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Background: Dacryocystorhinostomy (DCR) is commonly performed for epiphora, dacryocystitis and during tumor surgery. External (EXT-DCR) and endoscopic DCR (END-DCR) are both practiced. END-DCR was initially performed with laser (EL-DCR) but has shifted to careful bone removal with mechanical drills (EM-DCR). High level evidence from comparative cohorts was sought to compare outcomes. Method: Medline (1966 - January 28th, 2013) and Embase (1980 - January 28th, 2013) were searched for comparative studies (RCT/cohorts) of END-DCR to EXT-DCR for acquired nasolacrimal duct (NLD) obstruction. Primary outcome was DCR success, defined as resolution of symptoms and/or patent NLD on irrigation or dacroscintography. Secondary outcomes were scarring, infection and post-operative bleeding. Meta-analysis was performed with the Mantel-Haenszel Method and presented as Risk Ratios (RR) with Confidence Intervals (CI). Results: The search identified 3582 studies and 355 were reviewed after screening. Full text review yielded 19 studies (4 RCTs and 15 cohorts). Overall, EXT-DCR had slightly better success rates than END-DCR (RR 0.96, CI 0.93-1.00). However, EM-DCR outcomes were comparable to EXT-DCR (RR 1.02, CI 0.98-1.06), whereas EL-DCR had poorer outcomes (RR 0.85, CI 0.79-0.91) when compared separately. The RR for scarring, bleeding and infection with END-DCR versus EXT-DCR was 0.07 (CI 0.02-0.22), 0.72 (CI 0.46-1.13) and 0.24 (CI 0.11- 0.54), respectively. The rates of reported revision surgery were similar. Conclusion: DCR is a procedure with high success rates. Endoscopic procedures differ greatly by technique with EM-DCR offering comparable results to EXT-DCR, without the risk of cosmetically unacceptable scars. [ABSTRACT FROM AUTHOR]

We adapted a generic, individualised, patient-centred quality of life (QOL) assessment technique, the Quality of Life Assessment Schedule (QOLAS) for use with patients with dementia. The QOLAS was administered to a group of patients with mild to moderate dementia alongside a number of other measures of well-being to assess its psychometric properties. Each patient's main carer also completed the QOLAS, giving a proxy rating of the QOL of the patient. The patients understood the interview and were able to describe their quality of life both qualitatively and quantitatively. In this preliminary study the QOLAS was demonstrated to have good validity (content, construct, and criterion) and good internal reliability. The carers rated the patients as having a worse QOL than did the patients themselves on all subdomains of the QOLAS. The results suggest that patients with mild to moderate dementia can rate their own QOL and that the QOLAS is a promising method for assessing QOL in this patient group. The discrepancy between the patients' own views and the views of their carers raises important issues about whether the patient or a proxy is the best judge of QOL in patients with dementia. [ABSTRACT FROM AUTHOR]