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  1. Article ; Online: Inequality in uptake of bowel cancer screening by deprivation, ethnicity and smoking status: cross-sectional study in 86 850 citizens.

    Creavin, Alexandra / Creavin, Sam / Kenward, Charlie / Sterne, Jonathan / Williams, Jo

    Journal of public health (Oxford, England)

    2023  Volume 45, Issue 4, Page(s) 904–911

    Abstract: Background: Survival from colorectal cancer depends on stage at detection. In England, bowel cancer mortality has historically been highest in deprived areas. During the initial stages of the COVID-19 pandemic, it was necessary to temporarily halt many ... ...

    Abstract Background: Survival from colorectal cancer depends on stage at detection. In England, bowel cancer mortality has historically been highest in deprived areas. During the initial stages of the COVID-19 pandemic, it was necessary to temporarily halt many screening programmes, which may have led to inequalities in uptake since screening restarted.
    Methods: Cross-sectional data from the Bristol, North Somerset and South Gloucestershire Systemwide Dataset were analyzed. Associations of baseline characteristics with uptake of bowel screening were examined using logistic regression.
    Results: Amongst 86 850 eligible adults aged 60-74 years, 5261 had no screening record. There was little evidence of association between no screening and sex (adjusted odds ratio 0.95 (95% confidence interval 0.90, 1.02)). Absence of screening record was associated with deprivation (1.26 (1.14, 1.40) for the most compared with the least deprived groups), smoking (1.11 (1.04, 1.18)) compared with no smoking record and black (1.36 (1.09, 1.70)) and mixed (1.08 (1.01, 1.15)) ethnicity compared with white ethnicity.
    Conclusions: In a data set covering a whole NHS Integrated Care Board, there was evidence of lower uptake of bowel cancer screening in adults living in more deprived areas, of minority ethnic groups and who smoked. These findings may help focus community engagement work and inform research aimed at reducing inequalities.
    MeSH term(s) Adult ; Humans ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/prevention & control ; Cross-Sectional Studies ; Early Detection of Cancer ; Ethnicity ; Pandemics ; Smoking/epidemiology ; COVID-19 ; Social Determinants of Health ; Healthcare Disparities ; Health Services Accessibility
    Language English
    Publishing date 2023-09-22
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2142082-8
    ISSN 1741-3850 ; 1741-3842
    ISSN (online) 1741-3850
    ISSN 1741-3842
    DOI 10.1093/pubmed/fdad179
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Clinical judgement by primary care physicians for the diagnosis of all-cause dementia or cognitive impairment in symptomatic people.

    Creavin, Samuel T / Noel-Storr, Anna H / Langdon, Ryan J / Richard, Edo / Creavin, Alexandra L / Cullum, Sarah / Purdy, Sarah / Ben-Shlomo, Yoav

    The Cochrane database of systematic reviews

    2022  Volume 6, Page(s) CD012558

    Abstract: Background: In primary care, general practitioners (GPs) unavoidably reach a clinical judgement about a patient as part of their encounter with patients, and so clinical judgement can be an important part of the diagnostic evaluation. Typically clinical ...

    Abstract Background: In primary care, general practitioners (GPs) unavoidably reach a clinical judgement about a patient as part of their encounter with patients, and so clinical judgement can be an important part of the diagnostic evaluation. Typically clinical decision making about what to do next for a patient incorporates clinical judgement about the diagnosis with severity of symptoms and patient factors, such as their ideas and expectations for treatment. When evaluating patients for dementia, many GPs report using their own judgement to evaluate cognition, using information that is immediately available at the point of care, to decide whether someone has or does not have dementia, rather than more formal tests.
    Objectives: To determine the diagnostic accuracy of GPs' clinical judgement for diagnosing cognitive impairment and dementia in symptomatic people presenting to primary care. To investigate the heterogeneity of test accuracy in the included studies.
    Search methods: We searched MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), Web of Science Core Collection (ISI Web of Science), and LILACs (BIREME) on 16 September 2021.
    Selection criteria: We selected cross-sectional and cohort studies from primary care where clinical judgement was determined by a GP either prospectively (after consulting with a patient who has presented to a specific encounter with the doctor) or retrospectively (based on knowledge of the patient and review of the medical notes, but not relating to a specific encounter with the patient). The target conditions were dementia and cognitive impairment (mild cognitive impairment and dementia) and we included studies with any appropriate reference standard such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), International Classification of Diseases (ICD), aetiological definitions, or expert clinical diagnosis.
    Data collection and analysis: Two review authors screened titles and abstracts for relevant articles and extracted data separately with differences resolved by consensus discussion. We used QUADAS-2 to evaluate the risk of bias and concerns about applicability in each study using anchoring statements. We performed meta-analysis using the bivariate method.
    Main results: We identified 18,202 potentially relevant articles, of which 12,427 remained after de-duplication. We assessed 57 full-text articles and extracted data on 11 studies (17 papers), of which 10 studies had quantitative data. We included eight studies in the meta-analysis for the target condition dementia and four studies for the target condition cognitive impairment. Most studies were at low risk of bias as assessed with the QUADAS-2 tool, except for the flow and timing domain where four studies were at high risk of bias, and the reference standard domain where two studies were at high risk of bias. Most studies had low concern about applicability to the review question in all QUADAS-2 domains. Average age ranged from 73 years to 83 years (weighted average 77 years). The percentage of female participants in studies ranged from 47% to 100%. The percentage of people with a final diagnosis of dementia was between 2% and 56% across studies (a weighted average of 21%). For the target condition dementia, in individual studies sensitivity ranged from 34% to 91% and specificity ranged from 58% to 99%. In the meta-analysis for dementia as the target condition, in eight studies in which a total of 826 of 2790 participants had dementia, the summary diagnostic accuracy of clinical judgement of general practitioners was sensitivity 58% (95% confidence interval (CI) 43% to 72%), specificity 89% (95% CI 79% to 95%), positive likelihood ratio 5.3 (95% CI 2.4 to 8.2), and negative likelihood ratio 0.47 (95% CI 0.33 to 0.61). For the target condition cognitive impairment, in individual studies sensitivity ranged from 58% to 97% and specificity ranged from 40% to 88%. The summary diagnostic accuracy of clinical judgement of general practitioners in four studies in which a total of 594 of 1497 participants had cognitive impairment was sensitivity 84% (95% CI 60% to 95%), specificity 73% (95% CI 50% to 88%), positive likelihood ratio 3.1 (95% CI 1.4 to 4.7), and negative likelihood ratio 0.23 (95% CI 0.06 to 0.40). It was impossible to draw firm conclusions in the analysis of heterogeneity because there were small numbers of studies. For specificity we found the data were compatible with studies that used ICD-10, or applied retrospective judgement, had higher reported specificity compared to studies with DSM definitions or using prospective judgement. In contrast for sensitivity, we found studies that used a prospective index test may have had higher sensitivity than studies that used a retrospective index test.
    Authors' conclusions: Clinical judgement of GPs is more specific than sensitive for the diagnosis of dementia. It would be necessary to use additional tests to confirm the diagnosis for either target condition, or to confirm the absence of the target conditions, but clinical judgement may inform the choice of further testing. Many people who a GP judges as having dementia will have the condition. People with false negative diagnoses are likely to have less severe disease and some could be identified by using more formal testing in people who GPs judge as not having dementia. Some false positives may require similar practical support to those with dementia, but some - such as some people with depression - may suffer delayed intervention for an alternative treatable pathology.
    MeSH term(s) Aged ; Alzheimer Disease/diagnosis ; Clinical Reasoning ; Cognitive Dysfunction/diagnosis ; Cross-Sectional Studies ; Dementia/diagnosis ; Female ; Humans ; Physicians, Primary Care ; Prospective Studies ; Retrospective Studies ; Sensitivity and Specificity
    Language English
    Publishing date 2022-06-16
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Review ; Research Support, Non-U.S. Gov't ; Systematic Review
    ISSN 1469-493X
    ISSN (online) 1469-493X
    DOI 10.1002/14651858.CD012558.pub2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Ophthalmic abnormalities in children with Down syndrome.

    Creavin, Alexandra L / Brown, Ray D

    Journal of pediatric ophthalmology and strabismus

    2009  Volume 46, Issue 2, Page(s) 76–82

    Abstract: A comprehensive review of the available literature was performed to determine the common ophthalmic disorders in children aged 0 to 16 years with Down syndrome. The UK National Library for Health interface was used to search seven electronic databases, ... ...

    Abstract A comprehensive review of the available literature was performed to determine the common ophthalmic disorders in children aged 0 to 16 years with Down syndrome. The UK National Library for Health interface was used to search seven electronic databases, including MEDLINE and EMBASE. Terms related to Down syndrome, ophthalmology, and pediatrics were combined in the search strategy, which yielded 230 articles. Application of exclusion criteria left 23 articles to include in the review. Literature synthesis demonstrated that children with Down syndrome are at risk for several ocular disorders. Refractive error was a common finding, particularly hyperopia. Strabismus was also reported regularly, particularly esodeviation. Other frequent findings included poor visual acuity, nystagmus, and blepharitis, whereas cataract and glaucoma were less common but had potentially serious implications for future vision. Only one study compared routine pediatric examination to that of a pediatric ophthalmologist. The findings of this review confirm the need for an ophthalmic screening program for children with Down syndrome. Additional work should investigate how such a program could be best implemented and ascertain how to involve different professionals in such a service.
    MeSH term(s) Adolescent ; Child ; Child, Preschool ; Databases, Factual ; Down Syndrome/complications ; Down Syndrome/diagnosis ; Down Syndrome/epidemiology ; Eye Diseases/diagnosis ; Eye Diseases/epidemiology ; Eye Diseases/etiology ; Humans ; Infant ; Prevalence ; Risk Factors
    Language English
    Publishing date 2009-01-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 800921-1
    ISSN 1938-2405 ; 0191-3913
    ISSN (online) 1938-2405
    ISSN 0191-3913
    DOI 10.3928/01913913-20090301-06
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Ophthalmic abnormalities and reading impairment.

    Creavin, Alexandra L / Lingam, Raghu / Steer, Colin / Williams, Cathy

    Pediatrics

    2015  Volume 135, Issue 6, Page(s) 1057–1065

    Abstract: Objectives: To explore associations between specific learning disorder with impairment in reading (dyslexia) and ophthalmic abnormalities in children aged 7 to 9 years.: Methods: Cross-sectional analysis was performed on cohort study data from the ... ...

    Abstract Objectives: To explore associations between specific learning disorder with impairment in reading (dyslexia) and ophthalmic abnormalities in children aged 7 to 9 years.
    Methods: Cross-sectional analysis was performed on cohort study data from the Avon Longitudinal Study of Parents and Children. Reading impairment was defined according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Children who achieved >2 SD below the mean in the Neale Analysis of Reading Ability Scale II and level <4 in nonmathematical national key stage 2 tests were defined as having severe reading impairment (SRI). Children with blindness or IQ <70 were excluded.
    Results: Data were available for 5822 children, of whom 172 (3%) met the criteria for SRI. No association was found between SRI and strabismus, motor fusion, sensory fusion at a distance, refractive error, amblyopia, convergence, accommodation, or contrast sensitivity. Abnormalities in sensory fusion at near were mildly higher in children with SRI compared with their peers (1 in 6 vs 1 in 10, P = .08), as were children with stereoacuity worse than 60 seconds/arc (1 in 6 vs 1 in 10, P = .001).
    Conclusions: Four of every 5 children with SRI had normal ophthalmic function in each test used. A small minority of children displayed minor anomalies in stereoacuity or fusion of near targets. The slight excess of these children among those with SRI may be a result of their reading impairment or may be unrelated. We found no evidence that vision-based treatments would be useful to help children with SRI.
    MeSH term(s) Child ; Cohort Studies ; Cross-Sectional Studies ; Dyslexia/epidemiology ; Dyslexia/etiology ; Eye Abnormalities/complications ; Female ; Humans ; Longitudinal Studies ; Male ; Severity of Illness Index
    Language English
    Publishing date 2015-05-24
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2014-3622
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Why can't my child see 3D television?

    Creavin, Alexandra L / Creavin, Samuel T / Brown, Raymond D / Harrad, Richard A

    British journal of hospital medicine (London, England : 2005)

    2014  Volume 75, Issue 8, Page(s) 457–460

    Abstract: A child encountering difficulty in watching three-dimensional (3D) stereoscopic displays could have an underlying ocular disorder. It is therefore valuable to understand the differential diagnoses and so conduct an appropriate clinical assessment to ... ...

    Abstract A child encountering difficulty in watching three-dimensional (3D) stereoscopic displays could have an underlying ocular disorder. It is therefore valuable to understand the differential diagnoses and so conduct an appropriate clinical assessment to address concerns about poor 3D vision.
    MeSH term(s) Child ; Child, Preschool ; Depth Perception/physiology ; Esotropia/complications ; Esotropia/diagnosis ; Esotropia/therapy ; Humans ; Hyperopia/complications ; Hyperopia/diagnosis ; Hyperopia/therapy ; Imaging, Three-Dimensional ; Male ; Television ; Visual Acuity
    Language English
    Publishing date 2014-08
    Publishing country England
    Document type Case Reports ; Journal Article ; Review
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2014.75.8.457
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: The range of peripapillary retinal nerve fibre layer and optic disc parameters in children aged up to but not including 18 years of age, as measured by optical coherence tomography: protocol for a systematic review.

    Creavin, Alexandra L / Williams, Cathy / Tilling, Kate / Timpson, Nicholas / Higgins, Julian P T

    Systematic reviews

    2016  Volume 5, Page(s) 71

    Abstract: Background: The parameters of the optic disc and peripapillary retinal nerve fibre layer (pRNFL) in children may vary with disease processes that contribute to visual impairment and blindness and so could be useful as an objective measure in at-risk ... ...

    Abstract Background: The parameters of the optic disc and peripapillary retinal nerve fibre layer (pRNFL) in children may vary with disease processes that contribute to visual impairment and blindness and so could be useful as an objective measure in at-risk children. There is no standardised reference for the normal parameters of the optic disc and pRNFL in children; however, there are a large number of small individual studies that have been undertaken to look at these measures.
    Methods: A systematic review of current literature on the range of pRNFL and optic disc parameters in children aged less than 18 years will be performed. Studies will be considered for review if they report numerical data on optic disc and pRNFL parameters, measured using optical coherence tomography. Outcome measures will include mean pRNFL thickness and cup-disc ratio. The bibliographic databases Medline, CINAHL, EMBASE, Scopus and Web of Science will be systematically searched from 1991. Screening of search results will be conducted by two authors working independently, as will extraction of primary and secondary outcome data. Ten per cent of all other data extraction will be checked by a second author. Results will be compiled and presented in evidence tables. Where possible and appropriate, study-specific estimates will be combined to obtain an overall summary estimate of pRNFL thickness and cup-disc ratio across studies and results will be presented by age of population. Subgroup analyses will be undertaken for children of different ethnicities.
    Discussion: This review aims to provide an overview of the parameters of the optic disc and pRNFL in children of different ages in order to identify gaps in knowledge and to improve understanding of what might be considered within/outside the range of normality. The findings will be presented in peer-reviewed journals and will be presented at conferences.
    Systematic review registration: PROSPERO CRD42016033068.
    MeSH term(s) Adolescent ; Child ; Child, Preschool ; Humans ; Infant ; Optic Disk/anatomy & histology ; Optic Disk/diagnostic imaging ; Reference Values ; Research Design ; Retina/anatomy & histology ; Retina/diagnostic imaging ; Systematic Reviews as Topic ; Tomography, Optical Coherence
    Language English
    Publishing date 2016-04-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2662257-9
    ISSN 2046-4053 ; 2046-4053
    ISSN (online) 2046-4053
    ISSN 2046-4053
    DOI 10.1186/s13643-016-0247-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Do GPs respond to postal questionnaire surveys? A comprehensive review of primary care literature.

    Creavin, Samuel T / Creavin, Alexandra L / Mallen, Christian D

    Family practice

    2011  Volume 28, Issue 4, Page(s) 461–467

    Abstract: Background: There is a general consensus that postal surveys of physicians have low response rates. Recent systematic reviews have provided an improved evidence base to help researchers maximize response rates to self-completion questionnaires but to ... ...

    Abstract Background: There is a general consensus that postal surveys of physicians have low response rates. Recent systematic reviews have provided an improved evidence base to help researchers maximize response rates to self-completion questionnaires but to date, there is no comprehensive analysis of whether response rates have improved.
    Objective: To determine a contemporary estimate for the mean response rate to surveys of GPs published in primary care journals over the past decade.
    Method: Twenty-four primary care journals from January 2000 to summer 2009 were searched for postal surveys of GPs. A total of 2838 abstracts were screened, with 683 full-text articles being examined for eligibility and 355 citations included.
    Results: Three hundred and sixty-one surveys of GPs were identified. A total of 338 598 questionnaires were distributed during the study period, with 182 256 returned response rate 61% (95% confidence interval [CI] 59-63%). There was some evidence of an association between response rate and journal impact factor, with a statistically significant higher mean response rate for journals in the highest (mean 67%; 95% CI 64-70%) compared to journals in the lowest quartile of impact factor (mean 55%; 95% CI 51-59%). There was no evidence that mean response rate had increased in the period from 2000 to 2009.
    Conclusions: Postal questionnaires of GPs do not necessarily result in a low response rate. Response rates over the past decade appear relatively unchanged despite the greater evidence base for improving response and further work should explore reasons for this.
    MeSH term(s) Attitude of Health Personnel ; General Practitioners/statistics & numerical data ; Humans ; Surveys and Questionnaires
    Language English
    Publishing date 2011-08
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 605939-9
    ISSN 1460-2229 ; 0263-2136
    ISSN (online) 1460-2229
    ISSN 0263-2136
    DOI 10.1093/fampra/cmr001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Ophthalmic abnormalities in children with developmental coordination disorder.

    Creavin, Alexandra L / Lingam, Raghu / Northstone, Kate / Williams, Cathy

    Developmental medicine and child neurology

    2013  Volume 56, Issue 2, Page(s) 164–170

    Abstract: Aim: To explore associations between developmental coordination disorder (DCD) and ophthalmic abnormalities in children aged 7 to 8 years.: Method: Cross-sectional analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a ... ...

    Abstract Aim: To explore associations between developmental coordination disorder (DCD) and ophthalmic abnormalities in children aged 7 to 8 years.
    Method: Cross-sectional analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort, was performed. DCD was defined according to DSM-IV criteria. Children with neurological difficulties or IQ less than 70 were excluded. Ophthalmic abnormalities including visual acuity, refraction, and binocular function were assessed using standard tests. Children who achieved less than the 5th centile in the ALSPAC coordination test and either failed the National Curriculum handwriting test, or achieved less than the 10th centile in the Activities of Daily Living scale (ADL) were defined as having severe DCD, while those who scored between the 5th and 15th centiles in the coordination test and either failed the handwriting test, or achieved less than the 15th centile in the ADL were defined as having moderate DCD.
    Results: Complete data were available for 7154 children. One hundred and twenty children (1.8%) met the criteria for severe DCD. A further 215 children had moderate DCD. Children with severe DCD were more likely to have the following: abnormal sensory fusion at near (odds ratio [95% confidence interval]) (1.98 [1.13-3.48]) and distance (2.59 [1.16-5.79]) and motor fusion (1.74 [1.07-2.84]); reduced stereoacuity (2.75 [1.78-4.23]); hypermetropia (2.29 [1.1-4.57]) and anisometropia (2.27 [1.13-4.60]). The majority of children found to have both DCD and a refractive error, had been previously prescribed glasses and wore them for the assessments (71%).
    Interpretation: Children with severe DCD had abnormalities in binocular vision, refractive error, and ocular alignment. We recommend that children with DCD be assessed for ocular abnormalities as early intervention may improve long-term visual outcome. The impact of untreated ocular abnormalities such as refractive error on the accuracy of the diagnosis of DCD is difficult to ascertain and further work would be of benefit.
    MeSH term(s) Activities of Daily Living/classification ; Child ; Cohort Studies ; Comorbidity ; Cross-Sectional Studies ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Handwriting ; Humans ; Longitudinal Studies ; Male ; Motor Skills Disorders/diagnosis ; Motor Skills Disorders/epidemiology ; Neurologic Examination ; Neuropsychological Tests ; Refraction, Ocular ; United Kingdom ; Vision Disorders/diagnosis ; Vision Disorders/epidemiology ; Vision Tests ; Vision, Binocular ; Visual Acuity
    Language English
    Publishing date 2013-10-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80369-8
    ISSN 1469-8749 ; 0012-1622
    ISSN (online) 1469-8749
    ISSN 0012-1622
    DOI 10.1111/dmcn.12284
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: The range of peripapillary retinal nerve fibre layer and optic disc parameters, in children aged up to but not including 18 years of age who were born prematurely: protocol for a systematic review.

    Creavin, Alexandra L / Williams, Cathy E M / Tilling, Kate / Luyt, Karen / Timpson, Nicholas / Higgins, Julian P T

    Systematic reviews

    2016  Volume 5, Issue 1, Page(s) 144

    Abstract: Background: The parameters of the optic disc and peripapillary retinal nerve fibre layer (pRNFL) in premature children may vary with disease processes that contribute to visual impairment and blindness and so could be useful as an objective measure in ... ...

    Abstract Background: The parameters of the optic disc and peripapillary retinal nerve fibre layer (pRNFL) in premature children may vary with disease processes that contribute to visual impairment and blindness and so could be useful as an objective measure in at-risk children.
    Methods: A systematic review of current literature on the range of pRNFL and optic disc parameters in children aged less than 18 years, who were born before 37 weeks gestation, will be performed. The bibliographic databases MEDLINE, CINAHL, EMBASE, Scopus and Web of Science will be systematically searched. Where possible and appropriate, study-specific estimates will be combined using meta-analysis to obtain an overall summary estimate of pRNFL thickness and cup-disc ratio across studies, and results will be presented by age of population.
    Discussion: This review aims to improve understanding of what might be considered within/outside the range of normality for this high-risk group.
    Systematic review registration: The review is registered on
    Prospero: CRD42016037933.
    MeSH term(s) Humans ; Nerve Fibers ; Optic Disk/anatomy & histology ; Optic Disk/diagnostic imaging ; Premature Birth ; Reference Values ; Retina/anatomy & histology ; Retina/diagnostic imaging ; Systematic Reviews as Topic ; Tomography, Optical Coherence
    Keywords covid19
    Language English
    Publishing date 2016-08-31
    Publishing country England
    Document type Journal Article
    ZDB-ID 2662257-9
    ISSN 2046-4053 ; 2046-4053
    ISSN (online) 2046-4053
    ISSN 2046-4053
    DOI 10.1186/s13643-016-0319-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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