Comparison of Visual, Refractive and Aberrometic Outcomes of Intacs® Implant and Toric Implantable Collamer Lens (TICL) in Patients with Keratoconus: 4 Years Follow Up

Background: To assess the efficacy and clinical outcomes following the use of toric implantable collamer lens (TICL) and Intacs® implant in patients with mild keratoconus. Methods: This retrospective study evaluated 30 eyes of 30 patients with keratoconic and age of 25-35. These eyes were divided into group A (15 eyes), in which Visian Toric ICL™ was implanted, and group B (15 eyes), Intacs® implantation. The outcome and complications were evaluated. We assessed the visual, refractive, and aberrometric outcome in pre-operation and 6 month, and 1, 2, 3, and 4 year post-operation. Results: There was significant difference in the mean uncorrected and best corrected distance visual acuities between the groups (P < 0.01). An uncorrected distance visual acuity of 20/30 or better was achieved in 85% of eyes in the TICL group, and 20% of eyes in the Intacs® group; visual acuity of 20/20 or better in was seen in 80% and 15%, respectively. Intacs® implant produced a significant decrease in corneal refractive spherical equivalent and coma aberration (P < 0.01). Conclusion: Intacs® implant and TICL lens, both are useful, but it seems that the TICL is better and provides good visual and refractive outcomes; indicating that it is a more predictable procedure for refractive correction of keratoconus

Comparison of Control of Clostridium difficile Infection in Six English Hospitals Using Whole-Genome Sequencing

Background: Variation in Clostridium difficile infection (CDI) rates between healthcare institutions suggests overall incidence could be reduced if the lowest rates could be achieved more widely. Methods: We investigated whether whole-genome sequencing (WGS) of consecutive C. difficile isolates from six English hospitals over one year (2013-14) could be used to assess infection control performance. Fecal samples with a positive initial screen for C. difficile (GDH or toxin-PCR) were cultured and sequenced. Within each hospital, we estimated the proportion of cases plausibly acquired from previous cases, defined by an isolate ≤2 single nucleotide polymorphisms different from a previous isolate in the last 90-days. Results: 851/971(87.6%) sequenced culture-positive samples were toxigenic, and 451(46.4%) were fecal-toxin-positive. 128/652(20%,95%CI 17-23%) toxigenic isolates >90-days after the study started were genetically-linked to a prior patient’s isolate from the previous 90-days. Hospital-2 had the fewest linked isolates, 7/105(7%,3-13%), hospital-1 an intermediate proportion, 9/70(13%,6-23%), while hospitals 3-6 had similar proportions of linked isolates (22-26%) (p≤0.002 comparing hospital-2 vs 3-6). Results were similar adjusting for locally-circulating ribotypes. Adjusting for hospital, ribotype-027 had the highest proportion of linked isolates (57%, 95%CI 29-81%). Fecal-toxin-positive and toxin-negative patients were similarly infectious in terms of being a potential transmission donor, OR=1.01(0.68-1.49,p=0.97). There was no association between the estimated proportion of cases linked to a previous case within 90-days and testing rates (p=0.60). Conclusions: WGS can be used to identify varying rates of C. difficile transmission in different locations, and offers the potential to allow targeted efforts to reduce CDI incidence

Paramedics, poetry, and film: Health policy and systems research at the intersection of theory, art, and practice

Violence is a public health issue. It is the consequence of a complex set of interacting political, social, and economic factors firmly rooted in past and current injustice. South Africa remains one of the most unequal countries in the world, and in some areas, the rates of violence are comparable to a country that is at war. Increasingly, paramedics working in high-risk areas of Cape Town are being caught in the crossfire, and in 2018, there was an attack on a paramedic crew nearly every week. These attacks are a symptom of much deeper, complex societal issues. Clearly, we require new approaches to better understand the complexity as we collectively find a way forward. It is in this context that we are collaborating with paramedics, poets, and filmmakers to tell human stories from the frontline thereby bringing the lived experiences of healthcare workers into policy making processes. In this commentary, we share a series of poems and a poetry-film that form part of a larger body of work focused on the safety of paramedics, to catalyze discussion about the possibilities that arts-based methods offer us as we seek to better understand and engage with complex social issues that have a direct impact on the health system