The carbon footprint of cataract surgery pathways in England: an observational study using administrative data.

Background: The National Health Service (NHS) in England has set a target to be net zero for carbon emissions by 2045. The aim of this study was to investigate the estimated difference between the carbon footprint of the Getting It Right First Time (GIRFT) High Volume Low Complexity (HVLC) pathway for cataract surgery and current practice.

Methods: Retrospective analysis of administrative data.

A Curious Case of Black Limb in Tuberculosis.

With a global burden of 10 million new cases per year, tuberculosis (TB) is a major health problem in developing countries like India, with an incidence of 2.69 million. With its varied presentations and huge infected numbers, TB continues to remain a dilemma to physicians.

Incidence, Risk Factors and Prognosis of Hypokalaemia in Patients with Normokalaemia at Hospital Admission.

Background: Hypokalaemia (K+<3.5 mmol/L) is observed in 20% of hospitalised patients. Previous studies have often dealt with the symptoms, prevalence and risk factors in hospitalised patients.

A rare case of hydatid cyst of the neck with concurrent pulmonary hydatid disease.

Echinococcosis, commonly known as hydatid disease, is a zoonotic infection caused by dog tapeworm . Hydatid disease of the head and neck region is scarcely reported even in endemic areas. We herein report a case with with neck swelling and respiratory symptoms subsequently diagnosed to have disseminated echinococcosis of the neck and left lung.

Tuberculosis-Associated Septic Shock: A Case Series.

Tuberculosis septic shock (TBSS) is a rare diagnosis due to inherent diagnostic difficulty or attribution to alternate causes. We report six cases of TBSS, along with comorbidities, clinical characteristics, hospital course, and in-hospital outcomes. All patients were middle-aged, with a median age of 54.

Isolated myocardial abscess cavity: An incidental finding on intraoperative transesophageal echocardiography.

Myocardial abscess is a suppurative infection of myocardium, endocardium, native or prosthetic valves, perivalvular structures and cardiac conduction system. It develops in about 20% of patients with infective endocarditis. Due to avascular and fibrous structures, valvular regions are commonly involved.

Appropriateness of elective percutaneous coronary intervention and impact of government health insurance scheme - A tertiary centre experience from Western India.

Background: There is a dearth of data regarding the appropriateness of elective percutaneous coronary intervention (PCI) in a limited-resource country such as India. In an attempt to rationalise the use of PCI, Appropriate Use Criteria (AUC) were developed for cardiovascular care in the USA. In the Indian context, considering the high prevalence of coronary artery disease, the dramatic rise in the number of revascularization procedures and an increasing role of government/private reimbursements, application of AUC could potentially guide policy to optimize the utilization of resources and the benefit-risk ratio for individual patients.

Perioperative management of a patient with left ventricular dysfunction and anomalous coronary arteries.

Anesthetic management of patients with coronary artery disease undergoing noncardiac surgery is quite challenging. Such patients are at increased risk of perioperative cardiac complications and death. We report an illustrative case of a 62-year-old male with ischemic heart disease and anomalous coronary arteries for obstructed paraumbilical hernia repair.

Intracranial arachnoid cyst; an unusual cause of epiphora.

Purpose: To describe a case of unilateral intracranial arachnoid cyst in association with enophthalmos and epiphora on the same side.

Methods: Case report.

Results: A young man with symptoms of unilateral epiphora is described.

Temporary Gortex (polytetrafluoroethylene) spacer for the treatment of fornix shortening following severe alkali chemical injury.

Background: Gortex is an inert, smooth, flexible material, which is well tolerated in situ. We describe a case of fornix shortening secondary to alkali injury, which was treated successfully with a temporary Gortex patch.

Method: Retrospective case report.

Trends in chronic peritoneal dialysis utilization in New England.

Utilization of chronic peritoneal dialysis (CPD) continues to decline in the United States. Technique failure remains a key factor in this decline. Center size has been associated with technique failure.

The role of intravenous methylprednisolone immunosuppression in the management of active thyroid eye disease.

Purpose: To analyze the efficacy of intravenous methylprednisolone (IVMP) immunosuppression in the management of active thyroid eye disease (TED).

Methods: This is a consecutive case series of 36 patients treated with 1 g of IVMP over 3 days, between January 2000 and January 2008. The indications for this treatment were moderate to severe active TED with or without optic nerve compression.

Knowledge and participation of front-line dialysis facility staff in end-of-life discussions.

The Centers for Medicare & Medicaid Services' Form 2746, the Death Notification Form, was revised in 2004. In addition to questions inquiring about discontinuation of dialysis, the revised form includes questions about patient and family involvement in the decision to discontinue treatment, whether the patient had received hospice care, as well as a new Cause of Death item #104, "Withdrawal from dialysis/uremia" However Form 2746 offers no instructions or explanation on how to decide whether a death is attributable to withdrawal from dialysis/uremia or what is considered dialysis discontinuation. We conducted a standardized telephone survey (N = 338) among front-line dialysis facility professionals (staff nurses, social workers, nurse managers) in ESRD Networks 1, 5, and 12, inquiring about 448 deaths of patients who discontinued dialysis.

Technique failure and center size in a large cohort of peritoneal dialysis patients in a defined geographic area.

Background: Hemodialysis (HD) and peritoneal dialysis (PD) are both viable options for renal replacement therapy. Technique failure has been shown to be a major problem in PD therapy.

Objective: To examine the relationship between center size and PD technique failure.

Hospice and ESRD: knowledge deficits and underutilization of program benefits.

Although hospice care for dying patients on dialysis has been recommended in clinical practice guidelines and policy statements of professional nephrology organizations, only a minority of dying patients on dialysis currently receive hospice services. This retrospective qualitative study investigated a variety of factors contributing to the low referral rate for patients with end stage renal disease (ESRD). Interviews (N=338) were conducted with dialysis facility professionals (RN staff nurses, social workers, nurse managers) in ESRD networks 1, 5, and 12 using a standardized telephone survey.

Views of glaucoma patients on provision of follow-up care; an assessment of patient preferences by conjoint analysis.

Aims: To determine patients' preferences for provision of glaucoma follow-up services examining preferences for location, access and personnel for delivery of this care.

Methods: 100 patient patients attending the glaucoma outpatient clinic for follow-up review underwent an interview-based assessment during which they completed the visual function questionnaire 25 and ranking of scenario options for provision of follow-up care for their glaucoma. Percentage preferences for aspects of care offered in the conjoint analysis scenario packages and generation of utility values for each of the factor levels included in the scenario design were calculated.

Persistent endocapsular hematoma following uneventful phacoemulsification and clear corneal incision cataract surgery.

We report the first case of persistent endocapsular hematoma following uneventful phacoemulsification and intraocular lens surgery through a clear corneal incision.

Views of glaucoma patients on aspects of their treatment: an assessment of patient preference by conjoint analysis.

Purpose: To determine by conjoint analysis which factors in the management and treatment of glaucoma were of most importance to patients and to relate these factors to the patient's clinical glaucoma condition.

Methods: An interview-based study was performed. Demographic and visual function data are recorded.

Eyetrack (ET) vs the conventional paper record (CPR): a study comparing the accuracy and speed of data retrieval from glaucoma patient records.

Purpose: To compare patient data retrieval between electronic patient record systems (Eyetrack) and conventional paper records (CPRs).

Methods: A total of 20 long term glaucoma patient records held on Eyetrack were randomised into two collections with 10 CPRs and 10 Eyetrack records in each collection. The Eyetrack records of one collection were the CPRs of the other collection and vice versa.

Risk management strategies following analysis of cataract negligence claims.

Introduction: Clinical governance and risk management is very important in today's clinical practice. Cataract surgery is one of the most common procedures performed in the NHS, with around 200,000 operations per year. In order to help minimise the frequency of negligence claims, we performed a collaborative study to analyse claims relating to cataract surgery, dealt with by the defence organisations of England, Scotland, Wales, and Northern Ireland.