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

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

Ionospheric Currents and F-Region Plasma Boundaries Near the Dayside Cusp

Observational evidence of the location of a dayside high‐latitude ionospheric current (DPY current) with respect to the different regimes of the high‐latitude magnetosphere is obtained by analyzing data from the magnetometer chain along the west coast of Greenland in conjunction with simultaneous measurements from the newly established incoherent‐scatter radar facility at Sondre Stromfjord. The latitudinal location of the DPY current is compared with the location of the maximum F‐region electron temperature and with the location of the plasma convection reversal from sunward to antisunward. The maximum in the F‐region electron temperature roughly coincides with the velocity reversal boundary, while the DPY current is always located more poleward, penetrating deep into the polar cap. When UT variations are examined, a correlation of 70 to 80 percent is found between the three locations

Technology-delivered undergraduate medical education involving patients and carers: A rapid systematic review

Background: Involving patients and carers in medical education centralises their voice in healthcare and supports students to develop key professional and person-centred skills. Medical schools are increasingly using technology to deliver educational activities. No review currently exists to establish the variety of technologies and their uses in undergraduate medical education when patients and/or carers are involved. / Methods: Ovid MEDLINE, Ovid EMBASE and medRxiv were searched in October 2020 and reference lists of key articles were hand searched. Eligible studies reported technology-assisted education, in any setting, involving authentic patients and/or carers. Studies in foreign languages, or describing actors or non-authentic patients were excluded. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Levels of patient involvement were assessed using Towle et al (2010) taxonomy. / Results: Twenty studies were included. The majority involved patients and/or carers via pre-recorded videos or online scenarios, with no student-interaction. Four studies evaluated remote consultations using telehealth technology, involving real-time interactions with authentic patients. Technology-supported teaching sessions involving patients and/or carers were found to be acceptable to students, educationally valuable (to students and educators), and enhanced student engagement, patient-centred attitudes, knowledge of specific patient groups, and communication and clinical skills. Two studies describing real-time remote interactions with authentic patients indicated potential barriers for students (reduced ability to build relationship with patients and examine them), educators (reduced ability to build rapport with students) and patients (issues with using or accessing telehealth). / Conclusions: No studies directly measured the perspective of patients or carers involved in technology-delivered medical education. Future research should establish barriers and facilitators to patients and carers taking up a role in medical students education when technology is used, and evaluate PPI activities at Levels 3 and above as described by Towle et al taxonomy