Syfte: Syftet med den här studien var att se om det är någon skillnad mellan ögonen när man utför testen Phenol röd tråd (PRTT) och Schirmers test, och därefter se om det visar någon skillnad mellan de två tester när man diagnostiserar om torra ögon.

Metod: 30 personer deltog i studien. Innan mätningar fyllde försökpersoner i informationsamtycke och enkäten Ocular Surface Disease Index (OSDI). De undersöktes med PRTT först och därefter utfördes Schirmers test. PRTT utfördes på 20 sekunder, det börjades alltid med höger öga, torka upp nedre fornix med en bomullspinne och till sist mättes den fuktiga delen. Schirmers test utfördes på 5 minuter. Testet består av en pappersremsa som placeras över undre ögonlocket. Resultatet kan läsas av remsan direkt.

Resultat: Resultatet visar att det inte fanns någon skillnad mellan ögonen och ingen signifikant skillnad mellan olika metoder. Studien visar att det inte fanns samband mellan någon av de två tester och OSDI symtomenkät.

Slutsats: Slutsatsen av denna studie var att det inte fanns någon skillnad mellan höger respektiv vänster öga när metoder Schirmers test och phenol röd tråd test utfördes. För tydligare resultat av de två tester krävs större urvalsgrupp.

The clinical support system Electronic Expert Support (EES) is available at all pharmacies in Sweden to examine electronic prescriptions when dispensing to prevent drug-related problems (DRPs). DRPs are common, and result in patient suffering and substantial costs for society. The aim of this research was to study the use of EES for the pediatric population (ages 0-12 years), by describing what types of alerts are generated for potential DRPs, how they are handled, and how the use of EES has changed over time. Data on the number and categories of EES analyses, alerts, and resolved alerts were provided by the Swedish eHealth Agency. The study shows that the use of EES has increased. The most common type of alert for a potential DRP among pediatric patients was regarding high doses in children (30.3% of all alerts generated). The most common type of alert for a potential DRP that was resolved among pediatrics was therapy duplication (4.6% of the alerts were resolved). The most common reason for closing an alert was dialogue with patient for verification of the treatment (66.3% of all closed alerts). Knowledge of which type of alerts are the most common may contribute to increased prescriber awareness of important potential DRPs.

Background

Care transitions are high-risk processes, especially for people with complex or chronic illness. Discharge letters are an opportunity to provide written information to improve patients' self-management after discharge. The aim of this study is to determine the impact of discharge letter content on unplanned hospital readmissions and self-rated quality of care transitions among patients 60 years of age or older with chronic illness.

Methods

The study had a convergent mixed methods design. Patients with chronic obstructive pulmonary disease or congestive heart failure were recruited from two hospitals in Region Stockholm if they were living at home and Swedish-speaking. Patients with dementia or cognitive impairment, or a "do not resuscitate" statement in their medical record were excluded. Discharge letters from 136 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of "SAFE-D score". Bivariate correlations between SAFE-D score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between SAFE-D score and time to readmission.

Results

All discharge letters contained at least five of eleven key elements. In less than two per cent of the discharge letters, all eleven key elements were present. Neither SAFE-D score, nor single key elements correlated with 30-day or 90-day readmission rate. SAFE-D score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.

Conclusions

While written summaries play a role, they may not be sufficient on their own to ensure safe care transitions and effective self-care management post-discharge.

Trial registration

Clinical Trials. giv, NCT02823795, 01/09/2016.

Aim: To determine the impact of discharge letter content on unplanned hospital readmissions within 30 and 90 days, and to identify correlations between discharge letter content and quality of care transitions among patients with chronic illness.

Design: A convergent mixed methods design.

Methods: Discharge letters from 154 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of 'discharge letter score'. Bivariate correlations between discharge letter score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between discharge letter score and time to readmission.

Results: All discharge letters contained at least five of eleven key elements. In less than four percent, all eleven key elements were present. Neither discharge letter score nor single key elements correlated with 30-day or 90-day readmission rate. Discharge letter score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.

Conclusion: Discharge letter score is not correlated with either 30-day or 90-day readmission rate or with time to readmission at 90 days, when patient characteristics are adjusted for.

Implications for the profession and patient care: Written discharge summaries are not enough to facilitate safe care transitions and self-management after discharge. A person-centred approach, providing written and verbal information to patients, encouraging patient involvement soon after discharge, may be needed to avoid readmission.

Objective To explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations.

Setting Two primary care centres in southern Sweden.

Participants Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis.

Results Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further.

Conclusion Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.No data are available.

Syfte: Syftet med denna studie var att undersöka effekten av ljusstimulering med flimrande ljus på den retinala mikrovaskulära funktionen hos friska unga och äldre vuxna. Metod: 17 friska unga vuxna med en genomsnittsålder på 24 ± 4,2 år och 17 friska äldre vuxna med en genomsnittsålder på 57 ± 5,2 år deltog i studien. Optisk koherenstomografi angiografi (OCTA) användes för att mäta förändringar i mikrovaskulaturen i makula innan och efter exponering med flimrande ljus. Deltagarna iakttog en handhållen flimrande LED med 8 Hz frekvens i 5 ½ minuter.

Resultat: Signifikanta skillnader i kärldensitet och perfusion observerades mellan de två åldersgrupperna. Central kärldensitet (F(1,32)=6,173) p=0,0184, inre kärldensitet (F(1,32)=8,423) p < 0,05, och total kärldensitet (F(1,32)=13,29) p < 0,01 visade signifikanta skillnader. Likaså uppvisade central perfusion (F(1,32)=7,318) p= < 0,05, inre perfusion (F(1,32)=9,679) p= < 0,05, och total perfusion (F(1,32)=15,29) p= < 0,01 signifikanta skillnader. Dock fanns inga signifikanta skillnader mellan före och efter exponering för flimmer inom grupperna för central kärldensitet, inre kärldensitet, och total kärldensitet. På samma sätt visade central perfusion, inre perfusion, och total perfusion inga signifikanta skillnader.

Slutsats: Denna studie visade inte på att det fanns signifikanta effekter av ljusstimulering med flimmer på den retinala mikrovaskulaturen bland friska äldre och yngre vuxna. Däremot visade studien att det fanns ett samband mellan blodflödet på näthinnan och ålder. Med ökad ålder minskar kärldensiteten och perfusionen.

Carbapenem resistant Enterobacteriaceae (CRE) are a threat to public health globally, yet the role of the environment in the epidemiology of CRE remains elusive. Given that wild birds can acquire CRE, likely from foraging in anthropogenically impacted areas, and may aid in the maintenance and dissemination of CRE in the environment, a spatiotemporal comparison of isolates from different regions and timepoints may be useful for elucidating epidemiological information. Thus, we characterized the genomic diversity of CRE from fecal samples opportunistically collected from gulls (Larus spp.) inhabiting Alaska (USA), Chile, Spain, Turkey, and Ukraine and from black kites (Milvus migrans) sampled in Pakistan and assessed evidence for spatiotemporal patterns of dissemination. Within and among sampling locations, a high diversity of carbapenemases was found, including Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-beta-lactamase (NDM), oxacillinase (OXA), and Verona integron Metallo beta-lactamase (VIM). Although the majority of genomic comparisons among samples did not provide evidence for spatial dissemination, we did find strong evidence for dissemination among Alaska, Spain, and Turkey. We also found strong evidence for temporal dissemination among samples collected in Alaska and Pakistan, though the majority of CRE clones were transitory and were not repeatedly detected among locations where samples were collected longitudinally. Carbapenemase-producing hypervirulent K. pneumoniae was isolated from gulls in Spain and Ukraine and some isolates harbored antimicrobial resistance genes conferring resistance to up to 10 different antibiotic classes, including colistin. Our results are consistent with local acquisition of CRE by wild birds with spatial dissemination influenced by intermediary transmission routes, likely involving humans. Furthermore, our results support the premise that anthropogenicallyassociated wild birds may be good sentinels for understanding the burden of clinically-relevant antimicrobial resistance in the local human population.

Refractive surgery is an effective method for correcting visual refractive errors. The method has evolved quickly over the past decade.

The aim of this study was to examine what refractive surgery is in Sweden today. What complications exist and which methods are used, are described by making a presentation of the refractive surgery techniques FS-LASIK, LASEK, TransPRK and RLE. This was done by a survey to find out the various complications between different age groups.

A web-based survey was disseminated trough social media like Facebook, different forum sites and e-mail. The survey was also submitted to various eye clinics. The respondents were asked questions about their age, gender, the surgical method used and the complications after surgery.

The results of the survey showed that there is no difference in the complication rate between the different age groups. Complications only depend on the type of method used and the patient’s refractive errors.

BackgroundA growing body of evidence suggests that exposure to nature is beneficial for human health. However, the observed health effect of nature may be mediated by physical activity and that humans are physically active at a higher intensity outdoors compared to when they are physical active indoors.ObjectiveThis study examines the variation of heart rate and power output for a fixed rating of perceived exertion in a group of healthy older adults in three different environments representing three levels of exposure to nature.MethodsTo this randomized, 3-by-3 crossover design study, healthy older adults (≥65 years) were recruited from local gyms. All participants participated in three experimental conditions; indoors, simulated outdoors and outdoor environments, in a randomized order. The participants exercised for 20 minutes at an intensity equivalent to a rating of 11–13 on the Borg scale for perceived exertion (RPE). Measurements of heart rate, power output (Watt) and ratings of perceived exertion were taken at minutes 1 to 6 and at minute 20. To examine the effect of the environment on heart rate and power, linear mixed models were used.ResultsIn all, 48 participants (56% females) were included in the analysis. No significant main effects on the outcomes were observed for power output (p = 0.073, η2 = 0.04) or heart rate (p = 0.067, η2 = 0.04)ConclusionNo significant effect on the outcomes was observed. However, borderline significant outcomes for power output or heart rate outdoors in nature, along with previous studies in the field, indicates that such an effect cannot be completely ruled out, but any effect is likely to be small. Future research examining health benefits of the independent exposure to nature are encouraged to adjust for the dose of physical activity.

I denna rapport från framtiden kan vi visa redan nu, hur man i framtiden – utan nämnvärda svårigheter – lyckades utforma ett integrerat, koordinerat och mänskligt vårdsystem, baserat på kunskapsområdet geriatrik och anpassat för äldre personer med multipla, ofta komplexa, hälsoproblem. Det är påtagligt hur smidigt reformeringen kunde ske när man utgick från de enskilda äldre personerna i stället för från organisation, ekonomi och styrning.

Sverige ligger högst i en internationell jämförande studie om värdebaserad vård. Rapporten visar tydligt ambitionerna från ett flertal internationella organ att införa värdebaserad vård för styrningen av sjukvården globalt.

Jörgen Nordenström försöker få det till att vår kritik av värdebaserad vård egentligen handlar om att vi vill ha mer resurser. Han har helt missuppfattat oss, skriver 26 specialistläkare i en replik.

‘Undernutrition state’ (UNS) is an ominous condition, in particular when associated with chronic obstructive pulmonary disease (COPD). In this review we discuss pathophysiological mechanisms and how UNS is defined and diagnosed. It seems unlikely that COPD-patients with established UNS have similar potential of reversibility (treatability) upon nutrition interventions as patients at a risk of developing such a condition, i.e. patients with low energy/nutrient intake, since pathophysiological, biochemical and metabolic conditions may differ substantially.

We summarize the results of 7 of 17 published randomized controlled trials of nutritional supplementation in COPD-patients with defined UNS in the latest Cochrane review (2012). We thus excluded 10 of 17 trials included in review (2012), mostly because those studies also included patients with ’risk of’ UNS.

The seven included trials exhibit extensive heterogeneity for all studied variables. Most studies did not show beneficial effects of nutritional supplementation, although some reported minor increase in body weight and physical function of unclear clinical relevance.

In contrast to the Cochrane review we conclude that it is difficult to draw firm conclusions regarding the effect of nutritional supplements in patients with COPD and UNS. Improved knowledge in this area is of utmost importance and some factors which should be considered in future studies are suggested.

There is a need to better understand the peripheral optics of the human eye and their correction. Current eye models have some limitations to accurately predict the wavefront errors for the emmetropic eye over a wide field. The aim here was to develop an anatomically correct optical model of the human eye that closely reproduces the wavefront of an average Caucasian-only emmetropic eye across a wide visual field. Using an optical design program, a schematic eye was constructed based on ocular wavefront measurements of the right eyes of thirty healthy young emmetropic individuals over a wide visual field (from 40&#x00B0; nasal to 40&#x00B0; temporal and up to 20&#x00B0; inferior field). Anatomical parameters, asymmetries, and dispersion properties of the eye&#x2019;s different optical components were taken into account. A geometry-independent gradient index model was employed to better represent the crystalline lens. The RMS wavefront error, wavefront shapes, dominant Zernike coefficients, nasal-temporal asymmetries, and dispersion properties of the developed schematic eye closely matched the corresponding measured values across the visual field. The developed model can help in the design of wide-field ophthalmic instruments and is useful in the study and simulations of the peripheral optics of the human eye.

BackgroundMedication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient's medication use at home.AimIn preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients, and data collection to reduce medication discrepancies at discharge and improve medication adherence, and (2) to explore the outcomes of the interventions.MethodParticipants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed.ResultsOf 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores.ConclusionBased on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.

Syfte: Att mäta kontrastkänsligheten på en multifokal kontaktlins, med tre olika additioner för att se om kontrastkänsligheten ändras med olika additioner.

Metod: 19 personer deltog i studien. En Biofinity multifokal CD (center distance) kontaktlins valdes till studien. Testet gjordes med tre olika additioner, en låg addition på +1,00 D, en mellanaddition på +1,50 D och en hög addition på +2,00 D och även med en kontaktlins utan addition som också var Biofinity. Mätning av hög- och lågkontrastvisus 10 % gjordes med samtliga kontaktlinser.

Resultat: Medelvärdet för högkontrastvisus var -0,15 logMAR för linsen utan addition, och något högre dvs. sämre visus med addition. Alla olika styrkor på addition visade samma logMAR-värde med högkontrastvisus.

Medelvärdet för lågkontrastvisus 10 % var 0,23 logMAR för linsen utan addition och något högre dvs sämre visus med kontaktlinser med olika addition. Lågkontrastvisus påverkades mer av de olika additionerna än vad högkontrastvisus gjorde.

Slutsats: Det fanns en signifikant skillnad mellan de 4 olika linser på lågkontrastvisus. Ju högre addition linsen hade desto sämre blir lågkontrastvisus, men inte i mellan addition +1,50 D och +2,00 D. Med dessa två additioner +1,50 D och +2,00 D blev lågkontrastvisus nästan lika.

Purpose: The purpose of this study was to compare Digital Eye Strain DES-symptoms after reading on a printed hardcopy versus a smartphone. To understand if results obtained from earlier studies that have showed DES when reading in from computer also applies to smartphones.

Methods: 16 participants in the study were asked to read a Swedish book quietly for 20 minutes, either on a hardcopy or on a smartphone. The participants were told to use their normal working distance while reading from book or smartphone. They read the same book with the same textsize and font in both conditions. Directly after reading the participants completed a written questionnaire that consisted of ten questions about their level of ocular discomfort during the task.  

Results: This study showed significant differences in mean symptom scores between printed hardcopy and smartphone on three of the symptoms; blurred vision while viewing the text (p=0,016), eyestrain (0,023) and tired eyes (0,015). In all three cases the symptoms were higher during smartphone use. No significant differences were found between the other seven symptoms. There were a significant difference in reading distance, smartphone were held closer than the hardcopy.

Conclusion: This study shows that the symptoms after smartphone use is perceived as more severe than after reading on a hardcopy. The three symptoms that showed a significant difference were all higher after smartphone use.

Background The study addresses knowledge gaps in research regarding influences of routine health care delivery of physical activity on prescription (PAP). The aim was to investigate if patient and health care characteristics are associated with increased physical activity 1 year after prescription among patients offered counselor support in addition to health care professionals' prescription. The study was conducted in primary and secondary care in a Swedish health care region. Methods All PAP recipients during 1 year were invited (N = 1503) to participate in this observational prospective study. Data were collected from medical records and questionnaires (baseline and follow-up). Descriptive statistics and multiple logistic regression analysis were used. The outcome variable was increased physical activity after 1 year. Study variables were patient and health care characteristics. Results Three hundred and fifty-five patients with complete follow-up data were included. The mean age was 62 years (SD = 14; range, 18-90) and 68% were females. Almost half (47%) had increased physical activity 1 year after PAP. Multiple logistic regression analysis showed that increased physical activity at follow-up was positively associated with lower baseline activity, counselor use, and positive perception of support. Counselor users with low baseline activity had higher odds ratio for increased physical activity at follow-up than non-users (OR = 7.2, 95% CI = 2.2-23.5 vs. OR = 3.2, 95% CI = 1.4-7.5). Positive perception of support was associated with increased physical activity among counselor users but not among non-users. Conclusions An increase in physical activity after PAP was related to low baseline activity, positive perception of support, and use of counselor support after PAP. Qualified counseling support linked to PAP seems to be important for achieving increased physical activity among patients with lower baseline activity.

The effectiveness of counsellor support in addition to physical activity on prescription (PAP) from health care professionals has rarely been evaluated. This observational follow-up study investigated differences in physical activity levels and health-related quality of life (HRQoL) one year after PAP regarding patients' use of counsellor support in addition to PAP in routine care. The study was conducted in a Swedish health care region in which all patients receiving PAP from health care professionals were offered counsellor support. Data were collected from medical records and questionnaires (baseline and follow-up). Of the 400 study participants, 37% used counsellor support. The group of counsellor users attained a higher level of physical activity one year after receiving PAP compared to the group of non-users (p< 0.001). The level of physical activity was measured by a validated index (score 3-19) calculated from weekly everyday activity and exercise training. Comparison of the change in scores between baseline and follow-up showed a significant difference between the two groups, (p< 0.001). The median difference in the PAP + C group was 2.0 (interquartile range, 7.0) and 0.0. among non-users (interquartile range, 4.0). Significant differences in HRQoL were due to positive improvements among counsellor users, with the main improvement in general health. The conclusion is that patients using counsellor support after receiving PAP from health care professionals had higher physical activity and better HRQoL one year after compared with patients who did not use this support.

The aim of this study is to investigate the occurrence of pinguecula and pterygia among people who sought visual aid during a journey with the charity organisation Vision For All. Associations between these changes in the eye and UV-exposure, age and gender are also investigated, as well as if either pinguecula or pterygia is more common overall and if one of them is more common in any of the visited cities. 

The measurements were conducted during a journey with Vision For All in Kenya in April 2019. There were 160 participants in the study, out of them were 99 women and 61 were men. The participants were between 11–88 years old and the average age was 47.3 ± 13.5 years. An ophthalmoscope was used to examine pinguecula and pterygia. First the participant was asked to look straight ahead and then right and left so both the central, nasal and temporal conjunctiva and cornea could be examined. All the participants in the study had pinguecula and/or pterygia in one or both eyes. 

Pinguecula in both eyes was most common among the participants. Pinguecula was documented in 136 of the participants and pterygia in 42 participants. This means that 18 participants had both pinguecula and pterygia, either both changes in one eye or one in each one. Both pinguecula and pterygia was most commonly existing in the nasal part of the eye. Working outdoors was more common than working indoors in all of the cities visited. 

In this study no association between the changes and age could be found, because people without changes was not included in this study. Association between changes and gender and working indoors or outdoors could not be found. Pinguecula was more common when it was placed both in the nasal and temporal part of the eye and pterygia was more commonly placed in the nasal part of the eye. A significant difference between the changes in the cities visited could not be found. 

Background: There is an imbalance in the Swedish welfare sector due to demogra­phic changes. Elderly care is an area of welfare where digitization can create great opportunities by thinking and working in new ways in combination with using digital technology and e-health. However, to take advantage of the opportunities, adaptations need to be made within the elderly care. 

Aim: The purpose of the study is to describe managers' and employees' experiences of how adaptation to conditions such as vision, competence, incentives, resources, and action plan can promote change in a digital transformation of a municipality's elderly care. 

Method: A qualitative case study was conducted, including three fo­cus group interviews with managers and employees in elderly care in a small muni­cipality. The selection of informants was based on a generic purpose-driven selection and the focus group interviews were based on a semi-structured interview guide. The data were analyzed through qualitative directed content analysis with a deductive ap­proach based on the building blocks in Thylefors' change model.

Results: Managers' and employees' experiences of how adaptations to conditions can promote digital transformation in elderly care in a municipality are described, as well as managers' and employees' needs for support in the change. A total of ten subcate­gories were identified related to Thylefors' building blocks: vision, competence, in­centives, resources, and action plan. 

Conclusion: Managers' and employees' experiences of how adaptations can promote change in elderly care during digital transformation, in the municipality where the case study was conducted, show that vision, change management and digital compe­tence play a central role. Managers' and employees' experiences of support in the change process show the need for time regarding training, innovation and an action plan which should be included in systematic quality management. Managers’ and em­ployees’ experience similar needs for adaptations and support, which could indicate that the findings can be considered in a similar context of digital transformation in elderly care. Suggestions for future research include for example investigating how digital transformation in elderly care can promote sustainable leadership and emplo­yee empowerment skills.

Purpose: The purpose of this study was to investigate current practiceamongst optometrists in Sweden regarding evidence-based work toencourage compliance in their contact lens patients. Moreover, to highlightthe potential areas where the optometrists possibly could improve their workwithin the field of encouraging contact lens-related compliance.

Method: An online based survey was developed and shared with membersof the Swedish Optometrists’s Association, Optikerförbundet, and theFacebook-group ‘Optikforum’. The responses were compiled and analysed.Selected questions were scored, where the maximum score amounted to a“passing grade”, meaning that the participant always does what is requestedin the questionnaire, in accordance with the Quality Norm of vision care.

Result: The number of respondents was 196, of which 190 were included.108 of these worked independently, i.e. without delegation to other staff,during new fitting, return visits and annual control during contact lens fitting,and were therefore scored. 24% of the 108 received full points and wereconsidered to be working evidence-based to encourage contact lens-relatedcompliance. Areas where these 108 opticians scored the lowest, and thuscould improve their work to encourage contact lens-related compliance, wereinformative of: the importance of self-examination of the eyes, theimportance of the correct care routine if the patient wears make-up, how longthe contact lenses should be rubbed and the importance of contact lens rest.In the responses of all 190 included, it emerged that 4 out of 5 opticians inconnection with the annual check-up never or rarely ask their patients toshow how they clean their contact lenses, nor ask their patients to show howthey put in and take out their contact lenses.

Conclusion: All optometrists in this study were not always working in anevidence-based manner. This study showed that optometrists in Sweden’swork to encourage contact lens-related compliance can be improved, one ofthem being in terms of providing patient information. This can contribute toincreased compliance in this patient group, which in turn can reduce the riskof contact lens-related complications. Increasing the amount of extraeducation for the optometrists regarding contact lenses, could also improvetheir work in this regard.

Aim: The aim of this study was to compare the effect of multifocal and monofocal contact lenses in the accommodative response and contrast sensitivity in young emmetropic adults.

Method: The requirements to take part in the current study were no ocular pathology, healthy corneas, no refractive surgery and an acuity of at least 1.0 on the Snellen chart with a good binocular vision. Thirteen individuals participated in the study, 9 females and 4 males, with an mean age of 22.6 years (SD=3.4). In separated fittings, participants were fitted with: 1) multifocal lenses, centre-distance design and 0.00D (add +2.00D) (Coopervision Biofinity) and with 2) single vision  +2.00D (Coopervision Biofinity. Refraction was assessed 3 times in both eyes: with each fitting and also without any lens. A Metropsis system (CRS) was used to measure the contrast sensitivity and visual acuity.

Results: In this study we found statistically significant differences in accommodative response between the conditions non-lens and multifocal contact lens (p<0.05) and non-lens and monofocal lens (p<0.001). The difference between the multifocal lens and monofocal lens was not statistically significant. The results from the contrast measurement showed an increased contrast thresholds with the multifocal contact lens when compared with non-lens.

Conclusion: This study shows that the multifocal lens reduce only partially the accommodative response in young individuals. In addition multifocal contact lenses, fitted in emmetropic participants, reduced contrast sensitivity.

Aim: This pilot study aimed to compare a center distance design against a center near design for aspheric multifocal contact lenses and their performance regarding visual function in presbyopes

Method: 11 participants, between the age of 45-55, completed measurements in visual acuity for distance and near, stereoacuity for distance and near, contrast sensitivity and reading speed. These tests were performed three times, one time with spectacle correction, one time with a center distance contact lens design and a one time with a center near contact lens design in a randomized order. Regarding the tests with normally distributed data, a repeated measures ANOVA was conducted, and for the non-normally distributed data, a Friedman non parametric ANOVA was used.

Results: No statistical difference was found between the two lens designs in any of the tests regarding visual function or regarding visual acuity. A statistically significant difference was found (p<0,05) between spectacle correction and the two contact lenses regarding visual acuity for both distance and near, where a spectacle correction performed better.  

Conclusion: This study did not find any difference in the visual function in presbyopes between a center distance design and a center near design for aspheric multifocal contact lenses. 

Purpose: To compare segmented retinal layer thicknesses between male and female diabetics with clinically significant macular edema (CSME). This study expands our earlier analysis of central macular thickness (CMT) measurements in diabetic males vs. females. Methods: Diabetic retinopathy screening of 2080 diabetics from Alameda County, CA, indicated 142 patients with CSME, as judged by EyePACS certified graders using color fundus images (Canon CR6-45NM). Of the 2080 diabetics, 1784 were imaged with SD-OCT (Optovue iVue). From the 142 patients, we selected 11 males with good fixation, CMT > 300 µm, and no other ocular complications, along with 11 females with the greatest values of CMT while controlling for age, HbA1c and diabetes duration. Manual segmentation of retinal layers using custom software (Mathworks Matlab) of the SD-OCT images of these subjects was done. We analyzed thicknesses for regions 1 deg - 2 deg for nasal and temporal retina in a B-scan centered on the fovea. A 2 X 2 ANOVA probed the differences in thickness for gender, meridian, and their interaction. We also analyzed the central 1 mm of the outer retinal layers, and performed t-tests. Results: Males had significantly thicker nerve fiber layer (NFL) (13.30 ± 2.85 µm) than females (10.13 ± 6.13 µm) and ganglion cell layer-inner plexiform layer (GCL-IPL) (62.54 ± 21.18 µm) than females (48.07 ± 25.91 µm), p < 0.05. There was no effect of meridian and no interaction (p > 0.05). All other layers except the retinal pigment epithelium (RPE) were thicker for males than females even though these were not significant (p > 0.05). There were no significant differences for the layers of the outer retina, which were highly variable and distorted by cysts. Conclusion: Outside the fovea, NFL and GCL-IPL thicknesses were significantly higher in males than females.

SIGNIFICANCE The pathological changes in clinically significant diabetic macular edema lead to greater retinal thickening in men than in women. Therefore, male sex should be considered a potential risk factor for identifying individuals with the most severe pathological changes. Understanding this excessive retinal thickening in men may help preserve vision. PURPOSE The purpose of this study was to investigate the sex differences in retinal thickness in diabetic patients. We tested whether men with clinically significant macular edema had even greater central macular thickness than expected from sex differences without significant pathological changes. This study also aimed to determine which retinal layers contribute to abnormal retinal thickness. METHODS From 2047 underserved adult diabetic patients from Alameda County, CA, 142 patients with clinically significant macular edema were identified by EyePACS-certified graders using color fundus images (Canon CR6-45NM). First, central macular thickness from spectral domain optical coherence tomography (iVue; Optovue Inc.) was compared in 21 men versus 21 women without clinically significant macular edema. Then, a planned comparison contrasted the greater values of central macular thickness in men versus women with clinically significant macular edema as compared with those without. Mean retinal thickness and variability of central macular layers were compared in men versus women. RESULTS Men without clinically significant macular edema had a 12-μm greater central macular thickness than did women (245 ± 21.3 and 233 ± 13.4 μm, respectively; t40 = −2.18, P = .04). Men with clinically significant macular edema had a 67-μm greater central macular thickness than did women (383 ± 48.7 and 316 ± 60.4 μm, P < .001); that is, men had 55 μm or more than five times more (t20 = 2.35, P = .02). In men, the outer-nuclear-layer thickness was more variable, F10,10 = 9.34. CONCLUSIONS Underserved diabetic men had thicker retinas than did women, exacerbated by clinically significant macular edema.

Introduction

Cornea is the medium with the highest power of refraction in the eye. This means that small differences in the curvature affects the refractive power which can lead to corneal astigmatism. Measuring of corneal astigmatism is essential in some cases for finding the correct prescription and treatment of corneal dystrophies.

Purpose

The purpose of this study was to examine the repeatability and comparability of Essilor WAM700+, Topcon TRK-2P and CSO/BON Sirius when it comes to corneal astigmatism.

Methods

This quantitative, cross-sectional study’s only exclusion criteria was that the participants did not have any known pathological eye conditions. At least three measurements were made per participant per machine according to a protocol.

Results

The majority of the 64 patients in the study were <50 years of age. In total 122 eyes were used in analysis after the exclusion of cases with incomplete data. No significant difference was found for either the J180 or the power scalar component, whereas the J45-compontent showed a significant difference. The ICC-values for all data groups were calculated to >0,90 which means the repeatability is good. The CR for P in all instruments was calculated to ~0,50DC. 

Conclusion

The results of this study shows that, in healthy eyes, more than one measurement is necessary in measuring corneal astigmatism. The differences found between the instruments are only clinically significant for oblique astigmatism. 

Purpose: The purpose of this study was to evaluate whether Spontaneous Eye Blink Rate (SEBR) differ when reading on hard copy, tablet or smartphone. Complete and incomplete blinks were also evaluated to see if there were any differences regarding the hard copy, tablet and smartphone. 

Methods: The participants read three different texts on hard copy, tablet and smartphone while they were being filmed. Afterwards, each video was analysed twice in order to count complete blinks, incomplete blinks and total blink rate (SEBR).

Results: This study showed that there is a significant difference in total blink rate between reading on hard copy and tablet (p=0.03), where blinks/minute decreased by 14.9% for the hard copy condition. There was also a significant difference in incomplete blinks regarding the two devices (p=0.02), where incomplete blinks increased by 30.0% when reading on tablet. Tablet and smartphone reading also resulted in a significant difference, where incomplete blinks increased  by 42% when reading on tablet (p=0.01).

Conclusion: Spontaneous Eye Blink Rate differ when reading on hard copy and tablet. Incomplete blinks increase when reading on tablet. No significant differences are found between hard copy and smartphone.

Background: Polypharmacy implies that the patient uses several drugs at the same time. This is an issue among the elderly population. This issue is associated with different risks such as: increased risk of falling injuries, side effects and hospitalization. All these indicate the need to facilitate clinical decision making with the aim to reduce prescription of inappropriate drugs, avoidance of medication errors and support the use of evidence-based medicine. There is also a lack of support and guidelines for drug withdrawal. Such withdrawal of drugs requires time, knowledge and care.

Aim: The study objective is to examine the need for developing an electronic clinic decision support system for drug withdrawal. Furthermore, this study aims to examine the obstacles of drug withdrawal and the requirements of developing such a decision support system. To that end, two aims have been defined. The first aim is to examine the potential user’s demands of an electronic clinical decision support system for drug withdrawal, and the second is to examine how the potential knowledge database should be structured.

Method: This qualitative study consists of semi-structured interviews with doctors and pharmacists. A qualitative content analysis was performed as a method for processing of the empirical data which was collected through a targeted selection.

Results: The results indicate that there is a need to develop a clinical decision support system for drug withdrawal. There’s little, if any, guidelines or resources to further pursue drug withdrawal studies. The structure and usability of database in clinical practice need to be ensured from the outset.

Conclusion: This study provides several aspects on the difficulty of withdrawing medicines. Doctors need fast, simple and up-to-date information, filtered, summarized and synthesized from reliable sources. The information is preferably integrated into pre-existing medical record systems. Therefore, a need-based assessment analysis should be conducted early in the developmental process.  This is to ensure the expected benefits of an electronic clinical decision support system.