Implementing a dry eye service in primary optometric care

The aim of this thesis was to understand the demand and uptake of private optometric community services outside the scope of traditional services having the outcome of supplying spectacles, and of locally commissioned shared care schemes. Dry eye is known to reduce quality of life, be highly prevalent, underdiagnosed and clinically significant. Dry eye is a condition with poor association and discordance between signs and symptoms, and so is poorly managed. Dry eye does not command priority in secondary care where patients sometimes present when self-help measures fail, considering it is generally not sight threatening. The global consensus on dry eye have recommended a tiered management approach highlighting advanced pharmacological care options that could be applied by optometrists with an independent prescribing qualification. Emerging technologies also show promise in advanced dry eye diagnostics and management but the investments required means that practices need to develop a strong business plan to make them commercially viable. This research was based on a single independent optometric practice and two hospitals with a relationship to the practice. Service blueprinting was applied to the dry eye service to demonstrate its usefulness in optometric service innovation. Decision tree analysis and principal component analysis were used to discriminate between people self-reporting dry eye, to predict severity, and to identify clinical tests to explain the variability between those with predominately evaporative dry eye from a sample of patients. Despite having signs of dry eye, there were no differences in visual outcomes post-lens surgery based on dry eye sign status, and there were no strong trends to link discontinuation of contact lens wear to dry eye. Dry eye is a condition that presents to the local eye casualty department that can be managed within the community along with other conditions that may have an acute or recurring presentation

Analysis of UK eye casualty presentations

Clinical relevance Optometrists upskilling and participating in enhanced optometric schemes has the potential to improve service accessibility and alleviate pressure on hospital eye services. Background There is a growing demand for eye care in the UK with rising hospital attendances thought to be due in part to an ageing population and a shift in behaviour to favour emergency secondary care. Methods Records of first-time presentations to the eye casualty department at the County Hospital (Wye Valley NHS Trust), Hereford, UK, over a month were analysed retrospectively and sequentially. The proportion of patients from optometrist referrals with conditions potentially requiring pharmacological intervention, that could have been retained within community optometry by an independent prescriber, was assessed. For general practitioner and self-referrals, the reasons for visit were compared to the Minor Eye Conditions Service criteria for inclusion. Patient conditions reviewed at the hospital following their initial presentation were grouped according to those who could have been discharged to a commissioned optometric service. Results The records of 421 patients were organised by the source of referral and condition diagnosed by the hospital practitioner. Thirty-three percent of optometrist referrals could have been managed by an independent prescribing optometrist. Ninety-two percent of patients presenting from general practitioner referrals and 83 percent of self-referrals could have been assessed via the local optometric scheme. Sixty-six percent of patients attending hospital for follow-up could have been seen within the community. Conclusion The present analysis highlights the value of commissioned local optometric community services to address acute ocular symptoms and the value of an independent prescribing qualification in helping to further alleviate the burden on hospital emergency eye services. The large number of self-referrals suggests that the general public needs to be further educated on services that are available at a community optometry level

Nipplegate and the Effects of Implicit vs. Explicit Sexuality in Pop Music Performance

Janet Jackson’s pop career was severely impacted by Justin Timberlake ripping her costume during the 2004 Super Bowl halftime show. The exposure of her nipple was deemed vulgar and became the subject of a heated media backlash, while numerous sexually provocative moments of the show that did not include Jackson were seemingly accepted This paper analyze the performance and its aftermath, and explores factors that contributed to the Nipplegate controversy, including race, gender, and the corporate entities that controlled the media reaction

Women’s perceptions of discussions about gestational weight gain with health care providers during pregnancy and postpartum: a qualitative study

Abstract Background Maternal body weight is an indicator of the health of a mother and her developing fetus. Risks of poor maternal and fetal health issues increase when women gain too little or too much weight during pregnancy. A study of 600 women from Alberta, Canada, reported approximately 30, 46, 80, and 80% of underweight, healthy weight, overweight, and obese women, respectively, gained in excess of Health Canada gestational weight gain guidelines. Behavioural interventions during pregnancy have shown to be effective at supporting women achieve gestational weight gain (GWG) recommendations and return to their pre-pregnancy weight postpartum, yet few women are counseled about weight gain during pregnancy. A discrepancy exists between health care providers’ (HCP) reported counseling behaviours and women’s perceptions of counseling by HCPs; most HCPs report counseling women about GWG; conversely, most women report not receiving counseling about GWG. This study explored women’s experiences with GWG and their perceptions of discussions about GWG with HCPs during pregnancy and postpartum. This will help to identify gaps in service delivery and highlight areas for improvement that may better support women to achieve GWG recommendations leading to better health outcomes for women and children. Methods Five focus groups (n = 26) were conducted with women up to 1 year postpartum across the five Alberta health zones. Focus groups were transcribed verbatim and analyzed using qualitative content analysis. Results GWG is important to women, for their health and for the health of their baby. In-depth conversations with HCPs about GWG or weight loss do not occur; however, women want the opportunity to discuss weight gain/loss with HCPs. Women would like discussions about gestational weight gain/loss to become part of standard care and offered to all women. Conclusions Women suggested that discussions about GWG should occur with all women, and that HCPs should initiate these discussions by asking women how they feel about discussing weight. Conversations should begin early on in pregnancy and continue through to the postpartum period. Interventions assessing discussions about GWG should be implemented and evaluated as this has been identified as a gap in prenatal service delivery

Assessing the impact of multiple ultraviolet disinfection cycles on N95 filtering facepiece respirator integrity

Abstract During the COVID-19 pandemic, N95 filtering facepiece respirators (FFRs) were recommended to protect healthcare workers when providing care to infected patients. Despite their single-use disposable nature, the need to disinfect and repurpose FFRs is paramount during this global emergency. The objectives of this study were to (1) determine if UV treatment has an observable impact on respirator integrity; (2) test the impact of UV treatment on N95 FFR user fit; and (3) test the impact of UV treatment on FFR integrity. Ultraviolet (UV) disinfection was assessed in maintaining N95 FFR integrity. Two models of FFRs were exposed to UV fluences ranging from 0 to 10,000 mJ cm−2 per side and subsequently tested for fit, respirator integrity, and airflow. Inspection of N95 FFRs before and after UV treatment via microscopy methods showed no observable or tactile abnormalities in the integrity of respirator material or straps. Tensile loading tests on UV-treated and untreated respirator straps also demonstrated no impact on breaking strength. Standardized fit test methods showed no compromise in user fit following UV treatment. Evaluation of particle penetration and airflow through N95 FFRs showed no impact on integrity, and average filtration efficiency did not fall below 95% for any of the respirator types or fluence levels. This work provides evidence that UV disinfection does not compromise N95 FFR integrity at UV fluences up to 10,000 mJ cm−2. UV disinfection is a viable treatment option to support healthcare professionals in their strategy against the spread of COVID-19

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes