantly lower in the ZDG group. CONCLUSIONS: In glaucoma, the FAZ enlarges when the visual field defect is centralised and VD decreases significantly in the area of fovea.

[Classification of floater patients : Evaluation of a study database on the relationship between characteristics and impairment]. / Typisierung von Floaterpatienten : Auswertung einer Studiendatenbank zum Zusammenhang von Merkmalen und Beeinträchtigung.

Subjective impairment of floater patients can only be partially quantified using ophthalmological test methods. In order to classify floater patients, patient-related characteristics associated with higher level of impairment should be identified. A data set of a prospective, multicenter single-arm primary study of 64 floater patients who underwent vitrectomy includes patient-related characteristics and information on subjective preoperative and postoperative (3 months after vitrectomy) impairment. Data on impairment were collected with a floater-specific questionnaire and condensed into self-rated impairment indices (SRI). Medians of the SRI were calculated for the manifestation of sociodemographic and ophthalmological parameters as well as for the classification of floaters on the study and second eye and tested for significance. Higher preoperative SRI were associated with professional activity, young age, reduced preoperative visual acuity, retinal alterations and higher refractive errors as well as floaters on the second eye. Higher postoperative SRI were found in combination with cataract and younger age. The SRI differences were only occasionally significant. Classification of floaters as documented by the surgeon and by SRI were significantly correlated only for patients without other visual comorbidities besides floaters. The primary study reported high preoperative subjective impairment and a significant decrease in SRI after vitrectomy for almost all patients. The current study showed that some individual patient-related characteristics tended to be associated with greater preoperative impairment and greater benefit from vitrectomy.

[Do Clinical Trial Publications in AMD Healthcare Provide Sufficient Information on the Underlying Samples' Baseline Characteristics to Enable Generalizability Considerations on the Trial Design?] / Berichten RCT-Publikationen zur Versorgung von AMD-Patienten Baseline-Daten zum eingebrachten Patientengut mit Blick auf die Generalisierbarkeit des Studiendesigns?

BACKGROUND: Results of RCTs must enable readers to assess applicability of the presented information into clinical routine. Therefore, the CONSORT statement's item 15 recommends explicit information on (baseline) characteristics for RCT samples. We sought to quantify the adherence to this CONSORT item by evaluation of RCTs on "age-related macular degeneration" (AMD). MATERIALS AND METHODS: A full survey comprised of 132 RCTs (01/2004 - 12/2013). Two parallel independent readers evaluated, and then consented, whether baseline characteristics as recommended were provided in the publication, and whether this information was formally and correctly presented. The evaluation was performed hierarchically in accordance to the sub-criteria of the CONSORT-statement. In the case of formally correct documentation, characteristics for age, gender, the primary clinical endpoint outcome, and the stage of AMD were checked, as well as for systemic or ophthalmological pre-existing conditions. RESULTS: 129 of 132 (98%) publications provided the documentation of baseline data, but only 67 (51%) showed a correct implementation. 77 (58%) RCT reports presented baseline data at study initiation, among which n = 67 (87%) publications presented the data stratified for samples. CONCLUSION: The implementation rate of the CONSORT criterion "baseline data" in publications appeared high. On closer inspection, publications often provided incomplete or even misleading baseline data. As a consequence, everybody in the publication process should be aware of the conditions for publishing.

Comparison of Visual Outcomes and Patient Satisfaction After Bilateral Implantation of an EDOF IOL and a Mix-and-Match Approach.

PURPOSE: To evaluate visual outcomes at different distances (near, intermediate, and far), depth of focus, optical quality, quantitative dysphotopsia, and patient satisfaction in two groups. METHODS: The extended depth of focus (EDOF) only group (n = 40 eyes) was implanted bilaterally with an EDOF intraocular lens (IOL) and the mixed group (n = 40 eyes) was implanted with the same EDOF IOL in the dominant eye and a trifocal IOL in the fellow eye. At the 3-month postoperative visit, refractive outcomes and monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance visual acuities for far UDVA, CDVA, distance-corrected intermediate visual acuity (DCIVA) at 80 cm, uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA) at 40 cm, and binocular defocus curve were evaluated. RESULTS: The mean spherical equivalent (SE) 3 months postoperatively was -0.16 ± 0.41 diopters (D) in the EDOF only group and -0.39 ± 0.63 D in the mixed group. In the EDOF only group, binocular visual acuities were: UDVA = -0.04 ± 0.07 logMAR (20/18); CDVA = -0.04 ± 0.06 logMAR (20/18); DCIVA (80 cm) = 0.07 ± 0.19 logMAR (20/23); DCNVA (40 cm) = 0.32 ± 0.15 logMAR (20/42); and UNVA (40 cm) = 0.24 ± 0.17 logMAR (20/35). In the mixed group, binocular visual acuities were: UDVA = 0.03 ± 0.09 logMAR (20/21) (P = .08); CDVA = -0.01 ± 0.07 logMAR (20/20) (P = .25); DCIVA (80 cm) = 0.24 ± 0.23 logMAR (20/35) (P = .08); DCNVA (40 cm) = 0.19 ± 0.07 logMAR (20/31) (P = .03); and UNVA (40 cm) = 0.18 ± 0.10 logMAR (20/30) (P = .37). CONCLUSIONS: Effective restoration of visual acuity was demonstrated in both groups, with high levels of visual quality and patient satisfaction. Better results in near visual acuity were demonstrated in the mixed group. [J Refract Surg. 2019;35(7):408-416.].

Rotation of a toric intraocular lens with and without capsular tension ring: data from a multicenter non-inferiority randomized clinical trial (RCT).

BACKGROUND: Evaluation of clinical outcome in cohorts with versus without simultaneous implantation of a capsular tension ring (CTR) and a toric lens (Tecnis Toric). Main parameter was rotation referring - in contrast to misalignment - to the IOL axis change from immediately after implantation to the final postoperative position. METHODS: Lens position was measured at baseline with the patient still in recumbent position, postoperative rotation was calculated by software. Postoperative evaluation included measurement three months after surgery or prior to an indicated revision surgery. Explorative re-evaluation of the underlying RCT's intent-to-treat population was performed for the entire sample and stratified for cohorts by 95% confidence intervals for binary endpoints' incidences (primary endpoint: absolute postoperative rotation ≤5 degrees; secondary endpoints: absolute deviation between achieved cylinder and target cylinder ≤0.5 dpt, postoperative corrected distance visual acuity (CDVA) ≥ 0.8). Data exploration was based on medians and quartiles. SETTING: Outpatient study sites. DESIGN: Re-evaluation based on data from a multicenter non-inferiority randomized clinical trial (RCT). RESULTS: Sub cohorts (without CTR 89, with CTR 90 patients) did not present clinically relevant differences in preoperative characteristics: revision surgery was performed in 7 cases (3 without and 4 with CTR). Primary endpoint incidences for the total sample, without and with CTR were 90%/89%/90%; cylinder endpoint incidences were 46%/45%/46% and CDVA endpoint incidences 90%/92%/88%. Median absolute rotations were 1.74°/1.79°/1.72°, median absolute cylinder deviations 0.55/0.52/0.55 dpt and median visual acuity 1.0/1.0/1.0. CONCLUSION: No clinically relevant differences between CTR subgroups were found; a satisfying three months rotational stability was achieved. TRIAL REGISTRATION: The trial was registered retrospectively in the trial registry DRKS, trial registration number DRKS00015316 , date of registration 27. August 2018.

[DNVF-Memorandum III - Methods for Health Services Research, Part 4 - Concept and Methods for Organizational Health Services Research: Short Version]. / DNVF-Memorandum III ­ Methoden für die Versorgungsforschung, Teil 4 ­ Konzept und Methoden der organisationsbezogenen Versorgungsforschung: Kurzfassung.

Organizational health services research in Germany is of increasing relevance. Based on the guide on methods for organizational health services research of the Memorandum III, part 1 from the year 2009, the fundamentals and standards have now been refined. The memorandum captures the theoretical framework, basic methodological approaches and methods in health services research for the design, evaluation and implementation of complex interventions in healthcare organizations.

[DNVF-Memorandum III - Methods For Health Services Research, Part 4 - Concept and Methods For Organizational Health Services Research. Chapter 1 - Definition and Concept of Organizational Health Services Research]. / DNVF-Memorandum III ­ Methoden für die Versorgungsforschung, Teil 4 ­ Konzept und Methoden der organisationsbezogenen Versorgungsforschung. Kapitel 1 ­ Definition und Konzept der organisationsbezogenen Versorgungsforschung.

Organizational health services research is still a relatively young field of research in Germany which is of increasing interest. The German Network Health Services Research e.V. (DNVF e.V.) published in 2009 - supported by expert associations and individual members of the DNVF - a guide on "Methods for organizational health services research" of the Memorandum III, part 1[1]. Originating from this publication and facilitated by the increasing relevance of the field, a necessity to refine the conceptual and methodological basis became evident. The update and extension of the publication from 2009 consists of three chapters: (1) Definition and concept of organizational health services research, (2) Methodological approaches in organizational health services research: indicators, data sources, data collection and data analysis, (3) Methodological approaches for the design, evaluation and implementation of complex interventions in health care organizations. The aim of the first chapter is to present the theoretical framing and the definition of terms and tasks within organizational health services research.

[DNVF-Memorandum III - Methods for Health Services Research, Part 4 - Concept and Methods for Organizational Health Services Research. Chapter 2 - Methodological Approaches for Organizational Health Services Research: Measures, Data Sources, Data Collection and Data Analysis]. / DNVF-Memorandum III ­ Methoden für die Versorgungsforschung, Teil 4 ­ Konzept und Methoden der organisationsbezogenen Versorgungsforschung. Kapitel 2 ­ Methodische Ansätze der organisationsbezogenen Versorgungsforschung: Zielgrößen, Datenquellen, Datenerhebung und Datenanalyse.

Organizational health services research is still a relatively young field of research in Germany which is of increasing interest. The German Network Health Services Research e.V. (DNVF e.V.) published in 2009 - supported by expert associations and individual members of the DNVF - a guide on "Methods for organizational health services research" of the Memorandum III, part 1 1. Originating from this publication and facilitated by the increasing relevance of the field, a necessity to refine the conceptual and methodological basis became evident. The update and extension of the publication from 2009 consists of 3 chapters: (1) Definition and concept of organizational health services research, (2) Methodological approaches in organizational health services research: indicators, data sources, data collection and data analysis, (3) Methodological approaches for the design, evaluation and implementation of complex interventions in healthcare organizations. The aim of the second chapter is to derive methodological requirements and characteristics of organizational health services research - based on the unique characteristics of the research field presented in chapter 1.

Outcomes of combining a trifocal and a low-addition bifocal intraocular lens in patients seeking spectacle independence at all distances.

PURPOSE: To assess the visual and refractive outcomes and patient satisfaction after cataract surgery in patients with a diffractive multifocal intraocular lens (IOL) with a low addition (add) power (+2.75 diopters [D]) (Tecnis ZKB00) in the dominant eye and a diffractive trifocal IOL (AT LISA tri 839MP) in the nondominant eye. SETTING: Augenärzte Gerl, Kretz, and Kollegen, Head Office, Ahaus, Germany. DESIGN: Prospective case series. METHODS: All patients had implantation of the low-add multifocal IOL in the dominant eye and a trifocal IOL in the fellow eye. Patients were evaluated preoperatively and 3 months postoperatively for monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity, intermediate and near visual acuities, the binocular defocus curve, and manifest refraction. Dysphotopic phenomena were objectively evaluated and subjective patient satisfaction questionnaires administered. RESULTS: The study included 42 patients (84 eyes). The mean postoperative spherical equivalent was -0.06 D ± 0.57 (SD). The binocular visual acuities were 0.00 ± 0.05 logarithm of the minimum angle of resolution (logMAR) (UDVA), 0.19 ± 0.11 logMAR (uncorrected intermediate visual acuity at 80 cm), 0.16 ± 0.10 logMAR (distance-corrected intermediate visual acuity at 80 cm), 0.11 ± 0.09 logMAR (uncorrected near visual acuity at 40 cm), and 0.08 ± 0.09 logMAR (distance-corrected near visual acuity at 40 cm). The binocular defocus curve showed a visual acuity of 0.20 logMAR or better between +0.50 D and -3.00 D. Of the patients, 92%, 92%, and 75% reported never wearing spectacles for distance, intermediate, or near distance, respectively. CONCLUSION: The mix-and-match approach seemed to provide functional visual performance at all distances while achieving spectacles independence in the majority of patients.

23G pars plana vitrectomy for vitreal floaters: prospective assessment of subjective self-reported visual impairment and surgery-related risks during the course of treatment.

PURPOSE: Quantifying the subjective impairment due to floaters based on an indication-specific questionnaire and setting its change between prior to and 3/12 months after elective vitrectomy in relation to surgical risks. METHODS: Single-arm longitudinal observational multicenter study. Sixty-four floater patients underwent 23G pars plana vitrectomy; simultaneous phacoemulsification was excluded. An overall self-rated impairment index (SRI) and sub-indices SRI were calculated on the basis of a modified Visual Quality of Life questionnaire (VQoL), which addresses general vision, glare, near-sight problems and mobility of floaters. SRI ranged from 0 to 100% (maximum impairment). Secondary endpoints included corrected visual acuity and complications. RESULTS: Data were collected prior to and 3 (n = 64) and 12 (n = 62) months after surgery. The median overall SRI improved (44, 12, 11%) with a statistically significant median reduction of 69% (95% confidence interval 50-89%) 3 months postop. The median sub-SRIs improved for glare (50, 17, 17%), near sight problems (50, 17, 8%), and mobility of floaters (43, 5, 0%). Sixteen eyes needed cataract surgery during follow-up (10 showed cataract already prior to vitrectomy). Eight complications were reported (6 intra-operative retinal holes, 2 post-operative retinal detachments). CONCLUSION: For the majority of floater patients, subjective impairment was profoundly reduced by vitrectomy. Benefits of surgery prevailed despite complications.

Results and methodology of cost-utility evaluation of cataract surgery in developed countries: Quality-adjusted life years and cataract.

This review surveyed the results and methods of cost-utility analyses of cataract surgery. Thirteen studies were included. Based on decision-theoretic time trade-off, utilities ranged from 0.148 to 0.8 and quality-adjusted life years (QALY) ranged from 1.424 to 2.43. Based on psychometric instruments such as Euroqol 5 dimensions, utilities ranged from 0.017 to 0.056 and QALY ranged from 0.141 to 0.547. Reported costs per QALY were between $1307 and $14 302. Although the review found consistent favorable cost QALY ratios for cataract surgery according to the British National Institute for Care and Health Excellence threshold, the findings raise doubts about the general applicability of existing studies as a tool for allocation decision. The observed large heterogeneity of the approaches and outcomes for all parameters reflected the complexity of the various evaluation methods and medical care processes and, in some cases, inadequate data.

A methodological approach to identify external factors for indicator-based risk adjustment illustrated by a cataract surgery register.

BACKGROUND: Risk adjustment is crucial for comparison of outcome in medical care. Knowledge of the external factors that impact measured outcome but that cannot be influenced by the physician is a prerequisite for this adjustment. To date, a universal and reproducible method for identification of the relevant external factors has not been published. The selection of external factors in current quality assurance programmes is mainly based on expert opinion. We propose and demonstrate a methodology for identification of external factors requiring risk adjustment of outcome indicators and we apply it to a cataract surgery register. METHODS: Defined test criteria to determine the relevance for risk adjustment are "clinical relevance" and "statistical significance". Clinical relevance of the association is presumed when observed success rates of the indicator in the presence and absence of the external factor exceed a pre-specified range of 10%. Statistical significance of the association between the external factor and outcome indicators is assessed by univariate stratification and multivariate logistic regression adjustment.The cataract surgery register was set up as part of a German multi-centre register trial for out-patient cataract surgery in three high-volume surgical sites. A total of 14,924 patient follow-ups have been documented since 2005. Eight external factors potentially relevant for risk adjustment were related to the outcome indicators "refractive accuracy" and "visual rehabilitation" 2-5 weeks after surgery. RESULTS: The clinical relevance criterion confirmed 2 ("refractive accuracy") and 5 ("visual rehabilitation") external factors. The significance criterion was verified in two ways. Univariate and multivariate analyses revealed almost identical external factors: 4 were related to "refractive accuracy" and 7 (6) to "visual rehabilitation". Two ("refractive accuracy") and 5 ("visual rehabilitation") factors conformed to both criteria and were therefore relevant for risk adjustment. CONCLUSION: In a practical application, the proposed method to identify relevant external factors for risk adjustment for comparison of outcome in healthcare proved to be feasible and comprehensive. The method can also be adapted to other quality assurance programmes. However, the cut-off score for clinical relevance needs to be individually assessed when applying the proposed method to other indications or indicators.

Determination of valid benchmarks for outcome indicators in cataract surgery: a multicenter, prospective cohort trial.

OBJECTIVE: To evaluate a systematic approach to derive valid benchmarks for 2 outcome indicators intended to ascertain quality in cataract surgery and to propose benchmark levels drawn from the study results. DESIGN: Prospective, multicenter cohort trial. PARTICIPANTS: A total of 1685 patients (206-239 eyes per trial site) were recruited consecutively at 7 study sites. The patients featured age-related cataracts and were undergoing unilateral cataract surgery in the period between January 2007 and August 2008. METHODS: Only patients with uncomplicated age-related cataracts were included. Cataract surgery was performed by phacoemulsification. The SN60AT (Alcon, Inc., Fort Worth, TX) intraocular lens (IOL) was used as a study lens. The IOL power was calculated using the SRK-T formula with a standardized A constant. Biometry was performed with the IOL Master (Carl Zeiss Meditex, Jena, Germany). Only highly experienced senior surgeons were involved. MAIN OUTCOME MEASURES: The outcome indicators 1 month and 3 months after surgery were the respective achievement of: (1) maximum absolute deviation of 0.5 diopter (D) between target refraction and postoperative spherical equivalent (primary end point, refractive accuracy); (2) best-corrected visual acuity of at least 0.8 (secondary end point, visual acuity outcome). RESULTS: In the pooled data, maximum absolute deviation of ± 0.5 D from target refraction was achieved in 80% (95% confidence interval, 78%-82%) of cases. Visual acuity of 0.8 or more was reached in 87% (95% confidence interval, 80%-93%) of cases. The results from the trial centers differed significantly in the outcomes of the primary and secondary end points (P<0.001). CONCLUSIONS: The study quantified benchmark levels for 2 outcome indicators in a standardized cataract surgery procedure. External confounding factors such as the comorbidity of patients, which cannot be influenced by the surgeon, were excluded. The derived benchmarks selectively illustrate the quality of the surgery and are superior to success rates published in the literature from unspecific data collections. This method is more suited for improving outcome quality by benchmarking. General methodologic problems are discussed, leading to recommendations for future study designs. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Health promotion by means of health sport--a framework and a controlled intervention study with sedentary adults.

Only 10-20% of adults in industrialized countries reach the health-related minimum level of a consumption of energy of more than 800 kcal week(-1), additional to activities of daily living. The objective of this longitudinal study was to evaluate the impact of a health-promoting exercise program for sedentary adults on medical and subjective health status and on behavioral changes. The first 12 months of the study (t1-t2) consisted of a structured intervention exercise program. After this period, participants had the opportunity to stay in a follow-up-program or to change to other programs of the same club for further 12 months (t2-t3). Within these 2 years data have been collected from the intervention group (117 subjects) and control group (40 subjects). It can be shown that on the basis of a structured intervention (one session per week, 90 min, for 1 year), a stable behavioral change is reached with positive effects on fitness status, risk factors and mental health. Contrary to findings in other studies, the average health effects are at least stable in the second year in this study.