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Biomedical subjects

A Fielder

Publications and source records attributed to A Fielder.

At least 19 recordsLinked to original sources
PubMed2005

Decreasing strabismus surgery.

AIM: To determine whether there has been a consistent change across countries and healthcare systems in the frequency of strabismus surgery in children over the past decade. METHODS: Retrospective analysis of data on all strabismus surgery performed in NHS hospitals in England and Wales, on children aged 0-16 years between 1989 and 2000, and between 1994 and 2000 in Ontario (Canada) hospitals. These were compared with published data for Scotland, 1989-2000. RESULTS: Between 1989 and 1999-2000 the number of strabismus procedures performed on children, 0-16 years, in England decreased by 41.2% from 15 083 to 8869. Combined medial rectus recession with lateral rectus resection decreased from 5538 to 3013 (45.6%) in the same period. Bimedial recessions increased from 489 to 762, oblique tenotomies from 43 to 121, and the use of adjustable sutures from 29 to 44, in 2000. In Ontario, operations for squint decreased from 2280 to 1685 (26.1%) among 0-16 year olds between 1994 and 2000. CONCLUSION: The clinical impression of decrease in the frequency of paediatric strabismus surgery is confirmed. In the authors' opinion this cannot be fully explained by a decrease in births or by the method of healthcare funding. Two factors that might have contributed are better conservative strabismus management and increased subspecialisation that has improved the quality of surgery and the need for re-operation. This finding has a significant impact upon surgical services and also on the training of ophthalmologists.

Adolescent↗
PubMed2002

The assessment and management of strabismus and amblyopia: a national audit.

AIMS: To determine what systems are in place within ophthalmic services for the assessment and management of children suspected of having amblyopia and strabismus. To find out what methods are used for the assessment of these children. METHODS: A questionnaire-based study auditing 288 orthoptic departments in the UK. RESULTS: Responses were received from 75% orthoptic departments. Most hospitals employ more than one system for the assessment of strabismus and amblyopia, which is generally dependent on route of referral. These include 'orthoptic assessment without refraction' (66%), 'combined orthoptist and ophthalmologist assessment' (66%), while 22% have an entirely orthoptist/optometric system. Ophthalmologists are involved in the initial assessment in 145 units (67%), whereas some units involve an ophthalmologist only if response to treatment is poor (15%), or if surgery is required (6%). Fourteen per cent of units reviewed all children, with discharge criteria being based on normal visual acuity (52%), accurate visual acuity (39%) and a normal orthoptic assessment (42%). Seventy-six per cent of units review some children, commonly as a result of family history (55%), parental concern (43%), poor co-operation (30%) and young age (72%). In the absence of squint or amblyopia children are discharged at the first visit, in only 8% of units. There is considerable variation in the tests used to assess visual acuity. LogMAR-based tests (eg EDTRS) are not routinely used in 75% of units. CONCLUSION: Different systems exist for the assessment and management of squint and amblyopia across the country. While much of this variation is to be expected given their possible aetiologies, some could be reduced to produce a more cohesive service. There is also considerable scope for rationalising the tests used to screen infants and children for amblyopia and strabismus.

Amblyopia↗
PubMed2000

Sight unseen

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Journal Article↗
PubMed1999

Epilepsy education in schools.

The objective of this study was to assess the effect of an epilepsy education initiative on the management of epilepsy in Southampton schools. A self-completion questionnaire survey was undertaken of staff in 19 Southampton primary schools and ten secondary schools. Changes in knowledge and management of seizures in children with epilepsy were measured following an education session and a recommended implementation of an individual seizure protocol for children with epilepsy. There were significant changes in some areas of seizure management and knowledge. Only a small number (three) of primary schools had a protocol in place. Two primary and four secondary schools were in the process of putting the protocol in place. An improvement in knowledge and seizure management has been demonstrated. Further work is needed to implement an individual seizure protocol for all children with epilepsy.

Child↗
PubMed1998

An audit of paediatric epilepsy care.

Basic standards for the process of paediatric epilepsy care were identified and applied in a clinical audit; findings were presented and the audit repeated. Standards agreed related to quality of correspondence, prescribing practice, appropriateness of drug monitoring, use of neuroimaging, and quality of requests for electroencephalography (EEG). Parent satisfaction with staff courtesy, doctor communication, and clinic visits were also assessed. In the second audit prescribing practice and appropriateness of drug monitoring had improved, but quality of patient correspondence and requests for EEG were unchanged. In both periods of care many parents were dissatisfied with the quality and amount of information provided about epilepsy. Standards of care for the medical management of children with epilepsy can be agreed and used to identify achievable improvements in that care.

Appointments and Schedules↗
PubMed1997

Visual search, perception, and visual-motor skill in "healthy" children born at 27-32 weeks' gestation.

Visual-perceptual, attentional, and visual-motor skills were examined in a group of 16 school-age children, born at 27-32 gestational weeks, who had performed normally on pediatric screening tests. Compared with 16 matched full-term controls, the preterms performed poorly on only two measures: they took longer to point to the missing arc of an annulus displayed on a computer screen and failed to find targets more often in a complex visual search task. They showed no deficits on tests of visual form extraction and closure. These data suggest that in the absence of any disability that is clinically detectable, prematurity results in a cluster of small but significant visual-motor impairments that persist into middle childhood. These relate to the maintenance of attention and visual-motor coordination, though visual form perception is not measurably affected. The results are discussed in the context of current neurobiological models of visual system organization.

Analysis of Variance↗