PURPOSE:To validate a patient-reported-experience-measure, PREM, of the NHS paediatric epilepsy service.METHODS:Section 1 of the PREM recorded demographic and clinical characteristics, and Section 2 collected information about the users' experience with the service. Section 2 included eighteen statements around three constructs: communication and provision of information to service users, interpersonal skills of staff, and clinic visits and accessibility to the services. Face validity, construct validity, internal reliability, and internal consistency were used to examine the robustness of these statements. The PREM was completed by parents/carers and also children/young people.RESULTS:PREMs were received from 145 of the 192 audit units; 2335 completed forms were returned; the attitude statements were completed by 750 children/young people and 1550 parents/carers. Face validity of the PREM was good. Construct validity was indecisive; confirmatory factor analysis of the hypothesised construct was weak. Exploratory factor analysis identified a four factor solution for the parent/carers dataset and a five factor solution for the children/young people's dataset. Internal reliability was good for the parent/carers dataset but less good for the children/young people. Internal consistency was moderately good for both datasets.CONCLUSIONS:These findings indicate that the PREM is likely to be a valid tool with the potential to elicit a wide variety of reliable views from parents/carers of children with epilepsy. The construct validity for the PREM should be reassessed with confirmatory factor analysis in a new dataset. More work needs to be undertaken with children/young people to design statements that capture their specific needs.

Background: Since the introduction of 2009 WHO dengue case classification, no literature was found regarding its effect on dengue death. This study was to evaluate the effect of 2009 WHO dengue case classification towards dengue case fatality rate. Methods: Various databases were used to search relevant articles since 1995. Studies included were cohort and cross-sectional studies, all patients with dengue infection and must report the number of death or case fatality rate. The Joanna Briggs Institute appraisal checklist was used to evaluate the risk of bias of the full-texts. The studies were grouped according to the classification adopted: WHO 1997 and WHO 2009. Meta-regression was employed using a logistic transformation (log-odds) of the case fatality rate. The result of the meta-regression was the adjusted case fatality rate and odds ratio on the explanatory variables. Results: A total of 77 studies were included in the meta-regression analysis. The case fatality rate for all studies combined was 1.14% with 95% confidence interval (CI) of 0.82-1.58%. The combined (unadjusted) case fatality rate for 69 studies which adopted WHO 1997 dengue case classification was 1.09% with 95% CI of 0.77-1.55%; and for eight studies with WHO 2009 was 1.62% with 95% CI of 0.64-4.02%. The unadjusted and adjusted odds ratio of case fatality using WHO 2009 dengue case classification was 1.49 (95% CI: 0.52, 4.24) and 0.83 (95% CI: 0.26, 2.63) respectively, compared to WHO 1997 dengue case classification. There was an apparent increase in trend of case fatality rate from the year 1992-2016. Neither was statistically significant. Conclusions: The WHO 2009 dengue case classification might have no effect towards the case fatality rate although the adjusted results indicated a lower case fatality rate. Future studies are required for an update in the meta-regression analysis to confirm the findings.

BACKGROUND:Common foot problems are independent risk factors for falls in older people. There is evidence that podiatry can prevent falls in community-dwelling populations. The feasibility of implementing a podiatry intervention and trial in the care home population is unknown. To inform a potential future definitive trial, we performed a pilot randomised controlled trial to assess: (i) the feasibility of a trial of a podiatry intervention to reduce care home falls, and (ii) the potential direction and magnitude of the effect of the intervention in terms of number of falls in care home residents. METHODS:Informed by Medical Research Council guidance on developing and evaluating complex interventions, we conducted a single blind, pilot randomised controlled trial in six care homes in the East of Scotland. Participants were randomised to either: (i) a three month podiatry intervention comprising core podiatry care, foot and ankle exercises, orthoses and footwear provision or (ii) usual care. Falls-related outcomes (number of falls, time to first fall) and feasibility-related outcomes (recruitment, retention, adherence, data collection rates) were collected. Secondary outcomes included: generic health status, balance, mobility, falls efficacy, and ankle joint strength. RESULTS:474 care home residents were screened. 43 (9.1%) participants were recruited: 23 to the intervention, 20 to control. Nine (21%) participants were lost to follow-up due to declining health or death. It was feasible to deliver the trial elements in the care home setting. 35% of participants completed the exercise programme. 48% reported using the orthoses 'all or most of the time'. Completion rates of the outcome measures were between 93% and 100%. No adverse events were reported. At the nine month follow-up period, the intervention group per-person fall rate was 0.77 falls vs. 0.83 falls in the control group. CONCLUSIONS:A podiatry intervention to reduce falls can be delivered to care home residents within a pilot randomised controlled trial of the intervention. Although not powered to determine effectiveness, these preliminary data provide justification for a larger trial, incorporating a full process evaluation, to determine whether this intervention can significantly reduce falls in this high-risk population. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT02178527 ; Date of registration: 17 June 2014.

BACKGROUNDS: The recommendation for enteral iodide intake for preterm infants is 30 to 40 mu g/kg per day and 1 mu g/kg per day for parenteral intake. Preterm infants are vulnerable to iodide insufficiency and thyroid dysfunction. The hypothesis tested whether, compared with placebo, iodide supplementation of preterm infants improves neurodevelopment.METHODES: A randomized controlled trial of iodide supplementation versus placebo in infants <31 weeks' gestation. Trial solutions (sodium iodide or sodium chloride; dose 30 mu g/kg per day) were given within 42 hours of birth to the equivalent of 34 weeks' gestation. The only exclusion criterion was maternal iodide exposure during pregnancy or delivery. Whole blood levels of thyroxine, thyrotropin, and thyroid-binding globulin were measured on 4 specific postnatal days. The primary outcome was neurodevelopmental status at 2 years of age, measured by using the Bayley Scales of Infant Development-Ill. The primary analyses are by intention-to-treat, and data are presented also for survivors.RESULTS: One thousand two hundred seventy-three infants (637 intervention, 636 placebo) were recruited from 21 UK neonatal units. One hundred thirty-one infants died, and neurodevelopmental assessments were undertaken in 498 iodide and 499 placebo supplemented infants. There were no significant differences between the intervention and placebo groups in the primary outcome: mean difference cognitive score, -0.34, 95% confidence interval (CI) -2.57 to 1.89; motor composite score, 0.21, 95% CI -2.23 to 2.65; and language composite score, -0.05, 95% CI -2.48 to 2.39. There was evidence of weak interaction between iodide supplementation and hypothyroxinemic status in the language composite score and 1 subtest score.CONCLUSIONS: Overall iodide supplementation provided no benefit to neurodevelopment measured at 2 years of age.

INTRODUCTION:Amiodarone is associated with significant long-lasting adverse drug reactions (ADRs). Guidelines recommend laboratory monitoring during long-term use. However, data of compliance with laboratory monitoring are lacking. AIMS:The aim of this study was to assess laboratory monitoring of liver and thyroid function during amiodarone prescribing from 1989 to 2011 in the Tayside, UK, population (approximately 400 000) in relation to National Guidelines recommending laboratory monitoring every 6 months. We also report the population-level incidence of abnormal liver and thyroid function in relation to total exposure of amiodarone. METHODS:Utilizing well-established record-linkage database, a longitudinal retrospective analysis of 1413 patients on long-term amiodarone was carried out, analyzing prescribing, biochemical, and clinical data. RESULTS:Forty-six percent (46%), 28%, and 21% of patients underwent liver, thyroid, and combined testing, respectively, in accordance with guideline recommendations. Thirteen percent and 17% of patients did not have any ALT or TSH testing, respectively. During follow-up, 117 (9.5%) patients had an ALT 3×ULN and 16% patients had an abnormal TSH, (n=125, <0.4 mU/L and n=28, >10 mU/L). One hundred and forty patients (10%) required thyroxine replacement therapy, and 40 (3%) required on hyperthyroid medication. Total amiodarone exposure increased the likelihood of abnormal biochemical testing 2.5-fold after 4 years therapy for liver and thyroid function (P<.0005). CONCLUSION:In this population-based study, adherence to laboratory monitoring guidelines was suboptimal. There was a positive correlation with total amiodarone exposure and biochemical abnormalities and development of thyroid disease compared to the general population, highlighting the need for improvement and continued amiodarone monitoring.

BackgroundMethotrexate (MTX) has been used to treat psoriasis for over half a century. Even so, clinical data characterising its efficacy and safety are sparse.ObjectiveIn order to enhance the available evidence, we conducted two meta-analyses, one for efficacy and one for safety outcomes, respectively, according to PRISMA checklist. (Data sources, study criteria, and study synthesis methods are detailed in Methods).ResultsIn terms of efficacy, only eleven studies met criteria for study design and passed a Cochrane risk of bias analysis. Based on this limited dataset, 45.2% [95% confidence interval 34.1-60.0] of patients achieve PASI75 at primary endpoint (12 or 16 weeks, respectively, n = 705 patients across all studies), compared to a calculated PASI75 of 4.4 [3.5-5.6] for placebo, yielding a relative risk of 10.2 [95% C.I. 7.1-14.7]. For safety outcomes, we extended the meta-analysis to include studies employing the same dose range of MTX for other chronic inflammatory conditions, e.g. rheumatoid arthritis, in order not to maximise capture of relevant safety data. Based on 2763 patient safety years, adverse events (AEs) were found treatment limiting in 6.9 +/- 1.4% (mean +/- s.e.) of patients treated for six months, with an adverse effect profile largely in line with that encountered in clinical practice. Finally, in order to facilitate prospective clinical audit and to help generate long-term treatment outcomes under real world conditions, we also developed an easy to use documentation form to be completed by patients without requirement for additional staff time.LimitationsMeta-analyses for efficacy and safety, respectively, employed non-identical selection criteria.ConclusionsThese meta-analyses summarise currently available evidence on MTX in psoriasis and should be of use to gauge whether local results broadly fall within outcomes.

Table of contentP3 Medial longitudinal arch development of school childrenJasper W.K. Tong, Veni P. KongP4 Is measuring the subtalar joint reliable?Lily Sze, Susie Gale, John Veto, Carla McArdleP5 Comparison of turning gait biomechanics between able‐bodied and unilateral transtibial amputee participantsThanaporn Tunprasert, Victoria Bradley, Siobhan StrikeP6 Comparison of walking gait biomechanics between able‐bodied and unilateral transtibial amputee participants using a new model of energy‐storage‐and‐return (ESAR) prostheticThanaporn Tunprasert, Victoria Bradley, Siobhan StrikeP7 An observational study of in‐shoe plantar and dorsal pressures of skilled downhill skiers on a dry ski slopeRobert Ashford, Roozbeth Naemi, Nachiappan Chocklingam, Xavi de BlascP8 If the shoe fits: a footwear choice toolkit informed by social science methodologiesLisa Farndon, Vicki Robinson, Emily NichollsP9 The identification of emotions from gaitTabitha Birch, Ivan BirchP11 Experience of foot problems in patients with systemic lupus erythematosusSimon Otter, Sunil Kumar, Peter Gow, Nicola Dalbeth, Michael Corkill, Kevin Davies, Sam Panthakalam, Maheswaran Rohan, Keith RomeP14 Negative pressure wound therapy for the management of foot wounds in the diabetic population: a review of the literatureChloe Egan, Lisa ChandlerP15 Lower limb vascular assessment in diabetes: a multifaceted assessment of objective screening techniquesPeta Tehan, Vivienne Chuter, Jennifer Sonter, Sean LantingP16 Improving outcomes for diabetes foot complicationsLorna HicksP17 Acupuncture… an alternative or adjunctive treatment option for diabetes‐related neuropathic pain?Christopher Joyce, David Watterson, Caroline McIntoshP18 “My back is in agony” – A cross‐sectional study into the relationship between musculoskeletal complaints and a whole body postural risk assessment in podiatry studentsChristopher Joyce, Nigel RobertsP19 Swabs of the treatment couches: Does the material type and texture of podiatric treatment couches increase microorganism contamination?Jacqueline Forss, Chrystalla Charalambous, Jack Kirby, Oluwakemi OjoP20 Does increased exudate viscosity effect the absorption rate of exudate into four different wound dressings?Jacqueline Forss, Sarah Caukill, Jacqueline Capon, Radiance Fong, Louis LoyP21 An investigation into the microbial load of a 40 °C and 60 °C washMatthew Diment, Madeleine Murray, Mairghread Ellis, Carla McArdleP23 The sensitivity and specificity of the toe brachial index in detecting peripheral arterial disease: a systematic review and meta‐analysisPeta Tehan, Vivienne Chuter, Christopher OldmeadowP24 Medicines management activities and non‐medical prescribing within podiatry and physiotherapy: an integrative review of the literatureNicola Carey, Karen Stenner, Heather Gage, Jane Brown, Peter Williams, Simon Otter, Ann Moore, Jude Edwards, Freda Mold, Molly CourtenayA7.2 Non‐invasive vascular assessment in the foot with Diabetes: Diagnostic accuracy of ankle brachial index, toe brachial index and continuous wave DopplerPeta Tehan, Alan Bray, Vivienne ChuterA7.5 The efficacy of dressings on post nail surgery phenolised woundsPamela HindmoorB7.1 Cross‐sectional study investigating the role of proximal and distal factors in the development of patellofemoral joint painCraig Gwynne, Sarah CurranB7.2 Podiatrist's interpretation and use of evidence in MSK practiceAndy BridgenB7.4 Predictors of falling in older podiatry patients – findings from the REFORM studyCaroline Fairhurst, Dr Joy Adamson, Belen Corbacho Martin, Sarah Cockayne, Prof Catherine Hewitt, Kate Hicks, Anne‐Maree Keenan, Lorraine Loughrey‐Green, Hylton Menz, Anthony Redmond, Sara Rodgers, Jude Watson, David Torgerson, Robin Hull, Sarah Lamb, Caroline McIntosh, Wesley Vernon, Lisa FarndonB7.5 The REFORM study: Insole preference, requirements and compliance of podiatry patient's aged 65 and over and at risk of fallingLorraine Loughrey‐Green, Sarah Cockayne, Anthony Redmond, Anne‐Maree Keenan, Sara Rodgers, Lisa Farndon, Wesley Vernon, David Torgerson, Caroline Fairhurst, Jude Watson, Hylton Menz, Sarah Lamb, Robin HullB7.6 A podiatry intervention to reduce falls in care home residents is feasible and demonstrates benefits: results from PIRFECT, a feasibility randomised controlled trialGavin Wylie, Zoe Young, Brian Williams, Frank Sullivan, Hylton Menz, Simon Ogston, Jacqui MorrisC7.1 A survey exploring footwear habits in people with stroke and people with Parkinson'sCathy Bowen, Dorit Kunkel, Mark Cole, Margaret Donovan‐Hall, Ruth Pickering, Malcolm Burnett, Dan Bader, Judy Robison, Louis Mamode, Ann AshburnC7.2 Painful foot osteoarthritis; a common symptom in a common pathology?Peter McQueen, Maxine Daniels, Michael Doherty, Nigel Arden, Cathy BowenC7.4 Clinical diagnosis of symptomatic forefoot neuroma in the general population: Delphi based recommendationsCharlotte Dando, Lindsey Cherry, Cathy BowenC7.5 The development and implementation of a Clinical Quality Improvement Framework suitable for use in community servicesNichola StefanouC7.6 The REFORM study ‐ methodological considerations in running a cohort randomised controlled trial within a podiatry patient caseloadSarah Cockayne, Joy Adamson, Caroline Fairhurst, Catherine Hewitt, Anne‐Maree Keenan, Sally Lamb, Lorraine Loughrey‐Green, Caroline McIntosh, Hylton Menz, Anthony Redmond, Sara Rodgers, Wesley Vernon, Jude Watson, Lisa Farndon, Belen Corbacho, Robin Hull, David TorgersonA31 Jewel in the crown: Exploring the factors contributing to the development and impact of foot problems in Systemic Sclerosis (SSc)Begonya Alcacer‐Pitarch, Anthony Redmond, Maya Buch, Anne‐Maree Keenan

BACKGROUND:Metabolic acidosis is more common with advancing chronic kidney disease, and has been associated with impaired physical function, impaired bone health, accelerated decline in kidney function and increased vascular risk. Although oral sodium bicarbonate is widely used to correct metabolic acidosis, there exist potential risks of therapy including worsening hypertension and fluid overload. Little trial evidence exists to decide whether oral bicarbonate therapy is of net benefit in advanced chronic kidney disease, particularly in older people who are most commonly affected, and in whom physical function, quality of life and vascular health are at least as important outcomes as decline in renal function. METHODS/DESIGN:BiCARB is a multi-centre, double-blind, placebo controlled, randomised trial evaluating the clinical and cost-effectiveness of oral sodium bicarbonate in the management of older people with chronic kidney disease and severely reduced glomerular filtration rate (GFR) who have a mild degree of metabolic acidosis. The trial will recruit 380 patients from renal, Medicine for the Elderly, and primary care services across centres in the United Kingdom. Male and female patients aged 60 years and older with an estimated glomerular filtration rate of <30 mL/min/1.73 m(2), not on dialysis, and with serum bicarbonate concentrations <22 mmol/L will be eligible for participation. The primary clinical outcome for the trial is the between-group difference in the Short Physical Performance Battery score at 12 months. Secondary outcomes include muscle strength, quality of life measured using the EQ-5D score and KDQoL tools, cost effectiveness, renal function, presence of albuminuria and blood pressure. Markers of bone turnover (25-hydroxyvitamin D, 1,25-hydroxyvitamin D, tartrate-resistant acid phosphatase-5b and bone-specific alkaline phosphatase) and vascular health (B-type natriuretic peptide) will be measured. Participants will receive a total of 24 months of either bicarbonate or placebo. The results will provide the first robust test of the overall clinical and cost-effectiveness of this commonly used therapy in older patients with severely reduced kidney function. TRIAL REGISTRATION:www.isrctn.com; ISRCTN09486651, registered 17 February 2012.

Successful randomisd controlled trials (RCTs) require successful participant recruitment; poor recruitment leads to poor, under-powered studies, and may waste grant funds. Recruitment of older care home residents to RCTs is challenging. This is problematic for podiatry, because older people within care home settings are high users of podiatry services; therefore it is essential that strategies are employed to maximise recruitment to RCTs. We describe the experience of recruiting to a feasibility study of a podiatry intervention to reduce falls in care home residents in the East of Scotland. This was the first phase of a two phase project consisting of the feasibility study to acquire data (recruitment strategy, selection of suitable outcome measures) to inform the conduct of the second phase, an exploratory RCT. Recruitment difficulties became apparent early in the study. Difficulties arose when it came to assessing whether or not potential participants fulfilled certain inclusion criteria: (1) Presence of foot pain (defined as foot pain lasting for at least a day in the last month and a positive response of “some days” or “most/every days” to at least one item on the Manchester Foot Pain and Disability Index (MFPDI)) (2) Ability to provide informed consent. The reasons for these difficulties are that (1) we discovered that in the area in which our study was conducted, the majority of care home residents receive basic NHS podiatry care to treat any superficial lesions (i.e. pathological nails and skin callus) thus the prevalence of foot pain resulting from these lesions was lower than we had originally anticipated, and (2) the care homes that we engaged for this phase of the study had residents who were far more dependent and with much higher levels cognitive impairment than we anticipated, making obtaining informed consent difficult. Based on the existing inclusion criteria, it was deemed unlikely that we would meet our recruitment target for the subsequent exploratory randomised controlled trial (n=40).

Aim: To assess factors contributing to cord venous glucose homeostasis in term infants delivered by elective cesarean section.Methods: Observational study of women-infant pairs at delivery. Biochemical and clinical data were collected about factors which might affect the levels of glucose, lactate, norepinephrine, epinephrine, cortisol, human growth hormone, glucagon, and insulin.Results: In the context of this data-set, three models explained a substantial amount regarding the variation: 79% of the variation in cord glucose levels is explained by levels of maternal glucose, cord venous pH, and cord lactate; 77% of the variation of cord lactate is explained by levels of cord venous pH, valine, maternal lactate and glucose, and cord norepinephrine; and 71% of the variation in cord norepinephrine is explained by levels of cord venous pO(2), maternal lactate, cord insulin, cord GABA (gamma-aminobutyric acid), cord lactate, cord epinephrine, cord norepinephrine sulfate, and cord valine.Conclusions: Term infants delivered by cesarean section are relatively hyperinsulinemic (insulin: glucose ratio of 2.4) and glucose levels are strongly associated with maternal glucose levels, cord pO(2), and lactate levels. There were no associations with levels of cord glucose and levels of cortisol, epinephrine and lactate, which have been shown to be important contributors to postnatal glucose homeostasis in some infant groups.

People who live in care homes often fall. Foot and ankle muscle weakness, sub-optimal footwear, and common foot problems such as corns and hallux valgus are known and potentially modifiable contributory factors to falls in older people. Conducting a randomised controlled trial in a care home setting to address these issues is challenging and presents a number of uncertainties that need to be addressed prior to undertaking a phase III trial. Therefore, this study used a qualitative approach to assess the feasibility and acceptability of a podiatry falls intervention to care home residents and staff. The data acquired during this qualitative preparatory phase will inform the conduct of a subsequent exploratory randomised controlled trial of a podiatry intervention to reduce falls in care homes.

Aims/Objectives: In a climate of workforce transition, enhanced specialisation and role transfer, it is timely to address the impact of workforce flexibility on practitioners in non-specialist roles. This study aimed to use podiatry as a case exemplar (as one of the Allied Health Professions) to explore the possible impact of workforce redesign policies on role boundaries on generalist podiatrists and examine the current position of generalist podiatrists in the workforce. Content of presentation: The study explored views and experiences of key actors from The Society of Chiropodists and Podiatrists through a qualitative research methodology, incorporating focus groups and indepth, semi-structured interviews supported by explanatory sociological theory, drawn from the sociology of the professions, workforce literature, and Government policies, noting their impact upon the podiatry profession. Data collected was analysed via a thematic analysis. Relevance/Impact: This research is relevant to professionals involved in the SCP, academic departments across the UK and individuals that have influence over policy changes. The findings of this project may also be of interest to those who organise and deliver undergraduate and postgraduate training. This project has added to the evidence base for generalist podiatrists, for which there was no previous research considering the impact of workforce redesign policies on their role. This study has provided an example of how role boundaries can be affected and the perceived impact on the podiatry profession. Outcomes: Three themes emerged: the impact of change, concerns about future provision, and meeting the challenge of considering future service provision. The key message was to encourage podiatrists to embrace change by working together, learn from other professions and develop new leaders or ‘champions’ to lead people towards change. Discussion: The role of the generalist podiatrist in the NHS may be under threat due to the profession’s focus on the pursuit of specialist ‘virtuoso’ roles, in an attempt to further professionalise. Generalist NHS podiatry is viewed as less of a professional priority, and difficult to sustain and justify in a climate of fiscal restraint. This in turn suggests, therefore, that generalist podiatry may in future become a role entirely associated with private practice. A2 CODIFI (Concordance in Diabetic Foot Infection): Agreement in reported presence of likely pathogens in swabs and tissue samples from infected diabetic foot ulcers Michael Backhouse, Andrea Nelson, Alexandra Wright-Hughes, Moninder Bhogal, Sarah Brown, Catherine Reynolds, Benjamin Lipsky, Christopher Dowson, Jane Nixon, The Codifi Study Group School of Healthcare, University of Leeds, Leeds, UK; Clinical Trials Research Unit, University of Leeds, Leeds, UK; Division of Medical Sciences, University of Oxford, Seattle, United States; School of Life Sciences, University of Warwick, Coventry, UK Journal of Foot and Ankle Research 2015, 8(Suppl 1):A2

Objective To evaluate national trends of trabeculectomy, aqueous shunts and cycloablation performed in Scotland, England and Wales from 1993 to 2012. Methods The annual numbers of trabeculectomies and aqueous shunts carried out between 1993 and 2012 were obtained from national Scottish, English and Welsh National Health Service databases. The annual rates of trabeculectomy, aqueous shunts and cycloablation were calculated per 100 000 of the population and analysed in the following age groups: 0–14 years, 15–59 years, over 60 years. Results The highest annual rate of trabecuelctomy was in 1995, this was followed by a sharp decline and subsequent stable rates since 2000. The total annual rates of aqueous shunts have increased more than sixfold from 2003 to 2012. In the 0–14 years age group from 2003 to 2012 the ratio of trabeculectomy to aqueous shunts has reversed; trabeculectomy rates have decreased while rates of aqueous shunts have increased. From 2003 to 2012, rates of cyclocryotherapy have reduced while rates of photocoagulation to the ciliary body have doubled. Conclusions Trabeculectomy is the most commonly performed glaucoma operation. Aqueous shunts are rapidly increasing in the surgical management of glaucoma. During the study period, the ratio of trabeculectomy to aqueous shunts has reversed in the younger age group (0–14 years). Rates of cyclocyrotherapy to the ciliary body have dramatically declined while laser photocoagulation to the ciliary body is gaining wider acceptability.

Introduction Amiodarone is associated with significant adverse drug reactions (ADRs) and guidelines recommend continued monitoring for ADRs during long-term use. However data of compliance with monitoring guidelines is lacking. The aim of this study was to assess the monitoring of liver and thyroid function on long-term amiodarone over 22-years in Tayside and secondly, to determine the incidence of abnormal biochemical results in relation to total exposure of amiodarone. Methods Uutilizing the well-established record linkage database and the prescription-record linkage database available in Tayside, all patients who were prescribed amiodarone over the 22 years were identified. Long-term prescribing of amiodarone was defined as exposure greater than 6 months, baseline testing was defined as blood tests 6 months before or one month after commencing amiodarone and frequency of testing was performed looking at the mean number of days between testing. The test with closest temporal proximity to the commencement of amiodarone was used to identify patients with abnormal liver or/and thyroid function. Patients with baseline biochemical liver and thyroid abnormalities were excluded from the analysis. Results A total of 1413 patients (mean age 71 ± 11, 57% male) on regularly prescribed amiodarone for more than 6 months were included for final analysis. Only 46%, 27% and 21% of patients had liver, thyroid, and combined testing respectively in accordance with national guidance, though monitoring had significantly improved over the last 22 years (p < 0.0005). Importantly our data also shows that, despite monitoring guidance, patients on long-term amiodarone are at risk of hepatic and thyroid toxicity (9.5% and 16% of patients respectively) and are more likely to develop thyroid disease compared to the general population. There was a positive correlation between duration of amiodarone exposure and percentage of patients with an abnormal result (2.46 and 2.5 fold increase over 4 years for liver and thyroid dysfunction respectively .0005). Discussion Risks of developing ADR on amiodarone increase with continued exposure. Our study highlights the need for awareness and continued surveillance.

Drivers considered by the police for prosecution for driving with blood alcohol concentrations in excess of the legal limit are assessed by a battery of psychological and biochemical tests (N = 1,046). These were evaluated against police and medical records, and self reports. A perception-of-risk test devised by the authors prove the most effective means of detecting individuals with drink related problems in a bus-sample (n = 169) . The test does not follow conventional lines in requesting information about drinking habits, past or present; it is a test of various "risky" activities, of which only 3 out of 20 relate to drink. The means by which the test is effective, other than that it seems difficult to fake good performance, have yet to be determined but a number of implications seem evident. Most important, the test may have predictive ability and, therefore, preventive and educational potential. Also, it is a generally applicable test, correlating highly with social problems.