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Purpose: To compare spherical aberration and contrast sensitivity function following implantation of four different foldable posterior chamber intraocular lenses (IOLs), namely Sensar, Akreos AO, Tecnis, and AcrySof IQ. Methods: In this randomized clinical trial, 68 eyes of 68 patients with senile cataracts underwent phacoemulsification and IOL implantation with Sensar (n=17), Akreos AO (n=17), Tecnis (n=17), or AcrySof IQ (n=17). Uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), spherical aberration and contrast sensitivity function (CSF) were compared among the study groups, 3 months after surgery. Results: There was no significant difference between the study groups in terms of age (P = 0.21). Mean postoperative BSCVA with Sensar, Akreos AO, Tecnis, and AcrySof IQ was 0.15±0.10, 0.12±0.9, 0.08±0.08, and 0.08±0.07 logMAR, respectively (P=0.08). Spherical aberration measured over a 4 mm pupil was significantly higher with Sensar and Akreos AO than the two other IOLs. The difference between Tecnis and AcrySof IQ was significantly in favor of the former IOL. Over a 6 mm pupil, spherical aberrations were comparable with Sensar and Akreos AO, furthermore spherical aberration was also comparable among eyes implanted with Akreos AO, AcrySof IQ, and Tecnis. Sensar yielded significantly inferior results as compared to Acrysof IQ and Tecnis. CSF with Sensar was inferior to the three aspheric IOLs at the majority of spatial frequencies. Tecnis yielded significantly better mesopic CSF at 1.5 and 3 cycles per degree spatial frequencies. Conclusion: Tecnis and AcrySof IQ provided significantly better visual function as compared to Sensar and Akreos AO, especially with smaller pupil size. However, this difference diminished with increasing pupil size.

Purpose: To compare spherical aberration and contrast sensitivity function following implantation of four different foldable posterior chamber intraocular lenses (IOLs), namely Sensar, Akreos AO, Tecnis, and AcrySof IQ. Methods: In this randomized clinical trial, 68 eyes of 68 patients with senile cataracts underwent phacoemulsification and IOL implantation with Sensar (n=17), Akreos AO (n=17), Tecnis (n=17), or AcrySof IQ (n=17). Uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), spherical aberration and contrast sensitivity function (CSF) were compared among the study groups, 3 months after surgery. Results: There was no significant difference between the study groups in terms of age (P = 0.21). Mean postoperative BSCVA with Sensar, Akreos AO, Tecnis, and AcrySof IQ was 0.15±0.10, 0.12±0.9, 0.08±0.08, and 0.08±0.07 logMAR, respectively (P=0.08). Spherical aberration measured over a 4 mm pupil was significantly higher with Sensar and Akreos AO than the two other IOLs. The difference between Tecnis and AcrySof IQ was significantly in favor of the former IOL. Over a 6 mm pupil, spherical aberrations were comparable with Sensar and Akreos AO, furthermore spherical aberration was also comparable among eyes implanted with Akreos AO, AcrySof IQ, and Tecnis. Sensar yielded significantly inferior results as compared to Acrysof IQ and Tecnis. CSF with Sensar was inferior to the three aspheric IOLs at the majority of spatial frequencies. Tecnis yielded significantly better mesopic CSF at 1.5 and 3 cycles per degree spatial frequencies. Conclusion: Tecnis and AcrySof IQ provided significantly better visual function as compared to Sensar and Akreos AO, especially with smaller pupil size. However, this difference diminished with increasing pupil size. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether the choice of an intraocular lens (IOL) with rigid haptics (Sensar) or an IOL with pliable haptics (Acrysof) has an effect on refractive stability following cataract surgery.Methods: Seventy-three patients were recruited consecutively as they returned for their 6-month visit following cataract surgery. There were 37 patients who had received an Acrysof IOL and 36 who had received a Sensar IOL. Each patient had their refractive error measured at the 1-month postoperative visit. At the 6-month follow-up visit, refraction was repeated. The change in refractive error was then compared between IOL groups and other factors that may affect postoperative refractive stability including preoperative refraction, axial length, keratometry, wound type and wound meridian.Results: An Acrysof IOL showed minimal myopic movement, whereas a Sensar IOL was more likely to move hypermetropically. However, this difference was not statistically significant (t = 1.92;P = 0.06). The magnitude of the shift in spherical equivalent in either direction for the Acrysof group was 0.37 ± 0.35 D and for the Sensar group was 0.28 ± 0.31 D. Again, this difference was not statistically significant (t = 1.17;P = 0.25). However, preoperative anterior chamber depth was associated with postoperative refractive shift (t = 2.66;P = 0.009). Furthermore, patients with a scleral wound showed a small against-the-rule shift in cylindrical refractive error. No other factors were associated with postoperative refractive shift amongst the sample.Conclusions: There were no clinically significant differences in postoperative refractive stability between the Acrysof and Sensar groups. However, preoperative anterior chamber depth was associated with the magnitude of shift in spherical equivalent. [ABSTRACT FROM AUTHOR]

Cada vez más se reconoce la seguridad asistencial como uno de los campos en los que más margen de mejoría puede existir. La anestesia y el cuidado de los pacientes críticos son situaciones complejas especialmente vulnerables para la aparición de incidentes que pongan en riesgo la vida de nuestros pacientes. La European Society of Intensive Care Medicine (ESCIM) desarrolló un primer estudio de eventos centinela (Sentinel events evaluation, SEE 1) que recogió una incidencia de 38,8 incidentes por cada 100 días y paciente en varias categorías. Para su segundo SEE decidieron centrarse en los errores de medicación por su potencial para producir daño relevante.

Los errores de comunicación son unos de los problemas de seguridad más frecuentes en la asistencia hospitalaria. La transferencia de información puede ser deficitaria o errónea en múltiples niveles: entre instituciones sanitarias (de centro de salud a hospital y viceversa, por ejemplo), entre médico o enfermera y enfermo, entre médicos, o entre estos profesionales entre sí. Una situación muy típica en la que pueden producirse errores de comunicación es en la transferencia de información al cambiar un enfermo de dependencia o de servicio asistencial o en los pases de visita. En Anestesia en concreto hay situaciones como el cambio de anestesista en una cirugía, el traslado desde quirófano a reanimación u otras dependencias, etc. en que existen oportunidades de error. En la literatura reciente hay un acuerdo generalizado en que un efectiva transferencia de información (“pase del paciente”, “handoff” o “handover”) entre el personal sanitario es fundamental para la seguridad del paciente, ya que facilita la continuidad y calidad de los cuidados y la coordinación entre todo el equipo sanitario, y así lo recomiendan las organizaciones internacionales de anestesistas. La prevención del error en la transferencia de información y conseguir una comunicación eficaz se plantean como objetivos de seguridad para el paciente desde el año 2006 y 2007. Recientemente se ha publicado en Critical Care un trabajo donde se analiza el “handoff” del paciente crítico y lo presenta como una fotografía que deben construir de forma conjunta ambas partes. Describe de forma práctica un modelo de handoff y aporta ideas sobre cómo mejorar las técnicas de comunicación. Nos ha parecido útil comentarlo en estas páginas.