Referral for rehabilitation in case of permanent visual handicap:guideline of the Dutch Society of Ophthalmology

The Dutch Society of Ophthalmology (NOG) has developed an evidence-based guideline for the referral of visually impaired people for rehabilitation and support. Referral for rehabilitation and support must be preceded by diagnosis and treatment. Consultation of an ophthalmologist is essential. Information about the disease should be given to the patient orally as well as in writing. The ophthalmologist brings up the possibility of rehabilitation in the presence of a visual acuity &lt; 0.5 and/or visual field of &lt; 30 degrees in the better eye and a well-defined request for help. Visually impaired patients with a relatively simple request for help are referred to a specialised optometrist whenever possible. Visually impaired patients with more complex requests for help are referred to a multidisciplinary (regional or national) rehabilitation centre for people with a visual handicap. Visually impaired and blind patients are informed about the existence of patient organisations. Referral for rehabilitation is done by means of a structured letter with all relevant information. A copy of this letter should be sent to the family physician and all other attending physicians.</p

Evolution of the Red Sequence Giant to Dwarf Ratio in Galaxy Clusters out to z ~ 0.5

We analyze deep g' and r' band data of 97 galaxy clusters imaged with MegaCam on the Canada-France-Hawaii telescope. We compute the number of luminous (giant) and faint (dwarf) galaxies using criteria based on the definitions of de Lucia et al. (2007). Due to excellent image quality and uniformity of the data and analysis, we probe the giant-to-dwarf ratio (GDR) out to z ~ 0.55. With X-ray temperature (Tx) information for the majority of our clusters, we constrain, for the first time, the Tx-corrected giant and dwarf evolution separately. Our measurements support an evolving GDR over the redshift range 0.05 < z < 0.55. We show that modifying the (g'-r'), m_r' and K-correction used to define dwarf and giant selection do not alter the conclusion regarding the presence of evolution. We parameterize the GDR evolution using a linear function of redshift (GDR = alpha * z + beta) with a best fit slope of alpha = 0.88 +/- 0.15 and normalization beta = 0.44 +/- 0.03. Contrary to claims of a large intrinsic scatter, we find that the GDR data can be fully accounted for using observational errors alone. Consistently, we find no evidence for a correlation between GDR and cluster mass (via Tx or weak lensing). Lastly, the data suggest that the evolution of the GDR at z < 0.2 is driven primarily by dry merging of the massive giant galaxies, which when considered with previous results at higher redshift, suggests a change in the dominant mechanism that mediates the GDR.Comment: 20 pages, 15 figures. Accepted to MNRA

Health-related quality of life in lower-risk MDS patients compared with age- and sex-matched reference populations: a European LeukemiaNet study

In myelodysplastic syndromes (MDS), health-related quality of life (HRQoL) represents a relevant patient-reported outcome, which is essential in individualized therapy planning. Prospective data on HRQoL in lower-risk MDS remain rare. We assessed HRQOL by EQ-5D questionnaire at initial diagnosis in 1690 consecutive IPSS-Low/Int-1 MDS patients from the European LeukemiaNet Registry. Impairments were compared with age- and sex-matched EuroQol Group norms. A significant proportion of MDS patients reported moderate/severe problems in the dimensions pain/discomfort (49.5%), mobility (41.0%), anxiety/depression (37.9%), and usual activities (36.1%). Limitations in mobility, self-care, usual activities, pain/discomfort, and EQ-VAS were significantly more frequent in the old, in females, and in those with high co-morbidity burden, low haemoglobin levels, or red blood cells transfusion need (

Global Research Priorities to Better Understand the Burden of Iatrogenic Harm in Primary Care: An International Delphi Exercise

There is a need to identify and reach agreement on key foci for patient safety research in primary care contexts and understand how these priorities differ between low-, middle-, and high-income settings. We conducted a modified Delphi exercise, which was distributed to an international panel of experts in patient safety and primary care. Family practice and pharmacy were considered the main contexts on which to focus attention in order to advance patient safety in primary care across all income categories. Other clinical contexts prioritised included community midwifery and nursing in low-income countries and care homes in high-income countries. The sources of patient safety incidents requiring further study across all economic settings that were identified were communication between health care professionals and with patients, teamwork within the health care team, laboratory and diagnostic imaging investigations, issues relating to data management, transitions between different care settings, and chart/patient record com- pleteness. This work lays the foundation for a range of research initiatives that aim to promote a more comprehensive appreciation of the burden of unsafe primary care, develop understanding of the main areas of risk, and identify interventions that can enhance the safety of primary care provision internationall

Additional psychometric information and vision-specific questionnaires are available for age-realted macular degeneration

Purpose: To present psychometric information and studies dealing with questionnaires for age-related macular degeneration (AMD) and visually impaired patients in addition to the study by Finger et al. "Quality of life in AMD: a review of available vision-specific psychometric tools". We propose that their literature search should not have focused solely on the specific eye disease AMD. Methods: The literature search was partly replicated (PubMed) by using "visual impairment" instead of "macular degeneration" as free text words. Psychometric information was obtained from the additional studies. Preliminary results from a differential item functioning (DIF) analysis used to examine the relationship between item responses on the Vision-related quality of life Core Measure (VCM1) of AMD patients versus patients with other eye conditions are discussed. Results: Eight studies of visually impaired patient populations, including AMD patients, are discussed, with psychometric information from six vision-specific questionnaires. The VCM1 items did not present DIF, which means that the items were equally interpreted by all patients. Conclusions: The results on DIF and the additional studies presented here confirm that a specific eye disorder is of minor importance in the choice of a vision-specific questionnaire or, in this case, a literature search