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Young SL, Cheng KKW, O' Connell N, Sanders R, Agarwal PK. PACS plus criteria: a retrospective cohort review of 612 consecutive patients treated with bilateral YAG peripheral iridotomies. Eye (Lond) 2023; 37:3834-3838. [PMID: 37340048 PMCID: PMC10698168 DOI: 10.1038/s41433-023-02626-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/28/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION With an ageing population and better life expectancy, the prevalence of angle closure disease is expected to increase by 20% per decade. In 2022, the Royal College of Ophthalmologists (RCOphth) issued a guideline on managing angle closure disease. Hospital eye service (HES) referral and prophylactic treatment are recommended only for primary angle closure suspect (PACS) with "Plus" features only. We aimed to examine patients previously treated with YAG peripheral iridotomies (YAG PI) for the presence of "PACS Plus" features. METHODS A retrospective cohort study of consecutive patients treated with YAG PI between 2015 and 2019 at a tertiary referral NHS eye centre was reviewed. Cases were examined to identify and classify patients into Primary Angle Closure (PAC), PACS, and Primary Angle Closure Glaucoma (PACG). Patients with PACS were studied for "Plus" features. RESULTS Six hundred twelve patients with gonioscopy-confirmed angle closure (defined as a minimum 180 degrees iridotrabecular contact) treated with YAG PI from years 2015 to 2019 were included in the analysis. The mean age of patients presenting with angle closure disease was 68.5 years (SD 11.3). There were 390 (63.7%) patients with PACS, 102 (16.6%) with PAC and 120 (19.7%) with PACG. Of the PACS patients, 159(40.8%) patients had no "Plus" features. 181 (40.2%) patients had 1 "Plus" feature, 37 (9.5%) had 2 "Plus" features and 13 (3.3%) patients had 3 "Plus" features. CONCLUSION In our cohort, a considerable proportion (40.8%) of PACS patients treated with YAG PI did not have Plus features and therefore that would not meet the proposed criteria for HES referral and YAG PI. With the proposed guidance, we expect a considerable reduction in HES referrals. Nonetheless, community optometry services should be supported and trained to provide monitoring for patients with PACS not referred to the HES.
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Affiliation(s)
- Su Ling Young
- Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK.
- Department of Ophthalmology, University of Edinburgh, Edinburgh, UK.
| | - Kelvin K W Cheng
- Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
- Department of Ophthalmology, University of Edinburgh, Edinburgh, UK
| | | | - Roshini Sanders
- Department of Ophthalmology, University of Edinburgh, Edinburgh, UK
- Queen Margaret Hospital, NHS Fife, Dunfermline, UK
| | - Pankaj K Agarwal
- Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
- Department of Ophthalmology, University of Edinburgh, Edinburgh, UK
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2
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Foster PJ, Ng WS, Nolan WP, Tanner L, Gazzard G, Day AC, Sanders R, Foot B, Salmon JF, Azuara-Blanco A. Prevention of angle-closure glaucoma: balancing risk and benefit. Eye (Lond) 2022; 36:2229-2231. [PMID: 35725765 PMCID: PMC9674842 DOI: 10.1038/s41433-021-01881-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Paul J Foster
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- UCL Institute of Ophthalmology, London, UK.
| | | | - Winifred P Nolan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Luke Tanner
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gus Gazzard
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Alex C Day
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Roshini Sanders
- Queen Margaret Hospital, Dunfirmline, Fife, UK
- Department of Ophthalmology, University of Edinburgh, Edinburgh, UK
| | - Barny Foot
- Royal College of Ophthalmologists, London, UK
| | - John F Salmon
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Augusto Azuara-Blanco
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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3
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Saxby E, Cheng K, O'Connell N, Sanders R, Agarwal PK. Is there an association of socioeconomic deprivation with acute primary angle closure? Eye (Lond) 2022; 36:1246-1252. [PMID: 34117395 PMCID: PMC8193016 DOI: 10.1038/s41433-021-01615-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Socioeconomic deprivation is known to increase the risk of late presentation of many diseases. This is the largest study in United Kingdom investigating the relationship between socioeconomic deprivation and acute primary angle closure (APAC). METHODS A retrospective review of case notes was conducted of 718 consecutive patients who underwent laser peripheral iridotomy (LPI) in Edinburgh (Princess Alexandra Eye Pavilion) and Fife (Queen Margaret Hospital) between 2015 and 2019. Baseline demographics including sex, age, ethnicity, pre-existing diabetes, use of anti-depressants, and family history of glaucoma were collected. Deprivation was scored using the Scottish Index of Multiple Deprivation (SIMD) Index 2020v2. A lower rank and decile indicate higher degrees of deprivation. We investigated differences in characteristics between patients who were referred routinely versus patients who referred as APAC. RESULTS The SIMD rank and deciles were consistently lower in patients who were referred urgently with APAC in both centres (P = <0.05) when compared to those referred routinely for LPI. On univariate and multivariate logistic regression, the presentation of APAC is negatively associated with SIMD Decile (OR = -0.101, 95% CI -0.178 to -0.026, P = 0.008) and family history of glaucoma (OR = -1.010, 95% CI -1.670 to -0.426, P = 0.001), and positively associated with age (OR = 0.029, 95% CI 0.009-0.049, P = 0.004). CONCLUSIONS Socioeconomic deprivation is an important risk factors for patients presenting with APAC. Socioeconomic deprivation should be incorporated into the design of glaucoma services and considered when triaging patients for prophylactic and therapeutic LPI and cataract surgery.
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Affiliation(s)
| | | | - Niamh O'Connell
- Ophthalmology Department, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Roshini Sanders
- Ophthalmology Department, Queen Margaret Hospital, Dunfermline, Fife, UK
- University of Edinburgh, Edinburgh, UK
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4
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Cheng KK, Anderson MJ, Velissaris S, Moreton R, Al-Mansour A, Sanders R, Sutherland S, Wilson P, Blaikie A. Cataract risk stratification and prioritisation protocol in the COVID-19 era. BMC Health Serv Res 2021; 21:153. [PMID: 33596884 PMCID: PMC7887562 DOI: 10.1186/s12913-021-06165-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/09/2021] [Indexed: 12/28/2022] Open
Abstract
Background The COVID-19 pandemic halted non-emergency surgery across Scotland. Measures to mitigate the risks of transmitting COVID-19 are creating significant challenges to restarting all surgical services safely. We describe the development of a risk stratification tool to prioritise patients for cataract surgery taking account both specific risk factors for poor outcome from COVID-19 infection as well as surgical ‘need’. In addition we report the demographics and comorbidities of patients on our waiting list. Methods A prospective case review of electronic records was performed. A risk stratification tool was developed based on review of available literature on systemic risk factors for poor outcome from COVID-19 infection as well as a surgical ‘need’ score. Scores derived from the tool were used to generate 6 risk profile groups to allow prioritised allocation of surgery. Results There were 744 patients awaiting cataract surgery of which 66 (8.9 %) patients were ‘shielding’. One hundred and thirty-two (19.5 %) patients had no systemic comorbidities, 218 (32.1 %) patients had 1 relevant systemic comorbidity and 316 (46.5 %) patients had 2 or more comorbidities. Five hundred and ninety patients (88.7 %) did not have significant ocular comorbidities. Using the risk stratification tool, 171 (23 %) patients were allocated in the highest 3 priority stages. Given an aging cohort with associated increase in number of systemic comorbidities, the majority of patients were in the lower priority stages 4 to 6. Conclusions COVID-19 has created an urgent challenge to deal safely with cataract surgery waiting lists. This has driven the need for a prompt and pragmatic change to the way we assess risks and benefits of a previously regarded as low-risk intervention. This is further complicated by the majority of patients awaiting cataract surgery being elderly with comorbidities and at higher risk of mortality related to COVID-19. We present a pragmatic method of risk stratifying patients on waiting lists, blending an evidence-based objective assessment of risk and patient need combined with an element of shared decision-making. This has facilitated safe and successful restarting of our cataract service.
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Affiliation(s)
- Kelvin Kw Cheng
- Ophthalmology Department, NHS Fife, Queen Margaret Hospital, Fife, Dunfermline, UK.
| | - Martin J Anderson
- Ophthalmology Department, NHS Fife, Queen Margaret Hospital, Fife, Dunfermline, UK
| | - Stavros Velissaris
- Ophthalmology Department, NHS Fife, Queen Margaret Hospital, Fife, Dunfermline, UK
| | - Robert Moreton
- Ophthalmology Department, NHS Fife, Queen Margaret Hospital, Fife, Dunfermline, UK.,University of Edinburgh, Edinburgh, UK
| | - Ahmed Al-Mansour
- Ophthalmology Department, NHS Fife, Queen Margaret Hospital, Fife, Dunfermline, UK
| | - Roshini Sanders
- Ophthalmology Department, NHS Fife, Queen Margaret Hospital, Fife, Dunfermline, UK.,University of Edinburgh, Edinburgh, UK
| | - Shona Sutherland
- Ophthalmology Department, NHS Fife, Queen Margaret Hospital, Fife, Dunfermline, UK
| | - Peter Wilson
- Ophthalmology Department, NHS Fife, Queen Margaret Hospital, Fife, Dunfermline, UK
| | - Andrew Blaikie
- Ophthalmology Department, NHS Fife, Queen Margaret Hospital, Fife, Dunfermline, UK.,University of St Andrews, St. Andrews, UK
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5
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Ah-See KL, Blaikie A, Boyle N, Foulds J, Wheeldon C, Wilson P, Styles C, Sutherland S, Sanders R. Cataract Surgery Redesign: Meeting Increasing Demand, Training, Audit and Patient-Centered Care. Clin Ophthalmol 2021; 15:289-297. [PMID: 33531794 PMCID: PMC7846846 DOI: 10.2147/opth.s268190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The demand for cataract surgery in Fife (a well-defined region in southeast Scotland) was steadily increasing over 15 years. Cataract surgery was therefore being outsourced to meet demand with consequences on list mix, training needs, patient experience and staff morale. We aimed to redesign our services to meet local demand, retain a patient-centered service and continue to fulfil training needs. Methods We quantified cataract surgery delivery over an 18-month period: before, during and after redesign of services. We studied numbers of operations, trainee cases and number of outsourced cases. We also considered the economic implications of the redesign. Results We studied three periods (each of six months duration): before redesign (BR), redesign period (RP) and post-redesign (PR). Data were collected on total operation numbers, number of cases performed by trainees, and numbers performed out with normal working hours (weekend lists) and external providers. An economic analysis examined the cost of outsourcing cataracts during BR and RP and the costs of the redesign, including building, equipment and additional nursing staff. Conclusion Regional fulfilment of cataract surgery provision remains a continuous challenge within the NHS. We show that with minimal investment, smart redesign process and collaborative working, increased local provision is possible while fulfilling trainee needs and achieving the necessary clinical audits and national standards.
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Affiliation(s)
- Kim Lawrence Ah-See
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, Scotland, UK
| | - Andrew Blaikie
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Natalie Boyle
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Jonathan Foulds
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Catherine Wheeldon
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Peter Wilson
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Caroline Styles
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Shona Sutherland
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Roshini Sanders
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
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6
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Yasin O, Sugrue A, Van Zyl M, Ladejobi A, Tri J, Rynbrandt J, Seifert G, Sanders R, Pedersen J, Yngsdal L, Ladewig D, Taubel R, Ritrivi C, Asirvatham S, Friedman P. A cool modality to restore sinus rhythm. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Slowing electrical conduction by cooling the myocardium can be used for defibrillation. We previously demonstrated the efficacy of a small cold device placed in oblique sinus (OS) in terminating atrial fibrillation (AF). However, the parameters needed to achieve effective atrial defibrillation are unknown.
Purpose
Assess effect of the size of cooled myocardium on frequency of AF termination in acute canine animal models.
Methods
Sternotomy was performed under general anesthesia in 10 acute canine experiments. AF was induced using rapid atrial pacing and intra-myocardial epinephrine and acetylcholine injections. Once AF sustained for at least 30s, either a cool (7–9°C) or placebo (body temperature) device was placed in the OS. Four device sizes were tested; ½X½, ¾X¾, and 1X1 inch devices and two ¾X¾ inch devices placed side by side simultaneously. Time to AF termination was recorded. Chi-squared or Fisher's exact test were used to compare the frequency of arrhythmia termination with cooling versus placebo.
Results
A total of 166 applications were performed (89 cool vs 77 placebo) in 10 animal experiments. Overall, AF terminated in 82% of the cooling applications vs. 67.5% of placebo (P=0.03, Figure 1). For the ½X½ inch device 88% of cold applications restored sinus rhythm vs. 63.6% for placebo (P=0.05). The frequency of sinus restoration for cold ¾X¾, 1X1 and two ¾X¾ side by side devices was 86.7%, 83.3% and 70% respectively. Time to sinus restoration when achieved was within three minutes was also not significantly changed.
Conclusion
Placing a cool device in the oblique sinus can terminate AF and efficacy is not affected by the size of device.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MediCool Technologies
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Affiliation(s)
- O Yasin
- Mayo Clinic, Rochester, United States of America
| | - A Sugrue
- Mayo Clinic, Rochester, United States of America
| | - M Van Zyl
- Mayo Clinic, Rochester, United States of America
| | - A Ladejobi
- Mayo Clinic, Rochester, United States of America
| | - J Tri
- Mayo Clinic, Rochester, United States of America
| | - J Rynbrandt
- Medicool Technologies Inc, Rochester, United States of America
| | - G Seifert
- Medicool Technologies Inc, Rochester, United States of America
| | - R Sanders
- Medicool Technologies Inc, Rochester, United States of America
| | - J Pedersen
- Mayo Clinic, Rochester, United States of America
| | - L Yngsdal
- Mayo Clinic, Rochester, United States of America
| | - D Ladewig
- Mayo Clinic, Rochester, United States of America
| | - R Taubel
- Mayo Clinic, Rochester, United States of America
| | - C Ritrivi
- Medicool Technologies Inc, Rochester, United States of America
| | - S Asirvatham
- Mayo Clinic, Rochester, United States of America
| | - P Friedman
- Mayo Clinic, Rochester, United States of America
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7
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Abstract
Tackling visual impairment remains an important public health issue. Due to limited resources and the increasing demand on hospital eye services (HES), delivery of quality eye care within the community is essential. Training of clinical ophthalmic specialists and allied health-care professionals in the detection and management of common eye conditions can thus help to reduce the burden of eye disease and improve prognostic outcomes. Digital imaging has become a useful tool in facilitating eye-care delivery in both the community and hospital setting. In the last decade, the advent of electronic image exchange via a centralized referral unit in Scotland has revolutionized screening for ophthalmic disease, referrals, and shared care between community and HES clinicians. A government-led initiative known as the Scottish Eyecare Integration Project introduced electronic transfer of digital images within referrals from community optometrists to HES, which greatly reduced outpatient waiting times and improved patient satisfaction. The catalogue of live clinical information and digital images that resulted from the project led to the creation of a virtual learning platform through the University of Edinburgh. Participating professionals involved in eye care have interactive discussions about common eye conditions by sharing digital images of cases and investigations on a global online platform. This has received worldwide attention and inspired the creation of other university courses, e-learning platforms in eye-health education, and shared-care schemes in the screening of eye disease. We show that digital ophthalmology plays a vital role in the integration of community and HES partnership in delivery of patient care and in facilitating eye-health education to a global audience.
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Affiliation(s)
| | - Sirjhun Patel
- Ophthalmology Department, Ninewells Hospital, Dundee, UK
| | - Daniel Beck
- Princess Alexandra Eye Pavilion, Edinburgh, UK,
| | - Heather Ellis
- Ophthalmology Department, Lauriston Building, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Bal Dhillon
- Princess Alexandra Eye Pavilion, Edinburgh, UK, .,University of Edinburgh, Edinburgh, UK
| | - Roshini Sanders
- University of Edinburgh, Edinburgh, UK.,Queen Margaret Hospital, Dunfermline, UK
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Smith JM, Sanders R, Kosoko-Lasaki O, Stone JR. Training Community Health Ambassadors to Administer SOPARC. J Health Sci Educ 2019; 3:1-7. [PMID: 37538301 PMCID: PMC10398416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Preparing lay Community Health Ambassadors (CHA) to assess, document and monitor physical activity using standardized instruments can be daunting. Administering some instruments needs specialized training. System for Observing Play and Recreation in Communities (SOPARC) is a standardized instrument requiring extensive training. The question guiding this project was: Can lay Community Health Ambassadors (CHA) be trained to administer SOPARC at Racial and Ethnic Approaches to Community Health (REACH) physical activity fitness sites? This manuscript presents the process undertaken to train Community Health Ambassadors (CHAs) and some preliminary results. Preliminary results are that fifty-six (56) Community Health Ambassadors (CHAs) representing four (4) community partner groups were certified in the SOPARC training. These CHAs successfully documented pre/post data for 20 different physical activity sites. Additionally, the results support the premise that Community Health Ambassadors are a viable liaison in community health delivery.
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Affiliation(s)
- JM Smith
- Corresponding author: Jeffrey M. Smith, Counselor Education Program, Room 412 Eppley Building, Creighton University, Omaha, NE 68178, USA; Tel: 402.280.2413, Fax: 402.2801117,
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9
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Asfari A, Ahmed M, Edwards L, Irby K, Agarwal A, Pasala S, Prodhan P, Frazier B, Sanders R. Survival from Septic Shock Secondary to Disseminated Group A Streptococcal Infection after Central Extracorporeal Membrane Oxygenation. JCS 2017. [DOI: 10.1055/s-0037-1607312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective The objective of this study was to describe a case of severe life-threatening acute respiratory distress syndrome (ARDS) and septic shock in a child who responded to a prolonged extracorporeal membrane oxygenation (ECMO) support course utilizing different cannulation techniques depending on the physiological derangement until he recovered.
Design This is a case report.
Setting This study was done at the medical–surgical pediatric intensive care unit in an academic freestanding children's hospital.
Patient A previously healthy 4-year-old boy was presented with respiratory distress and fever. He was diagnosed with respiratory syncytial viral upper respiratory tract infection and group A β-hemolytic Streptococcus septic shock.
Interventions The patient was referred to peripheral ECMO for hemodynamic, ventilatory, and oxygenation support; conversion to central ECMO to augment blood flow; and transition to extracorporeal carbon dioxide removal before successful wean off extracorporeal support.
Measurements and Main Results Patient experienced severe pediatric ARDS and septic shock that were refractory to maximal medical therapy. Patient was able to be decannulated after 75 days of extracorporeal support. He was weaned completely off of mechanical ventilation and oxygen after 6 months. The only neurological deficit he exhibited was poor fine motor skills of his hands for which he continued to receive physical therapy.
Conclusion Central ECMO may benefit children with pediatric ARDS and septic shock who require higher flows than what can be provided from peripheral ECMO. Extracorporeal membrane carbon dioxide removal may be an effective option in children who do not respond to mechanical ventilation alone.
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Affiliation(s)
- A. Asfari
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - M. Ahmed
- Section of Critical Care, Department of Pediatrics, Texas Children's Hospital, Houston, Texas, United States
| | - L. Edwards
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - K. Irby
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - A. Agarwal
- Section of Pulmonology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - S. Pasala
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - P. Prodhan
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Section of Cardiology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - B. Frazier
- Department of Extracorporeal Membrane Oxygenation, Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - R. Sanders
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
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10
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Colpitts M, Malinowski M, Phillion R, Coleman R, Mitchell L, Malone A, Eberhart L, Sanders R, Langholz D. Echocardiographic imaging options in ovine research subjects. J Vet Cardiol 2017; 19:502-513. [PMID: 29097107 DOI: 10.1016/j.jvc.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/13/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine the feasibility of acquiring quality transesophageal (TEE), epicardial (EE), and intracardiac (ICE) echocardiographic images in ovine subjects and to discuss the merits of each technique with a focus on ICE image acquisition. ANIMALS Eleven male castrated Dorset adult sheep. METHODS Transesophageal echocardiography was performed under general anesthesia. Epicardial echocardiography was performed as part of an open chest (thoracotomy or sternotomy) experiment. Subjects were recovered with permanent jugular vein indwelling catheter and ICE from this approach was described. Feasibility of each technique was qualitatively assessed based on subjective image quality from three images for each image plane in each sheep. RESULTS Transesophageal echocardiography was technically challenging and did not provide adequate image quality for consistent interpretation. Epicardial echocardiography and ICE had more favorable results with ICE demonstrating unique benefits for post-operative serial monitoring. CONCLUSIONS Epicardial echocardiography and ICE were effective imaging techniques. Epicardial echocardiography required the least specialized training but was considered to have limited feasibility due to its requirement for an open chest procedure. Even with the necessity for permanent indwelling jugular cannulation, ICE was the least invasive of the three imaging techniques and potentially the most practical approach for chronic studies by minimizing post-operative stress. Transesophageal echocardiography was not a feasible technique in this study.
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Affiliation(s)
- M Colpitts
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA.
| | - M Malinowski
- Division of Cardiothoracic Surgery, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA; Medical University of Silesia, Department of Cardiac Surgery, Ziolowa 47, 40-635, Katowice, Poland
| | - R Phillion
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - R Coleman
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - L Mitchell
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - A Malone
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - L Eberhart
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - R Sanders
- Michigan State University - College of Veterinary Medicine, Department of Cardiology, 736 Wilson Road, East Lansing, MI 48823, USA
| | - D Langholz
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
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11
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Sharp WG, Allen AG, Stubbs KH, Criado KK, Sanders R, McCracken CE, Parsons RG, Scahill L, Gourley SL. Successful pharmacotherapy for the treatment of severe feeding aversion with mechanistic insights from cross-species neuronal remodeling. Transl Psychiatry 2017; 7. [PMID: 28632204 PMCID: PMC5537647 DOI: 10.1038/tp.2017.126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Pediatric feeding disorders affect up to 5% of children, causing severe food intake problems that can result in serious medical and developmental outcomes. Behavioral intervention (BI) is effective in extinguishing feeding aversions, and also expert-dependent, time/labor-intensive and not well understood at a neurobiological level. Here we first conducted a double-blind, placebo-controlled trial comparing BI with BI plus d-cycloserine (DCS). DCS is a partial N-methyl-d-aspartate (NMDA) receptor agonist shown to augment extinction therapies in multiple anxiety disorders. We examined whether DCS enhanced extinction of feeding aversion in 15 children with avoidant/restrictive food intake disorder (ages 20-58 months). After five treatment days, BI improved feeding by 37%. By contrast, BI+DCS improved feeding by 76%. To gain insight into possible mechanisms of successful intervention, we next tested the neurobiological consequences of DCS in a murine model of feeding aversion and avoidance. In mice with conditioned food aversion, DCS enhanced avoidance extinction across a broad dose range. Confocal fluorescence microscopy and three-dimensional neuronal reconstruction indicated that DCS enlarged dendritic spine heads-the primary sites of excitatory plasticity in the brain-within the orbitofrontal prefrontal cortex, a sensory-cognition integration hub. DCS also increased phosphorylation of the plasticity-associated extracellular signal-regulated kinase 1/2. In summary, DCS successfully augments the extinction of food aversion in children and mice, an effect that may involve plasticity in the orbitofrontal cortex. These results warrant a larger-scale efficacy study of DCS for the treatment of pediatric feeding disorders and further investigations of neural mechanisms.
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Affiliation(s)
- W G Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA,Pediatric Psychology and Feeding Disorders Program, The Marcus Autism Center, Atlanta, GA, USA,Pediatric Psychology and Feeding Disorders Program, The Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA. E-mail:
| | - A G Allen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA,Yerkes National Primate Research Center, Atlanta, GA, USA
| | - K H Stubbs
- Pediatric Psychology and Feeding Disorders Program, The Marcus Autism Center, Atlanta, GA, USA
| | - K K Criado
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA,Pediatric Psychology and Feeding Disorders Program, The Marcus Autism Center, Atlanta, GA, USA
| | - R Sanders
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - C E McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - R G Parsons
- Graduate Program in Integrative Neuroscience and Program in Neuroscience, Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - L Scahill
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA,Pediatric Psychology and Feeding Disorders Program, The Marcus Autism Center, Atlanta, GA, USA
| | - S L Gourley
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA,Pediatric Psychology and Feeding Disorders Program, The Marcus Autism Center, Atlanta, GA, USA,Yerkes National Primate Research Center, Atlanta, GA, USA,Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
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Kirkpatrick S, Arden M, Beever D, Bradley J, Cantrill H, Daniels T, Drabble S, Elston C, Flight W, Gates A, Horsley A, Hutchings M, Johnson S, Langman H, Maguire C, McVean R, Ryan S, Sanders R, Wildman M. 368 CFHealthHub: development and evaluation of videos incorporating peer description of successful self-management with inhaled therapies in adults with CF used to build self-efficacy to support self-care within the CFHealthHub complex intervention. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cavan EL, Trimmer M, Shelley F, Sanders R. Remineralization of particulate organic carbon in an ocean oxygen minimum zone. Nat Commun 2017; 8:14847. [PMID: 28322218 PMCID: PMC5364423 DOI: 10.1038/ncomms14847] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 02/06/2017] [Indexed: 12/01/2022] Open
Abstract
Biological oceanic processes, principally the surface production, sinking and interior remineralization of organic particles, keep atmospheric CO2 lower than if the ocean was abiotic. The remineralization length scale (RLS, the vertical distance over which organic particle flux declines by 63%, affected by particle respiration, fragmentation and sinking rates) controls the size of this effect and is anomalously high in oxygen minimum zones (OMZ). Here we show in the Eastern Tropical North Pacific OMZ 70% of POC remineralization is due to microbial respiration, indicating that the high RLS is the result of lower particle fragmentation by zooplankton, likely due to the almost complete absence of zooplankton particle interactions in OMZ waters. Hence, the sensitivity of zooplankton to ocean oxygen concentrations can have direct implications for atmospheric carbon sequestration. Future expansion of OMZs is likely to increase biological ocean carbon storage and act as a negative feedback on climate change. The downward transfer of organic carbon from the surface to the deep ocean is increased in oxygen minimum zones relative to oxic waters. Here, the authors show reduced interactions of zooplankton with sinking particles owing to low oxygen are likely the primary reason for the observed high transfer of carbon.
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Affiliation(s)
- E L Cavan
- National Oceanography Centre, European Way, Southampton SO14 3ZH, UK.,University of Southampton, National Oceanography Centre, European Way, Southampton SO14 3ZH, UK
| | - M Trimmer
- Queen Mary University London, Mile End Road, London E1 4NS, UK
| | - F Shelley
- Queen Mary University London, Mile End Road, London E1 4NS, UK
| | - R Sanders
- National Oceanography Centre, European Way, Southampton SO14 3ZH, UK
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Jeganathan VSE, Hall HN, Sanders R. Electronic Referrals and Digital Imaging Systems in Ophthalmology: A Global Perspective. Asia Pac J Ophthalmol (Phila) 2017; 6:3-7. [PMID: 28161930 DOI: 10.22608/apo.2016110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/05/2016] [Indexed: 11/08/2022] Open
Abstract
Ophthalmology departments face intensifying pressure to expedite sight-saving treatments and reduce the global burden of disease. The use of electronic communication systems, digital imaging, and redesigned service care models is imperative for addressing such demands. The recently developed Scottish Eyecare Integration Project involves an electronic referral system from community optometry to the hospital ophthalmology department using National Health Service (NHS) email with digital ophthalmic images attached, via a virtual private network connection. The benefits over the previous system include reduced waiting times, improved triage, e-diagnosis in 20% without the need for hospital attendance, and rapid electronic feedback to referrers. We draw on the experience of the Scottish Eyecare Integration Project and discuss the global applications of this and other advances in teleophthalmology. We focus particularly on the implications for management and screening of chronic disease, such as glaucoma and diabetic eye disease, and ophthalmic disease, such as retinopathy of prematurity where diagnosis is almost entirely and critically dependent on fundus appearance. Currently in Scotland, approximately 75% of all referrals are electronic from community to hospital. The Scottish Eyecare Integration Project is globally the first of its kind and unique in a national health service. Such speedy, safe, and efficient models of communication are geographically sensitive to service provision, especially in remote and rural regions. Along with advances in teleophthalmology, such systems promote the earlier detection of sight-threatening disease and safe follow-up of non-sight-threatening disease in the community.
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Affiliation(s)
- V Swetha E Jeganathan
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
- Queen Margaret Hospital, NHS Fife
| | - H Nikki Hall
- Queen Margaret Hospital, NHS Fife
- University of Edinburgh, Edinburgh
- Princess Alexander Eye Pavillion, Edinburgh, Scotland, UK
| | - Roshini Sanders
- Queen Margaret Hospital, NHS Fife
- Princess Alexander Eye Pavillion, Edinburgh, Scotland, UK
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Abstract
Skull radiographs and special views are still requested in ophthalmology despite the increasing availability of other radiological investigations such as CT, MR imaging and ultrasound. In order to assess the value of skull radiography in ophthalmology we retrospectively studied the use of skull radiographs and CT images in our department. In only one instance was patient management based purely on skull radiograph findings. Over 50% of CT examinations had been preceded by skull films which made no contribution towards management. In some cases the skull films had been misleading by not showing significant pathology and had consequently created considerable delay before diagnosis was reached. It is therefore unjustifiable to use skull films as a method of screening for orbital or intracranial disease and there is little indication for skull radiography in ophthalmology, except in detection of intraocular foreign bodies, facial and orbital fractures and simple sinusitis.
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Brook P, Ness A, Sanders R, Smith B, Prior D, Gock H. Heart Failure Patients Admitted Under General Medicine and Cardiology are Different. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ness A, Sanders R, Brook P, Gock H, Prior D. Heart Failure in Patients with a Normal Left Ventricular Ejection Fraction. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sanders R. Book Review: Basic Microsurgical Techniques: A Laboratory Manual. J R Soc Med 2016. [DOI: 10.1177/014107688808101229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- R Sanders
- Consultant Plastic Surgeon Mount Vernon Hospital, Northwood, Middx
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Abstract
Adult onset, multiple oculo-motor nerve palsies are usually due to neoplasia and trauma. We report two cases whose initial presenting sign was oculo-motor cranial nerve palsy and were later found to have metastatic carcinoma.
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Affiliation(s)
- D Kumudhan
- Department of ophthalmology, Queen Margaret Hospital, Dunfermline, Scotland.
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Gillan SN, Wilson PJ, Knight DS, Sanders R. Trends in Acute Primary Angle-Closure Glaucoma, Peripheral Iridotomy and Cataract Surgery in Scotland, 1998–2012. Ophthalmic Epidemiol 2016; 23:1-5. [DOI: 10.3109/09286586.2015.1083035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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El-Assal K, Foulds J, Dobson S, Sanders R. A comparative study of glaucoma referrals in Southeast Scotland: effect of the new general ophthalmic service contract, Eyecare integration pilot programme and NICE guidelines. BMC Ophthalmol 2015; 15:172. [PMID: 26643710 PMCID: PMC4672504 DOI: 10.1186/s12886-015-0161-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 12/02/2015] [Indexed: 08/08/2023] Open
Abstract
Background Glaucoma is a progressive disease responsible for the second commonest cause of blindness in the UK. Identifying appropriate patients for hospital care remains an ongoing challenge for all UK hospital glaucoma services. The purpose of our study is to evaluate accuracy and outcome of community optometry referrals before and after implementation of the new general ophthalmic service contract in 2006, the Eyecare Integration Programme pilot in 2008 and the effect of NICE guidelines in glaucoma in 2009, over a 12-year period Methods A retrospective case analysis using a glaucoma electronic patient record was performed encompassing two six-year periods, 2000–2006 (Group A), and 2007–2012 (Group B). Results One thousand six hundred twenty-two new patients’ records were analysed. Waiting times reduced from 12.3 to 9.4 weeks. Significantly more patients kept first appointment (p = 0.0002) in group B. Glaucoma symptoms were significantly more in group A (p <0.0001) and only three patients lost Snellen’ visual acuity before appointment in group B compared to 12 in group A. Documentation of intraocular pressure was made in 74.1 % of Group A and 75.9 % of Group B, optic disc appearance in 85.4 % of Group A, and 93 % of Group B and visual fields in 84.4 % of Group A and 81.3 % of Group B. Significantly less normal (p < 0,0001), more glaucoma suspects (p < 0.0001), more open angle glaucoma (p = 0.0006) and fewer other conditions (p = 0.0024) were present in group B, compared to group A. Conclusion Patients were referred earlier with shorter waiting times for hospital appointments with the new Scottish general ophthalmic service and Eyecare Integration Programme. Additionally there were fewer false positive referrals with more diagnosis of glaucomatous disease. We discuss the benefits of these national screening and referral pathways together with their limitations and further refinements.
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Affiliation(s)
- Karim El-Assal
- Department of Ophthalmology, Queen Margaret Hospital, Whitefield Road, KY12 0SU, Dunfermline, Fife, UK.
| | | | - Stuart Dobson
- Medical Informatics, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Roshini Sanders
- Department of Ophthalmology, Queen Margaret Hospital, Whitefield Road, KY12 0SU, Dunfermline, Fife, UK
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Al Attar W, Soomro N, Sinclair P, Pappas E, Sanders R. How effective are F-MARC injury prevention programs for soccer players? A systematic review and meta-analysis. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Syrogiannis A, Rotchford AP, Agarwal PK, Kumarasamy M, Montgomery D, Burr J, Sanders R. Glaucoma-service provision in Scotland: introduction and need for Scottish Intercollegiate Guidelines Network guidelines. Clin Ophthalmol 2015; 9:1835-43. [PMID: 26491244 PMCID: PMC4599172 DOI: 10.2147/opth.s91818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the pattern of glaucoma-service delivery in Scotland and identify areas for improvement, taking into account Scottish General Ophthalmic Services (GOS) arrangements and the Eye Care Integration project, and to design Scottish Intercollegiate Guidelines Network (SIGN) guidelines to refine the primary and secondary interface of glaucoma care. Materials and methods A glaucoma-survey questionnaire was sent to all consultant glaucomatologists in Scotland. The design of SIGN guidelines was based on the results of the questionnaire using SIGN methodology. Results Over 90% of Scottish glaucoma care is triaged and delivered within hospital services. Despite GOS referral, information is variable. There are no consistent discharge practices to the community. These results led to defined research questions that were answered, thus formulating the content of the SIGN guidelines. The guideline covers the assessment of patients in primary care, referral criteria to hospital, discharge criteria from hospital to community, and monitoring of patients at risk of glaucoma. Conclusion With increasing age and limitations to hospital resources, refining glaucoma pathways between primary and secondary care has become a necessity. Scotland has unique eye care arrangements with both the GOS and Eye Care Integration project. It is hoped that implementation of SIGN guidelines will identify glaucoma at the earliest opportunity and reduce the rate of false-positive referrals to hospital.
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Affiliation(s)
- Andreas Syrogiannis
- SIGN Working Group, SIGN Guidelines for Glaucoma Referral and Safe Discharge, Edinburgh, Scotland
| | | | - Pankaj Kumar Agarwal
- SIGN Working Group, SIGN Guidelines for Glaucoma Referral and Safe Discharge, Edinburgh, Scotland
| | - Manjula Kumarasamy
- SIGN Working Group, SIGN Guidelines for Glaucoma Referral and Safe Discharge, Edinburgh, Scotland
| | - Donald Montgomery
- SIGN Working Group, SIGN Guidelines for Glaucoma Referral and Safe Discharge, Edinburgh, Scotland
| | - Jennifer Burr
- SIGN Working Group, SIGN Guidelines for Glaucoma Referral and Safe Discharge, Edinburgh, Scotland
| | - Roshini Sanders
- SIGN Working Group, SIGN Guidelines for Glaucoma Referral and Safe Discharge, Edinburgh, Scotland ; Healthcare Improvement Scotland, Edinburgh, Scotland
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Sniatecki JJ, Styles C, Boyle N, Sanders R. Cataract surgery: factors influencing decision to treat and implications for training (south-east Scotland 2008-2014). Clin Ophthalmol 2015; 9:1821-7. [PMID: 26491242 PMCID: PMC4599148 DOI: 10.2147/opth.s92803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To describe the population referred for cataract surgery, identify factors that influenced decision to treat, and patients suitable for ophthalmic training. PATIENTS AND METHODS A total of 2,693 consecutive referrals over 6 years were interrogated using Business Objects software on cataract electronic patient records. RESULTS A total of 2,693 patients were referred for cataract surgery (group A). Of these patients 2,132 (79%) had surgery (group B) and 561 (21%) did not (group C). Age for group B vs group C: 672 (32%) vs 115 (20%) ≤69 years, P<0.001; 803 (38%) vs 225 (40%) 70-79 years, P=0.48; 586 (27%) vs 203 (36%) 80-89 years, P<0.05; 71 (3%) vs 18 (3%) ≥90 years, P=1.0. Visual acuity, group B vs group C: 556 (26%) vs 664 (59%) 6/12 or better; 1,275 (60%) vs 367 (33%) 6/18-6/60; 266 (12%) vs 64 (6%) counting fingers or worse, P<0.05. Medical history for group B vs C: cognitive impairment: 55 (2.6%) vs 29 (5.2%), P<0.05; cardiovascular accident: 158 (7.4%) vs 60 (10.7%), P<0.05; diabetes: 372 (17.4%) vs 96 (17.1%), P=0.87; COPD/asthma: 382 (17.9%) vs 93 (16.6%), P=0.53; heart disease: 535 (25.1%) vs 155 (27.6%), P=0.35; hypertension: 971 (45.5%) vs 263 (46.9%), P=0.73. Ocular history for group B vs C was significant (P<0.05) for age-related macular degeneration 255 (12.0%) vs 93 (16.6%), other macular pathology 38 (1.8%) vs 25 (4.5%), corneal pathology 92 (4.3%) vs 36 (6.4%), amblyopia 37 (1.7%) vs 22 (3.9%). Detailed data on presenting complaint, ophthalmic history, and social status is discussed. CONCLUSION We observed that surgery at a younger age with good levels of visual acuity was a factor in deferring cataract surgery. Cognitive impairment, cardiovascular accident, amblyopia, corneal and macular pathology significantly affected decision not to operate. We estimate that 80% of patients would be suitable for ophthalmic training.
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Affiliation(s)
- Jan J Sniatecki
- Cataract Unit, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Caroline Styles
- Cataract Unit, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Natalie Boyle
- Cataract Unit, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Roshini Sanders
- Cataract Unit, Queen Margaret Hospital, Dunfermline, Fife, UK
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Cheng ML, Henderson C, Sinclair A, Sanders R. Visual health awareness, the Scottish community optometry service and Eyecare Integration Project: Breaking barriers in preventing visual impairment. British Journal of Visual Impairment 2015. [DOI: 10.1177/0264619615600009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are 34,492 registered with severe or partial sight impairment in Scotland, with 75% aged over 65. With the ageing population, the proportion of those who will develop sight impairing disease will only increase. Therefore, early presentation and treatment are important. Recently, new sight saving treatments and community screening programmes for sight impairing disease have been introduced with concomitant advance in ophthalmic digital imaging. In order to assess older patients’ attendance of free eye tests, awareness of different sight impairing disease and treatments. We describe the first electronic visual healthcare system within any global public healthcare service – ‘The Scottish Eyecare Integration Project’ – and potential improvements along with the General Ophthalmic Service (GOS) contract. A 14-point questionnaire was devised to assess 100 patients’ awareness of free annual eye tests, and the three most common causes and treatment for severe sight impairment: age-related macular degeneration (ARMD), glaucoma, and diabetic retinopathy (DR). In all, 82% of patients were aware of the free annual eye tests; however, 31% had not attended community optometrist for over 2 years. There was good awareness of glaucoma (77%), but poor understanding of glaucoma treatment (24%), ARMD (43%) and ARMD treatment (17%). Only 39% of patients had heard of free annual DR screening, but there was a significant difference between the two groups ( p = .0263), with increased awareness in the middle-aged group. More education is required to encourage the older population to use existing and new eye services. The Scottish Eyecare Integration Project along with the GOS contract is a significant step of change towards meeting the demand for a multidisciplinary approach, bringing ophthalmic care closer to home and into the community.
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Sleigh J, Sanders R, Absolom A. Reply: the lure of inductivism. Br J Anaesth 2015; 114:849. [PMID: 25904612 DOI: 10.1093/bja/aev082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
We describe a case of a 68-year-old man, referred by his optometrist with suspected low-tension glaucoma, who presented with advanced cupped optic discs and field of vision loss that were subsequently found to be due to a giant prolactinoma. Failing vision in low-tension glaucoma suspects should have a low threshold for neuroimaging.
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Affiliation(s)
- David Karl
- Ophthalmology Department, NHS Tayside, Dundee, Angus, UK Ophthalmology Department, Queen Margaret Hospital, Dunfermline, UK
| | - Stewart Neil Gillan
- Ophthalmology Department, NHS Tayside, Dundee, Angus, UK Ophthalmology Department, Queen Margaret Hospital, Dunfermline, UK
| | - Colin Goudie
- Ophthalmology Department, Queen Margaret Hospital, Dunfermline, UK
| | - Roshini Sanders
- Ophthalmology Department, Queen Margaret Hospital, Dunfermline, UK
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Bird C, Sanders R, Smith B, Gock H, Beswick W, Bateman S, Prior D. Management of patients admitted with acute decompensated heart failure in a tertiary metropolitan hospital. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khan AA, Mustafa MZ, Sanders R. Improving patient access to prevent sight loss: ophthalmic electronic referrals and communication (Scotland). Public Health 2014; 129:117-23. [PMID: 25515043 DOI: 10.1016/j.puhe.2014.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/07/2014] [Accepted: 10/20/2014] [Indexed: 02/03/2023]
Abstract
INTRODUCTION With the number of people with sight loss predicted to double to four million people in the UK by the year 2050, preventable visual loss is a significant public health issue. Sight loss is associated with an increased risk of falls, accidents and depression and evidence suggests that 50% of sight loss can be avoided. Timely diagnosis is central to the prevention of sight loss. Access to care can be a limiting factor in preventable cases. By improving referrals and access to hospital eye services it is possible to treat and minimise the number of patients with preventable sight loss and the impact this has on wider society. CLINICAL PILOT STUDY In 2005, NHS Fife took part in a flagship pilot funded by the Scottish government e-health department to evaluate the feasibility, safety, clinical effectiveness, and cost of electronic referral with images of patients directly from community optometrists to Hospital Eye Service (HES). The pilot study showed that electronic referral was feasible, fast, safe, and obviated the need for outpatient appointments in 128 (37%) patients with a high patient satisfaction. CENTRALISED OPHTHALMIC ELECTRONIC REFERRAL UNIT The results of the pilot study were presented and in May 2007, the electronic referral system was rolled out regionally in southeast Scotland. Referrals were accepted at a single site with vetting by a trained team and appointments were allocated within 48 hours. Following the implementation of electronic referral, waiting times were reduced from a median of 14 to 4 weeks. Significantly fewer new patients were seen (7462 vs 8714 [p < 0.001]). There were also fewer casualties (1984 vs 2671 [p < 0.001]) and 'did not arrive' (DNA) new patients (503 vs 635 [p < 0.001]). EYE CARE INTEGRATION PROJECT (SCOTLAND) In 2010 the Scottish Government Health Department committed £ 6.6 million to community and hospital ophthalmic services forming the Eyecare Integration Project in 2011. The main aim of this project was to create electronic communication between community optometry practices and hospital eye departments. Five electronic forms were specifically designed for cataract, glaucoma, macula, paediatric and general ophthalmic disease. A Virtual Private Network was created which enabled optometrists to connect to the Scottish clinical information gateway system and send referrals to hospital and receive referral status feedback. Numerous hurdles have been encountered and overcome in order to deliver this project. DISCUSSION An efficient unique system has been described within the NHS whereby the provision of eye care has been modernised by creating a user-friendly electronic interface between the community and HES. This system ensures patients are vetted into the correct specialist clinic and thus will be less likely to go blind from treatable conditions. Urgent conditions will continue to be prioritised and savings made with efficiencies gained can be re-invested towards better overall patient care.
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Affiliation(s)
- A A Khan
- Queen Margaret Hospital, Dunfermline, Fife, UK.
| | - M Z Mustafa
- Queen Margaret Hospital, Dunfermline, Fife, UK
| | - R Sanders
- Queen Margaret Hospital, Dunfermline, Fife, UK
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Goudie C, Lunt D, Reid S, Sanders R. Ophthalmic digital image transfer: benefits to triage, patient care and resource. Ophthalmic Physiol Opt 2014; 34:628-35. [PMID: 25223370 DOI: 10.1111/opo.12154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 08/13/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Hospital capacity in the UK is currently significantly challenged due to new treatments, targets and resource limitations. There have been significant improvements in training, equipment and shared care services in community primary care optometry services. Despite this the challenges to ophthalmic service delivery are considerable. One area of potential benefit is the effect on outcome when a clinical image is attached to a referral. We aimed to quantify the effect of attaching digital images to ophthalmic referrals. METHODS Retrospective analysis of 358 consecutive optometry referrals to the Hospital Eye Service in Dunfermline, Scotland using electronic referral with digital images. All images were screened by consultant ophthalmologists. RESULTS The patients were aged between 9 and 100 years (mean age 63.6 years). Sixty four (18%) referrals were deemed urgent (requiring appointment within 24-60 h), with the majority, 28 (8%) being wet macular degeneration. One hundred and seventy (48%) were deemed routine (appointment within 2-6 weeks), with categories including macular disease, glaucoma, cataract, optic disc and retinal abnormalities. Twenty seven (8%) patients were already attending the hospital eye service, or had been referred previously for the same condition. Categories were mainly glaucoma, diabetic retinopathy and cataract. Ninety-five (25%) were 'e-diagnosed' based on image and referral information (i.e. with no secondary eye care appointment). Diagnosis included glaucoma suspect (22, 6%), macular pathology (12, 3%), abnormal looking discs (9, 2.5%) and cataract (9, 2.5%). The overall 'did not attend' rate for those patients seen in the hospital eye service (254) was <1% (two patients). CONCLUSIONS The attachment of digital images improved the quality of referral triaging from optometry to secondary eye care in the hospital eye service. It allowed detection of sight threatening disease early and more appropriate allocation of patients to specific specialist clinics at first visit. They allowed safe and speedy 'e-diagnosis' of a subgroup, saving hospital capacity and minimising patient inconvenience. Indirectly the service also reduced the 'did not attend' rate. With recent improvements in camera and internet technology digital images will have an ever increasing role in secondary eye care as it continues to adapt to meet modern demands.
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Affiliation(s)
- Colin Goudie
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Scotland, UK
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Takwoingi Y, Botello AP, Burr JM, Azuara-Blanco A, Garway-Heath DF, Lemij HG, Sanders R, King AJ, Deeks JJ. External validation of the OHTS-EGPS model for predicting the 5-year risk of open-angle glaucoma in ocular hypertensives. Br J Ophthalmol 2013; 98:309-14. [PMID: 24357494 DOI: 10.1136/bjophthalmol-2013-303622] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To independently evaluate and compare the performance of the Ocular Hypertension Treatment Study-European Glaucoma Prevention Study (OHTS-EGPS) prediction equation for estimating the 5-year risk of open-angle glaucoma (OAG) in four cohorts of adults with ocular hypertension. METHODS Data from two randomised controlled trials and two observational studies were analysed individually to assess transferability of the prediction equation between different geographical locations and settings. To make best use of the data and to avoid bias, missing predictor values were imputed using multivariate imputation by chained equations. Using the OHTS-EGPS risk prediction equation, predicted risk was calculated for each patient in each cohort. We used the c-index, calibration plot and calibration slope to evaluate predictive ability of the equation. RESULTS Analyses were based on 393, 298, 188 and 159 patients for the Rotterdam, Moorfields, Dunfermline, and Nottingham cohorts, respectively. The discriminative ability was good, with c-indices between 0.69 and 0.83. In calibration analyses, the risk of OAG was generally overestimated, although for the Rotterdam cohort the calibration slope was close to 1 (1.09, 95% CI 0.72 to 1.46), the ideal value when there is perfect agreement between predicted and observed risks. CONCLUSIONS The OHTS-EGPS risk prediction equation has predictive utility, but further validation in a population-based setting is needed.
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Affiliation(s)
- Yemisi Takwoingi
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, , Birmingham, UK
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Borooah S, Grant B, Blaikie A, Styles C, Sutherland S, Forrest G, Curry P, Legg J, Walker A, Sanders R. Using electronic referral with digital imaging between primary and secondary ophthalmic services: a long term prospective analysis of regional service redesign. Eye (Lond) 2012; 27:392-7. [PMID: 23258310 DOI: 10.1038/eye.2012.278] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Demands on publicly funded ophthalmic services worldwide continue to increase with new treatments, waiting time targets, working time limits, and restricted budgets. These highlight the necessity to develop innovative ways of utilising existing capacity more effectively. METHOD A new regional, fully electronic ophthalmic-referral service with digital imaging was trialled using existing information-technology (IT) infrastructure. Following successful pilot study, the service was rolled out regionally. Service delivery data was prospectively collated for all the attendances in the year prior to (2006) and the year following (2008) introduction. RESULTS Comparing 2006 against 2008, median waiting times reduced (14 vs 4 weeks), and fewer new patients were observed (8714 vs 7462 P<0.0001), with 1359 referrals receiving electronic diagnosis (e-diagnosis). New patient did not arrive (635 vs 503 P<0.0001) and emergencies also reduced (2671 v 1984 P<0.0001). DISCUSSION Novel use of existing IT infrastructure improves communication between primary and secondary care. This promotes more effective use of limited outpatient capacity by retaining patients with non-progressive, asymptomatic pathology in the community, whilst fast-tracking patients with sight-threatening disease. Resultant significant, sustained improvements in regional service delivery point to a simple model that could easily be adopted by other providers of universal healthcare globally.
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Affiliation(s)
- S Borooah
- Princess Alexandra Eye Pavilion, Edinburgh, UK.
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Burr JM, Botello-Pinzon P, Takwoingi Y, Hernández R, Vazquez-Montes M, Elders A, Asaoka R, Banister K, van der Schoot J, Fraser C, King A, Lemij H, Sanders R, Vernon S, Tuulonen A, Kotecha A, Glasziou P, Garway-Heath D, Crabb D, Vale L, Azuara-Blanco A, Perera R, Ryan M, Deeks J, Cook J. Surveillance for ocular hypertension: an evidence synthesis and economic evaluation. Health Technol Assess 2012; 16:1-271, iii-iv. [PMID: 22687263 DOI: 10.3310/hta16290] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways. DESIGN A discrete event simulation economic modelling evaluation. Data from systematic reviews of risk prediction models and agreement between tonometers, secondary analyses of existing datasets (to validate identified risk models and determine optimal monitoring criteria) and public preferences were used to structure and populate the economic model. SETTING Primary and secondary care. PARTICIPANTS Adults with ocular hypertension (IOP > 21 mmHg) and the public (surveillance preferences). INTERVENTIONS We compared five pathways: two based on National Institute for Health and Clinical Excellence (NICE) guidelines with monitoring interval and treatment depending on initial risk stratification, 'NICE intensive' (4-monthly to annual monitoring) and 'NICE conservative' (6-monthly to biennial monitoring); two pathways, differing in location (hospital and community), with monitoring biennially and treatment initiated for a ≥ 6% 5-year glaucoma risk; and a 'treat all' pathway involving treatment with a prostaglandin analogue if IOP > 21 mmHg and IOP measured annually in the community. MAIN OUTCOME MEASURES Glaucoma cases detected; tonometer agreement; public preferences; costs; willingness to pay and quality-adjusted life-years (QALYs). RESULTS The best available glaucoma risk prediction model estimated the 5-year risk based on age and ocular predictors (IOP, central corneal thickness, optic nerve damage and index of visual field status). Taking the average of two IOP readings, by tonometry, true change was detected at two years. Sizeable measurement variability was noted between tonometers. There was a general public preference for monitoring; good communication and understanding of the process predicted service value. 'Treat all' was the least costly and 'NICE intensive' the most costly pathway. Biennial monitoring reduced the number of cases of glaucoma conversion compared with a 'treat all' pathway and provided more QALYs, but the incremental cost-effectiveness ratio (ICER) was considerably more than £30,000. The 'NICE intensive' pathway also avoided glaucoma conversion, but NICE-based pathways were either dominated (more costly and less effective) by biennial hospital monitoring or had a ICERs > £30,000. Results were not sensitive to the risk threshold for initiating surveillance but were sensitive to the risk threshold for initiating treatment, NHS costs and treatment adherence. LIMITATIONS Optimal monitoring intervals were based on IOP data. There were insufficient data to determine the optimal frequency of measurement of the visual field or optic nerve head for identification of glaucoma. The economic modelling took a 20-year time horizon which may be insufficient to capture long-term benefits. Sensitivity analyses may not fully capture the uncertainty surrounding parameter estimates. CONCLUSIONS For confirmed ocular hypertension, findings suggest that there is no clear benefit from intensive monitoring. Consideration of the patient experience is important. A cohort study is recommended to provide data to refine the glaucoma risk prediction model, determine the optimum type and frequency of serial glaucoma tests and estimate costs and patient preferences for monitoring and treatment. FUNDING The National Institute for Health Research Health Technology Assessment Programme.
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Affiliation(s)
- J M Burr
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Melchers M, Bontjer I, Tong T, Chung N, Klasse P, Eggink D, Gentile M, Cerutti A, Montefiori D, Olson W, Berkhout B, Binley J, Moore J, Sanders R. Targeting HIV-1 envelope glycoprotein trimers to B cells using APRIL improves antibody responses. Retrovirology 2012. [PMCID: PMC3441255 DOI: 10.1186/1742-4690-9-s2-p300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Figueiredo P, Sanders R, Gorski T, Vilas-Boas JP, Fernandes RJ. Kinematic and electromyographic changes during 200 m front crawl at race pace. Int J Sports Med 2012; 34:49-55. [PMID: 22903317 DOI: 10.1055/s-0032-1321889] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to analyse eventual kinematic and electromyographic changes during a maximal 200 m front crawl at race pace. 10 male international level swimmers performed a 200 m maximal front crawl test. Images were recorded by 2 above and 4 under water cameras, and electromyographic signals (EMG) of 7 upper and lower limbs muscles were analysed for 1 stroke cycle in each 50 m lap. Capillary blood lactate concentrations were collected before and after the test. The variables of interest were: swimming speed, stroke length, stroke and kick frequency, hand angular velocity, upper limb and foot displacement, elbow angle, shoulder and roll angle, duration of stroke phases, and EMG for each muscle in each stroke phase. Generally, the kinematic parameters decreased, and a relative duration increased for the entry and pull phases and decreased for the recovery phase. Muscle activation of flexor carpi radialis, biceps brachii, triceps brachii, peitoral major and upper trapezius increased during specific stroke phases over the test. Blood lactate concentration increased significantly after the test. These findings suggest the occurrence of fatigue, characterised by changes in kinematic parameters and selective changes in upper limbs muscle activation according to muscle action.
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Affiliation(s)
- P Figueiredo
- Centre of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto, Portugal.
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Guzmán-Suarez BB, Buckley MW, Gilmore ET, Vocca E, Moss R, Marty FM, Sanders R, Baden LR, Wurtman D, Issa NC, Fang F, Koo S. Clinical potential of DAS181 for treatment of parainfluenza-3 infections in transplant recipients. Transpl Infect Dis 2012; 14:427-33. [PMID: 22340538 DOI: 10.1111/j.1399-3062.2012.00718.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/18/2011] [Accepted: 11/06/2011] [Indexed: 11/28/2022]
Abstract
Parainfluenza virus (PIV) infections can cause serious respiratory infections and death in immunocompromised patients. No antiviral agents have proven efficacy against PIV, and therapy generally consists of supportive care. DAS181, a novel sialidase fusion protein that temporarily disables airway epithelial PIV receptors by enzymatic removal of sialic acid moieties, has been shown to inhibit infection with PIV strains in vitro and in an animal model. We describe here the clinical course of 2 immunocompromised patients with PIV-3 infection, one with a history of lung transplantation and the other neutropenic after autologous hematopoietic stem cell transplantation for multiple myeloma. Both patients had substantial clinical improvement in respiratory and systemic symptoms after a 5-day DAS181 treatment course, although the clinical improvement in the autologous stem cell transplantation patient also paralleled neutrophil engraftment.
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Affiliation(s)
- B B Guzmán-Suarez
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Khan A, Lascaratos G, Rane-Malcolm T, Sanders R. A rare case of zolendronate infusion complication leading to glaucoma filtration surgery. Clin Ophthalmol 2011; 5:1147-9. [PMID: 21887097 PMCID: PMC3162295 DOI: 10.2147/opth.s22429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Indexed: 11/23/2022] Open
Abstract
Zolendronic acid is a nitrogenous biphosphonate commonly used as an intravenous infusion for the management of Paget's disease, osteoporosis, and hypercalcemia of malignancy. We report a rare and challenging complication of zolendronate infusion: unilateral acute anterior uveitis followed by persistently raised intraocular pressure despite being on four different classes of antiglaucoma medication. The challenge was that the patient required topical steroid to treat her uveitis in the background of known glaucoma with corresponding steroid response. She eventually underwent a left phacotrabeculectomy augmented with 5-fluorouracil. Four weeks postoperatively she developed an encapsulated bleb and underwent needling with 5-fluorouracil. This case highlights the importance of having a high index of suspicion for anterior uveitis in patients with a red and painful eye after initiating biphosphonate therapy. Caution should also be exercised when prescribing biphosponates to glaucoma patients.
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Affiliation(s)
- A Khan
- Princess Alexandra Eye Pavilion, Edinburgh
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Megaw R, Rane-Malcolm T, Brannan S, Smith R, Sanders R. Revalidation and electronic cataract surgery audit: a Scottish survey on current practice and opinion. Eye (Lond) 2011; 25:1471-7. [PMID: 21869834 DOI: 10.1038/eye.2011.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine current knowledge and opinion on revalidation, and methods of cataract surgery audit in Scotland and to outline the current and future possibilities for electronic cataract surgery audit. METHODS In 2010 we conducted a prospective, cross-sectional, Scottish-wide survey on revalidation knowledge and opinion, and cataract audit practice among all senior NHS ophthalmologists. Results were anonymised and recorded manually for analysis. RESULTS In all, 61% of the ophthalmologists surveyed took part. Only 33% felt ready to take part in revalidation, whereas 76% felt they did not have adequate information about the process. Also, 71% did not feel revalidation would improve patient care, but 85% agreed that cataract surgery audit is essential for ophthalmic practice. In addition, 91% audit their cataract outcomes; 52% do so continuously. Further, 63% audit their subspecialist surgical results. Only 25% audit their cataract surgery practice electronically, and only 12% collect clinical data using a hospital PAS system. Funding and system incompatibility were the main reasons cited for the lack of electronic audit setup. Currently, eight separate hospital IT patient administration systems are used across 14 health boards in Scotland. CONCLUSION Revalidation is set to commence in 2012. The Royal College of Ophthalmologists will use cataract outcome audit as a tool to ensure surgical competency for the process. Retrospective manual auditing of cataract outcome is time consuming, and can be avoided with an electronic system. Scottish ophthalmologists view revalidation with scepticism and appear to have inadequate knowledge of the process. However, they strongly agree with the concept of cataract surgery audit. The existing and future electronic applications that may support surgical audit are commercial electronic records, web-based applications, centrally funded software applications, and robust NHS connections between community and hospital.
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Affiliation(s)
- R Megaw
- Queen Margaret Hospital, Dunfermline, UK.
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O’Colmain U, Anijeet D, Vosoughi M, Sinclair A, Sanders R. Glaucoma blind registration in Fife (2000-2009) - a retrospective cohort study. Ophthalmic Physiol Opt 2011; 31:360-6. [DOI: 10.1111/j.1475-1313.2011.00849.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Welch J, Vani A, Cackett P, Vallance J, Cobb C, Devlin H, Sanders R. Glaucoma surgery: trainee outcomes and implications for future training: southeast Scotland. Eye (Lond) 2010; 24:1700-7. [DOI: 10.1038/eye.2010.135] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Petterson B, Leonard H, Bourke J, Sanders R, Chalmers R, Jacoby P, Bower C. IDEA (Intellectual Disability Exploring Answers): A population-based database for intellectual disability in Western Australia. Ann Hum Biol 2009; 32:237-43. [PMID: 16096222 DOI: 10.1080/03014460500075035] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite the demands it places on individuals, families and the community, intellectual disability (ID) is a neglected area of public health. Accurate estimates of prevalence are sparse and range from 0.5 to 3.0%. The cause of the condition is unknown in at least 50% of cases. This paper describes the Intellectual Disability Exploring Answers (IDEA) database set up in Western Australia to provide an infrastructure for research and to facilitate the planning of service provision for people with ID. Since 1953 a database for ID has been maintained in Western Australia, a state with a population of 1.95 million in an area of 2.52 million km2. The current IDEA database aims to obtain ongoing population-based ascertainment of ID from providers of clinical and educational services, with the potential for linkage to a network of other state databases. The average prevalence of ID for children born in Western Australia over the years 1983-1996 was 15.2 per 1000 live births, with 50% ascertained only through the education system. During this time period 60% of cases were male. Of children with an ID born in Western Australia in 1980-1999 and surviving to 1 year, 30.1% had a birth defect, and the prevalence ratio of birth defects in this group compared to the population with no birth defects was 6.5 (CI 6.3-6.8).
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Affiliation(s)
- B Petterson
- TICHR, Centre for Child Health Research, University of Western Australia, Perth, Australia.
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Anijeet D, Timlin H, Sanders R. West J Med 2009; 338:b1885-b1885. [DOI: 10.1136/bmj.b1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sanders R, Prior D. Improvements in Functional Class and Ejection Fraction with Adherence to Heart Failure Treatment Guidelines. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lampitt RS, Achterberg EP, Anderson TR, Hughes JA, Iglesias-Rodriguez MD, Kelly-Gerreyn BA, Lucas M, Popova EE, Sanders R, Shepherd JG, Smythe-Wright D, Yool A. Ocean fertilization: a potential means of geoengineering? Philos Trans A Math Phys Eng Sci 2008; 366:3919-45. [PMID: 18757282 DOI: 10.1098/rsta.2008.0139] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The oceans sequester carbon from the atmosphere partly as a result of biological productivity. Over much of the ocean surface, this productivity is limited by essential nutrients and we discuss whether it is likely that sequestration can be enhanced by supplying limiting nutrients. Various methods of supply have been suggested and we discuss the efficacy of each and the potential side effects that may develop as a result. Our conclusion is that these methods have the potential to enhance sequestration but that the current level of knowledge from the observations and modelling carried out to date does not provide a sound foundation on which to make clear predictions or recommendations. For ocean fertilization to become a viable option to sequester CO2, we need more extensive and targeted fieldwork and better mathematical models of ocean biogeochemical processes. Models are needed both to interpret field observations and to make reliable predictions about the side effects of large-scale fertilization. They would also be an essential tool with which to verify that sequestration has effectively taken place. There is considerable urgency to address climate change mitigation and this demands that new fieldwork plans are developed rapidly. In contrast to previous experiments, these must focus on the specific objective which is to assess the possibilities of CO2 sequestration through fertilization.
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Affiliation(s)
- R S Lampitt
- National Oceanography Centre, European Way, Southampton, UK.
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Howard R, Sanders R, Lydall-Smith SM. The implementation of Restoring Health – a chronic disease model of care to decrease acute health care utilization. Chron Respir Dis 2008; 5:133-41. [DOI: 10.1177/1479972308091487] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Restoring Health Program, a multi-disciplinary model of care for patients with chronic lung diseases, heart failure, and diabetes, was established to improve the quality of life and function for patients with these target chronic diseases, while reducing their disproportionately high demand on acute health care services. Acute health care utilization at St Vincent’s Hospital Melbourne for all patients recruited between February 2003 and June 2005 ( n = 351) was analyzed using within-subjects paired sample t-tests to compare the 6 months of pre-recruitment with 6 months of post-recruitment. Analysis showed statistically significant decreases in emergency department presentations ( P < 0.001), hospital admissions ( P < 0.001), and length of stay ( P < 0.001). This article describes the current model of care, the program’s enablers, and its impact on health service demand after the first 4 years of implementation.
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Affiliation(s)
- R Howard
- Restoring Health Program, St Vincent’s Health, Melbourne, Australia
| | - R Sanders
- Restoring Health Program, St Vincent’s Health, Melbourne, Australia
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Affiliation(s)
- Vikas Chadha
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline KY12 0SU.
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MacLeod TM, Cambrey A, Williams G, Sanders R, Green CJ. Evaluation of Permacol as a cultured skin equivalent. Burns 2008; 34:1169-75. [PMID: 18468801 DOI: 10.1016/j.burns.2008.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2007] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
Abstract
Skin loss following severe burn requires prompt wound closure to avoid such complications as fluid and electrolyte imbalance, infection, immune suppression, and pain. In clinical situations in which insufficient donor skin is available, the development of cultured skin equivalents (dermal matrices seeded with keratinocytes and fibroblasts) may provide a useful alternative. The aim of this study was to assess the suitability of a porcine-derived dermal collagen matrix (Permacol) to function as a cultured skin equivalent in supporting the growth of keratinocytes in vitro and providing cover to full thickness wounds in the BALB C/nude mouse model. A histological comparison was against Glycerol treated-Ethylene Oxide Sterilised Porcine Dermis (Gly-EO Dermis) which has successfully been used as a cultured skin equivalent in previous studies. Both Gly-EO Dermis and to a lesser extent Permacol were able to support the growth of cultured keratinocytes following a 16-day period of cell culture, however, this study was only able to demonstrate the presence of an epidermal layer on Gly-EO dermis 2 weeks after grafting onto full-thickness wounds in the BALB C/nude mouse model.
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Affiliation(s)
- T M MacLeod
- Restoration of Appearance and Function Trust, Mount Vernon Hospital, Northwood, Middlesex HA62RN, UK.
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