Anti-VEGF intervention in neovascular AMD: benefits and risks restated as natural frequencies.

OBJECTIVE: Clear information is essential to properly determine preference in medical intervention. In neovascular age-related macular degeneration, patients need to understand the balance of risk and benefit of anti-vascular endothelial growth factor (VEGF) treatment. This balance is altered by the number of injections administered. METHODS: Natural frequencies, displayed as pictographically as icon arrays, are used to show material outcomes from the MARINA and HARBOR (12 months) trials. We also calculated the number needed to treat (NNT) and number needed to harm (NNH). RESULTS: MARINA 24-month data show the absolute risk reduction is 37% and the NNT is 3; meaning for one patient to benefit three need to be treated.12 months' HARBOR data show that compared with as-needed treatment, scheduled monthly injection treatment increases the number of patients achieving a better visual outcome. The number of patients suffering harm is also increased by the additional injections. CONCLUSION: Displaying MARINA and HARBOR trial data as natural frequencies, with numbers needed to treat and harm, communicates complimentary information on the positive and negative aspects of anti-VEGF treatment.

Tattoo-associated panuveitis: A 10-year follow-up.

INTRODUCTION: There has been an increasing number of tattoo-related uveitis without evidence of systemic sarcoidosis. This finding may indicate a possible association of tattoos with uveitis. CASE DESCRIPTION: This report is a 10-year follow-up of a single case of tattoo-related uveitis with no proven systemic sarcoidosis. CONCLUSION: Literature review suggests possible pathogenesis and the patient's management is discussed. This case highlights the importance of a good systemic history and physical examination, especially with regard to tattoos.

Building a safer foundation: the Lessons Learnt patient safety training programme.

OBJECTIVES: To develop, implement and evaluate a novel patient safety training programme for junior doctors across a Foundation School-'Lessons Learnt: Building a Safer Foundation'. DESIGN, SETTING AND PARTICIPANTS: Prospective preintervention /postintervention study across 16 Foundation Programmes in North West England, UK. 1169 participants including all Foundation Programme Directors, Administrators, Foundation trainees and senior faculty. INTERVENTIONS: Half-day stakeholder engagement event and faculty development through recruitment and training of local senior doctors. Foundation trainee-led monthly 60-min sessions integrated into compulsory Foundation teaching from January to July 2011 comprising case-based discussion and analysis of patient safety incidents encountered in practice, facilitated by trained faculty. MAIN OUTCOME MEASURES: Participants' satisfaction and Foundation trainees' patient safety knowledge, skills, attitudes and behavioural change. RESULTS: Participants reported high levels of satisfaction with 'Lessons Learnt'. There was a significant improvement in trainees' objective patient safety knowledge scores (Meanpreintervention=51.1%, SD=17.3%; Meanpostintervention=57.6%, SD=20.1%, p<0.001); subjective knowledge ratings and patient safety skills. Trainees' perceived control and behavioural intentions regarding safety improved significantly postintervention. Feelings and personal beliefs about safety did not shift significantly. Trainees reported significantly more patient safety incidents in the 6 months following introduction of 'Lessons Learnt' (Meanpreintervention=0.67, SD=1.11; Meanpostintervention=1.18, SD=1.46, p<0.001). 32 quality improvement projects were initiated by trainees, spanning the development of novel clinical protocols; implementation of user-informed teaching and improved rota design CONCLUSIONS: Patient safety training can be implemented and sustained to deliver significant improvements in patient safety knowledge, skills and behaviours of junior doctors-with potential for wider positive organisational impact. Medical education commissioners and providers could adopt and build upon the 'Lessons Learnt' approach as a springboard to promote medical engagement in quality and safety improvement.

Candida: an unexpected cause of the acute abdomen.

The infected intrauterine contraceptive device (IUCD) is a well-described cause of the acute abdomen. However, severe pelvic infection from Candida is an extremely rare complication of the IUCD. We present the first reported description of a Candida-infected IUCD manifesting as an acute abdomen where the degree of infection precluded a conclusive diagnostic workup and necessitated multiple laparotomies. This case highlights the importance for the clinicians to thoroughly exclude such causes of acute sepsis even after exclusion in the presenting history.