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 (r 2 =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.
Seminar Description The focus of this seminar is on the healthcare team’s role in influencing patient outcomes through assessment and management of pain. The barriers that affect the team’s performance in assessing and managing pain are addressed. Current recommended pharmacologic and nonpharmacologic approaches for managing pain are presented. The practical considerations related to using selected therapies, such as around-the-clock oral dosing, long-acting analgesics, titration, PCA, intraspinal analgesia, and continual peripheral nerve block infusions, are explained. The needs of special populations, such as neonates, infants, children, older adults, critically ill, and the cognitively impaired, are addressed.
Bringing a new optometrist into a practice, even if only on an employer-employee basis, is a complicated process that should not be taken lightly by hirer or hiree. This article explores the many aspects of the process and the relationship that must be understood and worked out in advance.
BACKGROUND:Occurrence of refractive errors and uncorrected visual acuity impairment among self-selected, indigent, medically underserved Hispanic, white, and black adults examined by the staff of the UCLA Mobile Eye Clinic (MEC) are described in this study and compared to population-based studies. METHODS:The study sample consisted of all 2,970 Hispanic, 1,228 white, and 1,028 black participants, for a total of 5,226 self-selected adults, ages 25 to 74 years, who received vision screenings and eye examinations by the staff of the UCLA MEC from 1987 to 1997. Tests consisted of visual acuity, refractive error, intraocular pressure, retinoscopy, slit-lamp biomicroscopy, direct ophthalmoscopic examination, and indirect ophthalmoloscopy with pupillary dilation. Levels of visual acuity impairment were defined as mild (20/50-20/80), moderate (20/100), or severe (20/200 or worse) in either eye. RESULTS:Self-selected whites in this study had higher rates of astigmatism, anisometropia, and hyperopia, while myopia was higher among self-selected blacks. Myopia and hyperopia occurred more frequently among younger age groups for all ethnic groups. Whites had a higher occurrence of mild, moderate, and severe visual acuity impairment, as compared with Hispanics and blacks. CONCLUSIONS:Both refractive errors and impaired visual acuity of this self-selected sample are similar to those of adults from the National Health and Nutrition Examination Survey, Hispanic Health and Nutrition Examination Survey, and the Baltimore Eye Survey. The data presented in this study provide a crude estimate of the occurrence of refractive errors and impaired visual acuity among self-selected, medically underserved, indigent Hispanic, white, and black adults in the Los Angeles area.
BACKGROUND Most eye injuries are preventable. Military personnel, workers, athletes, and other spectacle wearers--especially children and the functionally one-eyed--who require protection from impact, should expect that safety eye-wear actually protects. PURPOSE To present to eye care professionals the current state-of-the-art in eye injury prevention. METHODS A review of the current eye protection standards, guidelines, and warnings for the activities of daily living, work, hobbies, education, and sports with emphasis on the importance of standards and the role of the recently organized Protective Eyewear Certification Council (PECC). CONCLUSIONS The prescriber and dispenser are obliged to prescribe, fabricate, and dispense safe and effective eyewear. PECC will help the eye care professional fulfill this obligation.
BACKGROUND We conducted a pilot study to assess the effect of 0.1% diclofenac sodium eyedrops on the initial comfort of rigid gas permeable (RGP) contact lenses. METHODS A double-masked, placebo-controlled, crossover trial was performed on 20 unadapted subjects. In Phase I, subjects used either 0.1% diclofenac or placebo eyedrops four times per day for 3 days before RGP lenses were dispensed. Contact lenses were inserted on Day 4 and worn for 8 continuous hours. Eyedrops were used twice during the 8-hour period. Ocular symptoms were graded on a visual analog scale at six points during the day. Visual acuity and slitlamp examinations were performed at the same six study points. After a 2-week wash-out period, subjects received the opposite treatment in Phase II, following the same protocol used in Phase I. RESULTS The treatment effect was tested using the Mainland-Gart chi-square test. There was no statistically significant treatment effect (chi-square = 0.20, p = 0.653) on patient symptoms. Biomicroscopy findings were analyzed and, likewise, showed no significant treatment effect (chi-square = 2.10, p = 0.15). CONCLUSIONS Data from this pilot study showed no statistically significant reduction in symptoms or signs with diclofenac eyedrops.
BACKGROUND:This is the first ophthalmic report--to our knowledge--of an anterior uveitis secondary to sarcoidosis in a patient infected with human immunodeficiency virus (HIV). Other reported causes of uveitis in HIV-infected patients have included HIV, herpes zoster, tuberculosis, syphilis, toxoplasmosis, cryptococcus, rifabutin prophylaxis for mycobacterium, and protease inhibitors such as ritonavir and indinavir. Uveitis secondary to sarcoidosis in the non-HIV population is classically seen in young, female, African-American patients. There are rare reports, found exclusively in the pulmonary literature, of sarcoidosis in HIV-infected patients.CASE REPORT:A 38-year-old African-American male infected with HIV was treated for chronic recurrent anterior uveitis secondary to sarcoidosis. His sarcoidosis was diagnosed 1 month earlier, along with the onset of his uveitis. During the previous 6 years he has been treated with anti-HIV antivirals as well as prophylaxis for opportunistic infections. To date, his infectious disease specialist continues to treat his HIV and systemic sarcoidosis.CONCLUSION:Patients with HIV infection in whom sarcoidosis with secondary uveitis develops are very rare. Management of these patients requires careful use of topical and oral steroidal anti-inflammatories to control ocular and systemic sequelae of sarcoidosis. This case initiates some interesting questions about the immunology of sarcoidosis and its presence in immunocompromised patients. Use of steroids in an immunocompromised patient is clinically complex. Further clinical study is needed to elicit the full clinical significance of sarcoidosis and HIV infection.
BACKGROUND:Diabetic retinopathy (DR) remains the leading contributor to severe vision loss in the United States among persons 20 to 70 years of age. Despite advances in disease management and treatment, patients with vision loss from DR continue to constitute a significant portion of patients served in vision rehabilitation service (VRS) settings. These patients present special challenges to VRS providers because of early onset, fluctuations in and the complex nature of vision loss, unique visual demands of disease management, and associated multi-system losses.CASE REPORTS:After introductory epidemiologic review, a case presentation format is used to illustrate solutions a multidisciplinary VRS can offer the special visual challenges of the person with diabetes with vision loss from DR. Four patients are presented--ages 30 to 70 years--with varying degrees and types of vision loss, with different lifestyle demands and disease management needs. The cases address vocational issues, vision fluctuation, coordinating adaptive solutions to complex visual losses, and meeting diabetic needs to measure medication, insulin, and blood glucose levels, to maintain skin care, diet, exercise, transportation, family roles, and support systems.CONCLUSIONS:The unique and complex needs of people with diabetes who experience vision loss can be well addressed through timely and ongoing VRS consultations, in conjunction with medical/ocular disease management.
BACKGROUND:Almost 25 million workers in 1.2 million commercial buildings in the United States have symptoms of sick building syndrome (SBS). It is a source of ocular discomfort and may exacerbate the successful wear of contact lenses. This study examines the relationship between SBS and oculovisual discomfort.METHODS:Measurements of carbon dioxide, formaldehyde, temperature, and humidity were performed in 12 public office buildings that contained a total of 877 occupants. A questionnaire survey of the occupants was also performed.RESULTS:Thirty-five percent of the occupants of the buildings were dissatisfied with the indoor-air quality. Twenty-nine percent of the office building occupants reported ocular discomfort.CONCLUSION:There was a significant correlation between eye irritation, throat irritation, and symptoms of blurred near vision. Ocular discomfort could be an indicator of poor indoor-air quality and a sick building syndrome.
Background: Optometrists and Ophthalmologists have a history of difficult professional relationships This paper discusses common issues both professions face while working under managed care Conclusions: Managed care initiatives may help to improve the ability of Optomotrists and Ophthalmologists to work together to treat the patient's eye problems.
BACKGROUND:Management of HIV infection has been revolutionized in the past 3 years by the introduction of drugs significantly more potent than those previously available. Simultaneously revelations about dynamics of HIV infection and viral replication have altered concepts about HIV disease, as well as the need for therapeutic interventions.METHODS:A literature search was conducted of journals listed in the Index Medicus, as well as abstracts from annual meetings of the American Society for Microbiology, the Infectious Disease Society of America (Conference on Retroviruses and Opportunistic Infections), and the International Conferences on AIDS.RESULTS:Antiretroviral drugs of four differing pharmacologic classes are able to achieve profound suppression of viral replication when combined in varying regimens. Costs of medications remain high, many toxicities are associated with drug therapy, and regimens are both complex and daunting. In spite of many difficulties associated with highly active anti-retroviral therapy (HAART), many patients are able to achieve improved quality of life and longer survival.CONCLUSIONS:Optometrists, as members of the health care team, play a role in diagnosis and management of HIV patients, in providing encouragement and empathy to patients--particularly emphasizing the need for adherence to complex therapy regimens, as well as the importance of regular followup.
