Toward reducing shunt placement rates in patients with myelomeningocele

2008 ◽  
Vol 1 (5) ◽  
pp. 361-365 ◽  
Author(s):  
Aabir Chakraborty ◽  
Darach Crimmins ◽  
Richard Hayward ◽  
Dominic Thompson
Keyword(s):  
Primary Closure ◽  
Inclusion Criteria ◽  
Ventricular Dilation ◽  
Shunt Insertion ◽  
Shunt Placement ◽  
Reduced Rate ◽  
Clinical Records ◽  
Time Of Presentation ◽  
Previous Series

Object The prevalence of shunt-dependent hydrocephalus in patients with myelomeningocele has been reported to be in the region of 85%, and shunt-related complications are a significant cause of morbidity and mortality in these patients. Since 1997 the authors have adopted a stringent policy with respect to shunt placement in patients with myelomeningocele, reserving this treatment for those with symptomatic hydrocephalus, severe ventricular dilation at the time of presentation, and/or unequivocal progressive ventriculomegaly after primary closure. They report their experience. Methods The authors reviewed all cases of myelomeningocele involving patients who presented to their institution over a 10-year period. They excluded cases in which the primary closure was carried out at another institution or in which there was not at least 12 months of clinical and imaging follow-up. Data regarding shunt insertion shunt-related complications, and clinical outcome were obtained from a review of the clinical records and analyzed. Results Fifty-four cases satisfied the inclusion criteria for this study. Shunt insertion was performed in 28 of these cases (51.9%). Conclusions Applying more stringent guidelines for shunt placement, permitting moderate ventricular dilation, and accepting some mild increase in ventricular size after myelomeningocele closure has resulted in a reduced rate of shunt placement compared with previous series. The rate is comparable to that reported following in utero closure of myelomeningocele.

Transventricular, transaqueductal scope-in-scope endoscopic excision of fourth ventricular neurocysticercosis: a series of 13 cases and a review

2008 ◽  
Vol 1 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Ashish Suri ◽  
Rohit Kumar Goel ◽  
Faiz Uddin Ahmad ◽  
Ananth Kesav Vellimana ◽  
Bhawani Shankar Sharma ◽  
...  
Keyword(s):  
English Language ◽  
Third Ventriculostomy ◽  
Cyst Excision ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
The Central Nervous System ◽  
The Mean ◽  
Clinical Records ◽  
Ventricle Size

Object Neurocysticercosis (NCC) is the most common parasitic infestation of the central nervous system worldwide. In patients presenting with acute hydrocephalus due to intraventricular NCC, surgery is the only option. Still, there is no consensus regarding the optimal surgical strategy, although neuroendoscopic excision is a promising method. However, the literature regarding the use of this modality in fourth ventricular NCC is scarce. The authors describe a series of patients with fourth ventricular NCC treated endoscopically. Methods The clinical records of 13 patients with fourth ventricular NCC who had presented with hydrocephalus were retrospectively analyzed. A fourth ventricular cyst was completely excised in all patients by using a transventricular, transaqueductal “scope-in-scope” endoscopic technique. Twelve endoscopic third ventriculostomies and 1 septostomy had been performed. Results Shunt placement was avoided in all patients. There were minimal peri- and postoperative complications. The mean duration of follow-up was 22.3 months (range 3–41 months). All patients had an improved clinical outcome. Follow-up neuroimaging revealed no residual lesion and a decreased ventricle size in all patients. Conclusions The present series of patients with fourth ventricular NCC is the largest in the existing English-language medical literature. Endoscopic fourth ventricular cysticercal cyst excision along with internal cerebrospinal fluid diversion via endoscopic third ventriculostomy is an effective alternative to open microneurosurgical procedures and avoids shunt placement and its related complications.

Use of Intraoperative Negative Margins Reduces Inverted Papilloma Recurrence

2018 ◽  
Vol 32 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Amar Miglani ◽  
Joseph M. Hoxworth ◽  
Matthew A. Zarka ◽  
Devyani Lal
Keyword(s):  
Frozen Section ◽  
Standard Of Care ◽  
Inverted Papilloma ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Predictive Values ◽  
Endoscopic Techniques ◽  
Time Of Presentation ◽  
Very High

Background Recurrence of inverted papilloma (IP) is a problem in 12–17% of tumors. Controversy exists regarding benefits of intraoperative frozen section histopathology (IFSH) for IP resection; however, to our knowledge, no study has specifically investigated this. IFSH for IP resection is the standard of care in our practice. We, therefore, reviewed our outcomes of using IFSH for IP resection. A secondary goal was to assess the reliability of IFSH. Methods Patients with IP who underwent surgical resection (2010–2016) with minimum 9–month follow-up were included. Results Twenty-two adults with IP met inclusion criteria. All underwent surgery via endoscopic techniques, supplemented by external ports in five patients. At the time of presentation, 36% IPs were recurrent tumors; 68% were graded as Krouse stage 3. Resection was conducted until “clear” (negative) mucosal margins were achieved on IFSH. In 6 (27%), a “positive” IFSH result dictated additional resection to clear margins. Final negative margins were achieved in all the patients. Both positive and negative predictive values for IFSH were 100% (concordance with final pathology results). Surveillance was performed every 1–6 months with nasal endoscopy by using imaging when necessary. No recurrences were noted (0%) at mean follow-up of 40 months (range, 10 -73 months). Conclusions Positive IFSH results led to increased resection in 27% of the patients, with a 0% recurrence rate in this cohort. The reliability of IFSH for IP is very high. No recurrence of IP was noted in any patient at a mean follow-up of 3.3 years. IFSH may help reduce recurrence rates of IP, but additional studies with longer follow-up are warranted.

scholarly journals Therapeutic Plasma Exchange (PLEX) in Thrombotic Microangiopathy (TMA): Experiences of an Inner-City Hospital over a Decade

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3691-3691
Author(s):  
Aakash Putta ◽  
Hafeez Shaka ◽  
Shristi Upadhyay Banskota ◽  
Sunny R K Singh ◽  
Sindhu Malapati ◽  
...  
Keyword(s):  
Inner City ◽  
Validation Studies ◽  
Patient Population ◽  
Final Diagnosis ◽  
Safety Net ◽  
Inclusion Criteria ◽  
Safety Net Hospital ◽  
Study Population ◽  
Time Of Presentation

Introduction: There are multiple mechanisms of occurrence of TMA. Some of the etiologies are associated with high morbidity and mortality, but there are very subtle differences in presentation. A high index of suspicion is recommended for thrombotic thrombocytopenic purpura (TTP) due to the time sensitive nature of treatment initiation and poor outcomes associated with delay in treatment. Due to this, treatment with PLEX is often initiated empirically before diagnostic test results are available. We aim to report the management and outcomes of TMA along with the predictive value of the PLASMIC score in our patient population, over a 10-year period in an inner-city safety net hospital. Methods: This is a single center observational study including patients who underwent PLEX for a diagnosis of TMA, due to concern for TTP between January 2009 and May 2019 at an inner-city safety net hospital. Patients were identified from blood bank records and data was collected by review of electronic medical record. We excluded patients <18 years old and who received PLEX for indications other than that described previously. Data was collected until death or last follow-up. Statistical analysis was done using STATA. Results: A total of 40 patients met the inclusion criteria. Of these, 57.5% (n=23) were male, 17.5% (n=7) had a known malignancy and 15% (n=6) had human immunodeficiency virus infection. Study population was predominantly African American and Hispanic- comprising 75% (n=30) and 17.5% respectively- which differentiates our study from other validation studies for the PLASMIC score. Symptoms at presentation to emergency department, time to initiation of PLEX from presentation, and lab parameters before and after PLEX are shown in the attached table. ADAMTS13 activity level is available in 65% (n=26) patients, 57.7% of which were sent before initiation of PLEX. Average number of PLEX sessions during the admission was 9.4 (range: 2-30). As part of treatment, 85% (n=34) received steroids and 17.5% (n=7) received hemodialysis. 5 patients received rituximab and 2 received eculizumab. Final diagnoses included TTP in 62.5% (n=25), complement mediated TMA in 5% (n=2), drug induced TMA in 10% (n=4), TMA from sepsis or rheumatological condition in 15% (n=6), bone marrow suppression due to chemotherapy in 5% (n=2) and unsure in 2.5% (n=1). Average length of stay was 22.2 days (range: 6-85 days). Of the total 40 patients, 7.5% (n=3) died on the same admission, 10% (n=4) died after discharge and 3 were readmitted for repeat PLEX. Duration of follow-up after discharge ranged from 9 to 3319 days (mean 1102.6 days). We retrospectively estimated the PLASMIC score at the time of presentation for all the patients. Amongst the patients eventually diagnosed with TTP, 50% had a PLASMIC score of >5 and 70.83% had a score ≥5 at the time of presentation. Among non-TTP TMA, 25% had a score of >5 and 62.5% had a score ≥5. The sensitivity, specificity and positive predictive value of PLASMIC score for prediction of final diagnosis of TTP was calculated for all patients who met inclusion criteria and is shown in the attached table. Of those who underwent PLEX in the setting of TMA for the concern of TTP, only about a third were started on PLEX within 24 hours. Conclusion:Among our study population, only about a third were started on PLEX within 24 hours which is concerning and highlights the need for quality improvement initiatives to increase provider awareness and decrease time to PLEX. Final diagnosis of TTP was made in 62.5% of the patients but notably, the performance of PLASMIC score in our patient population was inferior compared to prior validation studies. One possible explanation for this could be the difference in baseline patient demographics, with our patients belonging mostly to minority groups. There is a need for further studies with derivation and validation cohorts in this patient population to derive a scoring system that is more predictive. Table Disclosures No relevant conflicts of interest to declare.

scholarly journals Clinical and Radiological Predictors of Ventriculoperitoneal Shunt Insertion in Myelomeningocele Patients

2021 ◽  
Vol 9 (B) ◽  
pp. 522-532
Author(s):  
Ahmed M. F. El Ghoul ◽  
Ahmed Hamdy Ashry ◽  
Mohamed Hamdy El-Sissy ◽  
Ibrahim Mohamed Ibrahim Lotfy
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Repair ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Group A ◽  
Study Population ◽  
Group B ◽  
Increased Icp

BACKGROUND: Myelomeningocele (MMC) is one of the most common developmental anomalies of the CNS. Many of these patients develop hydrocephalus (HCP). The rate of cerebrospinal fluid diversion in these patients varies significantly in literature, from 52% to 92%. MMC repair conventionally occurs in the post-natal period. With the technological advances in surgical practice and fetal surgeries, intra uterine MMC repair IUMR is adopted in some centers. Cerebrospinal fluid shunting has numerous complications, most notably shunt failure and shunt infection. Studies have suggested that patients with greater numbers of shunt revisions have poorer performance on neuropsychological testing. There is also good evidence to suggest that the IQs of patients with MMC who do not undergo shunt placement are higher than that of their shunt treated counterparts. AIM: In this study, we are trying to identify strong clinical and radiological predictors for the need of ventriculoperitoneal (VP) shunt insertion in patients with MMC who underwent surgical repair and closure of the defect initially. This will decrease the overall rate of shunt placement in this group of patients through applying a strict policy adopting only shunt insertion for the desperately needing patient. METHODS: Prospective clinical study conducted on 96 patients with MMC presented to Aboul Reish Pediatric Specialized Hospital, Cairo University. After confirming the diagnosis through clinical and radiological aids, patients are carefully examined, if HCP is evident clinically and radiologically a shunt is inserted together with MMC repair at the same session after excluding sepsis or cerebrospinal fluid (CSF) infection, (GROUP A). If there are no signs of increased ICP, MMC repair shall be done alone (GROUP B). Those patients shall be monitored carefully postoperatively and after discharge and shall be followed up regularly to early detect and promptly manage latent HCP. Multiple clinical and radiological indices were used throughout the follow-up period and statistical significance of each was measured. RESULTS: Shunt placement was required in 45 (46.88%) of the 96 patients. Eighteen patients (18.75%) needed the shunt as soon as they presented to us (GROUP A), because they were having clinically active HCP. Twenty-seven (28.13%) patients were operated on by MMC repair initially without shunt placement because they did not have signs of increased ICP at the time of presentation. Yet, they developed latent HCP requiring shunt placement during the follow-up period (GROUP B2). Fifty-one patients of the study population (53.13%) underwent surgical repair of the MMC without the need of further VP insertion and they were followed up for 6 months period after the repair without developing latent HCP (GROUP B1). Patients of GROUP B were the study population susceptible for the development of latent HCP. Out of 78 patients in GROUP B, only 27 patients (34.62%) needed a VP shunt. CONCLUSION: In our study, we found that the rate of shunt insertion in patients with MMC is lower than the previously reported rate in the literature. A more thorough evaluation of the patient’s post-operative need for a shunt is mandatory. We suggest that we could accept postoperative (after MMC repair) ventriculomegaly provided it does not mean any deterioration in the patient’s clinical or developmental state. We assume that reduction of shunt insertion rate will eventually reduce what has previously been an enormous burden for a significant proportion of children with MMC.

Melanoma of the External Ear

1997 ◽  
Vol 83 (5) ◽  
pp. 814-817 ◽  
Author(s):  
Aldo Bono ◽  
Cesare Bartoli ◽  
Andrea Maurichi ◽  
Daniele Moglia ◽  
Gabrina Tragni
Keyword(s):  
Local Recurrence ◽  
Primary Closure ◽  
Wedge Resection ◽  
Tumor Thickness ◽  
Safe Procedure ◽  
External Ear ◽  
Partial Amputation ◽  
Clinical Records ◽  
And Cartilage

Aims and background Melanoma of the external ear is a rare disease, and its management is controversial. To address this problem, we reviewed the data concerning the patients observed at our Institution. Methods We retrospectively reviewed the clinical records of the 20 patients bearing primary ear melanoma observed over a period of about 20 years at the Istituto Nazionale Tumori of Milan. Results Initial evaluation of the patients revealed 7 stage I, 12 stage II and 1 stage III. The thickness of the tumors varied from 0.39 to 6.62 mm. Fourteen patients underwent a wedge resection of the skin and cartilage with primary closure, and 6 patients had a partial amputation of the ear. In 8 cases the section was performed at about 1 cm from the border of the tumor, in 6 cases at about 0.5 cm, and in 6 cases at more than 1 cm. The average follow-up was 57 months (range, 1-18 years). Since there was no local recurrence, it could not be related to type and extent of the local resection performed. In contrast, the development of metastases was related to tumor thickness. Conclusions A conservative excision with margins of 1 cm can be a safe procedure for invasive ear melanoma, irrespective of tumor thickness. Like melanomas of other sites, the prognosis is linked to the thickness of the tumor.

Effect of long-term rigid gas-permeable contact lens wear on keratoconus progression

2020 ◽  
pp. bjophthalmol-2020-315942
Author(s):  
Satoko Araki ◽  
Shizuka Koh ◽  
Daijiro Kabata ◽  
Ryota Inoue ◽  
Daichi Morii ◽  
...  
Keyword(s):  
Contact Lens ◽  
Linear Regression Analysis ◽  
Corneal Thickness ◽  
Radius Of Curvature ◽  
Inclusion Criteria ◽  
Contact Lens Wear ◽  
Chronological Change ◽  
Clinical Records

Background/aimsTo investigate the chronological corneal changes associated with long-term rigid gas-permeable contact lens (RGP-CL) wear in patients with keratoconus (KC).MethodsClinical records of 405 patients with KC or with KC suspect were retrospectively reviewed. Patients with mild-to-moderate KC and uneventful follow-up were classified into the CL (RGP-CL wear) and non-CL (without CL wear) groups. Inclusion criteria were (1) at least 3-year follow-up and (2) Scheimpflug-based corneal imaging examination at each visit. The anterior (ARC) and posterior (PRC) radius of curvature obtained in a 3.0 mm optical zone, the thinnest pachymetry reading of the corneal thickness (Tmin), and maximum keratometry values (Kmax) were investigated as tomographic parameters.ResultsTwenty-two and 15 patients who met the inclusion criteria were included in the CL and non-CL groups, respectively (31 and 20 eyes, respectively). The mean observation periods were 75 (CL group) and 63 (non-CL group) months. A multivariable non-linear regression analysis to assess the change in tomographic parameters over the follow-up period and difference of the trend between the two groups demonstrated no significant differences in the chronological change in ARC, PRC and Tmin between the CL and non-CL groups (p=0.318, p=0.280 and p=0.874, respectively).ConclusionBased on corneal tomographic evaluation over 5–6 years, the effects of long-term RGP-CL wear had no effect on KC progression.

Safety and Efficacy of Gamma Knife Radiosurgery for the Management of Koos Grade 4 Vestibular Schwannomas

Neurosurgery ◽  
2015 ◽  
Vol 78 (4) ◽  
pp. 521-530 ◽  
Author(s):  
Christian Iorio-Morin ◽  
Fahd AlSubaie ◽  
David Mathieu
Keyword(s):  
Gamma Knife ◽  
Tumor Size ◽  
Gamma Knife Radiosurgery ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Inclusion Criteria ◽  
Shunt Insertion ◽  
Safety And Efficacy ◽  
Nerve Preservation

Abstract BACKGROUND: Gamma Knife radiosurgery (GKRS) is commonly used in treating small vestibular schwannomas; however, its use for larger vestibular schwannomas is still controversial. OBJECTIVE: To assess the long-term safety and efficacy of treating eligible Koos grade 4 vestibular schwannomas with GKRS. METHODS: We conducted a single-center, retrospective evaluation of patient undergoing GKRS for Koos grade 4 vestibular schwannomas. We evaluated clinical, imaging, and treatment characteristics and assessed treatment outcome. Inclusion criteria were tumor size of ≥4 cm3 and follow-up of at least 6 months. Patients with neurofibromatosis type 2 were excluded. Primary outcomes measured were tumor control rate, hearing and facial function preservation rate, and complications. All possible factors were analyzed to assess clinical significance. RESULTS: Sixty-eight patients met inclusion criteria. Median follow-up was 47 months (range, 6-125 months). Baseline hearing was serviceable in 60%. Median tumor volume at radiosurgery was 7.4 cm3 (range, 4-19 cm3). The median marginal dose used was 12 Gy at the 50% isodose line. Actuarial tumor control rates were 95% and 92% at 2 and 10 years, respectively. Actuarial serviceable hearing preservation rates were 89% and 49% at 2 and 5 years, respectively. Facial nerve preservation was 100%. Clinical complications included balance disturbance (11%), facial pain (10%), facial numbness (5%), and tinnitus (10%). Most complications were mild and transient. Hydrocephalus occurred in 3 patients, requiring ventriculoperitoneal shunt insertion. Larger tumor size was significantly associated with persisting symptoms post-treatment. CONCLUSION: Patients with Koos grade 4 vestibular schwannomas and minimal symptoms can be treated safely and effectively with GKRS.

scholarly journals “Law of Temporary Diminishing Distraction Gains”: The Phenomenon of Temporary Diminished Distraction Lengths With Magnetically Controlled Growing Rods That Is Reverted With Rod Exchange

2020 ◽  
pp. 219256822094847
Author(s):  
Jason Pui Yin Cheung ◽  
Cora Bow ◽  
Kenneth M. C. Cheung
Keyword(s):  
Inclusion Criteria ◽  
Gradual Reduction ◽  
Growing Rods ◽  
The Mean ◽  
Reduced Rate ◽  
Magnetically Controlled Growing Rods ◽  
Magnetically Controlled Growing Rod ◽  
Relationship Of ◽  
The Relationship

Study Design: Prospective study. Objectives: To study the increasing divergence between targeted and achieved distractions observed with magnetically controlled growing rod (MCGR)lengthening, and the relationship of this reduced rate of achieved lengthening with remaining rod length. Methods: Patients with early onset scoliosis (EOS) who underwent MCGRs with minimum 2-year follow-up were consecutively enrolled. Targeted and achieved lengths were compared. Correlation between percentage of lengthening achieved from targeted length was identified with the timing of rod exchanges. Results: A total of 20 patients fulfilled the inclusion criteria. The mean age at index surgery was 9.5 years and mean postoperative follow-up was 68 ± 28 months. Of these, 8 patients had at least one rod exchange that occurred at 23 ± 4 months. A decrease in rate of achieved lengthening was observed when compared with targeted distractions. The achieved lengthening drops from 86% of targeted length at the first distraction to only 58.8% at the 21st distraction episode for the first set of rods. After rod exchange, the average achieved lengthening went back up to 81.3% of the targeted length but subsequently had a gradual reduction to 35% at the 19th distraction episode. Conclusions: We propose a “law of temporary diminishing distraction gains” that MCGR users should be aware of when monitoring rod lengthening. Diminishing distraction length gains is observed as the rod is lengthened and is a phenomenon independent of patient factors. It is only temporary as the rates of achieved lengthening returns to baseline after rod exchange.

scholarly journals 527. Project “Isolation Zero”: Discontinuing Contact Precautions for Patients Colonized/Infected with Multidrug-Resistant Organisms through Community-Level Follow-Up in Spain

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S253-S254
Author(s):  
Olaia Pérez Martínez ◽  
Alba Rapela Freire ◽  
Mª José Pereira Rodríguez
Keyword(s):  
Multidrug Resistant ◽  
Unintended Consequences ◽  
Community Level ◽  
Inclusion Criteria ◽  
Contact Precautions ◽  
Microbiological Culture ◽  
Multidrug Resistant Organisms ◽  
Clinical Records ◽  
And Control

Abstract Background In an effort to prevent and control the spread of multidrug-resistant organisms (MDROs), hospitals implement contact precautions (CP) for patients colonized/infected with MDROs. All agencies related to the prevention and control of infections recommend this practice, but they also recognize that is not exempt from unintended consequences. In 2017, SHEA published an expert guideline where they provide recommendations for discontinuation of CP. Currently, the most accepted recommendation is to perform at least one microbiological culture prior to discontinuing CP. The main objective of this project is to implement and evaluate a novel community -level approach to safely discontinue CP in patients with a history of colonization/infection with an MDRO. Methods The “Isolation Zero” project (IZ) was rolled out in November 2018 in the healthcare area of A Coruña, Spain. All clinical records of patients included in the MDROs alert system between 2005–2012 in A Coruña were reviewed. Patients included in the study were those who reside in the healthcare area of A Coruña and did not have any positive microbiological culture for MDROs in the last 2 years (Figure 1). Those who met the inclusion criteria were sent a letter suggesting that they obtain a nurse consultation in the next 2 months and that they provide specific MDRO cultures (Figure 2). Finally, the Department of Preventive Medicine (PM) reviewed all the results and identified patients for which CP could be safely discontinued in future hospitalizations. Results A total of 792 clinical records were reviewed (Table 1). 184 patients met the inclusion criteria. The response rate was 60.3% (111 patients). The most frequent MDRO tested was MRSA (84.8%), followed by MDR Acinetobacter (7.6%). CP were withdrawn for a total of 83 patients, while 15 patients continued to test positive (Table 2). Conclusion These results suggest that even after more than 2 years without a positive result, 13,5% of patients remain positive for MDROs. Therefore, in order to safely minimize the use of CP, we conclude that an approach similar to that used in IZ is a good option for PM Departments. Follow-up at the community -level can help reduce the number of hospital isolations required and can help improve the overall quality of care. Disclosures All authors: No reported disclosures.

scholarly journals Clinical safety of a minor eye conditions scheme in England delivered by community optometrists

2018 ◽  
Vol 3 (1) ◽  
pp. e000125 ◽  
Author(s):  
Evgenia Konstantakopoulou ◽  
Robert A Harper ◽  
David F Edgar ◽  
Genevieve Larkin ◽  
Sarah Janikoun ◽  
...  
Keyword(s):  
General Practitioners ◽  
Clinical Management ◽  
Training Programme ◽  
Good Position ◽  
Inclusion Criteria ◽  
Clinical Safety ◽  
Clinical Records ◽  
A Minor

ObjectiveThe aim of this study was to monitor the activity and evaluate the clinical safety of a minor eye conditions scheme (MECS) conducted by accredited community optometrists in Lambeth and Lewisham, London.Methods and analysisOptometrists underwent an accredited training programme, including attendance at hospital eye services (HES) clinics. Patients who satisfied certain inclusion criteria were referred to accredited MECS optometrists by their general practitioners (GPs) or could self-refer. Data were extracted from clinical records. A sample of MECS clinical records was graded to assess the quality of the MECS optometrists’ clinical management decisions. Referrals to the HES were assessed by the collaborating ophthalmologists and feedback was provided.ResultsA total of 2123 patients (mean age 47 years) were seen over 12 months. Two-thirds of the patients (67.3%) were referred by their GP. The most common reasons for patients needing a MECS assessment were ‘red eye’ (36.7% of patients), ‘painful white eye’ (11.1%), ‘flashes and floaters’ (10.2%); 8.7% of patients had a follow-up appointment. Of the patients seen, 75.1% were retained in the community, 5.7% were referred to their GP and 18.9% were referred to the HES. Of the HES referrals, 49.1% were routine, 22.6% urgent and 28.3% emergency. Of the records reviewed, 94.5% were rated as appropriately managed; 89.2% of the HES referrals were considered appropriate.ConclusionThe findings of this study indicate that optometrists are in a good position to work very safely within the remits of the scheme and to assess risk.

Sign in / Sign up

Export Citation Format

Share Document