A cross-over, randomised feasibility study of digitally-printed versus hand-painted artificial eyes in adults: PERSONAL-EYE-S.

BACKGROUND/OBJECTIVES: Over 60,000 patients in the United Kingdom are estimated to have artificial eyes. Manufacturing and hand-painting of artificial eyes have not changed significantly since 1948. Delays and colour-matching issues may severely impact a patient's rehabilitation pathway. Technology advances mean alternatives are now possible. This cross-over, randomised feasibility trial aimed to determine the feasibility of conducting a full-scale trial of the effectiveness and cost-effectiveness of digitally-printed artificial eyes compared to hand-painted. SUBJECTS/METHODS: Patients aged ≥18 years who were longstanding artificial eye users requiring a replacement were randomised to receive either a hand-painted or digitally-printed eye first followed by the other type of eye. Participants were asked to approach a close contact (CC) willing to participate alongside them. A subset of participants, their CCs, and staff were interviewed about their opinions on trial procedures, artificial eyes, delivery times and satisfaction. RESULTS: Thirty-five participants were randomised and 10 CCs consented. Participant retention at final follow-up was 85.7%. Outcome data completion rates ranged from 91-100%. EQ-5D-5L completion ranged from 83-97%. Resource-use completion ranged from 0-94% with total costs at £347 for hand-painted and £404 for digitally-printed eye. There were two adverse events. Twelve participants, five CCs, and five staff were interviewed. There were positive and negative features of both types of eyes. We identified that social and psychological wellbeing is affected, often for many years after eye removal. Participation in the feasibility study was well accepted. CONCLUSIONS: The feasibility study outcomes indicate that a full trial is achievable. TRIAL REGISTRATION NUMBER: ISRCTN85921622.

Digital photographic technique for the production of an artificial eye.

The use of hand painting an iris button using oil paint remains the conventional method of artificial eye manufacturing. The authors found that replacing this technique with a digital photograph taken of a patient's unaffected eye offers several advantages over the conventional method but the process from capture to print must be standardised and colour accurate. The authors of this paper suggest a tried and tested formulated photographic process of capture and printing prior to polymerisation. It discusses issues that can arise and how these can be overcome in order to achieve a high-quality print that can be used to produce a 'life like' ocular prosthesis.

Novel artificial eye service evaluation using patient reported outcome measures.

BACKGROUND: This service evaluation explores patient reported outcomes from patients provided with high definition ocular prostheses (artificial eyes). METHODS: Validated patient questionnaires (FACE-Q, DAS24 and HADS) were utilised to evaluate patient experiences of their new ocular prosthesis. 10 patients were included in the service evaluation, which was conducted between December 2018 and September 2019. Descriptive analysis of the mean and 95% CI was undertaken for all questionnaires. Statistical analysis was performed using SPSS 21 Principal Component Analysis (PCA) for FACE-Q questionnaires. Correlations were significant when factor loading is at α > 0.4. RESULTS: A questionnaire response rate of 80% was achieved (n = 8). PCA analysis showed the number of variables tested could be reduced. Two principal components (PC1 and PC2) had very good to excellent internal consistency between variables with factor loading (α = 0.7-0.9). PC1 contained questionnaires 1-7, all of which were highly correlated. PC2 contained question number 8 with a factor loading of α = 0.8. This indicates good reliability, validity and responsiveness. CONCLUSIONS: We hope to demonstrate the importance of service evaluations with respect to rapidly evolving technological advances in medical devices, pharmaceuticals and imaging modalities. Further feasibility and full clinical studies are required to confirm the positive results of the novel artificial eye service we have evaluated with respect to the traditional approach.

Evaluation on the effectiveness of a peer led video on oral hygiene education in young children.

This study evaluated the effectiveness of a peer-led oral hygiene education video in improving oral hygiene knowledge and behaviour in year 2 (6- to 7-year-old) and year 3 (7- to 8-year-old) children. A novel peer-led oral hygiene education video was created, in which a group of 6- to 10-year-old children delivered key oral hygiene messages. The video was then shown to children of the same age group, whom oral hygiene knowledge and behaviours were assessed before and after the video. Results found that the video was an effective method of improving overall oral hygiene knowledge. It was effective in improving specific aspects of oral hygiene such as knowledge of the frequency of brushing and toothpaste amount, and in the behaviour of using the toothbrush in a circular motion. It was not an effective method in improving the overall oral hygiene knowledge and behaviour of Year Two children, demonstrating children may develop significantly in just 1 year.

Presence with purpose: attitudes of people with developmental disability towards health care students.

CONTEXT: Early clinical encounters help medical and nursing students build professional competencies. However, there is a necessary emphasis on patient autonomy and appropriate consent. Although most individuals do not object to student involvement in clinical encounters, there are occasions when personal preference and health care education conflict. Many studies have evaluated patient attitudes towards students across a variety of specialties. OBJECTIVES: The purpose of this study was to identify the attitudes, comfort level and preferences of individuals with developmental disability (DD) towards the presence and involvement of medical and nursing students during clinical encounters. METHODS: Adults with DD across the Hamilton-Niagara region were invited to participate. Focus groups were moderated by two students with a health care facilitator and physician-educator. Participants were provided with focus group questions in advance and encouraged to bring communication aids or care providers. Data were analysed for emerging themes by two independent reviewers, who then compared results. RESULTS: Twenty-two individuals participated. A wide range of opinions were expressed. Some participants were positively disposed towards students and perceived better care and improved communication with the health care team. Others were indifferent to students in a clinical setting. The final group was opposed to the presence of health care students, expressing confusion over their role and purpose, uneasiness with deviation from the norm, and concerns about confidentiality. Informative introductions with confidentiality statements and the presence of a supervising clinician were seen as helpful. CONCLUSIONS: People with DD are affected by above-average health care needs. Their input into health care planning has been limited. Their opinions on health care learners varied considerably. Themes relating to attitudes, comfort and preferences about student involvement provide impetus for health care training practices that promote person-centred approaches and improvements to the quality of care received by people with DD.

The drive for operating room efficiency will increase quality of patient care.

PURPOSE OF REVIEW: The public is demanding that medicine both increase its efficiency and lower its costs. 'Watchdog' groups are scrutinizing our performance, publicizing our results, and forcing us to compete. They want doctors first to use evidence-based medicine to identify truly beneficial healthcare interventions and then to use continuous quality improvement to perform those beneficial interventions consistently at lower costs. RECENT FINDINGS: A renaissance is underway in our thinking about quality and efficiency in the operating room. 'Work process redesign' and 'the systems approach' are starting to be more than slogans, as researchers redesign the physical environment of the operating room, along with its 'workflow' and methods of communication. SUMMARY: Soon physicians and hospitals will be receiving 'pay-for-performance', whereby our income will depend on our ability to demonstrate both good patient care processes and good outcomes. Medicine is starting to act like a competitive industry, and this tendency will be good for quality and efficiency in the operating room. Community and academic practitioners need to understand and participate in this transformation in order to be able to influence its evolution and to survive financially.