Patients with diabetes get the best care with a collaborative team approach. Optometry and ophthalmology can improve our diabetes visits and improve care as well even though we are only a small part of the diabetes healthcare team.
Diabetes and eye care and the benefits of working together as a team to deliver this care. Presentation given at Midwestern University Arizona School of Optometry in 2015.
In this presentation students will have the opportunity to learn all definitions and acronyms related to patient assessment. We have links to YouTube videos to further demonstrate various assessments.
Strategies for Safe and Effective Resident SupervisionVineet Arora
Presented at Accreditation Council of Graduate Medical Education (ACGME) meeting in Nashville, TN Mar 2010. Includes overview of resident supervision, function and type of supervision in various specialties, and the SUPERB/SAFETY model of effective supervision. Includes link to video on YouTube for facilitating discussion.
Patients with diabetes get the best care with a collaborative team approach. Optometry and ophthalmology can improve our diabetes visits and improve care as well even though we are only a small part of the diabetes healthcare team.
Diabetes and eye care and the benefits of working together as a team to deliver this care. Presentation given at Midwestern University Arizona School of Optometry in 2015.
In this presentation students will have the opportunity to learn all definitions and acronyms related to patient assessment. We have links to YouTube videos to further demonstrate various assessments.
Strategies for Safe and Effective Resident SupervisionVineet Arora
Presented at Accreditation Council of Graduate Medical Education (ACGME) meeting in Nashville, TN Mar 2010. Includes overview of resident supervision, function and type of supervision in various specialties, and the SUPERB/SAFETY model of effective supervision. Includes link to video on YouTube for facilitating discussion.
Dental Implant 1 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
MRCPsych08 - How To Analyse Diagnostic Test Studies (June08)Alex J Mitchell
This is an educational talk/presentation on the science of diagnostic tests using examples from psychiatry. It was first presented for MRCPsych (Royal College of Psychiatrists UK) June 2008. Now updated in 2009...see newer version
Presentation by Dr Sheila Carey - Arrowe Park Hospital at the Regional Emergency Laparotomy Collaborative - Complex decision making collaborative at Arrowe Park Hospital on 24 January 2020.
Nursing process (fundamental of nursing)romanajavaid
Nursing process is systematic frame work to provide quality care to patients in which nurses learned how to assess,make nursing diagnose,plan ,implementation and evaluation.
Dental Implant 1 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
MRCPsych08 - How To Analyse Diagnostic Test Studies (June08)Alex J Mitchell
This is an educational talk/presentation on the science of diagnostic tests using examples from psychiatry. It was first presented for MRCPsych (Royal College of Psychiatrists UK) June 2008. Now updated in 2009...see newer version
Presentation by Dr Sheila Carey - Arrowe Park Hospital at the Regional Emergency Laparotomy Collaborative - Complex decision making collaborative at Arrowe Park Hospital on 24 January 2020.
Nursing process (fundamental of nursing)romanajavaid
Nursing process is systematic frame work to provide quality care to patients in which nurses learned how to assess,make nursing diagnose,plan ,implementation and evaluation.
Nursing Diagnosis is second step of Nursing Process.which is very important and depend on your good assessment.you must make nursing diagnosis skillfully to meet patient's need.
Litigations in our practice and modern assisted reproductive technologies - e...Anu Test Tube Baby Centre
Presentation given in 2015 : How much does litigation affect our practice of using assisted reproductive technologies for the management of infertility? What do we know and what are the issues surrounding this technology?
Diagnosis and treatment planning in completely edentulous patientsDr ARYA SUDARSANAN
If you like to view in my youtube channel Dr Aaryas Vlogs please click on these links for parts 1 to 4
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Clinical and dermographics profile of glaucoma patients in Hebron - Palestin...Riyad Banayot
ABSTRACT
BACKGROUND: The purpose of the study was to describe the clinical profile of glaucoma types, treatment modalities, visual outcomes, and intraocular pressure (IOP) control for patients in Palestine.MATERIAL AND METHODS: Data collection was done through the hospital record review, which included basic demographics including file number, age, sex, family history of glaucoma, history of anti-glaucoma and steroid medication, history of ocular trauma or surgery, etiology of secondary glaucoma and history of systemic illness. All the patients had a comprehensive eye examination, including visual acuity, intraocular pressure, vertical cup-disc ratio, and gonioscopy. Data were obtained, tabulated, and organized using Microsoft Excel, and statistical analyses were done using Wizard Version 1.9.49 by Evan Miller.RESULTS: There were 100 females with a mean age of 53 and 101 males with a mean age of 67. Primary open-angle glaucoma and its variants represented 45.3% of all patients, while secondary glaucoma represented 40.3% and primary angle closure glaucoma represented 10.4%. The prevalence of glaucoma increased with age, and the last visual acuity (VA) showed that 39.2% of eyes had Normal/near normal VA. The highest average IOP of 25 mm Hg was recorded among secondary glaucoma patients. Of all glaucoma eyes studied, 64% were on one or two medications, and the most common surgical procedures performed were peripheral iridectomy 18.2% followed by trabeculectomy 15.5%. CONCLUSION: Primary open-angle glaucoma (POAG) was the predominant glaucoma. Glaucoma increased significantly with advancing age. Pseudoexfoliation and neovascular glaucoma comprised the majority of secondary glaucoma.
Acute ocular chemical injury: a descriptive assessment and management review ...Riyad Banayot
Background: The purpose of the study was to assess caregivers’ compliance with the management protocol for
chemical injury at St. John Eye Hospital, Jerusalem.
Materia l and methods: Charts of all new chemical injury patients who presented to St. John Eye Hospital,
Jerusalem, between January and December 2019 were retrospectively reviewed. Data categories collected included:
Presentation, age, sex, injury, irrigation, lids, visual acuity, slit-lamp examination (SLE), management plan, and
medications given. Data were stored and analysed using Excel.
Results: Patients’ presentation date and time, sex, and age were recorded in over 90% of cases. The mechanism of
injury and type of offending chemical were recorded in 65% of cases. The irrigating solution was identified in 50%
of cases. Corrected visual acuity was recorded in both eyes in almost 50% of cases. Limbal ischemia was documented
in 45% of cases, and intraocular pressure (IOP) was recorded in 25%. The management plan and explanation of the
condition to patients were documented in less than 50% of cases. Antibiotics and steroids (drops/ointment) were
prescribed in 92.5% of cases.
Conclusi ons: The results of this study reveal that our documentation needs improvement for several parameters.
Several recommendations were formulated:
1. Emphasize to caregivers that irrigation must be done first.
2. Corrected visual acuity should be attempted for both eyes in all cases, and reasons for not recording it should be
documented.
3. It is important to document and record limbus details, iris details, and IOP in all cases.
open-globe injuries in palestinePalestine: epidemiology and factors associate...Riyad Banayot
Background: The purpose was to describe the epidemiology of open-globe injury (OGI) in Palestine and identify
the prognostic factors associated with profound visual loss.
Materia l and methods: The current study is a retrospective review of hospital files for 83 consecutive patients
with OGI who presented to St. John Eye Hospital, Jerusalem, within 5 years, between 2009 and 2013. Demographic
details included age, gender, wound characteristics, and visual acuity (VA). The Ocular Trauma Classification Group
was used for wound location, classification, and scoring for each case.
Results: We identified 83 OGI that presented to St. John eye hospital. The study group included 62 males and
21 females. The mean age was 16.66 years ± 3.216. The most frequent injuries were playground injuries (59%),
followed by workplace injuries (26.5%). Penetrating injuries represented 45.8% of injuries, and rupture globes
occurred in 39.8% of cases. The most frequent objects causing injury were metal (31.3%) and stone (20.5%). Kinetic
impact projectiles were a statistically significant poor prognostic factor for the visual outcome. Variables that
were statistically significant poor prognostic factors for visual outcome included: retinal detachment, macular scar,
vitreous hemorrhage.
Conclusi on: This study showed that the act of demonstration, street injuries, kinetic impact projectiles, zone III
injuries, globe disruption, retinal detachment, vitreous hemorrhage, and a poor VA at the first visit are poor prognostic
factors for OGI. Recognition of these prognostic factors will help the ophthalmologist evaluate the injury
and its prognosis.
Use of digital retinal camera to detect prevalence and severity of diabetic ...Riyad Banayot
ABStrAct
BAckGround: The purpose of this study was to determine the prevalence of diabetic retinopathy among Palestinian
refugees serviced by the Diabetic Retinopathy Screening Program in the Occupied Palestinian Territories (DRS-
-OPT).
MAterIAl And MethodS: This is a retrospective study of retinal images of 1891 diabetic patients in 15 urban
UNRWA clinics participating in the DRS-OPT program in Palestine over 12 months. A nonmydriatic Canon CR-2
fundus retinal camera was used to capture two 450 non-stereo fundus images for each eye. Qualified graders (nurses)
performed the grading based on the DRS-OPT grading system.
reSultS: Out of the 1891 diabetic patients screened, 1694 had at least one gradable eye. 16% of patients had
diabetic retinopathy (5.7% had mild nonproliferative diabetic retinopathy, 4.3% had moderate nonproliferative
diabetic retinopathy, 1.1% had severe, moderate nonproliferative diabetic retinopathy, and 1.7% had proliferative
diabetic retinopathy. Maculopathy without retinopathy amounted to 3%. Other findings included the identification
of blinding diseases such as age-related macular degeneration and optic disc glaucomatous cupping.
concluSIonS: The retinopathy screening program using a nonmydriatic fundus camera identified diabetic retino-
pathy in 16% of diabetic Palestinian refugees. A total of 72% of these patients were diabetics with nonproliferative
retinopathy. This program can be used to prevent progression by facilitating the education of patients and early
intervention.
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...Riyad Banayot
Ophthalmologists may be the first to consider the diagnosis of Alport’s Syndrome based on lens changes. Uncontrolled Blood pressure can delay surgery during which time IOP should be monitored closely. Results of lensectomies with foldable IOL implantation are successful. To our knowledge, this is the second report of a case of bilateral lens capsule rupture in a patient with previously undiagnosed Alport’s Syndrome.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...
Dr screening training for nurses 4-preparing the patient for retinopathy screening
1. UNIT 4:
PREPARING THE PATIENT FOR
RETINOPATHY SCREENING
Dr. Riyad Banayot
St. John of Jerusalem Eye Hospital
Diabetic Retinopathy Screening
2. Checking the patient’s identity
Patient identification errors occur at least
occasionally, leading to more than
embarrassment
Such errors can lead to serious harm
Prevention strategies include:
Checking the patient's identity card
Actively engaging the patient to confirm his or her
name as well as a second identifier, such as date of
birth
3. Ways in which screening is affected by
patient needs and the environment
Professional judgment and individual patient
symptoms and findings may significantly
influence the nature and course of screening.
Results of the examination may be influenced by
factors such as:
Patient age
Ability or special needs
Patient co-operation and comprehension
Examination setting
Exam modification for such factors which might
influence the results of the examination are
identified (record that the examination has been modified)
4. Ways in which screening is affected by
patient needs and the environment
Professional judgment and individual patient
symptoms and findings may significantly
influence the nature and course of screening.
Results of the examination may be influenced by
factors such as:
Patient age
Ability or special needs
Patient co-operation and comprehension
Examination setting
Exam modification for such factors which might
influence the results of the examination are
identified (record that the examination has been modified)
5. Communicating effectively with the
patient in preparation for
screening
Why is it important that the patient
understands why they are undergoing the
particular procedure?
Obstacles to understanding and how to
overcome them
Importance of patient consent to procedure
How to proceed if the patient did not
understand the procedures or did not wish to
proceed
6. Why is it important that the
patient understands why they are
undergoing the particular procedure
Patients need to feel that their circumstances and
feelings are appreciated and understood by the
health care team member without criticism or
judgment.
If patients feel that the attention they receive is
genuinely caring and tailored to meet their needs, it is
far more likely that they will develop trust and
confidence in the organization.
Health outcomes can be positively affected by
attempts to address emotional and psychosocial
needs. Care for patients’ emotional and spiritual needs
can therefore be considered a component of overall
health care quality.
7. A positive satisfying experience
Patients’ and/or families’ needs are handled
in a timely, considerate, and empathetic way
All tests, interventions, and treatments are
explained in an emotionally sensitive and
supportive decision making process
9. Barriers to screening (patients)
Barriers related to cultural backgrounds
They did not know of the need for eye exams
The belief “nothing is wrong with my eyes”
Poor access and transport to services
Cost of the service
Knowledge of who can screen for retinopathy
Perception that their diabetes is “only mild”
Other health priorities
Don’t want drops in eyes
10. Barriers to screening (patients)
Language and modes of communication
Process been inadequately explained and they do not
understand the consequences
They believe that, as they can see perfectly well, there
cannot be anything wrong
Do not wish to find out that they may have a problem
Housebound and physically unable to leave the house
They may be housebound and able to leave the house
with assistance, but have no-one to accompany them
They may have physical disabilities which prevent
successful photography or slit lamp and so they choose
not to attend.
11. How to proceed if the patient did
not understand the procedures or
did not wish to proceed
If the patient does not understand the
procedure, he or she cannot provide an
informed consent
You have to ask a relative or is next of kin.
Explain the procedure to the relative and this
will alleviate both the patient's anxiety and
yours.
Try to alleviate “patient barriers” 1st presentation
12. Importance of patient consent to
procedure
The process of informing the patient and
obtaining consent on a course of management is
regarded as a process and not a one-off event
consisting of obtaining a patient's signature on a
form.
Information about any patient procedure and
treatment should be tailored to the needs,
circumstances and wishes of the individual.
Information should be based on the current
available evidence in a form which is
comprehensible to patients.
13. Importance of patient consent to
procedure
Patients should be given sufficient information:
What is to take place
The risks
Uncertainties
Possible negative consequences of the proposed process
Any alternatives
Likely outcome
This enables patients to make a choice about how to
proceed.
Patients should be given the opportunity to ask questions
and should be provided with answers.
Patients are advised to have another person of their
choosing present when receiving information about a
procedure.
14. Consent for Digital Photos for Retinal Screening
UNRWA and SJEH are committed to providing the best patient care
possible. We are now offering high resolution Digital Retinal screening
photos. The photos allow us to carefully examine the central retina and can
also detect diabetes complications affecting the eye. These photos act as a
historical record for future comparisons.
The photos will be graded by professionals and if diabetic retinal
complications are detected, you will be advised and given options for
treatment.
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15. Landmark Studies
Diabetes Control and Complications
Trial
Demonstrated that intensive blood glucose
control:
Reduced the risk of progression of DR by 54%
Reduced the development of severe NPDR or
PDR by 47%
Reduced the need for laser surgery by 56%
Reduced the risk of DME by 23%
16. Landmark Studies
U.K. Prospective Diabetes Study
Demonstrated that patients with tight blood
pressure control (< 150/85 mmHg) compared to
patients with blood pressure less tightly controlled
(< 180/95 mmHg) were found to have:
Reduced risk of microvascular changes by 37%
Reduction in the need for laser treatment by 34%
Reduction in risk of decreased vision by 47%
17. Landmark Studies
Diabetes Retinopathy Study
Demonstrated Panretinal photocoagulation
(laser treatment to the peripheral retina)
Reduced the risk of severe vision loss from
PDR from 15.9% in untreated eyes to 6.4% in
treated eyes.
Once a patient reached the PDR stage, it was
observed that argon laser treatment of the
retina resulted in regression of the
neovascularization.
18. Landmark Studies
Early Treatment of Diabetic
Retinopathy Study
Demonstrated that
PRP can reduce the risk of severe vision loss to
< 2% if administered at the appropriate stage
Focal laser treatment (treatment to the macular
area with an argon laser) reduced moderate
visual loss (doubling of the visual angle) by 50%.
Also, it was found that aspirin did not alter rates
of progression of diabetic retinopathy and did
not increase the risk of vitreous hemorrhage.
19. Landmark Studies
Diabetic Retinopathy Vitrectomy
Study
showed that there was a benefit to early
vitrectomy (surgical removal of vitreous) in
very severe PDR in patients with type 1
diabetes.
Two years after surgery, 36% of the early
vitrectomy group and 12% of the late
vitrectomy group had visual acuity of 6/12 or
better.
20. Landmark studies
These landmark studies have demonstrated
that the blinding complications from
diabetes can be largely prevented medically
by:
Glycemic control
Blood pressure control
Early detection
Timely treatment of diabetic retinopathy with
photocoagulation/surgical techniques