A diagnosis of conditions leading to vision loss can be devastating and often impacts mental health. Understanding this allows us to consider what provisions might help those who are impacted. We undertook 18 semi-structured interviews with patients diagnosed with eye disease leading to vision loss to explore its psychological impact. Participants also completed the Beck Depression Inventory (BDI), providing a snapshot of their depression and anxiety levels at the time of interview. NVivo-12 software (QSR International Ltd, Burlington, Massachusetts, USA) was used to inductively analyse and code data to identify themes related to the psychological impact. Participants had a mean BDI score of 9.6, and thematic analysis generated five key themes and associated subthemes. Coming to terms with the diagnosis included discussion of subthemes of “denial” and moving towards “acceptance”. Effects on mental health included depression/low mood, anxiety, and stress-related worsening of vision. Loss included various losses following initial loss of vision. Effects on identity included facing a curtailed life, worry that visual impairment might define a person’s identity, and feelings of frustration with their own loss of function and with others’ reactions to their disability. The future included thoughts about long-term consequences, both negative and positive (e.g., maximizing experiences given the vision one has left). Although such a diagnosis will nearly always have a psychological impact and require work to move toward acceptance, support could mitigate impact on mental health, such as practical support (e.g., advice on low vision aids), and psychological support.
BackgroundWith the increase in clinical trials testing therapy for retinal disease, there is a need to ensure that outcome measures are both accurate and standardised. The US Food and Drug Administration favours the use of visual acuity measured using ETDRS logMAR charts. The loss of visual field can interfere with visual tracking across the charts, leading to increased variability of measurements. Electronic visual acuity (EVA) presents the optotype on the centre of a screen, thereby removing the tracking element of the task, and may provide a more precise measurement.MethodsVisual acuity was measured twice using ETDRS charts, EVA automated single letter (E-ETDRS) and EVA single line (EVA-SL) presentation (EMMES). Patients underwent microperimetry (MAIA; Centervue) to determine visual field. We tested 65 patients with rod-cone dystrophies and 41 healthy volunteers.ResultsBoth participant groups read 2–3 letters more on average on the electronic charts compared with ETDRS. Limits of agreement using a modified Bland-Altman analysis account for replicates were wider in eyes with foveal defects (−9 to 18) compared with eyes without foveal defects (−11 to 15). Electronic charts in the presence of foveal defects reduced the range (−11 to 13).ConclusionEVA may provide more accurate measures of visual acuity than traditional ETDRS charts in patients when the visual field loss encroached on the central vision. Electronic presentation with a single line of letters was the favoured style reported by patients and should be considered in future interventional clinical trials.
Background Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission. Methods We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient’s medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon’s rank test was used to look at the correlation between two subgroups upon admission and discharge. Results On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications. Conclusions Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission.
BackgroundSkin disease is one of the key domains of psoriatic disease (1) and most Psoriatic arthritis patients have skin psoriasis. However skin and joint disease are often managed separately by rheumatologists, dermatologists or primary care health care providers. This can lead to disjointed care, unmet need, and treatment decisions that don’t take into account all aspects of this heterogeneous condition.ObjectivesWe sought to evaluate how psoriatic skin disease is assessed and managed within our rheumatology services by identifying disease burden, approach to management and patient satisfaction.MethodsIn an existing psoriatic arthritis outpatient rheumatology clinic, patient swere asked to anonymously complete questionnaires on disease extent, management and satisfaction. Patients also completed dermatology quality of life index (DLQI) questionnaires. Case notes and clinic letters were reviewed to collect data relating to patient diagnosis, medications and extent of clinical assessment during consultations over a 4 month period.ResultsQuestionnaires were returned by 30 patients. 72% reported problems with psoriasis, with scalp was the most commonly affected body area. 77% participants reported receiving medication to manage joints only, 4% for skin only, 19% for both joints and skin. 13 participants were receiving topical medication for PsA, with the majority being managed by their GP.From the survey, 47% of respondents were asked about their skin in the rheumatology clinic, and 30% were given advice on its management. Of the patients that completed DLQI questionnaires mean score was 3.9 (SD 3.4). Average satisfaction with psoriasis management was 5/10 (SDEV 3.6).Of the 59 consultations from which data was extracted, 54% of consultations discussed joints only, and 37% discussed both joints and skin (remainder no discussion documented). At 45% of appointments joints and skin were examined, and at 35% of appointments joints only were examined (remainder no examination documented).ConclusionPsoriatic skin disease appears to be a significant burden in this population of patients, affecting 72% of those surveyed. Over half of these patients required topical therapy to manage their psoriasis, with some requiring systemic treatments. Of these patients, most of the management of their skin condition was done by their GP, with the topic being brought up at rheumatology clinic in only half of cases. Less than half had skin examined at rheumatology clinic and less than a third were advised on management of their skin disease by their rheumatologist.Satisfaction levels with psoriasis management were fairly neutral overall. An integrated approach to care with a focus on opportunistic assessment should be encouraged and has potential to benefit both patient and clinician.Reference[1]Coates LC, Corp N, van der Windt DA, O’Sullivan D, Soriano ER, Kavanaugh A. GRAPPA Treatment Recommendations: 2021 Update. J Rheumatol. 2022 Jun;49(6 Suppl 1):52-54. doi: 10.3899/jrheum.211331. Epub 2022 Mar 15. PMID: 35293339.Acknowledgements:NIL.Disclosure of InterestsMichael Reed Speakers bureau: Novartis, Heather Boagey: None declared, Beatrice Milligan: None declared.
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