The influence of the new general ophthalmic services (GOS) contract in optometrist referrals for glaucoma in Scotland

Purpose: To assess the quality of referrals from community optometrists in the northeast of Scotland to the hospital glaucoma service before and after the implementation of the new General Ophthalmic Services (GOS) contract in Scotland. Methods: Retrospective study encompassing two 6-month periods, one before the implementation of the new GOS (Scotland) contract in April 2006 (from June to November 2005), and the other after (from June to November 2006). The community optometrist referral forms and hospital glaucoma service notes were reviewed. Comparisons were performed using the t-test and ?- test. Results: In all, 183 referrals were made during the first 6-month period from June to November 2005, and 120 referrals were made during the second 6-month period from June to November 2006. After the introduction of the new GOS contract, there was a statistically significant increase in true-positive referrals (from 18.0 to 31.7%; P=0.006), decrease in false-positive referrals (from 36.6 to 31.7%; P=0.006), and increase in the number of referrals with information on applanation tonometry (from 11.8 to 50.0%; P=0.000), dilated fundal examination (from 2.2 to 24.2%; P=0.000), and repeat visual fields (from 14.8 to 28.3%; P=0.004) when compared to the first 6-month period. However, only 41.7% of referrals fulfilled the new GOS contract requirements, with information on applanation tonometry the most commonly missing. Conclusions: After the implementation of the new GOS (Scotland) contract in April 2006, there has been an improvement in the quality of the glaucoma referrals from the community optometrists in the northeast of Scotland, with a corresponding reduction in false-positive referrals. Despite the relatively positive effect so far, there is still scope for further improvement. © 2009 Macmillan Publishers Limited All rights reserved.

Labor and Place: The Contours of Freedpeoples' Mobilization in Reconstruction South Carolina

Important advances in scholarship on the post-emancipation South have made possible a new synthesis that moves beyond broad generalizations about African American agency to identify both the shared elements in black life across the region and the varying capacity of freedpeople to assert their interests in the face of white hostility. Building on a number of recent studies of Reconstruction this article seeks to demonstrate that the varying capacity of freedpeople in South Carolina to shape and defend the new society that would emerge after the end of slavery was rooted in their relative strength at work and in their communities. In Charleston and its lowcountry rural hinterland, demographic strength combined with deeply-rooted traditions of collective assertion to sustain a remarkably vibrant grassroots movement that persisted beyond the overthrow of Reconstruction. From very early on, by contrast, former slaves dispersed across the rural interior found their freedom severely circumscribed by a bellicose and heavily-armed white paramilitary campaign.