A comparison of spectacles purchased online and in UK optometry practice

YesPurpose: To compare spectacles bought online with spectacles from optometry practices. Methods: Thirty-three participants consisting of single vision spectacle wearers with either a low (N = 12, mean age 34 ± 14 years) or high prescription (N = 11, mean age 28 ± 9 years) and 10 presbyopic participants (mean age 59 ± 4 years) wearing progressive addition lenses (PALs) purchased 154 pairs of spectacles online and 154 from UK optometry practices. The spectacles were compared via participant-reported preference, acceptability, and safety; the assessment of lens, frame, and fit quality; and the accuracy of the lens prescriptions to international standard ISO 21987:2009. Results: Participants preferred the practice spectacles (median ranking 4th, IQR 1–6) more than online (6th, IQR 4–8; Mann-Whitney U = 7345, p < 0.001) and practice PALs (median ranking 2nd, IQR 1–4) were particularly preferred (online 6.5th, IQR 4–9, Mann-Whitney U = 455, p < 0.001). Of those deemed unacceptable and unsafe, significantly more were bought online (unacceptable: online 43/154 vs. practice 15/154, Fisher’s exact p = 0.0001; unsafe: online 14/154 vs. practice 5/154, Fisher’s exact p = 0.03). Conclusions: Participants preferred spectacles from optometry practice rather than those bought online, despite lens quality and prescription accuracy being similar. A greater number of online spectacles were deemed unsafe or unacceptable because of poor spectacle frame fit, poor cosmetic appearance, and inaccurate optical centration. This seems particularly pertinent to PAL lenses, which are known to increase falls risk. Recommendations are made to improve both forms of spectacle provision.College of Optometrist

Living with knee osteoarthritis: the positive impact of reducing the knee torque induced when sleeping supine. A randomised clinical trial

YesWhen lying supine, due to the reaction force from the mattress acting mostly through the heel, an external knee-extension joint-torque is induced that keeps the knee fully extended. This torque becomes zero if the feet are hung over the end of the support. This study investigated, in patients with knee-osteoarthritis (knee-OA) who routinely sleep supine, whether a change to such a sleeping position would ameliorate the knee pain and associated physical problems they suffer. Patients were recruited (General-Practitioners Centre, UK) over a 9-month period; those eligible (51/70) were randomly allocated to an intervention (65% female; age 71.5 [11.3] yrs; BMI, 29.20 [5.54] kg/m2; knee-OA severity, 20 mild–mod/3 severe) or control group (63% female; age, 68.3 [9.7] yrs; BMI, 28.69 [5.51] kg/m2; knee-OA severity, 17 mild–mod/2 severe). The primary outcome was improvements (0 [worst] to 100 [best]) in knee pain at 3 months and was rated in the Knee-Injury-and-Osteoarthritis-Outcome-Score questionnaire (KOOS). Secondary outcomes were improvements (0–100) in the other four KOOS-subscales. There were no differences between groups in KOOS outcomes at baseline, and there were no changes in KOOS outcomes in the control group at 3 months. Relative to the baseline KOOS values in Knee-Pain (50.1), Symptoms (52.5), Activities-of-Daily-Living (53.8) and Quality-of-Life (31.5), were all seen to improve at 3 months in the intervention group (by between 11.9 and 12.9); however, when comparing to controls, only the improvements in the subscale Activities-of-Daily-Living (which improved by 12.2) were statistically significant. Findings indicate that for those with knee-OA who routinely sleep supine, sleeping with the feet over the end of the mattress (to prevent the knee being pushed into/held in full extension) can help ameliorate the physical problems they suffer

Repeatability and Reproducibility of Macular Thickness Measurements Using Fourier Domain Optical Coherence Tomography

Aim: To evaluate repeatability and reproducibility of macular thickness measurements in visually normal eyes using the Topcon 3D OCT-1000. Methods: Phase 1 investigated scan repeatability, the effect of age and pupil dilation. Two groups (6 younger and 6 older participants) had one eye scanned 5 times pre and post- dilation by 1 operator. Phase 2 investigated between-operator, within and between-visit reproducibility. 10 participants had 1 un-dilated eye scanned 3 times on 2 separate visits by 2 operators. Results: Phase 1: No significant difference existed between repeat scans (p=0.75) and no significant difference was found pre- and post-dilation (p=0.54). In the younger group variation was low (95% limits ± 3.62 m) and comparable across all retinal regions. The older group demonstrated greater variation (95% limits ± 7.6 m). Phase 2: For a given retinal location, 95% confidence limits for within-operator, within-visit reproducibility was 5.16 m. This value increased to 5.56 m for the same operator over two visits and to 6.18 m for two operators over two visits. Conclusion: A high level repeatability, close to 6 m, of macular thickness measurement is possible using the 3D OCT- 1000. Measured differences in macular thickness between successive visits that exceed 6 m in pre-presbyopic individuals are therefore likely to reflect actual structural change. OCT measures are more variable in older individuals and it is advisable to take a series of scans so that outliers can be more easily identified

Performance of externally validated enhanced computer-aided versions of the National Early Warning Score in predicting mortality following an emergency admission to hospital in England: a cross-sectional study

YesOBJECTIVES: In the English National Health Service, the patient's vital signs are monitored and summarised into a National Early Warning Score (NEWS) to support clinical decision making, but it does not provide an estimate of the patient's risk of death. We examine the extent to which the accuracy of NEWS for predicting mortality could be improved by enhanced computer versions of NEWS (cNEWS). DESIGN: Logistic regression model development and external validation study. SETTING: Two acute hospitals (YH-York Hospital for model development; NH-Northern Lincolnshire and Goole Hospital for external model validation). PARTICIPANTS: Adult (≥16 years) medical admissions discharged over a 24-month period with electronic NEWS (eNEWS) recorded on admission are used to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) using the first electronically recorded NEWS (model M0) versus a cNEWS model which included age+sex (model M1) +subcomponents of NEWS (including diastolic blood pressure) (model M2). RESULTS: The risk of dying in-hospital following emergency medical admission was 5.8% (YH: 2080/35 807) and 5.4% (NH: 1900/35 161). The c-statistics for model M2 in YH for predicting mortality (in-hospital=0.82, 24 hours=0.91, 48 hours=0.88 and 72 hours=0.88) was higher than model M0 (in-hospital=0.74, 24 hours=0.89, 48 hours=0.86 and 72 hours=0.85) with higher Positive Predictive Value (PPVs) for in-hospital mortality (M2 19.3% and M0 16.6%). Similar findings were seen in NH. Model M2 performed better than M0 in almost all major disease subgroups. CONCLUSIONS: An externally validated enhanced computer-aided NEWS model (cNEWS) incrementally improves on the performance of a NEWS only model. Since cNEWS places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated to determine if it can improve care in hospitals that have eNEWS systems.This research was supported by the Health Foundation. The Health Foundation is an independent charity working to improve the quality of healthcare in the UK. This research was also supported by the National Institute for Health Research (NIHR) Yorkshire and Humberside Patient Safety Translational Research Centre (YHPSTRC)

See me, not just the dementia - Understanding people's experiences of living in a care home.

yesThis report looks at the experiences of people with dementia living in care homes in England, with a particular focus on whether their care offers dignity and respect. Most similar studies have relied on the views of carers, care staff and people in the early stages of dementia. This study examines directly the experiences of people including those with advanced dementia

Gait termination on a declined surface in trans-femoral amputees: Impact of using microprocessor-controlled limb system

YesBackground: Walking down ramps is a demanding task for transfemoral-amputees and terminating gait on ramps is even more challenging because of the requirement to maintain a stable limb so that it can do the necessary negative mechanical work on the centre-of-mass in order to arrest (dissipate) forward/downward velocity. We determined how the use of a microprocessor-controlled limb system (simultaneous control over hydraulic resistances at ankle and knee) affected the negative mechanical work done by each limb when transfemoral-amputees terminated gait during ramp descent. Methods: Eight transfemoral-amputees completed planned gait terminations (stopping on prosthesis) on a 5-degree ramp from slow and customary walking speeds, with the limb's microprocessor active or inactive. When active the limb operated in its ‘ramp-descent’ mode and when inactive the knee and ankle devices functioned at constant default levels. Negative limb work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across speeds and microprocessor conditions. Findings: Negative work done by each limb increased with speed (p < 0.001), and on the prosthetic limb it was greater when the microprocessor was active compared to inactive (p = 0.004). There was no change in work done across microprocessor conditions on the intact limb (p = 0.35). Interpretation: Greater involvement of the prosthetic limb when the limb system was active indicates its ramp-descent mode effectively altered the hydraulic resistances at the ankle and knee. Findings highlight participants became more assured using their prosthetic limb to arrest centre-of-mass velocity.ZA is funded by the Higher Committee of Education Development in IRAQ (HCED student number D13 626)

The use of history to identify anterior cruciate ligament injuries in the acute trauma setting: the 'LIMP index'

YesObjective To identify the injury history features reported by patients with ACL injuries and determine whether history may be used to identify patients requiring follow-up appointments from acute trauma services. Multi-site cross-sectional service evaluation using a survey questionnaire design conducted in the UK. The four injury history features investigated (LIMP) were ‘Leg giving way at the time of injury’, ‘Inability to continue activity immediately following injury’, ‘Marked effusion’ and ‘Pop (heard or felt) at the time of injury’. 194 patients with ACL injury were identified of which 165 (85.5%) attended an acute trauma service. Data on delay was available for 163 (98.8%) of these patients of which 120 (73.6%) had a follow-up appointment arranged. Patients who had a follow-up appointment arranged waited significantly less time for a correct diagnosis (geometric mean 29 vs 198 days; p<0.001) and to see a specialist consultant (geometric mean 61 vs 328 days; p<0.001). Using a referral threshold of any 2 of the 4 LIMP injury history features investigated, 95.8% of patients would have had a follow-up appointment arranged. Findings support the value of questioning patients on specific injury history features in identifying patients who may have suffered ACL injury. Using a threshold of 2 or more of the 4 LIMP history features investigated would have reduced the percentage of patients inappropriately discharged by 22.2%. Evidence presented suggests that this would significantly reduce the time to diagnosis and specialist consultation minimising the chance of secondary complications

Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes

YesPurpose To determine whether dizziness and falls rates change due to routine cataract surgery and to determine the influence of spectacle type and refractive factors. Methods Self-reported dizziness and falls were determined in 287 patients (mean age of 76.5 ± 6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Dizziness was determined using the short-form of the Dizziness Handicap Inventory. Six-month falls rates were determined using self-reported retrospective data. Results The number of patients with dizziness reduced significantly after cataract surgery (52% vs 38%; χ2 = 19.14, p < 0.001), but the reduction in the number of patients who fell in the 6-months post surgery was not significant (23% vs 20%; χ2 = 0.87, p = 0.35). Dizziness improved after first eye surgery (49% vs 33%, p = 0.01) and surgery on both eyes (58% vs 35%, p < 0.001), but not after second eye surgery (52% vs 45%, p = 0.68). Multivariate logistic regression analyses found significant links between post-operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post-operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction. Conclusions Dizziness is significantly reduced by first (or both) eye cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery.This work was supported by The Dunhill Medical Trust(grant number SA14/0711)

Prehension of a flanked target in individuals with amblyopia.

yesPurpose: Reduced binocularity is a prominent feature of amblyopia and binocular cues are thought to be important for prehension. We examine prehension in individuals with amblyopia when the target-object was flanked, thus mimicking everyday prehension. Methods: amblyopes (n=20, 36.4±11.7 years; 6 anisometropic, 3 strabismic, 11 mixed) and visually-normal controls (n=20, 27.5±6.3 years) reached forward, grasped and lifted a cylindrical target-object that was flanked with objects on either (lateral) side of the target, or in front and behind it in depth. Only 6 amblyopes (30%) had measurable stereoacuity. Trials were completed in binocular and monocular viewing, using the better eye in amblyopic participants. Results: Compared to visual normals, amblyopes displayed a longer overall movement time (p=0.031), lower average reach velocity (p=0.021), smaller maximum aperture (p=0.007) and longer durations between object contact and lift (p=0.003). Differences between groups were more apparent when the flankers were in front and behind, compared to either side, as evidenced by significant group-by-flanker configuration interactions for reach duration (p<0.001), size and timing of maximum aperture (p≤0.009), end-of-reach to object-contact (p<0.001), and between object contact and lift (p=0.044), suggesting that deficits are greatest when binocular cues are richest. Both groups demonstrated a significant binocular advantage, in that in both groups performance was worse for monocular compared to binocular viewing, but interestingly, amblyopic deficits in binocular viewing largely persisted during monocular viewing with the better eye. Conclusions: These results suggest that amblyopes either display considerable residual binocularity or that they have adapted to make good use of their abnormal binocularity

The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals

YesBackground The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. Methods Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. Results The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. Conclusions The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown