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Purpose : There is accumulating evidence that optical coherence tomography (OCT) in specialist settings can facilitate the diagnosis of glaucoma and retinal disease, however the impact of this technology on clinical decision-making by community optometrists in primary eye care is currently unclear.\ud \ud Methods : A group of community optometrists (n=50) initially completed a standardised training package on OCT interpretation followed by a computer-based assessment featuring 52 clinical vignettes, containing images of healthy (n=16) or diseased discs or fundi (n=36). Each vignette featured either a single fundus/disc photographic image, or a combination of a fundus/disc image with the corresponding OCT scan. For each case, the optometrist selected their diagnosis from a pull-down list and their confidence in their decision using a 10-point Likert scale. Pairwise statistical comparisons of the fundus image alone and fundus image/OCT combination were calculated.\ud \ud Results : The median period the optometrists had been qualified was 10 years (interquartile range (IQR) 4-19 years). The mean percentage of correct diagnoses using fundus imaging alone was 61.5% (95% CI 58.9%-64.2%) and for the combination of fundus image/OCT was 79.9% (95% CI 77.4%-82.1%). The median false negative rate with fundus alone was 27.8% (IQR 16.7%-33.3%) reducing to 11.1% (IQR 5.6%-16.7%). Median confidence scores for fundus imaging alone was 8.00 (IQR 7.00-8.00) and 8.25 (IQR 8.00-9.00) for the combination. Improvements in performance and confidence were statistically significant (p

OBJECTIVE: This research aims to evaluate the wider health system effects of the introduction of an intermediate-tier service for eye care. \ud \ud SETTING: This research employs the Minor Eye Conditions Scheme (MECS), an intermediate-tier eye care service introduced in two London boroughs, Lewisham and Lambeth, in April 2013. \ud \ud DESIGN: Retrospective difference-in-differences analysis comparing changes over time in service use and costs between April 2011 and October 2014 in two commissioning areas that introduced an intermediate-tier service programme with changes in a neighbouring area that did not introduce the programme.\ud \ud DATA SOURCES: MECS audit data; unit costs for MECS visits; volumes of first and follow-up outpatient attendances to hospital ophthalmology; the national schedule of reference costs. \ud \ud MAIN OUTCOME MEASURES: Volumes and costs of patients treated. \ud \ud RESULTS: In one intervention area (Lewisham), general practitioner (GP) referrals to hospital ophthalmology decreased differentially by 75.2% (95% CI -0.918% to -0.587%) for first attendances, and by 40.3% for follow-ups (95% CI -0.489% to -0.316%). GP referrals to hospital ophthalmology decreased differentially by 30.2% (95% CI -0.468% to -0.137%) for first attendances in the other intervention area (Lambeth). Costs increased by 3.1% in the comparison area between 2011/2012 and 2013/2014. Over the same period, costs increased by less (2.5%) in one intervention area and fell by 13.8% in the other intervention area. \ud \ud CONCLUSIONS: Intermediate-tier services based in the community could potentially reduce volumes of patients referred to hospitals by GPs and provide replacement services at lower unit costs.

Propafenone is a class Ic anti-arrhythmic agent with mild B-blocking properties which has recently become available in South Africa. We have used the drug in 3 patients with sustained m.onomorphic ventricular tachycardia not due to ischaemic heart disease. All had norm.al left ventricular function; 1 had Wegener's granulom.atosis and 2 had arrhythmogenic right ventricular dysplasia. In the latter 2, propafenone provoked incessant monomorphic ventricular tachycardia which persisted for m.ore than 24 hours despite repeated efforts at term.ination. The morphology was similar to the patients' spontaneous ventricular tachycardia, but the rate was slower and the QRS complexes broader, consistent with propafenone's marked ability to slow intraventricular conduction. It is postulated that incessant tachycardia results from. perpetuation of re-entry due to marked conduction slowing produced by the drug. Previous reports have suggested that this is most likely to occur in patients with poor left ventricular function, but our experience indicates that those with normal left ventricular function are also at risk, particularly if the substrate for reentry is present. Propafenone, like all other powerful antiarrhythmic agents, may provoke life-threatening arrhythmias and should be used with great caution after due consideration of the indications, even in patients with norm.al left ventricular function.

Purpose : Early identification and presentation for childhood cataract surgery remains a major challenge in developing countries. The main aim of this study was to identify potential barriers to childhood cataract services from the perspective of parents’ and carers’, as a critical step towards achieving the timely uptake of cataract services.\ud \ud Methods : We used a mixed methods explanatory sequential study and interviewed 572 parents/carers attending tertiary hospitals in 8 states across India for their child's cataract surgery. We collected information on barriers to accessing services using a 12-item questionnaire and for each reported barrier, responses recorded on a 5 point scale ranging from “low to high importance”. Based on the quantitative data, in-depth interview questions were prepared and 35 interviews were conducted with randomly selected parents/ carers. Majority of these interviews were conducted at the hospital and /at home for those who did not undergo the surgery. Quantitative questionnaires were completed by the trained interviewer and responses were recorded in a pre-designed format. In-depth interviews were audio taped and transcribed for analysis. Quantitative data were analysed using SPSS 22 while qualitative data were organised with NVivo 11 and a thematic analysis was conducted utilising TDF, an integrative framework of theories.\ud \ud Results : From the 831 responses the 5 most important barriers were: economic (40%; n=222); child too young for surgery (17%; n=97); the problem was not felt as severe (16%; n=90); distance (14.5%; n=83) and no one to accompany to the hospital (9.5%; n=54). In addition, being advised by a local ophthalmologist to delay the surgery was also reported (n=16). Domains identified by the TDF included “Knowledge”, “Beliefs about consequences”, “Intentions”, “Goals”, “Decision processes”, “Environmental context and resources”, “Social influences and emotion”. This comprehensive TDF approach enabled us to understand the parents perceived barriers to access services for the children.\ud \ud Conclusions : Barriers to accessing childhood cataract services include both practical concerns relating to the family’s socio economic status as well as obstacles from the providers. Mapping out the barriers is necessary to design appropriate intervention for achieving positive behaviour change that can have potential social and economic impact.

MCom (Risk Management), North-West University, Vaal Triangle Campus, 2017 A key component to the financial market is understanding how people act and react in different situations, with regard to investment decisions. Uncertainty, along with risk, is also a key concept in economic decision making. To predict and understand economic behaviour, one needs to understand an individual’s attitude toward perceived risk. In order for an individual to be able to make sound investment decisions, the individual will need to possess some knowledge of their level of risk appetite. Along with risk appetite, individuals tend to expect a certain amount of risk to encompass various risk-taking behaviours. Furthermore, the risk appetite of the individual depends on the individual’s attitude toward the perceived risk. When measuring the risk appetite of individuals, it is generally expected that there are two main categories of risk appetite, namely risk-averse and risk seeking individuals. The attitude an individual hold toward the taking or avoiding of a risk has mostly evolved in three main contexts namely decision processes, social psychology and personality models. With regard to an individual’s risk appetite, there is a general stereotype in literature that suggest female risk-takers are more risk averse than their male counterparts. Although risk behaviour has been widely studied, few studies have been conducted on the difference between gendered risk-taking of individuals. Little to no evidence exists on the notion or reasoning of the individual’s risk-taking behaviour beyond the quantitative measurement thereof. Few studies provide a precise answer as to the reasons for this level of risk aversion in the female context. The purpose of this study was to determine whether there is a difference in gendered risk-taking behaviour in the South African context, and if so, the causes in differences of gender-based risk-taking behaviour. This study followed a mixed methods research design. For the quantitative portion of this study, the target population comprised full-time students registered at the South African Higher Educational Institutions, who are enrolled for commerce degrees. From the sampling frame, a non-probability judgement sample of one traditional university in Gauteng was selected. A non-probability convenience sample of 462 registered full-time students was drawn. A self-administered questionnaire was distributed to the sample. The questionnaire took, on average, 20 minutes to complete. Upon completion of the questionnaire, students could indicate whether they wanted to participate in the qualitative portion of this study. Volunteers attended a semi-structured interview, pertaining to the data collection method for the qualitative phase. The interviews took on average 40 minutes to complete. The findings of this study indicate that individuals are willing to participate in risk-taking behaviour across the five domains of life. Participants also indicated that the male sample are more risk-seeking than their female counterparts. The male sample indicated to be less risk-seeking than their female counterparts, only in the social domain of life. Reasons pertaining to female risk aversion included females being more thorough in terms of research before engaging in risk-taking behaviour, their risk-taking behaviour was related to the outcome of the risk and they needed advice from their elders and/or peers before engaging in a risk-taking activity. Also, the level of financial knowledge an individual has affected their risk-taking behaviour, for both the male and female samples. Insights gained from this study would enable the development of interventions that could enhance female investment participation. This would enhance their level of economic empowerment and participation. The results obtained in this study can also aid in the development of investment vehicles designed specifically for students, given their risk-taking personality. Masters

OBJECTIVES: To explore views of all stakeholders (patients, optometrists, general practitioners (GPs), commissioners and ophthalmologists) regarding the operation of community-based enhanced optometric services.DESIGN: Qualitative study using mixed methods (patient satisfaction surveys, semi-structured telephone interviews and optometrist focus groups).SETTING: A minor eye conditions scheme (MECS) and glaucoma referral refinement scheme (GRRS) provided by accredited community optometrists.PARTICIPANTS: 189 patients, 25 community optometrists, 4 glaucoma specialist hospital optometrists (GRRS), 5 ophthalmologists, 6 GPs (MECS), 4 commissioners.RESULTS: Overall, 99% (GRRS) and 100% (MECS) patients were satisfied with their optometrists' examination. The vast majority rated the following as 'very good'; examination duration, optometrists' listening skills, explanations of tests and management, patient involvement in decision-making, treating the patient with care and concern. 99% of MECS patients would recommend the service. Manchester optometrists were enthusiastic about GRRS, feeling fortunate to practise in a 'pro-optometry' area. No major negatives were reported, although both schemes were limited to patients resident within certain postcode areas, and some inappropriate GP referrals occurred (MECS). Communication with hospitals was praised in GRRS but was variable, depending on hospital (MECS). Training for both schemes was valuable and appropriate but should be ongoing. MECS GPs were very supportive, reporting the scheme would reduce secondary care referral numbers, although some MECS patients were referred back to GPs for medication. Ophthalmologists (MECS and GRRS) expressed very positive views and widely acknowledged that these new care pathways would reduce unnecessary referrals and shorten patient waiting times. Commissioners felt both schemes met or exceeded expectations in terms of quality of care, allowing patients to be seen quicker and more efficiently.CONCLUSIONS: Locally commissioned schemes can be a positive experience for all involved. With appropriate training, clear referral pathways and good communication, community optometrists can offer high-quality services that are highly acceptable to patients, health professionals and commissioners.

About 1 in 1 000 children has Down syndrome. Extra chromosomal material results in a myriad of potential problems for the affected individual. About 40% of Down syndrome children will have cardiac abnormalities, ranging from the simple arterial duct to the complex atrioventricular septal defect. Virtually all these defects are amenable to surgical correction and extended survival is possible. In South Africa many of these children do not undergo cardiac surgery.

Conjoined twins represent a rare but fascinating congenital condition, the aetiology of which remains obscure. Over the past four decades, the paediatric surgeons at Red Cross Children's Hospital have been involved in the management of 46 pairs of conjoined twins, of which 33 have been symmetrical and 12 asymmetrical. Seventeen symmetrical twins have undergone separation with 22 children (65%) surviving; all of the live asymmetrical twins survived separation. We describe the important features of this unique cohort, outline our approach to management and present the results of this approach. We consider some of the ethical and moral dilemmas we have confronted, and discuss the prenatal diagnosis, obstetric implications and postnatal care of these children, including the relevant investigations and anaesthetic and surgical management. Specific aspects related to the cardiovascular system, hepatobiliary and gastrointestinal tracts, urogenital tract, central nervous system and musculoskeletal system are highlighted.