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Objective To search for and critically appraise the psychometric quality of patient-reported outcome measures (PROMs) developed or validated in optic neuritis, in order to support high-quality research and care. Methods We systematically searched MEDLINE(Ovid), Embase(Ovid), PsycINFO(Ovid) and CINAHLPlus(EBSCO), and additional grey literature to November 2021, to identify PROM development or validation studies applicable to optic neuritis associated with any systemic or neurologic disease in adults. We included instruments developed using classic test theory or Rasch analysis approaches. We used established quality criteria to assess content development, validity, reliability, and responsiveness, grading multiple domains from A (high quality) to C (low quality). Results From 3142 screened abstracts we identified five PROM instruments potentially applicable to optic neuritis: three differing versions of the National Eye Institute (NEI)-Visual Function Questionnaire (VFQ): the 51-item VFQ; the 25-item VFQ and a 10-item neuro-ophthalmology supplement; and the Impact of Visual Impairment Scale (IVIS), a constituent of the Multiple Sclerosis Quality of Life Inventory (MSQLI) handbook, derived from the Functional Assessment of Multiple Sclerosis (FAMS). Psychometric appraisal revealed the NEI-VFQ-51 and 10-item neuro module had some relevant content development but weak psychometric development, and the FAMS had stronger psychometric development using Rasch Analysis, but was only somewhat relevant to optic neuritis. We identified no content or psychometric development for IVIS. Conclusion There is unmet need for a PROM with strong content and psychometric development applicable to optic neuritis for use in virtual care pathways and clinical trials to support drug marketing authorisation.

To provide a case report of Retinal Vein Occlusion (RVO) with COVID-19 infection.A 15-year-old healthy male presented with blurring of vision, 2+ vitreous cells, retinal haemorrhages and dilated and tortuous retinal vessels in the left eye within 28 days of a positive COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) assay. He was diagnosed with left non-ischaemic CRVO, with a suspected aetiology of COVID-19.A literature review found 12 reported cases of RVO associated with COVID-19. All but one patient was younger than 60, with a mean age of 42 years. Management varied, but in the majority (8/12), visual acuity (VA) improved with follow-up, and five (42%) had a final VA of 20/20.In the absence of other known aetiological factors, ophthalmologists should consider COVID-19 as a cause of RVO. The outcome can vary, but the majority can expect improvement in VA with time.

Background Cesarean rates have increased significantly over the past decade. The reasons for this are both complex and context specific, and have significant consequences for health resources. The aim of this systematic review was to assess published, peer-reviewed, and gray qualitative literature on the reasons behind cesarean delivery on maternal request (CDMR). Methods A systematic search of MEDLINE, EMBASE, CINAHL, LILACS, and PsycINFO databases was performed for all relevant articles published between January 2006 and June 2016. Reference lists of all included studies were also searched in addition to select web-based sources. Studies were included if they qualitatively evaluated women's preferences for CDMR, with no geographic restriction. Findings from the studies were narratively and thematically synthesized. Results Sixteen studies were included in this review. Three themes were identified as to why women choose CDMR, which were: social norms, emotional experiences, and personal experiences. A woman's decision was often shaped by various influences including family, friends, and the media. In addition, previous experience of childbirth and interactions with health care professionals contributed to a strong preference for CDMR. CDMR provided women with a sense of control over the birth and diminished feelings of fear. Conclusions The reasons behind CDMR are multifactorial and complex. Situation-specific cultural factors, fear of pain during childbirth, previous experience, and interactions with health care professionals are likely to have led to the increase in CDMR. Multifaceted, context-specific approaches are required if there is to be a reduction in CDMR rates.

IntroductionCommunity-based screening for cervical cancer and task sharing to community health workers (CHWs) have been suggested as a potential way to increase screening coverage in low- and middle-income countries (LMICs). The aims of the scoping review were to understand the following: (i) where and how CHWs are currently deployed in screening in LMIC settings; (ii) the methods used to train and support CHWs in screening, and (iii) The evidence on the cost-effectiveness of using CHWs to assist in screening.MethodsA scoping literature search of 11 major databases and the grey literature was performed between 1978 and 2018. We included comprehensive search terms for ‘CHWs’ and ‘Cervical Cancer’, and used the World Bank criteria to define LMICs.ResultsOf the 420 articles screened, 15 met the inclusion criteria for review. Studies were located in Africa (n=5), Asia (n=5), and South and Central America (n=5). CHWs played a role in community education and raising awareness (n=14), conducting or assisting in cervical screening (n=5), or follow-up (n=1). 11 studies described CHW training activities. Only one study provided a formal cost analysis.ConclusionThe roles of CHWs in cervical cancer screening in LMICs have largely to date focused on education, outreach, and awareness programmes. Community-based approaches to cervical cancer screening are feasible, although the sociocultural context plays an important role in the acceptability of these interventions. Further in-depth contextually grounded studies exploring the acceptability of such interventions are required, as well as studies exploring the cost-effectiveness of involving CHWs in cervical cancer screening activities.

ObjectivesUnderstanding the current landscape of ongoing training for community health workers (CHWs) in low-income and middle-income countries (LMICs) is important both for organisations responsible for their training, as well as researchers and policy makers. This scoping review explores this under-researched area by mapping the current delivery implementation and evaluation of ongoing training provision for CHWs in LMICs. DesignSystematic scoping review. Data sourcesMEDLINE, Embase, AMED, Global Health, Web of Science, Scopus, ASSIA, LILACS, BEI and ERIC. Study selectionOriginal studies focusing on the provision of ongoing training for CHWs working in a country defined as low income and middle income according to World Bank Group 2012 classification of economies. ResultsThe scoping review found 35 original studies that met the inclusion criteria. Ongoing training activities for CHWs were described as supervision (n=19), inservice or refresher training (n=13) or a mixture of both (n=3). Although the majority of studies emphasised the importance of providing ongoing training, several studies reported no impact of ongoing training on performance indicators. The majority of ongoing training was delivered inperson; however, four studies reported the use of mobile technologies to support training delivery. The outcomes from ongoing training activities were measured and reported in different ways, including changes in behaviour, attitudes and practice measured in a quantitative manner (n=16), knowledge and skills (n=6), qualitative assessments (n=5) or a mixed methods approach combining one of the aforementioned modalities (n=8). ConclusionsThis scoping review highlights the diverse range of ongoing training for CHWs in LMICs. Given the expansion of CHW programmes globally, more attention should be given to the design, delivery, monitoring and sustainability of ongoing training from a health systems strengthening perspective.

Lower 25-hydroxyvitamin D2 /D3 levels at melanoma diagnosis are associated with thicker primaries and poorer survival. We postulated that this might relate to the deleterious effect of systemic inflammation as 25-hydroxyvitamin D2 /D3 levels are inversely associated with levels of C-reactive protein. 2,182 participants in the Leeds Melanoma Cohort (median follow-up 7.98 years) provided data on drug exposure, comorbidities and a serum 25-hydroxyvitamin D2 /D3 level at recruitment. Factors reported to modify systemic inflammation (low vitamin D levels, high body mass index, use of aspirin or nonsteroidal anti-inflammatory drugs or smoking were tested as predictors of microscopic ulceration (in which primary tumors are inflamed) and melanoma-specific survival (MSS). Ulceration was independently associated with lower 25-hydroxyvitamin D2 /D3 levels (odds ratio (OR) = 0.94 per 10 nmol/L, 95% CI 0.88-1.00, p = 0.05) and smoking at diagnosis (OR = 1.47, 95% CI 1.00-2.15, p = 0.04). In analyses adjusted for age and sex, a protective effect was seen of 25-hydroxyvitamin D2 /D3 levels at diagnosis on melanoma death (OR = 0.89 per 10 nmol/L, 95% CI 0.83-0.95, p0.001) and smoking increased the risk of death (OR = 1.13 per 10 years, 95% CI 1.05-1.22, p = 0.001). In multivariable analyses (adjusted for tumor thickness) the associations with death from melanoma were low 25-hydroxyvitamin D2 /D3 level at recruitment (20 nmol/L vs. 20-60 nmol/L, hazard ratio (HR) = 1.52, 95% CI 0.97-2.40, p = 0.07) and smoking duration at diagnosis (HR = 1.11, 95% CI 1.03-1.20, p = 0.009). The study shows evidence that lower vitamin D levels and smoking are associated with ulceration of primary melanomas and poorer MSS. Further analyses are necessary to understand any biological mechanisms that underlie these findings.

Mobile health (mHealth) approaches for medical education in developing countries may be particularly useful given the number of mobile phone subscription rates and the challenges faced by medical educators. The evidence to support its effectiveness has not been critically reviewed. The electronic databases PubMed, Scopus and MEDLINE were searched to retrieve English language articles published in international academic journals between January 2007 and September 2014. Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. Only articles addressing the use of mobile or tablet technologies and that met a prespecified keyword strategy were selected for review. The original search returned 583 results, of which only seven pertained to medical education in developing countries and had full text available. There was significant variation between the studies reviewed, in terms of intended audience, intervention design, assessment method and outcome. Three studies assessed the integration of mHealth solutions into the training of allied healthcare professionals, three assessed resident doctors, and another assessed undergraduate medical students. Six of the seven studies used mobile phones as the intervention tool. The majority of studies pointed towards mHealth as a promising tool for education and training of healthcare professionals, yet due to the limited size of the studies definite conclusions were limited. The results of this review suggest that more studies with larger sample sizes and more quantitative methods of evaluation are needed in order to demonstrate that mHealth holds more than mere potential.

We report the case of a 54-year-old, quadriplegic woman with a methicillin-resistant Staphylococcus aureus (MRSA) vaginal infection. After failing a five-day course of intravenous vancomycin therapy, the patient was treated for ten days with mupirocin ointment applied intravaginally twice daily, which resulted in eradication of the infection. This report details a novel approach in treating MRSA vaginal infections.

Most atypical Mycobacterium infections of the hand are caused by Mycobacterium marinum. We are presenting a rare case of a Mycobacterium chelonei tenosynovitis. The correct diagnosis is important because the chelonei species is resistant to most antituberculosis drugs. Treatment should include surgical debridement and long-term chemotherapy after sensitivities have been determined.

When the athletic young woman of the present day first made her appearance and began to make the fad popular, physicians thought that with the changed conditions of her life would come such an improvement in her general health that most of her minor ailments would disappear of themselves. Of these I wish, for the present, to consider dysmenorrhea as the chief, and the one that appeared to present the best hope of cure. Sermons innumerable had been preached against the high-heeled shoes and the tight lacing of the generation of girls just gone by, attributing to these pernicious influences most of the ills that afflicted women, and now that no heels, and waists of nature's own proportions had become fashionable, it was reasonable to suppose that the attendant train of evils would also disappear with their causes. But it did not follow; in spite of riding, walking, tennis, bicycling

Nearly all the children that are brought for treatment to the dispensary of the Woman's Medical College of Baltimore come from the "Black District" bordering on Druid Hill Avenue and the intersecting streets and alleys. We have children showing all proportions of negro blood, from the wooly-headed pure negro type to the palest yellow of the mulatto, and in the mothers, or friends, who accompany them, we find the widest possible range of intelligence. As most of the women have to work to help to support themselves, and often to take care of children of whom the father is unknown, it follows that the care of the children is frequently entrusted to older members of the family, as a maternal grandmother or aunt, who probably has already children of her own. We have found also that baby-farming is quite an industry in the neighborhood, and always attended by a very

Bacteriologists who have worked with the gonococcus of Neisser insist that it is an organism that is very refractory to cultivation outside of the living body, and that when it is removed from its usual habitat it dies very promptly. Immersion of gonorrheal pus in water, drying of the pus, or even simple exposure to air is said by some authorities to be sufficient to destroy the life of the gonococcus. Accepting the theory that the infectious nature of the discharge depends entirely on the specific organism, it would appear from this that it would be next to impossible to convey gonorrhea from one person to another in any way except by direct contact of surfaces subject to its invasion. This opinion might easily cause very serious complications from a medicolegal standpoint, and lead to the conviction of innocent parties accused of criminal procedure. The teaching of the laboratory in