02475nas a2200277   4500000000100000008004100001260000800042653004100050653002300091100001000114700001100124700001400135700001700149700001300166700002100179700001100200700001400211700001200225700001300237700001400250245008400264300001400348490000800362520180200370022002502172       2023                            d  bBMJ10atrachomatous trichiasis (TT) surgery10arefresher training1 aPak C1 aHall N1 aBekele DT1 aKollmann KHM1 aTadele T1 aTekle-Haimanot R1 aTaye T1 aQureshi B1 aYalew W1 aGower EW1 aKempen JH00aImpact of refresher training on the outcomes of trachomatous trichiasis surgery  a1049-10520 v1083 a<p><strong>Background/aims: </strong>Trachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher training (RT) for experienced surgeons (1–22 years) on the outcomes of upper lid (UL) TT surgery in rural Ethiopia.</p>

<p><strong>Methods:</strong> Patients undergoing UL TT surgery in at least one eye by a participating surgeon were included. Patients were split into two cohorts: patients enrolled prior to (C1) and after (C2) RT. RT consisted of a 1-week programme with practice on a HEAD START mannequin and supportive supervision in live surgery by expert trainers. Data were collected at preoperative enrolment, and at 6-month and 12-month follow-up visits. The primary outcome was development of postoperative TT (PTT). A series of multivariate generalised estimating equations were fit to model PTT involving potential covariates of interest.</p>

<p><strong>Results:</strong> A total of 261 eyes contributed by 173 patients were studied between 2017 and 2019. By 1-year postoperatively, 37/128 eyes (28.9%) in C1 and 22/133 eyes (16.5%) in C2 had developed PTT (p=0.03). Other than surgeon RT participation, no factors studied were associated with differences in PTT.</p>

<p><strong>Conclusion:</strong> Our results indicate a significant reduction in the risk of PTT after experienced surgeons’ participation in RT as compared with eyes receiving surgery before RT. This observation suggests a significant potential benefit of the RT with HEAD START mannequin practice and supportive supervision during surgery, and suggests RT may be a valuable strategy to improve surgical outcomes.</p>
  a0007-1161, 1468-2079