Biomedical subjects

D M Krumholz

Publications and source records attributed to D M Krumholz.

6 recordsLinked to original sources

PubMed2001

Prescribing patterns of optometrists newly licensed in therapeutic drug use in New York State.

PURPOSE: As part of the New York State law authorizing optometrists to use Therapeutic Pharmaceutical Agents (TPAs), the New York State Education Department commissioned a study to monitor and assess the prescribing patterns and competence of optometrists newly licensed to use TPAs. This report summarizes the findings of that study. METHODS: The database was obtained from more than 11,000 Patient Data Reporting Forms (PDRFs) returned by 535 optometrists, listing diagnosis, type(s) of medication(s) prescribed, treatment outcome, and possible adverse effects. RESULTS: Of the more than 11,000 forms returned by 535 optometrists, 8,936 were first visits, with 5,828 follow-up visits scheduled. For all reported initial visits, only 89 patients required ophthalmological referral for secondary or tertiary care. No adverse drug reactions requiring intervention were reported. The most-frequent diagnoses treated by optometrists were related to allergies, superficial trauma, conjunctivitis (unspecified), and then blepharitis. The most commonly prescribed ophthalmic preparations as actually reported on the PDRFs were Polytrim (trimethoprim/ polymixin B), tobramycin (brand name and generic), TobraDex (tobramycin/dexamethasone), and Livostin (levocabastine). CONCLUSIONS: When analyzed according to diagnosis, the data indicate that the prescribing patterns of the prescribing optometrists adhered to currently accepted clinical guidelines. Based on the available data and the lack of observed side effects, the use of topical medications to treat anterior-segment disease by optometrists in New York State appears to be safe, and should be of benefit to patients who seek care from optometrists.

Drug Prescriptions↗

PubMed2000

The effect of continuous quality improvement on compliance with clinical practice guidelines in an optometric clinic: a retrospective review.

BACKGROUND: Quantitative documentation of quality is becoming increasingly more important. The SUNY State College of Optometry established clinical protocols outlining clinical standards for patient care. We compared documentation of actual clinical performance to these standards. METHODS: The Primary Care Service's Quality Management Team retrospectively reviews a random 10% sample of charts of patients seen in the teaching clinic of the SUNY State College of Optometry on an ongoing basis. They compare the care documented in the medical record to internally distributed clinical protocols. We reviewed the resultant data from January 1995 through June 1997 by analyzing the number of indicators that were out of compliance for each month. Then we graphed these data to ascertain trends and variability to determine what effect this continuous quality improvement process had on clinical care as measured by compliance with clinical protocols. RESULTS: A least-squares regression analysis demonstrated a correlation (0.717) between the decreasing number of items out of compliance and the time during which feedback was provided (r2 = 0.5143, p = 0.0001). These data show a distinct downward trend, indicating better compliance with the clinical protocols over time. We also found that the variability of the data decreased during the time period studied. CONCLUSIONS: A properly designed continuous quality improvement program that gives appropriate feedback to faculty optometrists and student interns measurably increased their compliance with--and decreased their variability from--this clinic's internally distributed clinical protocols over a 30-month time period.

Clinical Competence↗

PubMed2000

Optimal clinical management of eye problems: the role of optometrists in managed care plans.

BACKGROUND: Recent developments in the education and licensure of optometrists have created new opportunities for more-efficient provision of eye care. This study was conducted to determine the extent to which optometrists provided various kinds of eye care independently in managed care organizations. We compared optometric practices in health plans located in states in which the legal authority of optometrists was limited, to optometric practices in plans situated in states in which optometric licensure permitted broader prescribing authority. The volume and nature of referrals to ophthalmologists were assessed in relation to state law and organizational protocols. METHODS: A 15-item patient encounter form was developed and completed for all patients examined by the optometrists at each site during a 4-week period in 1998. Specific conditions were selected and criteria developed to help determine whether referrals to ophthalmologists were appropriate, or if they could have been managed by the optometrist These referrals were assessed by an independent panel of four optometrists. RESULTS: This study documented that optometrists provide a substantial range of eye care, and their individual scope of practice is influenced not only by legal boundaries, but also by financial and organizational factors found within managed care organizations. The pattern of referrals to ophthalmologists helped indicate the extent to which optometrists were underutilized or used appropriately in various settings. CONCLUSIONS: There is no single reliable predictor of whether optometrists will be used at the highest level of their abilities and scope of license. Although state licensure sets the overall parameters for care, optometric practice in managed care plans may be modified by internal protocols and organizational factors.

Aged↗

PubMed1997

Gentamicin retinal toxicity after cataract surgery in an eye that underwent vitrectomy.

A cataract developed in a 23-year-old man 4 months after a vitrectomy to repair a traumatic retinal detachment. An uneventful phacoemulsification was performed, using antibiotic-fortified infusion solution. Afterward, a large area of atrophic retina, consistent with gentamicin toxicity, was observed in the macula. The patient remains stable with 20/200 best-corrected acuity. The authors suggest that because the vitreous had been removed, gentamicin was able to settle over the macula during the entire cataract procedure. Therefore, gentamicin should be used intracamerally with caution, especially in eyes in which vitrectomy has been performed.

Adult↗

PubMed1990

Nonsurgical management of blepharoptosis.

Ptosis of one or both eyelids is a problem which affects a small, but nonetheless significant, portion of the population. Ptosis can be managed in a variety of ways, all of which can usually bring about a resolution of the problem to varying degrees of satisfaction. Two patients who were helped significantly through the use of two non-invasive techniques are presented here. Both patients, somewhat handicapped by the ptosis, were able to return to a more normal daily routine as a result of the therapy employed. The etiology of blepharoptosis and its workup are briefly reviewed.

Adult↗

PubMed1986

Short-term changes in tonic accommodation.

Experiments were performed to determine the diurnal variation of, as well as the influence of total darkness on, tonic accommodation. In general, under both conditions trend analysis showed that variations in tonic accommodation over time were either nonsystematic in nature or could be best described by a simple linear function. Given the relatively small range of mean tonic accommodation values over time (0.5 to 1.1 D), the results demonstrate the robustness and stability of tonic accommodation under naturally occurring viewing conditions during the course of a day. In contrast, during the 2-hr period in total darkness, tonic accommodation exhibited a three-fold increase in mean range (0.6 to 2.5 D) as well as a significant increasing linear trend in some subjects, suggesting less stability of tonic accommodation in the absence of visual stimuli.

Accommodation, Ocular↗