Yes / Although urgent primary eye care schemes exist in some areas of England, their current safety is unknown. Accordingly, the aim of the present study was to quantify the clinical safety and effectiveness of a COVID-19 Urgent Eyecare Service (CUES) across Luton, Bedford, Hull, East Riding of Yorkshire and Harrogate. Consenting patients with acute onset eye problems who had accessed the service were contacted to ascertain what the optometrist's recommendation was, whether this worked, if they had to present elsewhere and how satisfied they were with the CUES. A total of 27% (170/629) and 6.3% (28/445) of patients managed virtually and in person, respectively, did not have their acute eye problem resolved. Regression analysis revealed that patients who attended a face-to-face consultation were 4.66 times more likely to be correctly managed [Exp (β) = 5.66], relative to those solely managed virtually. Optometrists' phone consultations failed to detect conditions such as stroke, intracranial hypertension, suspected space occupying lesions, orbital cellulitis, scleritis, corneal ulcer, wet macular degeneration, uveitis with macular oedema and retinal detachment. Of referrals to hospital ophthalmology departments, in total, 19% were false-positives. Patients, however, were typically very satisfied with the service. Uptake was associated with socioeconomic status. The present study found that a virtual assessment service providing optometrist tele-consultations was not effective at resolving patients' acute-onset eye problems. The range and number of pathologies missed by tele-consultations suggests that the service model in the present study was detrimental to patient safety. To improve this, optometrists should follow evidence based guidance when attempting to manage patients virtually, or in person. For example, patients presenting with acute-onset symptoms of flashing lights and/or floaters require an urgent dilated fundus examination. Robust data collection on service safety is required on an ongoing basis.

Yes / Background: There are a number of limitations to the present primary eye care system in the UK. Patients with minor eye conditions typically either have to present to their local hospital or GP, or face a charge when visiting eye care professionals (optometrists). Some areas of the UK have commissioned enhanced community services to alleviate this problem; however, many areas have not. The present study is a needs assessment of three areas (Leeds, Airedale and Bradford) without a Minor Eye Conditions Service (MECS), with the aim of determining whether such a service is clinically or economically viable. Method: A pro forma was developed for optometrists and practice staff to complete when a patient presented whose reason for attending was due to symptoms indicative of a problem that could not be optically corrected. This form captured the reason for visit, whether the patient was seen, the consultation funding, the outcome and where the patient would have presented to if the optometrists could not have seen them. Optometrists were invited to participate via Local Optical Committees. Results were submitted via a Google form or a Microsoft Excel document and were analysed in Microsoft Excel. Results: Seventy-five percent of patients were managed in optometric practice. Nine and 16% of patients required subsequent referral to their General Practitioner or hospital ophthalmology department, respectively. Should they not have been seen, 34% of patients would have presented to accident and emergency departments and 59% to their general practitioner. 53% of patients paid privately for the optometrist appointment, 28% of patients received a free examination either through use of General Ophthalmic Service sight tests (9%) or optometrist good will (19%) and 19% of patients did not receive a consultation and were redirected to other providers (e.g. pharmacy, accident and emergency or General Practitioner). 88% of patients were satisfied with the level of service. Cost-analyses revealed a theoretical cost saving of £3198 to the NHS across our sample for the study period, indicating cost effectiveness. Conclusions: This assessment demonstrates that a minor eye condition service in the local areas would be economically and clinically viable and well received by patients.

Yes / Purpose: Although urgent primary eye care schemes exist in some areas of England, their current safety is unknown. Accordingly, the aim of the present study was to quantify the clinical safety and effectiveness of a COVID-19 Urgent Eyecare Service (CUES) across Luton, Bedford, Hull, East Riding of Yorkshire and Harrogate. Methods: Consenting patients with acute onset eye problems who had accessed the service were contacted to ascertain what the optometrist’s recommendation was, whether this worked, if they had to present elsewhere and how satisfied they were with the CUES. Results: 27% (170/629) and 6.3% (28/445) of patients managed virtually and in person, respectively, did not have their acute eye problem resolved. Regression analysis revealed that patients who attended a face-to-face consultation were 4.66 times more likely to be correctly managed (Exp (β) = 5.66), relative to those managed solely virtually. Optometrists phone consultations failed to detect conditions such as stroke, intracranial hypertension, suspected space occupying lesions, orbital cellulitis, scleritis, corneal ulcer, wet macular degeneration, uveitis with macular oedema and retinal detachment. Of referrals to hospital ophthalmology departments, in total, 19% were false-positives. Patients, however, were typically very satisfied with the service. Uptake was associated with socio-economic status. Conclusion: The present study found that a virtual assessment service providing optometrist teleconsultations was not effective at resolving patient’s acute-onset eye problems. The range and number of pathologies missed by teleconsultations suggests that the service model in the present study was detrimental to patient safety. To improve this, optometrists should follow evidence based guidance when attempting to manage patients virtually, or in person. For example, patients presenting with acute-onset symptoms of flashing lights and/or floaters require an urgent dilated fundus examination. Robust data collection on service safety is required on an ongoing basis. / The full-text of this article will be released for public view at the end of the publisher embargo on 10 Nov 2022.

Cette thèse porte sur la fonction de direction d’une maison d’enfants à caractère social (MECS). Le travail réalisé s’inscrit dans une approche clinique d’orientation psychanalytique. À partir de quatre entretiens cliniques de recherche auprès de deux directrices et deux directeurs de MECS, la chercheuse, occupant elle-même des fonctions de direction de MECS, propose de poser un regard clinique sur les différentes postures sous-jacentes à l’exercice de cette fonction. La thèse est organisée en trois parties : la première partie analyse l’itinéraire professionnel de la chercheuse et témoigne de l’évolution de son positionnement dans une démarche clinique d’abord en tant que professionnelle puis en tant que chercheuse. La deuxième partie présente le champ de la Protection de l’Enfance, la spécificité des MECS comme institutions de la mésinscription et des adolescents qui y sont accueillis, la fonction de direction à travers plusieurs ouvrages consacrés à cette question mis en écho avec l’expérience de fonction de direction occupée par la chercheuse. Un dernier chapitre propose quelques éclairages théoriques à propos de la pulsion et la pulsion de mort. La troisième et dernière partie est dédiée à l’analyse des entretiens et à la mise en perspective de ces analyses dans laquelle sont avancées des hypothèses de compréhension des enjeux conscients et inconscients dans l’exercice de la fonction de direction de MECS. / This thesis focusses on the role of leadership in Children’s Social Care Homes (MECS) and on the analysis of the psychological sources which underlie this role. The work is done as part of a clinical approach from a psychoanalytical position. Based on clinical interviews conducted with directors of MECS, the researcher proposes to take a clinical look at the different aspects of this function. The thesis is organised in three parts : the first part traces the professional journey of the researcher and shows the evolution of her position in a clinical approach to psychoanalytical orientation, first as a professional and then as a researcher. The second part presents an overview of child protection as well as the specificities of the “MECS” as institutions of care (mesinscription) linked to the characteristics of the adolescents they welcome. Based on the reading of several works on the function of leadership in this type of institutions and using her own experience as a director of a MECS countertransferentially, the researcher analyses the outlines of the definition of this function. The third and final part is dedicated to the analysis of the interviews and putting into the perspective of these analyses in which are advanced hypotheses for understanding of the conscious and unconscious stakes process of “déliaison” in such an institution and to the dualism of the impulse to life/impulse to death.

Previous research has reported that inequalities exist in uptake of NHS sight tests in relation to socio-economic status, and that community optometric services have potential to improve system efficiency. The current research found inequalities in sight test outcome related to socio-economic status and the type of practice that a patient visits (multiple, or independent). Patients attending multiples were more likely to receive a ‘new or changed prescription’ relative to ‘no prescription’ compared to patients that attended independent opticians (36-71% more likely). Those living in the least deprived areas were also less likely to receive a new prescription (1-12%) and those aged <16 years were less likely to be referred (9%). The study examining the need for a Minor Eye Condition Service in Leeds and Bradford found it would produce theoretical cost savings, whilst maintaining high patient satisfaction. Subsequently, a MECS was commissioned in Bradford. The study attempting to collect data from MECS across all areas of England found that data is not routinely collected, or shared. The limited data available typically showed that 73-83% of patients were retained in optometric practice with 12-18% receiving a hospital referral. A prospective evaluation of a COVID urgent eye care service found that teleconsultations frequently did not resolve patients’ eye problems (27%). These telephone consultations failed to detect some serious conditions such as scleritis, wet macular degeneration, retinal detachment. The results from the thesis support the view that the current method of delivering eye care in England is contrary to the public health interest.