Referrals from community optometrists in England and their replies: A mixed methods study.

Purpose: Community optometrists, through routine eye examinations, identify patients with disease or ocular abnormalities requiring referral to the Hospital Eye Service. In many cases no reply to the referral letter is received, resulting in some patients being re-referred unnecessarily, potentially increasing the number of other patients who lose sight whilst on hospital waiting lists. This study investigated, qualitatively and quantitatively, factors influencing optometric referrals and replies.

Design and use of vignettes to investigate referral decision-making by optometrists.

Purpose: This study describes the design and application of a range of online clinical vignettes for measuring the impact of Continuing Education and Training (CET) and identifying unwarranted variation in optometric decision-making concerning referrals to secondary care.

Methods: Twenty computerised vignettes were developed to assess clinical and referral management decisions taken in primary care optometry. The online system was specifically designed to present vignettes (ten pre-CET and ten post-CET) that avoided prompting correct answers.

An evaluation of MRI lumbar spine scans within a community-based diagnostic setting.

Background: With an ongoing move towards more management of patients within the community setting, demand for magnetic resonance imaging (MRI) is increasing and commonly used in lower back conditions. There is well recorded overuse of MRI in this scenario which goes against evidence-based practice and adds to rising healthcare costs.

Methods: The study was a retrospective review of lumbar spine MRI scans performed within a community-based setting over an 18-month period.

Randomised controlled trial of corneal vs. scleral rigid gas permeable contact lenses for keratoconus and other ectatic corneal disorders.

Purpose: To compare the comfort and visual performance of corneal rigid gas permeable contact lenses (CoL) and scleral rigid gas permeable contact lenses (SL) in participants with corneal ectasia, successfully wearing "habitual" CoL.

Methods: In a randomised controlled trial (RCT) with a 2 × 2 crossover, 34 participants were recruited and randomised into two groups. Group 1 (sequence AB), were fitted in period 1, with new CoL and after a 4-week washout period, in which habitual CoL were worn, were fitted with and crossed-over to SL, period 2.

The relationship between unwarranted variation in optometric referrals and time since qualification.

Purpose: To investigate variation in optometric referral decision-making and the influence of experience and continuing education and training (CET).

Methods: To gain insight into unwarranted variation in referral activity in the United Kingdom (UK): (1) triage data were audited to investigate source of referral, provisional diagnosis, and outcome; (2) an online system was developed to present two sets of 10 vignettes, designed to avoid prompting answers. Participating optometrists completed 10 pre-CET vignettes, recording their tests and management decisions.

Digital imaging and radiographic practise in diagnostic radiography: An overview of current knowledge and practice in Europe.

Introduction: Recent research has identified the issue of 'dose creep' in diagnostic radiography and claims it is due to the introduction of CR and DR technology. More recently radiographers have reported that they do not regularly manipulate exposure factors for different sized patients and rely on pre-set exposures. The aim of the study was to identify any variation in knowledge and radiographic practice across Europe when imaging the chest, abdomen and pelvis using digital imaging.

Sunglass Filter Transmission and Its Operational Effect in Solar Protection for Civilian Pilots.

Introduction: The ocular effects of excess solar radiation exposure are well documented. Recent evidence suggests that ocular ultraviolet radiation (UVR) exposure to professional pilots may fall outside international guideline limits unless eye protection is used. Nonprescription sunglasses should be manufactured to meet either international or national standards.

Occupational Ocular UV Exposure in Civilian Aircrew.

Introduction: Ultraviolet radiation (UVR) increases with altitude; however, there are a number of other factors which may influence ocular exposure during flight. The aim of this study was to assess ocular UVR exposure of pilots in airline and off-shore helicopter operations on different aircraft types and to compare with exposure in a typical office environment.

Method: In-flight data were captured on equipment including a CCD array spectroradiometer on five return sector European airline flights and one transatlantic flight from London Gatwick in addition to four helicopter flights from Aberdeen Dyce airport.

Solar Eye Protection Practices of Civilian Aircrew.

Introduction: There is good evidence that long term exposure to ultraviolet (UV) radiation increases the risk of cataracts. The 'blue light hazard' is considered a risk factor for retinal changes similar to those seen in macular degeneration. Previous studies ascertaining the prevalence of radiation related ocular disease in pilot cohorts have not considered use of solar eye protection.

Knowledge, attitudes, beliefs, behaviour and breast cancer screening practices in Ghana, West Africa.

Background: Late presentation has been observed as the hallmark of breast cancer in Ghanaian women where over 60% of patients report with either stage 3 or 4 of the disease. This cross-sectional study aimed at exploring breast cancer related knowledge and practices in order to develop an appropriate socio-economic and cultural specific model to improve breast cancer care in Ghana.

Methods: The study which was conducted in Accra and Sunyani in Ghana used both quantitative and qualitative methods and employed the theory of planned behavior as a communication and educational model.

Civilian pilot exposure to ultraviolet and blue light and pilot use of sunglasses.

Population and animal studies indicate that long-term exposure to short-wavelength visible light and ultraviolet (UV) radiation causes increased risk of certain ocular pathologies such as cataracts and maculopathy. The potential risk to flight crew is unknown. The UK Civil Aviation Authority (CAA) has issued guidance to pilots regarding sunglass selection; however, it is not known if this guidance is appropriate given pilots' unique occupational environment.

The putative role of extra-synaptic mesolimbic dopamine in the neurobiology of nicotine dependence.

A majority of habitual tobacco smokers find it very difficult to quit the habit because they become addicted to the nicotine present in tobacco smoke. Nicotine, like other psychostimulant drugs of abuse, increases dopamine release in the principal terminal field of the mesolimbic system, the nucleus accumbens, and there is evidence that this mediates the 'rewarding' properties of the drug, which reinforce its self-administration. This review focuses on the working hypothesis that addiction to nicotine, and other psychostimulant drugs, depends upon their ability to evoke a sustained increase in dopamine release directly into the extracellular space which lies between the cells in the nucleus accumbens where it stimulates extra-synaptic dopamine receptors.

The influence of lobeline on nucleus accumbens dopamine and locomotor responses to nicotine in nicotine-pretreated rats.

In vivo brain microdialysis was used to investigate the influence of lobeline on dopamine (DA) and dihydroxyphenylacetic acid (DOPAC) overflow in the core of the nucleus accumbens of freely-moving rats pretreated with nicotine (0.4 mg x kg(-1), s.c.

Sensitization of the mesoaccumbens dopamine response to nicotine.

This article reviews the evidence that pretreatment with nicotine causes a regionally selective sensitization of its stimulatory effects on a pathway, the mesoaccumbens dopamine (DA) system, which has been implicated in the locomotor stimulant response to nicotine and its ability to reinforce self-administration. The sensitization evoked by daily injections of nicotine is associated with a regionally selective downregulation of the control of mesoaccumbens DA neurons by inhibitory autoreceptors and depends upon co-stimulation of NMDA glutamatergic receptors. It is suggested that the sensitization is related to enhanced burst firing of mesoaccumbens neurons, which results in an enhancement of DA release into the extracellular space between the cells where it acts upon putative extrasynaptic dopamine receptors.

Regional variation in the effects of nicotine on catecholamine overflow in rat brain.

The effects of acute, repeated intermittent and continuous administration of nicotine on the overflow of noradrenaline in the ventral hippocampus and dopamine in the nucleus accumbens and striatum have been studied. Daily injections of nicotine (0.4 mg/kg(-1) for 5 days) enhanced noradrenaline and dopamine overflow in the ventral hippocampus and nucleus accumbens respectively (P < 0.

Effects of acute D-CPPene on mesoaccumbens dopamine responses to nicotine in the rat.

Acute administration of the NMDA receptor antagonist, D-CPPene (SDZ EAA 494; 3-(2-carboxypiperazin-4-yl)-1-propenyl-1-phosphonic acid; 2 mg/kg), abolished (P < 0.01) the sensitised mesoaccumbens dopamine response to nicotine (0.4 mg/kg) measured using in vivo microdialysis, but not the increased locomotor activity, observed in rats pretreated with nicotine prior to the test day.

Neurochemical and behavioural interactions between ibogaine and nicotine in the rat.

1. In vivo brain microdialysis has been employed to investigate the effects of ibogaine on nicotine-induced changes in dopamine overflow in the nucleus accumbens (NAc) of freely moving rats. The effects of the compound on locomotor responses to nicotine and behaviour in the elevated plus-maze were also examined.

Desensitization of the nicotine-induced mesolimbic dopamine responses during constant infusion with nicotine.

1. The effects of constant nicotine infusions (0.25, 1.

Behavioural and neurochemical adaptations to nicotine in rats: influence of NMDA antagonists.

1. The repeated co-administration of the non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist dizocilpine (0.1 and 0.

Studies on the influence of nicotine infusions on mesolimbic dopamine and locomotor responses to nicotine.

The present study examined the effects of constant nicotine infusions on dopamine overflow in the nucleus accumbens and on locomotor activity and compared them with the changes evoked by repeated daily injections (one injection per day for 5 days) of the drug. The putative anxiolytic properties of nicotine have also been examined using the elevated plus-maze test of anxiety. Repetitive daily subcutaneous injections of nicotine (0.

Influence of tetrodotoxin and calcium on changes in extracellular dopamine levels evoked by systemic nicotine.

The influence of tetrodotoxin (TTX) and calcium on the increase of extracellular dopamine (DA) levels in the nucleus accumbens (NAcc), evoked by the systemic administration of nicotine, cocaine and d-amphetamine, have been studied in conscious, freely moving rats using in vivo microdialysis. TTX (10(-6) M), administered via the dialysis probe, completely abolished (P < 0.01) the elevations in extracellular DA, DOPAC and HVA seen following nicotine (0.

The effects of acute and repeated nicotine treatment on nucleus accumbens dopamine and locomotor activity.

1. The effects of acute and subchronic nicotine and (+)-amphetamine on the extracellular levels of dopamine and its metabolites, dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in nucleus accumbens (NAc) have been studied in conscious, freely-moving rats by use of in vivo microdialysis. 2.

Smoking-associated changes in the serotonergic systems of discrete regions of human brain.

This paper describes the results of a postmortem study of the effects of tobacco smoking on the concentrations of 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) as well as the binding of [3H]-8-hydroxy-(di-n-propylamino)-tetralin ([3H]-8-OH-DPAT) and [3H]-ketanserin in six discrete regions of human brain. Smoking was associated with significant decreases in the concentrations of 5-HIAA in the hippocampal neocortex (P less than 0.001), hippocampal formation (P less than 0.