SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A failure to diagnose was the basis for most of a series of 35 malpractice suits filed against ophthalmologists and other physicians. All of these cases presented problems in neuro-ophthalmologic diagnosis. Selected summaries illustrate typical diagnostic pitfalls. "Creative" consultation reports may be one effective prophylactic measure against such legal actions.
A questionnaire entitled "Present and Future Training of Ophthalmologists in the USA" was sent to members of the Association of University Professors of Ophthalmology. Data obtained from the questionnaire indicate that: the complex regulations pertaining to training foreign medical graduates (FMGs) in the USA are often not fully understood by the chairmen, most programs are willing to accept but do not actively recruit FMGs, there are a number of obstacles encountered in selecting and training FMGs, and most resident and fellowship positions are filled by US graduates.
The Wilmer Information System is a computerized medical information system used for the storage and retrieval of data pertaining to patient demographics, diagnosis, and therapy. The heart of the system is an expandable, hierarchical code based on International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes and Physicians' Current Procedural Terminology procedure codes. Customized coding sheets containing highly specific diagnosis and procedure codes have been designed for each subspecialty area in ophthalmology. Interactive database management software facilitates data entry and retrieval. The system can be used to search for patients who meet very specific criteria, or to produce cumulative visit reports and summary statistics.
Seven hundred medicolegal claims in ophthalmology were reviewed by one ophthalmologist who served as an expert for four decades. The ophthalmologist was personally involved in 620 claims. The 700 cases have been categorized and analyzed. The reasons for the claims and some lessons derived from them are presented. Familiarity with the claims encountered by others may enable ophthalmologists to avoid similar claims.
Ophthalmology residents attended a day-long training program designed to teach them about the rehabilitation needs of visually impaired and blind patients. A pretest measuring the participants' knowledge of rehabilitation services and their rehabilitation-oriented activities was administered before the training program and a posttest measuring the same items was administered 6 months after the program. Several of the rehabilitation-oriented measures that participants themselves take with visually impaired and blind patients increased substantially during the 6-month period as did their knowledge of rehabilitation services available in the community. The referrals made for these rehabilitation services and the participants' interactions with allied health professionals who serve visually impaired and blind patients increased only slightly. These findings suggest the need to institutionalize training for residents in the topic of rehabilitation and to allocate time within their schedules for making referrals and working cooperatively with allied health professionals.
The authors retrospectively analyzed the visual outcome and incidence of complications of 181 consecutive cases of phacoemulsification performed by eight third-year ophthalmology residents. A posterior chamber intraocular lens was implanted in 179 of these eyes. Vitreous loss occurred in 5.5% of cases. The overall incidence of posterior capsule rupture was 9.9%; of the 18 posterior capsular ruptures, 72% were detected during cortical removal and 22% during nuclear emulsification. Postoperative follow-up for 177 eyes was at least 2 months, and 70% were followed for 6 months or longer. Final best corrected visual acuity of 20/40 or better was obtained in 92.6% of eyes. These results are comparable with previous reports of residents' experience in performing planned extracapsular cataract extraction. With appropriate training and faculty supervision, residents learning to perform phacoemulsification and intraocular lens implantation can achieve acceptable results.
Pediatric ophthalmologists should respond to quality expectations inherent in all disciplines of medicine. The specialists must be able to collect data to document and prove the quality of their work if it anticipates continued reimbursement for services. Quality of medical practice is assessed by outcomes research, which is different from clinical research. All specialists are systemically measuring individual and group outcomes across the spectrum of American health care systems. Pediatric ophthalmologists, both in private practice and at academic centers, must concentrate their research efforts on the assessment of cost, quality, utilization, and patient-centered health-related quality of life for the most common pathologies in pediatric ophthalmology practice.
Genetic heterogeneity in ophthalmology adds a new dimension to differential diagnosis and prognosis. The indispensable clinical classification is refined by molecular genetic strategies. They sometimes build up new families of diseases, sometimes indicate that what was thought to be aetiologically related disorders are caused by different genetic mechanisms. Heterogeneity throws new light on embryological pathways, and the molecular genetics of the eye increases the information of the localisation of metabolically active substances and structural proteins in the eye.
Some of the objects from the Medical History Museum, University of Copenhagen, concerned with the century-old Danish Ophthalmological Society are mentioned, together with some objects concerned with our predecessors. Jannik Bjerrum's campimeter at 1-2 m-distance reveals glaucomatous arcuate scotoma. [figure: see text] Marius Tscherning's many scientific papers and his ophthalmophacometer (also measuring accommodation), abberoscope, adaptoscope, colour vision, punctual meniscen spectacle glasses etc. are housed in the Museum. K.K.K. Lundsgaard's spectacle collection and cataract paper, Gordon Norrie's colour vision lantern and his personal pince-nez are described. Gustav Østerberg's contact lens practice and his pictorial visual chart, Jørn Boberg-Ans' pioneer artificial lens surgery dating from 1958, are all examples of the work of members of the Society. From our predecessors, we refer to the first cataract extraction in Denmark in 1670 (F. Borri on a goose); Georg Heuermann's on humans dating from 1755 and the reintroduction of the operation in 1810 by C.C. Withusen, V. Krenchel's (1844-1885) ophthalmoscope with a movable mirror and his colour vision lantern; A. Stadfeldt's instruments for examination of the refractive index of the human lens, MD thesis dating from 1898. In addition, snow goggles from Greenland and eye-baths are described.
We report an evaluation of the British Ophthalmological Surveillance Unit (BOSU), a nationwide active surveillance scheme to assist with the case ascertainment of rare eye conditions. The evaluation assessed participation rates, study applications and research outputs. In addition, through an anonymous postal survey we ascertained the opinions of ophthalmologists regarding the usefulness, levels of feedback, barriers to participation and levels of case ascertainment. Over the first 3 years, the 4-month mean participation rate has improved from 58% to 71%. Ten studies have used this system for case ascertainment. To date three journal publications and 10 conference presentations have reported findings from these studies. It was observed that 582/870 (68%) questionnaires were returned by ophthalmologists, of whom 95% considered BOSU as very or quite useful. In all, 71% reported overall feedback to be sufficient. However, 34% requested greater feedback from research groups. Reported barriers to effective participation were 'having to remember the patient's identity' (52%) and paying for return postage of cards (22%). However, 72% of respondents did not consider the work involved in reporting a case to be prohibitive. Self-reported levels of case ascertainment by ophthalmologists for completed studies ranged between 72% and 95%. This population-based surveillance system provides an effective method for prospective case identification and subsequent data collection. It enables the study of sufficiently representative samples to allow meaningful epidemiological analysis and avoid bias. Its success relies upon the high level of support that it currently receives from ophthalmologists.
PURPOSE: To examine the basic surgical training received by Senior House Officers (SHOs) in ophthalmology and the influence on training of sociodemographic and organisational factors. METHODS: Cross-sectional survey of SHOs in recognised UK surgical training posts asking about laboratory training and facilities, surgical experience, demographic details, with the opportunity to add comments. RESULTS: A total of 314/466 (67%) questionnaires were returned. In all, 67% had attended a basic surgical course, 40% had access to wet labs and 39% had spent time in a wet lab in the previous 6 months. The mean number of part phakoemulsification (phako) procedures performed per week was 0.79; the mean number of full phakos performed per week was 0.74. The number of part phakos performed was negatively correlated, and the number of full phakos completed was positively correlated, with length of time as an SHO. Respondents who had larger operating lists performed more full phakos per week (P<0.001). Compared to men, women were less likely to have access to a wet lab (P=0.013), had completed fewer full phakos per week (P=0.003), and were less likely to have completed 50 full phakos (P=0003). SHOs' comments revealed concerns about their limited 'hands on' experience. CONCLUSIONS: There are significant shortcomings in the basic surgical training SHOs receive, particularly in relation to wet lab experience and opportunities to perform full intraocular procedures. SHOs themselves perceive their training as inadequate. Women are disadvantaged in both laboratory and patient-based training, but minority ethnic groups and those who qualified overseas are not.
AIM: To study the overall level of evidence-based practice in an accident and emergency eye unit in the UK and evaluate the extent of evidence-based practice by ophthalmologists and nurse practitioners (NPs). METHODS: The case notes of all new patients attending our accident and emergency department for a period of 1 week were reviewed prospectively. For each case, the diagnosis at presentation and its intervention was ascertained. A literature search using Medline and Cochrane library was performed to assess the level of evidence provided for each diagnosis-intervention pair. Each diagnosis-intervention pair was evaluated and graded to assess the best level of evidence provided. RESULTS: A total of 474 new patients attended the eye casualty during the study period. No diagnosis was made in 27 cases and they were excluded from the analysis. Out of 447 patients, 308 (68.9%) cases were managed by NPs and 139 (31.1%) by doctors. A total of 294 (65.8%) patient interventions were based on evidence from systematic reviews, meta-analysis and randomised-controlled trials, of which 223 were managed by NPs and 71 by ophthalmologists. This difference was statistically significant with P<0.001. One hundred and seven (23.9%) interventions were supported by evidence from prospective and retrospective trials. CONCLUSION: This study demonstrated that two-thirds of interventions were based on the highest level of evidence and was comparable to studies performed in other specialities. It also highlights the advanced role of trained NPs in acute ophthalmology.
AIMS: The present study was carried out to describe the patterns of prescription and drug use in Ophthalmology in out-patients at Dr Rajendra Prasad (R.P.) Centre for Ophthalmic Sciences of All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi. METHODS: Prescriptions of 1017 out-patients were audited through a specially designed form and analysed for the following: average number of drugs per prescription, duration of treatment (recorded or not), dosage forms prescribed, frequency of administration (recorded or not), number of encounters with antibiotics and percentage of drugs prescribed by generic name. RESULTS: Prescription analysis showed that the average number of drugs per prescription was 3.03. Duration of treatment was recorded for only 26.4% of the drugs prescribed. The maximum number of drugs prescribed were in the form of eye drops (76%), followed by tablets (10.9%), ointments (6.4%), syrups (1%), capsules (0.7%), lotions (0.3%) and injections (0.1%). No dosage form was recorded for 4.6% of the drugs prescribed. The frequency of administration was recorded for only 77.9% of the drugs prescribed. The number of antibiotics prescribed was 1059 which constitutes 34.2% of the total number of drugs prescribed. The percentage of drugs prescribed by generic name was only 35%. CONCLUSIONS: The results obtained in this study indicated an awareness of polypharmacy but a high incidence of common prescription writing errors such as not recording the duration of therapy, frequency of administration and dosage form. Moreover prescribing by generic name was also low.
Citation analysis has evolved over the last 50 years as one parameter for assessing the quality of research published in scientific, technology and social science journals. This is based on the assumption that influential research is widely cited by other scientists and clinicians. With the advent of the Internet, Journal Citation Reports from the Institute for Scientific Information (ISI-JCR) have become widely available to individuals and institutions. In an increasingly competitive research environ-ment, aspects of citation analysis have been suggested as simple proxy, objective measures to evaluate the research quality of a journal, published articles, research institutions and even individual researchers. This review article provides an overview of citation analysis, including definitions, uses of these reports, and related controversies and potential abuses. As it has become the most commonly used indicator, there is a particular focus on the use of the Journal Impact Factor (JIF). This is a widely quoted measure indicating the frequency with which the average article published in a journal of interest will be quoted within a specified time frame that therefore allows approximate comparisons of journals within a particular field of interest. Given the relative paucity of information in this area, emphasis is placed on citation analysis within ophthalmology, in particular in regard to the 43 ophthal-mology, vision science and optometry journals that are listed in the ISI-JCR 2001 reports.
BACKGROUND: Platelet concentrates were recently used for ophthalmologic treatment of macular holes. This strategy was investigated to define standardized blood bank components. STUDY DESIGN AND METHODS: Two different, highly concentrated autologous platelet components, one from whole-blood preparation and the other from plateletpheresis, were evaluated. In the first procedure, platelet-rich plasma was obtained from 250 mL of whole blood. After storage for 20 hours, platelet-rich plasma was concentrated in a second centrifugation step and adjusted to 10 x 10(9) platelets per mL. In the second procedure, platelets were collected by apheresis, stored overnight, centrifuged, and adjusted to 20 x 10(9) platelets per mL. The respective component was instilled during vitrectomy and gas tamponade in patients with stage II to IV macular holes. Patients were followed for 9 months. RESULTS: With regard to the various preparation procedures and final concentrations of platelets in the components, no differences in wound healing were observed. An anatomic closure of the macular hole was achieved in 18 of 19 treated patients. Visual acuity improved in 14 patients. CONCLUSION: Both types of highly concentrated platelet components were effective in achieving high closure rates of macular holes. These autologous platelet components possess the quality standard of blood bank components and could be of great benefit for initiating wound healing in other clinical settings.
An essential aspect in the cooperation of clinic and biometry consists in designing of studies, e.g. during the preparation of grant applications or for review by official drug surveillance institutions. A central aspect in study planning is the design-adequate and well-documented prediction of sample size, which should be recommended for any intended study. Based on several examples for sample size planning in study designs, which are of common relevance for ophthalmology, guidelines are derived to enable clinical researchers to perform sample size planning on their own. The latter can be based on the various available software packages for sample size prediction.
For all in-patients a fundamental change of hospital financing based only on diagnosis related groups (DRGs) is planned in Germany for 2004. Patients are grouped into different DRGs according to their coded diagnoses, operations and procedures. Hence, the quality of coding is essential for adequate reimbursement of cases and thus for hospital financing. The legal framework of coding is supplied by the so-called "general and special coding guidelines for coding diseases and procedures", presented jointly by the associations representing hospitals and public and private health insurance companies in early 2002. These German coding standards regulate how coding must be performed in daily practice and therefore have a major influence on the grouping of patients into DRGs. Because of their importance this paper describes the practical application of current coding standards. Specifically in Ophthalmology the problem exists that for many procedures adequate coding numbers are still missing, thus impairing further development of the DRG system.
The neuro-ophthalmologic examination provides an enormous amount of information about the 40% of fibers that provide afferent and efferent limbs of the visual, pupillary, and ocular motor pathways. A few tools and the correct testing approach will maximize the value of this examination. This chapter provides step-by-step examination methods and points out some of the common errors that are made.