Very Late Patent Foramen Ovale Occluder Device Structural Dysfunction and Thrombosis.

Mechanical dysfunction of patent foramen ovale (PFO) closure device is extremely rare. We present a 58-year-old male patient who had multiple episodes of ischemic strokes 3 years after PFO closure, which was related to PFO device mechanical dysfunction and thrombosis. He was successfully treated with surgical intervention.

Accuracy of referral diagnosis to an emergency eye clinic.

OBJECTIVE: To determine the accuracy of diagnosis of ophthalmic problems from health care practitioners such as optometrists, general practitioners, and emergency physicians in and around London, Ontario, Canada. DESIGN: Retrospective review of all referrals to the Ivey Eye Institute emergency eye clinic over a period of 6 months from January to July 2011. PARTICIPANTS: During the study period, there were 1810 patient encounters, including 1134 new referrals. METHODS: For each patient encounter, information was collected regarding basic demographics, referral source, referral diagnosis, and final diagnosis. Referrals were categorized by source of referral and anatomic location of the eye problem. The accuracy of each referral was assessed by comparing the referral diagnosis to the final diagnosis. Referrals were categorized as correct, incorrect, not yet diagnosed, nonspecific, or baseline examination. RESULTS: Referral diagnoses were correct in 45% and incorrect in 28% overall. Referral diagnoses from optometrists were correct in 54%, from emergency physicians were 39% correct, and from general practitioners were 33% correct. Ophthalmologists had the highest diagnostic accuracy, with 83% of referral diagnoses being correct. Diagnoses were incorrect in 36% from optometrists, 28% from emergency physicians, and 32% from general practitioners. CONCLUSIONS: This study demonstrates the low accuracy rate of referral diagnoses of emergency eye patients from nonophthalmologists to the Ivey Eye Institute emergency eye clinic. Better training in the diagnosis of ophthalmic problems for general practitioner and emergency medicine residents would be of benefit. Optometrists may also find it helpful to have improved emergency and urgency training. Ophthalmologists should be involved in this training.