The Effect of Two Weeks and Twenty-Four Hours Soft Contact Lens Cessation Times on Corneal Refractive Surgery Outcomes

Purpose To investigate the influence of previous soft contact lens (SCL) wear on outcomes of corneal refractive surgery (CRS). SCL wear can reduce accuracy of pre-operative corneal measurements and outcomes of CRS. Short SCL cessation times prior to CRS may be insufficient for resolution of SCL-induced corneal changes. It was hypothesised that the visual and refractive CRS outcomes would be worse in a SCL group compared to a non-contact lens (NCL) group and worse in a SCL group who ceased SCL wear for 24 hours when compared to those who ceased SCL wear for two weeks prior to examination and treatment. Method CRS outcomes for dominant eyes of two groups of previous full-time SCL wearing patients were analysed retrospectively; those who ceased SCL wear for two weeks (n = 45) and twenty four hours (n = 49) prior to examination and treatment. In both groups results were compared to a NCL control group (2 weeks NCL group n = 45; 24 hours NCL group n = 49). LASIK and PRK/LASEK one, three and six months post-operative outcomes were assessed for efficacy (unaided distance visual acuity (UDVA) and residual refractive error), predictability (number of eyes within ± 0.25D and ± 0.50D of desired refractive outcome) and safety. Results There was a trend towards superior CRS outcomes for efficacy, predictability and safety in the two weeks SCL cessation group compared to NCL group. These results were significantly better for LogMAR UDVA in the SCL group and were maintained to the six month post-operative visit (LASIK SCL: -0.10 ± 0.10, NCL: -0.06 ± 0.07, p = 0.03; LASEK/PRK SCL: -0.10 ± 0.08, NCL -0.04 ± 0.08, p = 0.03). These findings were reiterated in the 24 hours SCL cessation group where the trend towards superior CRS outcomes for efficacy, predictability and safety in the SCL group compared to the NCL group was continued. UDVA efficacy outcomes following LASEK/PRK were significantly better in the SCL group at the six month post-operative visit (SCL: -0.11 ± 0.03, NCL -0.04 ± 0.07, p = 0.03). Conclusion Previous SCL wear did not negatively impact on CRS outcomes. SCL cessation times of two weeks and twenty four hours did not result in negative outcomes compared to a NCL control group. While these results were statistically significant, the number of letters difference in UDVA between the SCL and NCL groups was low and so one cannot conclude that these results are clinically significant

The Influence of Soft Contact Lens Materials on the Central, Para-Central and Peripheral Corneal Endothelium

Title: The influence of soft contact lens materials on the central, para-central and peripheral corneal endothelium prior to and following two weeks cessation of soft contact lens wear. Purpose: To examine the influence of a variety of soft contact lens (SCL) materials on the central, para-central and peripheral corneal endothelium measurements, prior to and following two weeks cessation of SCL wear. Methods: Endothelial measurements were taken using the CEM-530 (Nidek, Japan) specular microscope. Full-time SCL wearers (n = 31 eyes) were compared to a non-contact lens (NCL) control group (n = 28 eyes) of a similar age. Seven areas of the endothelium were analysed: centrally, para-centrally (0.6mm from centre) at 0°, 90°, 180°, 270° and the superior and inferior periphery (3.7mm from center). Parameters examined were endothelial cell density (ECD; cell/mm2), mean cell area (MCA; µ2), coefficient of variation (COV) and hexagonality (%). Results: Prior to SCL cessation, two-way ANOVA testing resulted in significant differences between silicone hydrogel (SiH) SCL materials for the COV at 0º, with generation 2 SiH wearers showing increased COV (27.67 ±3.78) compared to generation 3 SiH wearers (24.50 ±3.73, p=0.01). COV at the superior periphery was significantly lower in the NCL group (25.63 ±2.79) compared to the hydrogel group (29.92 ±6.22, p=0.02). The MCA in the inferior periphery was also significantly higher in the NCL group (346.92 ±36.75) compared to the hydrogel group (314.92 ±16.57, p=0.02). Following 14 days SCL cessation the differences in measurements taken between day 0 and day 14 were calculated and analysed, no statistically significant differences in stability of endothelial parameters were detected between NCL and SCL material groups (all p values \u3e0.05). Conclusion: SCL wear has an effect on para-central and peripheral corneal endothelial measurements in SCL wearers compared to NCL wearers, with largest significant differences seen between NCL and hydrogel SCL wearers. Following two weeks SCL cessation, there was relative stability of all endothelial measurements, regardless of which SCL material was worn prior to SCL cessation

Overseeing oversight: governance of quality and safety by hospital boards in the English NHS

Objectives: To contribute towards an understanding of hospital Board composition and oversight of patient safety and health care quality in the NHS. Methods: A review of the theory related to hospital Board governance and two national surveys undertaken about Board management in NHS hospital trusts in England. The first was issued to 150 Trusts in 2011/12 and completed online via a dedicated web tool. A total of 145 replies were received (97% response rate). The second online survey undertaken in 2012/13 targeted individual Board members using the Board Self Assessment Questionnaire (BSAQ). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS Trusts then in existence (66% response rate). Results: Around 42% of Boards had 10-12 members and around 51% had 13-15 members. We found no significant difference in Board size between Foundation and non Foundation trusts. Around 62% of Boards had three or fewer serving Board members with clinical backgrounds. For about two-thirds of the Trusts (63%), Board members with a clinical background comprised less than 30% of the Board members. Boards were using a wide range of hard performance metrics and soft intelligence to monitor their organisation with regard to patient safety. Hard, quantitative data were reportedly used at every Board meeting across most hospital Trusts (>80%), including a range of clinical outcomes measures, infection rates and process measures such as medication errors and readmission rates. A much smaller proportion of Trusts (57%) routinely report morbidity rates at every Board meeting. Softer intelligence, used organisationally and reported at all Board meetings, was more variably reported, with discussions with clinicians (in 89% of Trusts) and executive walk-arounds (88%) being most often reported, alongside use of patient stories (83%). However, in only about two-thirds of Trusts did Board members shadow clinicians and report back to the Board (65%). The BSAQ data showed general high or very high levels of agreement with desirable statements of practice in each of the six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (interpersonal) to 85% (political). Conclusions: The study provides the best account to-date of English NHS Boards and their actions around health care quality and patient safety. While systematic differences between Trusts of different types were rare, there was nonetheless variation between individual Trusts on both Board composition and Board practices. These findings lay the groundwork for further empirical research exploring the dynamics, influences and impacts of Boards

Meta-regulation meets deliberation: situating the governor within NHS foundation trust hospitals

NHS Foundation Trust (FT) Hospitals in England have complex internal governance arrangements. They may be considered to exhibit meta-regulatory characteristics to the extent that Governors are able to promote deliberative values and steer internal governance processes towards wider regulatory goals. Yet, while recent studies of NHS FT Hospital governance have explored the role and experience of FT Governors and examined FT hospital Boards to consider executive oversight, there is currently no detailed investigation of interactions between Governors and members of hospital Boards. Drawing on observational and interview data from four case-study sites, we trace interactions between the actors involved; explore their understandings of events; and consider the extent to which the benefits of meta-regulation were realised in practice. Findings show that while Governors provided both a conscience and contribution to internal and external governance arrangements, the meta regulatory role was largely symbolic and limited to compliance and legitimation of executive actions. Thus while the meta-regulatory ‘architecture’ for Governor involvement may be considered effective, the soft intelligence gleaned and operationalised may be obscured by ‘hard’ performance metrics which dominate processes and priority setting. Governors were involved in practices that symbolised deliberative involvement but resulted in further opportunities for legitimising executive decisions.

An interactive 3-D application for pain management: Results from a pilot study in spinal cord injury rehabilitation

This is the post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2012 ElevierResearch on pain following spinal cord injury (SCI) has revealed that patients not only experience several types of pain that could prove to be challenging to address, but also that each individual can interpret such pain in different subjective ways. In this paper we introduce a 3-D system for facilitating the efficient management of pain, and thus, supporting clinicians in overcoming the aforementioned challenges. This system was evaluated by a cohort of 15 SCI patients in a pilot study that took place between July and October 2010. Participants reported their experiences of using the 3-D system in an adapted version of the System Usability Scale (SUS) questionnaire. Statistically significant results were obtained with regards to the usability and efficiency of the 3-D system, with the majority of the patients finding it particularly useful to report their pain. Our findings suggest that the 3-D system can be an efficient tool in the efforts to better manage the pain experience of SCI patients