Role of patient and public involvement in implementation research: a consensus study.

BACKGROUND: Patient and public involvement (PPI) is often an essential requirement for research funding. Distinctions can be drawn between clinical research, which generally focuses on patients, and implementation research, which generally focuses on health professional behaviour. There is uncertainty about the role of PPI in this latter field. We explored and defined the roles of PPI in implementation research to inform relevant good practice guidance. METHODS: We used a structured consensus process using a convenience sample panel of nine experienced PPI and two researcher members. We drew on available literature to identify 21 PPI research roles. The panel rated their agreement with roles independently online in relation to both implementation and clinical research. Disagreements were discussed at a face-to-face meeting prior to a second online rating of all roles. Median scores were calculated and a final meeting held to review findings and consider recommendations. RESULTS: Ten panellists completed the consensus process. For clinical research, there was strong support and consensus for the role of PPI throughout most of the research process. For implementation research, there were eight roles with consensus and strong support, seven roles with consensus but weaker support and six roles with no consensus. There were more disagreements relating to PPI roles in implementation research compared with clinical research. PPI was rated as contributing less to the design and management of implementation research than for clinical research. CONCLUSIONS: The roles of PPI need to be tailored according to the nature of research to ensure authentic and appropriate involvement. We provide a framework to guide the planning, conduct and reporting of PPI in implementation research, and encourage further research to evaluate its use.

Influence of macular pigment optical density spatial distribution on intraocular scatter / Influencia de la distribución espacial de la densidad óptica del pigmento macular sobre la dispersión intraocular

Purpose: This study evaluated the summed measures of macular pigment optical density (MPOD) spatial distribution and their effects on intraocular scatter using a commercially available device (C-Quant, Oculus, USA). Methods: A customized heterochromatic flicker photometer (cHFP) device was used to measure MPOD spatial distribution across the central 16º using a 1º stimulus. MPOD was calculated as a discrete measure and summed measures across the central 1º, 3.3º, 10º and 16º diameters. Intraocular scatter was determined as a mean of 5 trials in which reliability and repeatability measures were met using the C-Quant. MPOD spatial distribution maps were constructed and the effects of both discrete and summed values on intraocular scatter were examined. Results: Spatial mapping identified mean values for discrete MPOD [0.32 (s.d. = 0.08)], MPOD summed across central 1º [0.37 (s.d. = 0.11)], MPOD summed across central 3.3º [0.85 (s.d. = 0.20)], MPOD summed across central 10º [1.60 (s.d. = 0.35)] and MPOD summed across central 16º [1.78 (s.d. = 0.39)]. Mean intraocular scatter was 0.83 (s.d. = 0.16) log units. While there were consistent trends for an inverse relationship between MPOD and scatter, these relationships were not statistically significant. Correlations between the highest and lowest quartiles of MPOD within the central 1º were near significance. Conclusions: While there was an overall trend of decreased intraocular forward scatter with increased MPOD consistent with selective short wavelength visible light attenuation, neither discrete nor summed values of MPOD significantly influence intraocular scatter as measured by the C-Quant device (AU)

Objetivo: Este estudio evaluó la suma de las mediciones de la distribución espacial de la densidad óptica del pigmento macular (MPOD) y sus efectos sobre la dispersión intraocular, utilizando un dispositivo comercialmente disponible (C-Quant, Oculus, EEUU). Métodos: Se utilizó un fotómetro intermitente heterocromático personalizado (cHFP) para medir la distribución espacial de la MPOD a lo largo de los 16º centrales, utilizando un estímulo de 1º. La MPOD se calculó como medición discreta y como las sumas de las mediciones a lo largo de los diámetros centrales de 1º, 3,3º, 10º y 16º. Se calculó la dispersión intraocular como media de los cinco ensayos en los que se lograron mediciones de fiabilidad y repetibilidad utilizando el dispositivo C-Quant. Se construyeron mapas de distribución espacial de la MPOD, examinándose los efectos sobre la dispersión intraocular, tanto de los valores discretos como de la suma de valores. Resultados: El mapeado espacial identificó valores medios para la MPOD discreta [0,32 (DE = 0,08)], la suma de MPOD a lo largo de 1º central [0,37 (DE = 0,11)], la suma de MPOD a lo largo de 3,3◦ centrales [0,85 (DE = 0.20)], la suma de MPOD a lo largo de 10º centrales [1,60 (DE = 0,35)] y la suma de MPOD a lo largo de 16◦ centrales [1,78 (DE = 0,39)]. La dispersión intraocular media fue de 0,83 (DE = 0,16) unidades log. A pesar de producirse una tendencia consistente hacia una relación inversa entre MPOD y dispersión, dichas relaciones no fueron estadísticamente significativas. Las correlaciones entre los cuartiles superior e inferior de la MPOD dentro de 1º central fueron próximas a la significación estadística. Conclusiones: A pesar de producirse una tendencia general hacia la disminución de la dispersión intraocular con el incremento de la MPOD, consistente con una atenuación selectiva de la luz visible con longitud de onda corta, ni los valores discretos ni la suma de valores de la MPOD reflejaron una influencia significativa sobre la dispersión intraocular, según las mediciones realizadas con el dispositivo C-Quant (AU)

Influence of macular pigment optical density spatial distribution on intraocular scatter.

PURPOSE: This study evaluated the summed measures of macular pigment optical density (MPOD) spatial distribution and their effects on intraocular scatter using a commercially available device (C-Quant, Oculus, USA). METHODS: A customized heterochromatic flicker photometer (cHFP) device was used to measure MPOD spatial distribution across the central 16° using a 1° stimulus. MPOD was calculated as a discrete measure and summed measures across the central 1°, 3.3°, 10° and 16° diameters. Intraocular scatter was determined as a mean of 5 trials in which reliability and repeatability measures were met using the C-Quant. MPOD spatial distribution maps were constructed and the effects of both discrete and summed values on intraocular scatter were examined. RESULTS: Spatial mapping identified mean values for discrete MPOD [0.32 (s.d.=0.08)], MPOD summed across central 1° [0.37 (s.d.=0.11)], MPOD summed across central 3.3° [0.85 (s.d.=0.20)], MPOD summed across central 10° [1.60 (s.d.=0.35)] and MPOD summed across central 16° [1.78 (s.d.=0.39)]. Mean intraocular scatter was 0.83 (s.d.=0.16) log units. While there were consistent trends for an inverse relationship between MPOD and scatter, these relationships were not statistically significant. Correlations between the highest and lowest quartiles of MPOD within the central 1° were near significance. CONCLUSIONS: While there was an overall trend of decreased intraocular forward scatter with increased MPOD consistent with selective short wavelength visible light attenuation, neither discrete nor summed values of MPOD significantly influence intraocular scatter as measured by the C-Quant device.

Macular pigment optical density spatial distribution measured in a subject with oculocutaneous albinism.

PURPOSE: Previous studies of macular pigment optical density (MPOD) distribution in individuals with oculocutaneous albinism (OCA) have primarily used objective measurement techniques including fundus reflectometry and autofluorescence. We report here on a subject with OCA and their corresponding MPOD distribution assessed through heterochromatic flicker photometry (HFP). METHODS: A subject with a history of OCA presented with an ocular history including strabismus surgery of the LE with persistent amblyopia and mild, latent nystagmus. Best corrected visual acuity was 20/25- RE and 20/40- LE. Spectral domain optical coherence tomography (SD-OCT) and fundus photography were also obtained. Evaluation of MPOD spatial distribution up to 8 degrees eccentricity from the fovea was performed using HFP. RESULTS: SD-OCT indicated a persistence of multiple inner retinal layers within the foveal region in the RE and LE including symmetric foveal thickening consistent with foveal hypoplasia. Fundus photography showed mild retinal pigmented epithelial (RPE) hypopigmentation and a poorly demarcated macula. OriginPro 9 was used to plot MPOD spatial distribution of the subject and a 33-subject sample. The OCA subject demonstrated a foveal MPOD of 0.10 with undetectable levels at 6 degrees eccentricity. The study sample showed a mean foveal MPOD of 0.34 and mean 6 degree eccentricity values of 0.03. CONCLUSIONS: Consistent with previous macular pigment (MP) studies of OCA, overall MPOD is reduced in our subject. Mild phenotypic expression of OCA with high functional visual acuity may represent a Henle fiber layer amenable to additional MP deposition. Further study of MP supplementation in OCA patients is warranted.