Publications by authors named "Chung Shen Chean"

14 Publications

  • Page 1 of 1

An Atypical Presentation of Sympathetic Ophthalmia in an Intact Globe Following Mechanical Fall: A Case Report and Literature Review.

Vision (Basel) 2021 Feb 21;5(1). Epub 2021 Feb 21.

Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK.

Purpose: To describe an atypical case of sympathetic ophthalmia presenting after blunt trauma causing disinsertion of the iris in an intact globe.

Methods: Case report.

Results: A 71-year-old lady presented to the Emergency Department following a mechanical fall. On examination, she was noted to have periocular haematoma, subconjunctival haemorrhage, hyphaema, and vitreous haemorrhage in the left eye, but there was no evidence of globe rupture. The presenting visual acuity was 6/18. As the hyphaema and vitreous haemorrhage settled, a complete loss of the iris was noted with normal fundus. She was re-admitted a month later under the medical team with urinary tract infection and reduced vision in both eyes. On examination, there was mild conjunctival injection, keratic precipitates, anterior chamber flare, 180-degree posterior synechiae, and vitritis with no fundal view of the right eye. She was diagnosed with sympathetic ophthalmia and was treated with topical and systemic corticosteroid. Her vision improved gradually with treatment and was stable at 6/6 on the right (sympathising) eye and 6/9 on the left (excited) eye at final follow-up.

Conclusion: Sympathetic ophthalmia may result from non-penetrating ocular trauma. Comprehensive history of mechanism of injury and ophthalmic examination is essential so that prompt treatment can be given to improve the visual prognosis of affected patients.
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http://dx.doi.org/10.3390/vision5010011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930941PMC
February 2021

Lacrimal gland extranodal marginal zone B-cell lymphoma in the presence of amyloidosis.

Orbit 2020 Nov 20:1-4. Epub 2020 Nov 20.

United Lincolnshire Hospitals NHS Trust, Lincoln County Hospital , Lincoln, UK.

Amyloidosis is a protein metabolism disorder characterised by extracellular deposition of insoluble amorphous hyaline material. Orbital and ocular amyloid lesions account for only 4% of localised disease affecting the head and neck. Ocular adnexal lymphoma accounts for 1-2% of lymphoma, with lacrimal gland lymphomas being relatively uncommon. The most common form affecting the orbit is extranodal marginal zone lymphoma (EMZL) of mucosa-associated lymphoid tissue (MALT lymphoma). We report an extremely rare case of co-existent EMZL and amyloidosis of the lacrimal gland. Initial biopsy of the right lacrimal gland confirmed an EMZL with amyloid deposit, and a course of radiotherapy treatment was given. Recurrent lacrimal gland swelling developed within a year. Subsequent biopsy identified amyloidosis with scanty lymphoid tissue. To our knowledge, this is the first reported case of localised lacrimal gland amyloidosis of uncertain type with previous EMZL; the association described in this case report is not yet fully understood.
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http://dx.doi.org/10.1080/01676830.2020.1852578DOI Listing
November 2020

Identification of patterns of foot and ankle pain in the community: Cross-sectional findings from the clinical assessment study of the foot.

Musculoskeletal Care 2021 03 30;19(1):9-19. Epub 2020 Sep 30.

Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK.

Objectives: To investigate patterns of foot and ankle pain locations and symptoms, socio-demographic and comorbid characteristics to examine whether there are distinct foot and ankle pain phenotypes.

Methods: Adults aged ≥50 years registered with four general practices in North Staffordshire were mailed a Health Survey questionnaire. Participants reporting foot pain in the last month indicated foot pain location on a foot manikin. Foot and ankle pain patterns were investigated by latent class analysis. Associations between the classes with foot pain symptoms, socio-demographic and comorbid characteristics were assessed.

Results: Four thousand four hundred fifty-five participants with complete foot pain and manikin data were included in this analysis (mean age 65 years [SD 9.8], 49% male). Of those with foot and ankle pain (n = 1356), 90% had pain in more than one region. Six distinct classes of foot and ankle pain were identified: no pain (71%), bilateral forefoot/midfoot pain (4%), bilateral hindfoot pain (5%), left forefoot/midfoot pain (8%), right forefoot/midfoot pain (5%) and bilateral widespread foot and ankle pain (6%). People with bilateral widespread foot and ankle pain were more likely to be female, obese, depressed, anxious, have/had a manual occupation, have comorbidities, lower SF-12 scores and greater foot-specific disability. Age did not differ between classes.

Conclusions: Six distinct classes of foot and ankle pain locations were identified, and those with bilateral widespread foot and ankle pain had distinct characteristics. Further investigation of these individuals is required to determine if they have poorer outcomes over time and whether they would benefit from earlier identification and treatment.
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http://dx.doi.org/10.1002/msc.1502DOI Listing
March 2021

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

Authors:
Oliver Patrick Devine Andrew Christopher Harborne Hugo Layard Horsfall Tobin Joseph Tess Marshall-Andon Ryan Samuels Joshua William Kearsley Nadine Abbas Hassan Baig Joseph Beecham Natasha Benons Charlie Caird Ryan Clark Thomas Cope James Coultas Luke Debenham Sarah Douglas Jack Eldridge Thomas Hughes-Gooding Agnieszka Jakubowska Oliver Jones Eve Lancaster Calum MacMillan Ross McAllister Wassim Merzougui Ben Phillips Simon Phillips Omar Risk Adam Sage Aisha Sooltangos Robert Spencer Roxanne Tajbakhsh Oluseyi Adesalu Ivan Aganin Ammar Ahmed Katherine Aiken Alimatu-Sadia Akeredolu Ibrahim Alam Aamna Ali Richard Anderson Jia Jun Ang Fady Sameh Anis Sonam Aojula Catherine Arthur Alena Ashby Ahmed Ashraf Emma Aspinall Mark Awad Abdul-Muiz Azri Yahaya Shreya Badhrinarayanan Soham Bandyopadhyay Sam Barnes Daisy Bassey-Duke Charlotte Boreham Rebecca Braine Joseph Brandreth Zoe Carrington Zoe Cashin Shaunak Chatterjee Mehar Chawla Chung Shen Chean Chris Clements Richard Clough Jessica Coulthurst Liam Curry Vinnie Christine Daniels Simon Davies Rebecca Davis Hanelie De Waal Nasreen Desai Hannah Douglas James Druce Lady-Namera Ejamike Meron Esere Alex Eyre Ibrahim Talal Fazmin Sophia Fitzgerald-Smith Verity Ford Sarah Freeston Katherine Garnett Whitney General Helen Gilbert Zein Gowie Ciaran Grafton-Clarke Keshni Gudka Leher Gumber Rishi Gupta Chris Harlow Amy Harrington Adele Heaney Wing Hang Serene Ho Lucy Holloway Christina Hood Eleanor Houghton Saba Houshangi Emma Howard Benjamin Human Harriet Hunter Ifrah Hussain Sami Hussain Richard Thomas Jackson-Taylor Bronwen Jacob-Ramsdale Ryan Janjuha Saleh Jawad Muzzamil Jelani David Johnston Mike Jones Sadhana Kalidindi Savraj Kalsi Asanish Kalyanasundaram Anna Kane Sahaj Kaur Othman Khaled Al-Othman Qaisar Khan Sajan Khullar Priscilla Kirkland Hannah Lawrence-Smith Charlotte Leeson Julius Elisabeth Richard Lenaerts Kerry Long Simon Lubbock Jamie Mac Donald Burrell Rachel Maguire Praveen Mahendran Saad Majeed Prabhjot Singh Malhotra Vinay Mandagere Angelos Mantelakis Sophie McGovern Anjola Mosuro Adam Moxley Sophie Mustoe Sam Myers Kiran Nadeem Reza Nasseri Tom Newman Richard Nzewi Rosalie Ogborne Joyce Omatseye Sophie Paddock James Parkin Mohit Patel Sohini Pawar Stuart Pearce Samuel Penrice Julian Purdy Raisa Ramjan Ratan Randhawa Usman Rasul Elliot Raymond-Taggert Rebecca Razey Carmel Razzaghi Eimear Reel Elliot John Revell Joanna Rigbye Oloruntobi Rotimi Abdelrahman Said Emma Sanders Pranoy Sangal Nora Sangvik Grandal Aadam Shah Rahul Atul Shah Oliver Shotton Daniel Sims Katie Smart Martha Amy Smith Nick Smith Aninditya Salma Sopian Matthew South Jessica Speller Tom J Syer Ngan Hong Ta Daniel Tadross Benjamin Thompson Jess Trevett Matthew Tyler Roshan Ullah Mrudula Utukuri Shree Vadera Harriet Van Den Tooren Sara Venturini Aradhya Vijayakumar Melanie Vine Zoe Wellbelove Liora Wittner Geoffrey Hong Kiat Yong Farris Ziyada I C McManus

BMC Med 2020 05 14;18(1):126. Epub 2020 May 14.

Research Department of Medical Education, UCL Medical School, Gower Street, London, WC1E 6BT, UK.

Background: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL).

Method: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times.

Results: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content.

Discussion: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training.
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http://dx.doi.org/10.1186/s12916-020-01571-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222546PMC
May 2020

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

Authors:
I C McManus Andrew Christopher Harborne Hugo Layard Horsfall Tobin Joseph Daniel T Smith Tess Marshall-Andon Ryan Samuels Joshua William Kearsley Nadine Abbas Hassan Baig Joseph Beecham Natasha Benons Charlie Caird Ryan Clark Thomas Cope James Coultas Luke Debenham Sarah Douglas Jack Eldridge Thomas Hughes-Gooding Agnieszka Jakubowska Oliver Jones Eve Lancaster Calum MacMillan Ross McAllister Wassim Merzougui Ben Phillips Simon Phillips Omar Risk Adam Sage Aisha Sooltangos Robert Spencer Roxanne Tajbakhsh Oluseyi Adesalu Ivan Aganin Ammar Ahmed Katherine Aiken Alimatu-Sadia Akeredolu Ibrahim Alam Aamna Ali Richard Anderson Jia Jun Ang Fady Sameh Anis Sonam Aojula Catherine Arthur Alena Ashby Ahmed Ashraf Emma Aspinall Mark Awad Abdul-Muiz Azri Yahaya Shreya Badhrinarayanan Soham Bandyopadhyay Sam Barnes Daisy Bassey-Duke Charlotte Boreham Rebecca Braine Joseph Brandreth Zoe Carrington Zoe Cashin Shaunak Chatterjee Mehar Chawla Chung Shen Chean Chris Clements Richard Clough Jessica Coulthurst Liam Curry Vinnie Christine Daniels Simon Davies Rebecca Davis Hanelie De Waal Nasreen Desai Hannah Douglas James Druce Lady-Namera Ejamike Meron Esere Alex Eyre Ibrahim Talal Fazmin Sophia Fitzgerald-Smith Verity Ford Sarah Freeston Katherine Garnett Whitney General Helen Gilbert Zein Gowie Ciaran Grafton-Clarke Keshni Gudka Leher Gumber Rishi Gupta Chris Harlow Amy Harrington Adele Heaney Wing Hang Serene Ho Lucy Holloway Christina Hood Eleanor Houghton Saba Houshangi Emma Howard Benjamin Human Harriet Hunter Ifrah Hussain Sami Hussain Richard Thomas Jackson-Taylor Bronwen Jacob-Ramsdale Ryan Janjuha Saleh Jawad Muzzamil Jelani David Johnston Mike Jones Sadhana Kalidindi Savraj Kalsi Asanish Kalyanasundaram Anna Kane Sahaj Kaur Othman Khaled Al-Othman Qaisar Khan Sajan Khullar Priscilla Kirkland Hannah Lawrence-Smith Charlotte Leeson Julius Elisabeth Richard Lenaerts Kerry Long Simon Lubbock Jamie Mac Donald Burrell Rachel Maguire Praveen Mahendran Saad Majeed Prabhjot Singh Malhotra Vinay Mandagere Angelos Mantelakis Sophie McGovern Anjola Mosuro Adam Moxley Sophie Mustoe Sam Myers Kiran Nadeem Reza Nasseri Tom Newman Richard Nzewi Rosalie Ogborne Joyce Omatseye Sophie Paddock James Parkin Mohit Patel Sohini Pawar Stuart Pearce Samuel Penrice Julian Purdy Raisa Ramjan Ratan Randhawa Usman Rasul Elliot Raymond-Taggert Rebecca Razey Carmel Razzaghi Eimear Reel Elliot John Revell Joanna Rigbye Oloruntobi Rotimi Abdelrahman Said Emma Sanders Pranoy Sangal Nora Sangvik Grandal Aadam Shah Rahul Atul Shah Oliver Shotton Daniel Sims Katie Smart Martha Amy Smith Nick Smith Aninditya Salma Sopian Matthew South Jessica Speller Tom J Syer Ngan Hong Ta Daniel Tadross Benjamin Thompson Jess Trevett Matthew Tyler Roshan Ullah Mrudula Utukuri Shree Vadera Harriet Van Den Tooren Sara Venturini Aradhya Vijayakumar Melanie Vine Zoe Wellbelove Liora Wittner Geoffrey Hong Kiat Yong Farris Ziyada Oliver Patrick Devine

BMC Med 2020 05 14;18(1):136. Epub 2020 May 14.

UCL Medical School, 74 Huntley Street, London, WC1E 6BT, UK.

Background: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors.

Method: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail.

Results: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs.

Conclusions: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety.
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http://dx.doi.org/10.1186/s12916-020-01572-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222458PMC
May 2020

Renal arteriovenous malformation mimicking hydronephrosis-hidden danger.

BJR Case Rep 2019 Dec 15;5(4):20190034. Epub 2019 Nov 15.

Imaging Department, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom.

Renal arteriovenous malformations (AVMs) are rare, with an incidence of approximately 0.04%. Diagnosis is often challenging due to mimics of AVMs. We report a case of renal AVM mimicking hydronephrosis on ultrasound and unenhanced computed tomography (CT). A 24-year-old female with background of recurrent urinary tract infections (UTIs) presented to the Accident and Emergency department with 1 day history of bilateral flank pain, dysuria, rigors and pyrexia. Urine dipstick showed microscopic haematuria and blood tests showed mild neutrophilia. Dilated right renal pelvis was seen on ultrasound. Unenhanced CT of the urinary tract demonstrated right hydronephrosis with no evidence of calculi. Subsequent Uro-radiology meeting discussion concluded that renal pelvis might be pus-filled and recommended an urgent nephrostomy. However, ultrasound Doppler scan performed at the time of the planned nephrostomy demonstrated colour flow within dilated renal pelvis suggestive of an AVM. Nephrostomy was abandoned and subsequent CT angiogram confirmed a large congenital AVM. The patient was referred for embolization.Colour flow ultrasound imaging is a simple and quick technique to diagnose AVMs. However, as in our case, when colour flow Doppler imaging was not used at the initial ultrasound, the opportunity to obtain an accurate diagnosis was missed. If the subsequently planned nephrostomy had taken place, this may have led to potentially serious outcomes. We suggest that colour flow imaging should be used prior to nephrostomy insertion to differentiate hydronephrosis from vascular abnormalities.
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http://dx.doi.org/10.1259/bjrcr.20190034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945260PMC
December 2019

Protocol for a systematic review and network meta-analysis of the management of new onset atrial fibrillation in critically unwell adult patients.

Syst Rev 2019 10 28;8(1):242. Epub 2019 Oct 28.

University of Liverpool and The Royal Liverpool and Broadgreen University Hospitals, Liverpool Health Partners, Liverpool, UK.

Background: New onset atrial fibrillation is the most commonly encountered arrhythmia in critically unwell patients with a reported incidence of 4% to 29%. The occurrence of new onset atrial fibrillation may precipitate acute heart failure and lead to thromboembolic complications as well as being associated with increased in-hospital and in intensive care unit (ICU) mortality. Despite being common, much of our current knowledge regarding the treatment of new onset atrial fibrillation comes from patients with chronic atrial fibrillation or post cardiac surgery. It is unclear if management strategies in these patient cohorts can be applied to new onset atrial fibrillation in the general ICU. This protocol for a systematic review and network meta-analysis aims to address this uncertainty and define what is the most effective management strategy for the treatment of new onset atrial fibrillation (NOAF) in acutely unwell adult patients.

Methods: In this systematic review and network meta-analysis, we plan to search electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], MEDLINE, EMBASE, Science Citation Index Expanded on Web of Science and relevant trial registries) for relevant randomised and non-randomised trials. Citations will be reviewed by title, abstract and full text by two independent reviewers and disagreement resolved by discussion and a third independent reviewer, if necessary. The Cochrane Risk of Bias tool will be used to assess risk of bias in randomised trials and the Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I) tool will be used for non-randomised studies. Statistical analysis will be carried out using R package meta and netmeta. We will first conduct a pairwise meta-analysis. If conditions for indirect comparison are satisfied and suitable data are available, we will conduct network meta-analysis using frequentist methodology. Treatments will be ranked according to efficacy with associated P-scores. We will assess the quality of the evidence in the pairwise using GRADE methodology and network meta-analysis comparisons in the CINeMA module in R package meta.

Discussion: Our review will be the first to assess direct and indirect evidence to assess the efficacy and rank the treatments available for new onset atrial fibrillation in critically unwell patients. Our review findings will be applicable to the care of people in a range of acute settings including, ICU, the emergency department and acute medical units.

Systematic Review Registration: PROSPERO registry number: CRD42019121739.
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http://dx.doi.org/10.1186/s13643-019-1149-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816145PMC
October 2019

Characteristics of patients with giant cell arteritis who experience visual symptoms.

Rheumatol Int 2019 Oct 22;39(10):1789-1796. Epub 2019 Aug 22.

School of Primary, Community and Social Care, Keele University, David Weatherall Building, Keele, ST5 5BG, UK.

Permanent vision loss is one of the most serious complications of giant cell arteritis (GCA) and therefore prompt diagnosis is paramount. However, diagnosis of GCA remains challenging due to its frequently non-specific presentation. Our aim was to identify differences in the characteristics of GCA patients with, and without, current visual symptoms. A cross-sectional survey was mailed to patients with a GCA Read code entered in their GP electronic medical record. Responders were categorised as those currently reporting a visual symptom or not. We compared general and GCA-specific characteristics in these two groups. The association of diagnostic delay with subsequent experience of visual symptoms was examined using unadjusted and adjusted linear regression analysis. 318 GCA patients responded to the survey (59.6%). Responders were predominantly female (69.8%), with a mean age of 73.7 years (SD 8.2). 28% reported current visual symptoms. There was no statistically significant difference in the general characteristics between those with and without visual symptoms. Of GCA-specific characteristics, pre-GCA diagnosis of diplopia (p = 0.018), temporary (p ≤ 0.001) or permanent visual problems (p = 0.001) and hoarseness (p = 0.004) were more common among those reporting current visual symptoms. There was no association between the extent of diagnostic delay and reporting of current visual symptoms. Though we found few characteristics to distinguish between GCA patients with or without current visual symptoms, diagnostic delay was not associated with current visual symptoms. Our findings highlighted the continued difficulty for clinicians to identify GCA patients at the highest risk of visual complications.
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http://dx.doi.org/10.1007/s00296-019-04422-5DOI Listing
October 2019

Comparative analysis of the Lang Stereopad in a non-clinic population.

Strabismus 2019 09 22;27(3):182-190. Epub 2019 Jul 22.

Department of Health Services Research, University of Liverpool , Liverpool.

: New methods of measurement require testing to evaluate test validity. This study compares stereoacuity results of the Lang Stereopad to other common clinical stereoacuity assessments in a normal vision population. : A prospective cross-sectional study was conducted comparing the Lang Stereopad stereoacuity results to results from the Lang II, Frisby, and TNO stereo tests. Mean stereoacuity values and their correlation with inter-ocular visual acuity difference were compared for each stereo test. : 98 subjects (mean age of 33.5 years, SD 14.1; 39 males and 59 females) with normal parameters of visual function underwent multiple stereotest assessments. Median stereoacuity values were the lowest (i.e. more detailed stereoacuity) when using the Frisby stereotest (median 40"; 20-170" [minimum-maximum]) and TNO stereotest (median 60"; 15-480"). In comparison, medians were about double at 100" (50-800") for the Lang Stereopad and greater at 200" (200-200") for the Lang II stereotest. There was no correlation for each stereotest with interocular visual acuity differences. : The Lang Stereopad test is easy to administer and it has certain advantages such as no requirement for additional test glasses. It is a useful assessment to add to the clinical armamentarium for binocular assessment of stereopsis. The Lang Stereopad does not agree well with other stereo tests such as the TNO and Frisby but provides a greater stereoacuity test range than the Lang II. The Lang Stereopad now requires testing in a clinical population in which stereoacuity is a pre-requisite part of the assessment.
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http://dx.doi.org/10.1080/09273972.2019.1643893DOI Listing
September 2019

Refractive outcomes following cataract surgery in patients who have had myopic laser vision correction.

BMJ Open Ophthalmol 2019 9;4(1):e000242. Epub 2019 Apr 9.

International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.

Objective: Prediction errors are increased among patients presenting for cataract surgery post laser vision correction (LVC) as biometric relationships are altered. We investigated the prediction errors of five formulae among these patients.

Methods And Analysis: The intended refractive error was calculated as a sphero-cylinder and as a spherical equivalent for analysis. For determining the difference between the intended and postoperative refractive error, data were transformed into components of Long's formalism, before changing into sphero-cylinder notation. These differences in refractive errors were compared between the five formulae and to that of a control group using a Kruskal-Wallis test. An F-test was used to compare the variances of the difference distributions.

Results: 22 eyes post LVC and 19 control eyes were included for analysis. Comparing both groups, there were significant differences in the postoperative refractive error (p=0.038). The differences between the intended and postoperative refractive error were greater in post LVC eyes than control eyes (p=0.012), irrespective of the calculation method for the intended refractive error (p<0.01). The mean difference between the intended and postoperative refractive error was relatively small, but its variance was significantly greater among post LVC eyes than control eyes (p<0.01). Among post LVC eyes, there were no significant differences between the mean intended target refraction and between the intended and postoperative refractive error using five biometry formulae (p=0.76).

Conclusion: Biometry calculations were less precise for patients who had LVC than patients without LVC. No particular biometry formula appears to be superior among patients post LVC.
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http://dx.doi.org/10.1136/bmjophth-2018-000242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528761PMC
April 2019

Current practice in the management of new-onset atrial fibrillation in critically ill patients: a UK-wide survey.

PeerJ 2017 8;5:e3716. Epub 2017 Sep 8.

Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.

Background: New-onset atrial fibrillation (AF) is the most common arrhythmia in critically ill patients. Although evidence base and expert consensus opinion for management have been summarised in several international guidelines, no specific considerations for critically ill patients have been included. We aimed to establish current practice of management of critically ill patients with new-onset AF.

Methods: We designed a short user-friendly online questionnaire. All members of the Intensive Care Society were invited via email containing a link to the questionnaire, which comprised 21 questions. The online survey was conducted between November 2016 and December 2016.

Results: The response rate was 397/3152 (12.6%). The majority of respondents (81.1%) worked in mixed Intensive Care Units and were consultants (71.8%). Most respondents (39.5%) would start intervention on patients with fast new-onset AF and stable blood pressure at a heart rate between 120 and 139 beats/min. However, 34.8% of participants would treat all patients who developed new-onset fast AF. Amiodarone and beta-blockers (80.9% and 11.6% of answers) were the most commonly used anti-arrhythmics. A total of 63.8% of respondents do not regularly anti-coagulate critically ill patients with new-onset fast AF, while 30.8% anti-coagulate within 72 hours. A total of 68.0% of survey respondents do not routinely use stroke risk scores in critically ill patients with new-onset AF. A total of 85.4% of participants would consider taking part in a clinical trial investigating treatment of new-onset fast AF in the critically ill.

Discussion: Our results suggest a considerable disparity between contemporary practice of management of new-onset AF in critical illness and treatment recommendations for the general patient population suffering from AF, particularly with regard to anti-arrhythmics and anti-coagulation used. Amongst intensivists, there is a substantial interest in research for management of new-onset AF in critically ill patients.
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http://dx.doi.org/10.7717/peerj.3716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592903PMC
September 2017

Accuracy and Efficiency of Recording Pediatric Early Warning Scores Using an Electronic Physiological Surveillance System Compared With Traditional Paper-Based Documentation.

Comput Inform Nurs 2017 May;35(5):228-236

Author Affiliations: Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust (Ms Sefton); and Institute of Translational Medicine (Dr Lane), and The Learning Clinic Ltd, 1 Sussex Place, London (Mr Killen); Faculty of Medicine, University of Liverpool, Liverpool (Mr Black, Mr Lyon, Ms Ampah, Ms Sproule, Mr Loren-Gosling, Ms Richards, Mr Spinty, Ms Holloway, Ms Davies, Ms Wilson, and Mr Chean); University of Central Lancashire, College of Health and Wellbeing, Preston, and Children's Nursing Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool (Ms Carter); and Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom (Dr Carrol).

Pediatric Early Warning Scores are advocated to assist health professionals to identify early signs of serious illness or deterioration in hospitalized children. Scores are derived from the weighting applied to recorded vital signs and clinical observations reflecting deviation from a predetermined "norm." Higher aggregate scores trigger an escalation in care aimed at preventing critical deterioration. Process errors made while recording these data, including plotting or calculation errors, have the potential to impede the reliability of the score. To test this hypothesis, we conducted a controlled study of documentation using five clinical vignettes. We measured the accuracy of vital sign recording, score calculation, and time taken to complete documentation using a handheld electronic physiological surveillance system, VitalPAC Pediatric, compared with traditional paper-based charts. We explored the user acceptability of both methods using a Web-based survey. Twenty-three staff participated in the controlled study. The electronic physiological surveillance system improved the accuracy of vital sign recording, 98.5% versus 85.6%, P < .02, Pediatric Early Warning Score calculation, 94.6% versus 55.7%, P < .02, and saved time, 68 versus 98 seconds, compared with paper-based documentation, P < .002. Twenty-nine staff completed the Web-based survey. They perceived that the electronic physiological surveillance system offered safety benefits by reducing human error while providing instant visibility of recorded data to the entire clinical team.
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http://dx.doi.org/10.1097/CIN.0000000000000305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708717PMC
May 2017

Acute complete uterine inversion after controlled cord traction of placenta following vaginal delivery: a case report.

Clin Case Rep 2016 Jul 10;4(7):699-702. Epub 2016 Jun 10.

Department of Obstetrics and Gynaecology Liverpool Women's NHS Foundation Trust Hospital Liverpool UK.

Early recognition and active management of the third stage of labor will reduce the risks associated with uterine inversion. All staff members in the maternal unit should be updated with Green-Top guidelines No. 52 and be appropriately trained in the PROMPT course to provide a standardized approach in obstetric emergencies.
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http://dx.doi.org/10.1002/ccr3.599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929810PMC
July 2016