Long-Term Outcomes of Ahmed Glaucoma Valve Surgery in a Scottish Cohort of Patients With Refractory Glaucoma.

Purpose The purpose of this study was to evaluate the long-term efficacy and safety profile of the Ahmed glaucoma valve (AGV) implantation in cases of refractory glaucoma. Methods We conducted a retrospective audit of patients that underwent AGV implantation between 2006 and 2017 by two glaucoma surgeons in a tertiary glaucoma centre (Glasgow, UK). Primary outcome measures included the post-operative intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity, complications, re-operation rates, and failure (defined as IOP > 21 mmHg or not reduced by 20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma, removal of implant, or loss of light perception) at pre-defined time points (years 1 to 8). Results A total of 111 eyes of 94 patients were identified with a mean follow-up of 48.5 months (SD: 31.5); 60.3% of eyes had undergone at least one previous glaucoma surgery. Mean presenting IOP was 31.7 mmHg (SD: 11.4), and it reduced to 13.9 mmHg (SD: 4.2) in year 5 and 16.3 mmHg in year 8 (p<0.05). The number of glaucoma medications reduced from 3.8 (SD: 1.4) to 2.4 (SD: 1.4) and 2.6 (SD: 1.4) in the above time points (p<0.05 except year 8). The five-year success rate was 65.2%, and the five-year reoperation rate was 37% excluding cataract surgery. The most common early complications were hyphaema (12.6%) and transient hypotony (8.1%), whereas the most common late complication was an encapsulated bleb (15.1%). Conclusions AGV implantation is an effective procedure for controlling IOP in the long term in cases of refractory glaucoma.

The impact of SIGN glaucoma guidelines on false-positive referrals from community optometrists in Central Scotland.

BACKGROUND: Since the introduction of National Institute for Health and Care Excellence glaucoma guidelines 2009, the number of referrals from community optometrists to hospital eye services has increased across the UK, resulting in increase in first visit discharge rates (FVDRs). AIM: To assess the impact of Scottish Intercollegiate Guidelines Network (SIGN) 144 on quality of referrals from community optometrists. METHODOLOGY: A retrospective study of patient records who attended as new adult glaucoma referrals to clinics in Princess Alexandra Eye Pavilion, Edinburgh, and in Greater Glasgow and Clyde, was carried out across October-November 2014 (group 1) and September-October 2016 (group 2), before and after the introduction of SIGN 144. The primary outcome of this study is FVDRs. A secondary outcome is the extent of compliance to referral recommendations by SIGN guidelines. RESULTS: Three hundred and twelve and 325 patients were included in groups 1 and 2, respectively. There was a significant decline in FVDRs between these two periods from 29.2% to 19.2%. (p=0.004) (OR 0.58 (95%CI 0.40 to 0.84)). Post-SIGN guidelines, 87% of referrals were compliant to SIGN referral criteria while 13% remained non-compliant. The main reasons for non-compliance were no repeatable visual field defects (42.0%) and referrals due to high intraocular pressure were either not repeated or not interpreted in the context of age and central corneal thickness (36.8%). CONCLUSION: Patients referred after the introduction of SIGN guidelines were 33.5% less likely to be discharged at the first visit. Although compliance to most recommendations in SIGN guidelines has improved, there is still a need to improve adherence to referral criteria.

Working With LGBT Baby Boomers and Older Adults: Factors That Signal a Welcoming Service Environment.

Many providers recognize the importance of creating culturally competent services for lesbian, gay, bisexual, and transgender (LGBT) older adults. Although multiple resources list steps to make professional practices more LGBT-welcoming, these resources provide no empirical data to support their recommendations. LGBT older adults (N = 327) were asked to describe what signals that a provider is LGBT-welcoming. Six of the top 10 signals related to provider behavior and suggest the importance of staff training; the balance included display of signage and rainbow flags, use of inclusive language on forms and the presence of LGBT-identified staff. Results provide evidence-based recommendations for working with LGBT older adults.

Working with LGBT older adults: an assessment of employee training practices, needs, and preferences of senior service organizations in Minnesota.

As the population ages and LGBT older adults become more visible among senior service providers, the need for cultural competency training will grow. Although this training is a relatively new phenomenon, curricula exist. These are generally in person for 2- to 8-hr durations. Training to Serve embarked on a study to investigate preferences in cultural competency format and duration. One-hundred and eighty-four Minnesota service providers participated in the online survey. The majority (90%) were interested in participating in LGBT cultural competency training. Results suggest a preference for shorter duration and online formats. Implications for curricula development and future research are included.

Friends, family, and caregiving among midlife and older lesbian, gay, bisexual, and transgender adults.

The study examines the frequency and nature of the informal caregiving experience for midlife and older lesbian, gay, bisexual, or transgender (LGBT) adults. Responses from a Twin Cities Metropolitan Area LGBT aging needs assessment survey were analyzed for social supports, current caregiving activity and availability of a caregiver. The majority of respondents identified a primary caregiver who was not a legal relation; and compared to the general population were (a) less likely to have traditional sources of caregiver support and (b) more likely to be serving as a caregiver and caring for someone to whom they were not legally related. Implications of the findings for enhancing resources to more fully support the 10% of caregivers that are caring for non-kin are discussed.

Training, geography, and provision of aging services to lesbian, gay, bisexual, and transgender older adults.

This research study surveyed leaders of Area Agencies on Aging (agencies) to understand their services, training, and beliefs about serving lesbian, gay, bisexual, and transgender (LGBT) older adults. Half of the existing agencies in the United States (320) participated. Few agencies provided LGBT services or outreach. One-third had trained staff around LGBT aging and four-fifths were willing to offer training; these numbers were significantly higher for urban-based agencies. Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests. Training, policy, organizing, and research implications are considered.

Effectiveness of education and individualized counseling in reducing environmental hazards in the homes of community-dwelling older women.

OBJECTIVES: To test the effectiveness of an education and counseling intervention on reducing environmental hazards in the homes of older women. DESIGN: Secondary analysis from a randomized, controlled trial with two arms: fall prevention program and health education program (control). Environmental hazards were assessed at baseline and immediately posttreatment (12-weeks). SETTING: Participants' homes. PARTICIPANTS: Two hundred seventy-two community-dwelling women aged 70 and older at risk for falling. INTERVENTION: The fall prevention program involved a comprehensive fall risk evaluation, exercise, education, individualized counseling, and referrals. The health education program included topics unrelated to fall prevention. With the exception of the fall risk evaluation conducted by a nurse practitioner, baccalaureate-prepared nurses carried out the interventions. MEASUREMENTS: Summed and individual scores for hazards related to the bathroom, floor surfaces, lighting, furniture, stairways, and storage areas. RESULTS: Environmental hazards were found in all homes, with a baseline mean+/-standard deviation of 10.7+/-2.6 total hazards and range of four to 17 hazards. Analysis of within-group changes indicated that the fall prevention group had significantly fewer bathroom, lighting, and total hazards after the intervention, whereas the health education group had significantly fewer bathroom hazards but more floor hazards. At follow-up, the fall prevention group had significantly fewer lighting hazards and total hazards than the health education group. CONCLUSION: Education and counseling have only modest effects in helping older women make recommended home modifications. To be most effective in reducing environmental hazards, fall prevention programs may need to provide and install safety devices.

Measuring the direct healthcare costs of a fall injury event.

BACKGROUND: Falls are a leading cause of injury in older adults. Obtaining cost data for a randomized controlled trial aimed at preventing falls was problematic, and an approach was needed to obtain these data on a relatively small sample of women who used healthcare services. APPROACH: The study population was 272 community-dwelling women aged 70 and over who were participants in a fall prevention trial. Fall incident reports and billing records were used to obtain costs associated with outpatient visits, emergency department visits, acute care hospitalizations, nursing home stays, home healthcare visits, rehabilitation visits, and ambulance use. Average time and costs for obtaining fall-related healthcare cost data also were estimated. RESULTS: The mean age of those with falls requiring healthcare utilization was 78.9 years (SD = 5.1 years). Billing records were obtained for 47 of 55 injurious falls (85%). Costs ranged from $63 to $85,984, with a mean cost of $6,606 and a median cost of $658 per fall-related injurious event. The average time it took to collect the data was just over 5 hr per fall, with an estimated data collection cost of $170 per fall. DISCUSSION: The mean cost of falls was higher than seen in other studies, although methods differ. Collecting cost data related to a specific fall injury event directly from study participants was feasible, practical, and relatively inexpensive. Direct costs of injurious falls are greater than have been estimated in previous studies.

Use of time studies for determining intervention costs.

BACKGROUND: Cost-effectiveness analyses are increasingly recommended to evaluate the effectiveness of health interventions. Determining the costs associated with delivery of a particular intervention is essential in conducting a cost-effectiveness analysis. Yet, there are few guidelines available to assist investigators in how to assess intervention costs associated with the personnel portion of an intervention. OBJECTIVES: To describe the use of time studies in calculating the program costs of personnel for use in future cost-effectiveness analysis of health interventions. METHODS: The literature on calculating intervention costs for use in cost-effectiveness analyses is reviewed. The process for conducting a time study for determining personnel costs in delivering an intervention and a step-by-step example from a time study are used to illustrate how personnel costs associated with delivery of the intervention can be separated from those costs associated with implementation of research procedures in the determination of research costs. CONCLUSIONS: Time studies provide a good estimate of part of the cost of implementing an intervention that is often difficult to determine-personnel time. The design of the time study should consider intervention components, staff involvement, and the time period for data collection.