title: Novel system for distant assessment of cataract surgical quality in rural China.
abstract: BACKGROUND
  This study aims to assess the quality of various steps of manual small incision cataract surgery and predictors of quality, using video recordings.
  
  
  METHODS
  This paper applies a retrospective study.
  
  
  METHODS
  Fifty-two trainees participated in a hands-on small incision cataract surgery training programme at rural Chinese hospitals.
  
  
  METHODS
  Trainees provided one video each recorded by a tripod-mounted digital recorder after completing a one-week theoretical course and hands-on training monitored by expert trainers. Videos were graded by two different experts, using a 4-point scale developed by the International Council of Ophthalmology for each of 12 surgical steps and six global factors. Grades ranged from 2 (worst) to 5 (best), with a score of 0 if the step was performed by trainers.
  
  
  METHODS
  Mean score for the performance of each cataract surgical step rated by trainers.
  
  
  RESULTS
  Videos and data were available for 49/52 trainees (94.2%, median age 38 years, 16.3% women and 77.5% completing > 50 training cases). The majority (53.1%, 26/49) had performed ≤ 50 cataract surgeries prior to training. Kappa was 0.57∼0.98 for the steps (mean 0.85). Poorest-rated steps were draping the surgical field (mean ± standard deviation = 3.27 ± 0.78), hydro-dissection (3.88 ± 1.22) and wound closure (3.92 ± 1.03), and top-rated steps were insertion of viscoelastic (4.96 ± 0.20) and anterior chamber entry (4.69 ± 0.74). In linear regression models, higher total score was associated with younger age (P = 0.015) and having performed >50 independent manual small incision cases (P = 0.039).
  
  
  CONCLUSIONS
  More training should be given to preoperative draping, which is poorly performed and crucial in preventing infection. Surgical experience improves ratings.
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Lanhua
authors: L
authors: Wang
authors: Guangdong Hospital of Traditional Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
authors: Danping
authors: D
authors: Xu
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Bin
authors: B
authors: Liu
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Ling
authors: L
authors: Jin
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Decai
authors: D
authors: Wang
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.|University College London Institute of Ophthalmology, London, UK.|Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors: Mingguang
authors: M
authors: He
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.|ORBIS International, New York, New York, USA.
authors: Nathan G
authors: NG
authors: Congdon
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Wenyong
authors: W
authors: Huang
mesh_terms: D000328:Adult; D002387:Cataract Extraction / Q000193:education / Q000592:standards*; D002983:Clinical Competence / Q000592:standards; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000193:education / Q000592:standards*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards*; D014741:Video Recording; D014786:Vision Disorders / Q000534:rehabilitation
keywords: China; cataract surgery; outcome; rural; video