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Arblaster G, Buckley D, Barnes S, Davis H. Strabismus Surgery for Psychosocial Reasons-A Literature Review. Br Ir Orthopt J 2024; 20:107-132. [PMID: 38681188 PMCID: PMC11049605 DOI: 10.22599/bioj.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/04/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Strabismus surgery may be undertaken for visual benefit, to improve or eliminate diplopia symptoms, or to restore or improve binocular single vision (BSV). In patients without visual symptoms or expected visual benefit, strabismus surgery may still be undertaken if the presence of strabismus causes the patient psychosocial symptoms. To evaluate strabismus surgery undertaken for psychosocial reasons, evidence of postoperative outcomes in this specific cohort is needed. Methods A systematic search of the literature was conducted (1946-2023) to identify evidence where postoperative outcomes were reported for adult patients (age 18 years and above) who had undergone strabismus surgery for psychosocial reasons. Results Sixty-nine papers were included in the literature review. Most sources of evidence included patients within heterogeneous cohorts of strabismus surgery outcomes, with a range of symptoms and differing surgical aims. Discussion In adults who underwent strabismus surgery for psychosocial reasons, improved postoperative ocular alignment and/or improved health related quality of life (HRQoL) were common. Strabismus surgery outcomes appeared to be measured satisfactorily at three months postoperatively. Additional surgical outcomes, including an expanded field of vision, unexpected BSV, improved binocular summation, improved task performance and improved eye movements have been reported, but not fully investigated. There was a lack of consensus on how postoperative success should be defined and measured. A core outcome set for strabismus has been suggested and there is potential to add to the available evidence by investigating which outcome measures are most relevant to those with strabismus and psychosocial symptoms. There is a growing need for robust evidence in this specific subgroup of patients due to a lack of evidence specifically reporting postoperative outcomes in adults with strabismus and psychosocial symptoms.
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Affiliation(s)
- Gemma Arblaster
- Division of Ophthalmology and Orthoptics, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
- Orthoptic Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - David Buckley
- Division of Ophthalmology and Orthoptics, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
| | - Sarah Barnes
- School of Medicine and Population Health, University of Sheffield, UK
| | - Helen Davis
- Division of Ophthalmology and Orthoptics, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
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Bhattacharya S, Subhedar K, Bhadauria M, Shukla R, Manaktala R, Kumar A, Wilson A. Comparison of novel clinic-based approach (amblyopia school) Vs. home-based occlusion for amblyopia therapy - A retrospective study. Indian J Ophthalmol 2023; 71:2094-2099. [PMID: 37203088 PMCID: PMC10391462 DOI: 10.4103/ijo.ijo_1097_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To compare visual outcomes of standard occlusion therapy at home versus clinic in amblyopic children. Methods A retrospective study of case records of children aged <15 years with diagnosis of strabismic or anisometropic amblyopia or both was conducted at a tertiary eye hospital located in rural North India between Jan 2017-Jan 2020. Those with at least 1 follow-up visit were included. Children with ocular co-morbidities were excluded. Treatment in clinic by admission or at home was based on the parents' discretion. Children in clinic group underwent part time occlusion & near work exercises for minimum 1 month, in classroom format which we called amblyopia school. Those in home group underwent part time occlusion as per PEDIG recommendations. Primary outcome measure was improvement in number of Snellen's lines at the end of 1 month & at final follow-up. Results We included 219 children with mean age of 8.8±3.23 years, out of which clinic group had 122 (56%) children. At one-month, visual improvement in clinic group (2.1±1.1 lines) was significantly greater than home group (mean=1.1±0.8 lines) (P < 0.001). Both groups continued to improve vision on follow-up, however the vision in the clinic group (2.9±1.2 lines improvement at mean follow-up of 4.1±1.6 months), continued to be better than home group (2.3±1.1 lines improvement at mean follow-up 5.1±0.9 months) (P = 0.05). Conclusion Clinic based amblyopia therapy in the form of an amblyopia school can help expedite visual rehabilitation. Thus, it may be a better option for rural settings where patients in general tend to be poorly compliant.
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Affiliation(s)
- Subhajit Bhattacharya
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Ketaki Subhedar
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Madhu Bhadauria
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Ranjana Shukla
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Ruchita Manaktala
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Abhinav Kumar
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Ayush Wilson
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
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Roda M, Pellegrini M, Di Geronimo N, Vagge A, Fresina M, Schiavi C. Binocular treatment for amblyopia: A meta-analysis of randomized clinical trials. PLoS One 2021; 16:e0257999. [PMID: 34624028 PMCID: PMC8500435 DOI: 10.1371/journal.pone.0257999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background To date, there is still no consensus regarding the effect of binocular treatment for amblyopia. The purpose of this systematic review and meta-analysis was to summarize the available evidence to determine whether binocular treatment is more effective than patching in children with amblyopia. Methods Four electronic databases (PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) were searched for studies that compared binocular treatment and patching in children with amblyopia. The outcome measures were visual acuity and stereopsis. Pooled effects sizes were calculated with a random-effect model. The standardized difference in means (SDM) with 95% confidence intervals (CI) was calculated. Sensitivity analysis and assessment of publication bias were performed. Results Five randomized clinical trials were included. No significant difference in visual acuity between patients treated with binocular treatment and patching was observed (SDM = -0.12; 95% CI: -0.45–0.20; P = 0.464). No significant difference in stereopsis between patients treated with binocular treatment and patching was observed (SDM = -0.07; 95% CI: -0.61–0.48; P = 0.809). For both variables, the between-study heterogeneity was high (respectively, I2 = 61% and I2 = 57%). Conclusions This meta-analysis found no convincing evidence supporting the efficacy of binocular treatment as an alternative to conventional patching. Therefore, the binocular treatment cannot fully replace traditional treatment but, to date, it can be considered a valid complementary therapy in peculiar cases. Further studies are required to determine whether more engaging therapies and new treatment protocols are more effective.
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Affiliation(s)
- Matilde Roda
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
- * E-mail:
| | - Marco Pellegrini
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
| | - Natalie Di Geronimo
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
| | - Aldo Vagge
- University Eye Clinic, DINOGMI, Polyclinic Hospital San Martino IRCCS, Genoa, Italy
| | - Michela Fresina
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
| | - Costantino Schiavi
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
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Al-Jabri S, Rowe FJ, Kirkham JJ. Core outcome set for three ophthalmic conditions: a healthcare professional and patient consensus on core outcome sets for amblyopia, ocular motility and strabismus (COSAMS Study). BMJ Open 2021; 11:e042403. [PMID: 33980515 PMCID: PMC8118006 DOI: 10.1136/bmjopen-2020-042403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Amblyopia, strabismus and ocular motility disorders are common conditions with significant impact on visual function, appearance and quality of life. We aimed to establish a core set of outcomes for each of the three conditions for use in clinical trials and routine clinical practice. DESIGN A comprehensive databank of outcomes was developed from a systematic review of the literature and a series of focus groups with healthcare professionals, researchers, patients and carers. The databank of outcomes was scored in a two-round Delphi Survey completed by two stakeholder groups: healthcare professionals/researchers and patients/carers. Results of the online Delphi were discussed at a face-to-face consensus meeting where the core outcome sets were finalised. SETTING UK-wide consultation. PARTICIPANTS Researchers, clinicians, patients and carers. OUTCOME MEASURES Core outcome sets. RESULTS For amblyopia, strabismus and ocular motility, 40/42/33 participants contributed to both rounds of the Delphi; six/nine/seven members attended consensus meetings, respectively. Consensus was reached on ten core outcomes for both amblyopia and ocular motility and nine for strabismus. All three conditions shared the core outcomes: adverse events, cost, vision-related quality of life and ocular alignment. The strabismus and ocular motility disorder core sets included, in addition, measuring the deviation, binocular vision, ocular movement, patient satisfaction and symptoms. The amblyopia set, distinct from the sets for the other two conditions, included best corrected distance and near visual acuity, spherical and cylindrical refraction, compliance and treatment-related and functionality/long-term impacts. CONCLUSIONS The study used robust consensus methods to develop a core outcome set for three ophthalmic conditions. Implementation of these core outcome sets in clinical trials and routine clinical practice will ensure that the outcomes being measured and reported are relevant to all stakeholders. This will enhance the relevance of study findings and enable comparison of results from different studies.
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Affiliation(s)
- Samiya Al-Jabri
- Institute of Population Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Fiona J Rowe
- Institute of Population Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
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Definition of successful outcomes after surgery for each type of strabismus: a Delphi study. J AAPOS 2021; 25:3.e1-3.e5. [PMID: 33607273 DOI: 10.1016/j.jaapos.2020.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Delphi process has been widely used to delineate guidelines for the treatment of disorders for which there is little or no evidence in the published literature. The purpose of this study was to use the Delphi process to identify areas of consensus and disagreement on the definition of success after surgery for each type of strabismus. METHODS Two rounds of electronic questionnaires were sent to 28 members of the Strabismus Success Definition Delphi Study Group. For the first round, responses to 70 questions were captured as agree (= 1) and disagree (= 2). For round 2, a total of 89 questions were captured on a Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Consensus was determined a priori at 85%. RESULTS In both the first and second rounds, inter-rater agreement of 85% consensus was reached for only 20% of questions. Intra-rater agreement per question was low, with κ values ranging from -0.11 to 0.62. Intra-rater agreement was also low among themes, ranging from poor to fair agreement: κ = 0.25 for motor, κ = 0.28 for sensory, and κ = 0.35 for follow-up. CONCLUSIONS This study highlights consensus areas that could be considered by researchers in designing studies and identifies areas where lack of consensus indicates that further research is needed.
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Tallouzi MO, Mathers JM, Moore DJ, Bucknall N, Calvert MJ, Murray PI, Denniston AK. Development of a Core Outcome Set for Clinical Trials in Non-infectious Uveitis of the Posterior Segment. Ophthalmology 2021; 128:1209-1221. [PMID: 33515595 DOI: 10.1016/j.ophtha.2021.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To develop an agreed upon set of outcomes known as a "core outcome set" (COS) for noninfectious uveitis of the posterior segment (NIU-PS) clinical trials. DESIGN Mixed-methods study design comprising a systematic review and qualitative study followed by a 2-round Delphi exercise and face-to-face consensus meeting. PARTICIPANTS Key stakeholders including patients diagnosed with NIU-PS, their caregivers, and healthcare professionals involved in decision-making for patients with NIU-PS, including ophthalmologists, nurse practitioners, and policymakers/commissioners. METHODS A long list of outcomes was developed based on the results of (1) a systematic review of clinical trials of NIU-PS and (2) a qualitative study of key stakeholders including focus groups and interviews. The long list was used to generate a 2-round Delphi exercise of stakeholders rating the importance of outcomes on a 9-point Likert scale. The proportion of respondents rating each item was calculated, leading to recommendations of "include," "exclude," or "for discussion" that were taken to a face-to-face consensus meeting of key stakeholders at which they agreed on the final COS. MAIN OUTCOME MEASURE Items recommended for inclusion in the COS for NIU-PS. RESULTS A total of 57 outcomes grouped in 11 outcome domains were presented for evaluation in the Delphi exercise, resulting in 9 outcomes directly qualifying for inclusion and 15 outcomes being carried forward to the consensus meeting, of which 7 of 15 were agreed on for inclusion. The final COS contained 16 outcomes organized into 4 outcome domains comprising visual function, health-related quality of life, treatment side effects, and disease control. CONCLUSIONS This study builds on international work across the clinical trials community and our qualitative research to construct the world's first COS for NIU-PS. The COS provides a list of outcomes that represent the priorities of key stakeholders and provides a minimum set of outcomes for use in all future NIU-PS clinical trials. Adoption of this COS can improve the value of future uveitis clinical trials and reduce noninformative research. Some of the outcomes identified do not yet have internationally agreed upon methods for measurement and should be the subject of future international consensus development.
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Affiliation(s)
- Mohammad O Tallouzi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Jonathan M Mathers
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | - Melanie J Calvert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR Applied Research Collaboration West Midlands at the University Hospitals Birmingham NHS Foundation Trust, and the University of Birmingham, Birmingham, United Kingdom
| | - Philip I Murray
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Shoshany TN, Michalak SM, Chinn RN, Staffa SJ, Hunter DG. Evaluating Amblyopia Treatment Success Using the American Academy of Ophthalmology IRIS50 Measures. Ophthalmology 2020; 127:836-838. [PMID: 32199623 DOI: 10.1016/j.ophtha.2020.01.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/10/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Ryan N Chinn
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - David G Hunter
- Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
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Use of the Delphi process for defining successful outcomes for strabismus surgery. J AAPOS 2019; 23:309-312. [PMID: 31586584 DOI: 10.1016/j.jaapos.2019.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 10/25/2022]
Abstract
The purpose of this review was to identify areas of consensus and disagreement among experts for the definition of success following strabismus surgery using the Delphi process. Three rounds of electronic questionnaires were sent to a panel of 28 strabismus experts. Throughout the process, members of the panel were masked to one another's identities to minimize the possibility of influence among members. Prior to data collection, we defined consensus as an 85% agreement on the answer to each question. Questions for which there was no consensus were reworded, and the resultant new questions were used in each subsequent round of questioning. We arrived at consensus for 23 of the 36 questions (64%). Consensus was obtained for recommending unique criteria for the definition of success for certain specific strabismus conditions. In addition, it was considered important that stereopsis and the range of single binocular vision be included in the definition of success for certain types of strabismus.
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Hepworth L, Rowe F. Short-Listing the Program Choice for Perimetry in Neurological Conditions (PoPiN) Using Consensus Methods. Br Ir Orthopt J 2019; 15:125-132. [PMID: 32999983 PMCID: PMC7510368 DOI: 10.22599/bioj.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Neurological conditions frequently cause visual field loss, commonly resulting in perimetry requests for suspected or known conditions. Currently there are no national guidelines for perimetry in neurological conditions. A wide choice of perimetry programs exists. An inappropriate program choice could fail to detect visual field loss. Two phases in this study determined preference of perimetry programs for detection of visual field loss in four common neurological conditions (idiopathic intracranial hypertension (IIH), optic neuropathies, chiasmal compression and stroke), to aid the design of research and clinical practice guidelines. METHODS A survey consisted of 47 perimetry programs. Orthoptists and neuro-ophthalmologists were asked which perimetry programs they considered important for use in the four neurological conditions. These programs were short-listed for discussion in a consensus meeting. A nominal group technique was used for the consensus meeting to reach consensus on the three most favoured perimetry programs appropriate for the four conditions. RESULTS Twenty-six participants completed the survey (51% return rate). Nine programs were found to be not applicable to any of the conditions. The short-lists for the conditions varied between six and ten perimetry programs. Seven participants discussed the survey results at a consensus meeting to agree the three most favoured perimetry programs for IIH, optic neuropathy and chiasmal compression (manual/semi manual kinetic, static 30-2 and full-field 120) and for stroke (manual/semi manual kinetic, static 30-2 and monocular Esterman). CONCLUSION A wide range of perimetry programmes were explored thoroughly through survey and consensus methods in order to determine clinician preference for their use in neuro-ophthalmic practice. The three most favoured perimetry programs for the four conditions was established.
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Al Jabri S, Kirkham J, Rowe FJ. Correction to: development of a core outcome set for amblyopia, strabismus and ocular motility disorders: a review to identify outcome measures. BMC Ophthalmol 2019; 19:71. [PMID: 30857536 PMCID: PMC6410504 DOI: 10.1186/s12886-019-1073-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 12/04/2022] Open
Affiliation(s)
- Samia Al Jabri
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL, Liverpool, UK
| | - Jamie Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL, Liverpool, UK.
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