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Xu S, Li Z, Zhao W, Zheng B, Jiang J, Ye G, Feng Z, Long W, He L, He M, Hu Y, Yang X. Effect of atropine, orthokeratology and combined treatments for myopia control: a 2-year stratified randomised clinical trial. Br J Ophthalmol 2023; 107:1812-1817. [PMID: 36229177 DOI: 10.1136/bjo-2022-321272] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the 2-year efficacy of atropine, orthokeratology (ortho-k) and combined treatment on myopia. To explore the factors influencing the efficacy. METHODS An age-stratified randomised controlled trial. Children (n=164) aged 8-12 years with spherical equivalent refraction of -1.00 to -6.00 D were stratified into two age subgroups and randomly assigned to receive placebo drops+spectacles (control), 0.01% atropine+spectacles (atropine), ortho-k+placebo (ortho-k) or combined treatment. Axial length was measured at baseline and visits at 6, 12, 18 and 24 months. The primary analysis was done following the criteria of intention to treat, which included all randomised subjects. RESULTS All interventions can significantly reduce axial elongation at all visits (all p<0.05). Overall, the 2-year axial elongation was significantly reduced in combined treatment than in monotherapies (all p<0.05). After stratification by age, in the subgroup aged 8-10, the difference between combined treatment and ortho-k became insignificant (p=0.106), while in the subgroup aged 10-12, the difference between combined treatment and atropine became insignificant (p=0.121). A significant age-dependent effect existed in the ortho-k group versus the control group (p for interaction=0.013), and a significant age-dependent effect existed in the ortho-k group versus the atropine group (p for interaction=0.035), which indicated that ortho-k can achieve better efficacy in younger children. CONCLUSIONS Atropine combined with ortho-k treatment can improve the efficacy of myopia control compared with monotherapy in children aged 8-12. Younger children might benefit more from ortho-k. TRIAL REGISTRATION NUMBER ChiCTR1800015541.
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Affiliation(s)
- Shengsong Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhouyue Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenchen Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Bingru Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jinyun Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Guitong Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhibin Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wen Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Liying He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Surgery, Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Hofmann B. Ethical issues with geographical variations in the provision of health care services. BMC Med Ethics 2022; 23:127. [PMID: 36474244 PMCID: PMC9724375 DOI: 10.1186/s12910-022-00869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/26/2022] [Indexed: 12/12/2022] Open
Abstract
Geographical variations are documented for a wide range of health care services. As many such variations cannot be explained by demographical or epidemiological differences, they are problematic with respect to distributive justice, quality of care, and health policy. Despite much attention, geographical variations prevail. One reason for this can be that the ethical issues of geographical variations are rarely addressed explicitly. Accordingly, the objective of this article is to analyse the ethical aspects of geographical variations in the provision of health services. Applying a principlist approach the article identifies and addresses four specific ethical issues: injustice, harm, lack of beneficence, and paternalism. Then it investigates the normative leap from the description of geographical variations to the prescription of right care. Lastly, the article argues that professional approaches such as developing guidelines, checklists, appropriateness criteria, and standards of care are important measures when addressing geographical variations, but that such efforts should be accompanied and supported by ethical analysis. Hence, geographical variations are not only a healthcare provision, management, or a policy making problem, but an ethical one. Addressing the ethical issues with geographical variations is key for handling this crucial problem in the provision of health services.
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Affiliation(s)
- Bjørn Hofmann
- grid.5947.f0000 0001 1516 2393Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU), PO Box 191, 2801 Gjøvik, Norway ,grid.5510.10000 0004 1936 8921The Centre for Medical Ethics, University of Oslo, PO Box 1130, 0318 Oslo, Norway
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Zhao J, Li SA, Graham ID, Scientist S. A call for de-implementation research and clinical practice in Chinese healthcare. BMJ 2022; 377:o1203. [PMID: 35550301 DOI: 10.1136/bmj.o1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Junqiang Zhao
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Lu ZF. On the regretful death of Professor/Dr. Shi Ying-Kang. Quant Imaging Med Surg 2016; 6:334-7. [PMID: 27429922 DOI: 10.21037/qims.2016.06.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zhi-Fang Lu
- Handy Medical Investment and Management PLC, Suzhou 215022, China;; Hai-De Medical and Health Innovation Management Research Center, Hohai University, Changzhou 213022, China
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