Patient expectations of surgery outcomes for appearance-altering eye conditions

Conditions affecting the eyes can be associated with impaired vision, social functioning and reduced quality of life. Unsurprisingly, patients with these problems often seek surgery to improve their vision and change their appearance. Elizabeth Jenkinson and Sadie Wickwar consider research suggesting that patients may have differing expectations of outcomes that can be achieved with surgical interventions

Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review

Background: It is important that people with SMI receive early interventions to prevent mental health deterioration or relapse. Telecommunications and other technologies are increasingly used to assist healthcare delivery (‘telehealth’) , providing service users with immediate real-time information to improve the management of chronic health conditions. Telehealth has been found to be successful in improving management and symptoms across a number of health conditions, whilst also being acceptable to users. Initial findings suggest technology could improve quality of life in people with SMI. Objectives: This systematic review aimed to identify the variety of uses and efficacy of teleheal th technology for SMI. Methods: We systematically searched electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, AMED, He alth Techno logy Assessment, CINAHL plus and NHS EED ) for randomised controlled trials (RCTs) evaluating telehealth for adults with SMI , published in English. Additional literature was identified by searching reference lists of key articles. The articles meeting the inclusion criteria were systematically reviewed and assessed for quality and risk of bias. Results: The search identified 31 eligible articles, describing 29 trials. The included studies evaluated the use of computers to deliver cognitive rehabilitation (1 5 trials), patient education (3 trials), online self- management interventions (2 trials), and to support consultations (1 trial). Virtual reality (VR) was used to simulate work and social sit uations (2 trials ) and to deliver cognitive training (1 trial). Telephones were used to prompt medication use (3 trials ) and report SMI symptoms to healthcare teams (1 trial ). Remote sensors were used to monitor medication use (1 trial). Telephone support was found effective for improving medication adherence and reducing symptom severity and inpatient days. Computer assisted cognitive rehabilitation was effective in improving cognitive function. The impact of telehealth on other outcomes was inconsistent. Few studies evaluated the 3 use of remote medication telemonitoring, VR, online self-management and computer -mediated consultations, suggesting these are novel technologies for managing SMI, although all were found effective for improving psycho social and behavioural outcomes. The results of this review should be taken in the context of varied quality in study design, with only five studies demonstrating a low risk of bias. Conclusions : A growing variety of telehealth technologies are used to support SMI. Specific types of technology have been found to be effective for som e outcomes, for example telephone prompts for medication adherence, while other types of telehealth had no benefit over traditional methods and were less acceptable to patients. Few studies found benefits for telehealth on quality of life, except for novel technologies with a limited number of trials. Further research is warranted to establish the full potential benefits of telehealth for improving quality of life in SMI, acceptability from the service user perspective, and cost-effectivenes

Auroral Plasma Lines: A First Comparison of Theory and Experiment

In this preliminary report on low-energy (0.3 to 3 eV) secondary electrons in the auroral E layer (90 to 150 km), we compare intensities of plasma lines observed with the Chatanika radar to theoretical predictions obtained from a detailed numerical model. The model calculations are initiated with a flux of energetic auroral primary electrons which enter the atmosphere and lose energy to electrons, ions, and neutrals through a combination of elastic and inelastic collisions. This flux is chosen in order that the total calculated ionization rate matches one that is deduced from the radar measurements. From these same calculations the steady state secondary electron flux is deduced as a function of altitude, energy, and pitch angle. This flux is used to calculate plasma line intensities which are then compared with observed intensities. Initial comparisons suggest that the plasma line theory, when applied to low altitudes, must include the effect of electron-neutral collisions. When this is done, the good agreement obtained between theory and experiment indicates the promise of this approach for the study of low-energy auroral electrons

Which factors are associated with quality of life in patients with Graves' orbitopathy presenting for orbital decompression surgery?

Purpose: Graves’ orbitopathy (GO) is associated with changes in the appearance of the eyes and visual dysfunction. Patients report feeling socially isolated and unable to continue with day-to-day activities. This study aimed at investigating the demographic, clinical, and psychosocial factors associated with quality of life in patients presenting for orbital decompression surgery. Methods: One-hundred and twenty-three adults with GO due for orbital decompression at Moorfields Eye Hospital London were recruited prospectively. Clinical measures including treatment history, exophthalmos, optic neuropathy, and diplopia were taken by an ophthalmologist. Participants completed psychosocial questionnaires, including the Graves’ Ophthalmopathy Quality of Life Scale (GO-QOL), the Hospital Anxiety and Depression Scale, and the Derriford Appearance Scale. Hierarchical multiple regression analyses were used to identify predictors of quality of life. Results: Higher levels of potential cases of clinical anxiety (37%) and depression (26%) were found in this study sample than in patients with other chronic diseases or facial disfigurements. A total of 55% of the variance in GO-QOL visual function scores was explained by the regression model; age, asymmetrical GO and depressed mood were significant unique contributors. In all, 75% of the variance in GO-QOL appearance scores was explained by the regression model; gender, appearance-related cognitions and depressed mood were significant unique contributors. Conclusion: Appearance-related quality of life and mood were particularly affected in this sample. Predominantly psychosocial characteristics were associated with quality of life. It is important when planning surgery for patients that clinicians be aware of factors that could potentially influence outcomes

The psychosocial and clinical outcomes following orbital decompression surgery for thyroid eye disease and predictors of change in quality of life

Objective: Thyroid eye disease (TED) has been found to reduce quality of life for many patients due to changes in their appearance and vision, although some appear to adjust better than others. This study was designed to investigate whether a patient’s quality of life changes after having orbital decompression for improvement of appearance, vision, or both, and whether any demographic, clinical or psychosocial factors can predict which patients might benefit from this surgery. Design: This study employed a within-subjects repeated measures design, where patients were assessed before, and at 6 weeks and 6 months after surgery. Subjects: One hundred and twenty-three adults (>18 years) with TED and undergoing orbital decompression surgery were recruited at Moorfields Eye Hospital. Methods: Participants received lateral wall, medial wall, 2.5 or 3 wall decompression, and were followed up after surgery with a range of psychosocial and clinical assessments. Main Outcome Measures: The Graves’ Ophthalmopathy Quality of Life (GO-QOL) scale was completed at each time point and this was used as the dependent variable in each hierarchical multiple regression model. Results: Significant improvements were found in all clinical characteristics following orbital decompression and in most psychosocial variables. GO-QOL visual function scores did not change significantly until 6 months after surgery. In contrast, GO-QOL appearance scores changed significantly by 6 weeks after surgery and continued to increase to 6 months, reaching a minimal clinically important difference for this scale. None of the changes in clinical or psychosocial outcomes significantly predicted change in GO-QOL visual function. However, the hierarchical regression model explained 79% of the variance in change in GO-QOL appearance, with change in subjective evaluation of appearance being the only unique predictor of change in appearance-related quality of life. Conclusions: This study highlights the importance of appearance-related cognitions in predicting quality of life outcomes after surgery. Implications for clinical practice need to be considered in light of the limitations of this study, but it is suggested that psychosocial interventions targeting appearance-related cognitive processes - in particular personal evaluation of appearance - could enhance the quality of life outcomes for patients with TED undergoing orbital decompression surgery

Incoherent-Scatter Radar Observations of Westward Electric Fields, 2

In this paper we describe the results of a series of geomagnetic meridian plane radar incoherent scatter plasma transport measurements. From such data the eastward (zonal) component of the electric field can be deduced. The results show that the electric field has an eastward component whenever the discrete auroras are northward of the region of the measurement. The zonal field component turns westward as the discrete auroras move equatorward of the region of the measurement. Thus there is an eastward electric field boundary near the equatorward limit of the discrete aurora, which is the poleward boundary of the diffuse aurora during undisturbed periods. During a particularly disturbed period we also observed three pronounced substorm-related enhancements of the westward-directed zonal field. For midnight and morning sector substorms the enhancements preceded the substorm onset times by 20-30 min. We show from meridian chain all-sky camera data that all three enhancements coincided with equatorward expansions of the auroral oval

Patients’ Expectations of the Functional and Psychosocial Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: A Qualitative Study

Patients with appearance-altering conditions may be dissatisfied with the outcomes of reconstructive surgery due to unmet expectations. This study explored patients’ expectations of orbital decompression surgery for thyroid eye disease (TED) and whether these were met. Semi-structured interviews were conducted at two times: (1) in the weeks after patients were listed for decompression surgery and before surgery; (2) up to 12 months after surgery. Thematic analysis was performed for each time point, to identify themes within the data. Fourteen adults with TED were interviewed prior to surgery and five were followed up after surgery. Thematic analyses found: (1) Prior to surgery, patients had formed expectations through online information about the procedure, consultations with physicians, the impact TED had on their lives, and speaking to relevant others. Patients had specific expectations about the procedure, the recovery, post-operative appearance and post-operative vision. (2) After surgery, patients generally felt their appearance and well-being had improved. However, dissatisfaction was linked to unanticipated specific aspects of surgical care, recovery, or appearance. Dissatisfaction can arise from unmet expectations for the outcomes of reconstructive surgery. Physicians should be aware of the processes by which patients form expectations, for example different types and quality of online information. Ensuring that preoperative expectations are realistic could enhance satisfaction after surgery

Adaptation of the methotrexate in rheumatoid arthritis knowledge questionnaire (MiRAK) for use with parents of children with juvenile idiopathic arthritis (JIA)

Background: Although Methotrexate (MTX) is one of the most commonly prescribed disease-modifying drugs in JIA no questionnaire exists that assesses the knowledge of parents about this drug. A 60-item questionnaire was recently developed to measure rheumatoid arthritis (RA) patients’ knowledge about MTX; the Methotrexate in Rheumatoid Arthritis Knowledge Test (MiRAK; Ciciriello et al. (Arthritis Rheum 62:10–1009, 2010)). This study aimed to adapt the MiRAK for parents of children with JIA. Methods: Adaption of the MiRAK involved: 1) email consultations with clinicians working in the field of paediatric rheumatology (Panel 1) to ascertain the potential adaptations of the MiRAK from a clinical perspective, 2) synthesis of clinicians’ suggestions by a panel of experts, researchers and MiRAK developers (Panel 2) to reach consensus on which items needed to be modified and create a draft Methotrexate in Juvenile Idiopathic Arthritis Knowledge Test (MiJIAK), 3) a review of the draft by 5 parents of children with JIA (Panel 3) using the cognitive ‘think-aloud’ method, 4) a second consultation with Panel 2 to review parents’ suggestions and determine the final items. Results: A total of 9 items remained unchanged, e.g. “Methotrexate is effective at relieving joint stiffness”, 19 were deemed inappropriate in the paediatric setting and deleted, e.g. “It is safe to become pregnant 3 weeks after methotrexate has been stopped”, 32 underwent editorial changes largely to indicate that the questionnaire was about the children with JIA, e.g. “If you forget to give a dose of Methotrexate, you can still take it the next day” became “If your child misses a dose of Methotrexate, they can still take it the next day”, and 1 new item was added. A new 42-item questionnaire was produced and was found to be well understood by parents of children with JIA. Conclusions: The systematic modification of the MiRAK, a patient-centred MTX knowledge questionnaire, has generated a comprehensive new questionnaire for use in the JIA setting. The wide consultation process, including cognitive testing, has ensured the tool is both relevant and acceptable to clinicians and will therefore be a valuable addition in understanding the parents’ perspective of this treatment in JIA