Development of appropriateness explicit criteria for cataract extraction by phacoemulsification

Background: Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cataract extraction. We developed a new appropriateness of indications tool for cataract following the RAND method. We tested the validity of our panel results. Methods: Criteria were developed using a modified Delphi panel judgment process. A panel of 12 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the influence of all variables on the final panel score using linear and logistic regression models. The explicit criteria developed were summarized by classification and regression tree analysis. Results: Of the 765 indications evaluated by the main panel in the second round, 32.9% were found appropriate, 30.1% uncertain, and 37% inappropriate. Agreement was found in 53% of the indications and disagreement in 0.9%. Seven variables were considered to create the indications and divided into three groups: simple cataract, with diabetic retinopathy, or with other ocular pathologies. The preoperative visual acuity in the cataractous eye and visual function were the variables that best explained the panel scoring. The panel results were synthesized and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel original criteria, was 5.3%. Conclusion: The parameters tested showed acceptable validity for an evaluation tool. These results support the use of this indication algorithm as a screening tool for assessing the appropriateness of cataract extraction in field studies and for the development of practice guidelines.

The deliberate practice: the sports excellence versus the musical excellence

[ENG] If we look around us, we can observe that there is someone who is the best in each field of activity. We could think that they are exceptional individuals. This Final Project aims to increase knowledge of the effects of Deliberate Practice in the domains of music and sport. This will define you a concept of Deliberate Practice and then focus on the diversity of situations in which it shows us how it is presented in real life. From a questionnaire that has been designed for this study and distributed to the music students, I have expected to obtain a result that allow me to come to the conclusion that exists a relation between the hours of practice and the expertise in the execution. This reality has been linked to the regarding situation in the sport practice, whose information has been provided by the coordinators of the different sports. Taking into account the limited number of references available, this work has focused on a qualitative analysis of the data, interpreted from my point of view and my personal experience, which has been confirmed in the results obtained. The statistics managed allow me to conclude that, although the argument is not definitive, the guide effort through deliberate practice is essential to achieve the excellence.