Primary open angle glaucoma (POAG) is the most common type of glaucoma. It is characterized by an open anterior chamber angle, increased intraocular pressure (IOP), and glaucomatous optic nerve damage and visual field loss. Elevated IOP is the primary risk factor. Treatment involves medical therapy to lower IOP through various drug classes, laser trabeculoplasty to increase outflow, and surgeries like trabeculectomy or newer minimally invasive procedures if medication is insufficient. The goal is to lower IOP enough to prevent further optic nerve damage and vision loss.
visual field- its assessment, defects, diseases associated. Types of visual field defects. visual field defects in glaucoma in detail. Humphrey's visual field analyser chart.
visual field- its assessment, defects, diseases associated. Types of visual field defects. visual field defects in glaucoma in detail. Humphrey's visual field analyser chart.
this tells about the overview of glaucoma and the primary open angle glaucoma
valve surgery and cyclodestruction surgery are not listed, however they are important
This presentation describes all clinical aspects about primary open angle glaucoma ......
you can watch the illustrated video presentation at the following link : https://youtu.be/eA44Pu4l8Ow
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
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/
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.
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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.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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1. MODERATOR – DR. O. P. GUPTA
PRIMARY OPEN ANGLE
GLAUCOMA (POAG)
2. GLAUCOMA
Chronic, progressive optic neuropathy caused by a group
of ocular conditions which lead to damage of the optic
nerve with loss of visual function
IOP is the major risk factor
Normal tension glaucoma
3.
4. POAG
• K/a Chronic simple glaucoma
• Most prevalent of all glaucoma
• Affects both sexes equally
5. POAG
• An IOP >21 mmHg
• Glaucomatous optic nerve damage
• An open anterior chamber angle
• Characteristic visual field loss
• Absence of signs of secondary glaucoma or a non-glaucomatous
cause for the optic neuropathy
10. PATHOGENESIS OF GLAUCOMATOUS OPTIC
NEUROPATHY
1. Ischaemic theory
Suggests that poor blood perfusion of ONH
causes ischaemia and resultant loss of optic nerve
fibre
2. Mechanical theory
Suggests that weakness of supporting tissues of
optic nerve head makes it susceptible to mechanical
deformation by IOP with resultant nerve fibre damage
11. 3. Immune theory
Increased incidence of paraproteinemia and auto
antibodies and antiglutathione S-transferace
antibodies
Cause retinal ganglion cell apoptosis
4. Apoptotic theory
Genetically programmed destruction of retinal
ganglion cells may play a part in the pathogenesis
12. CLINICAL FEATURES
• Usually asymptomatic until a significant visual field
loss has occurred
• Eye ache, headache, haloes
• Delayed dark adaptation
• Frequent changes of presbyopic glasses
• Raised IOP & fluctuations in IOP
13. CHANGES IN IOP
• IOP >21 mm Hg on more than one occasion
• Circardian variation of IOP >8 mm Hg
• Asymmetry of IOP >5 mm Hg between two eyes
14. BASE LINE INFORMATION
• History: Ocular, Systemic, Family history,
History of medication
• Pupillary reaction
• Slit lamp biomicroscopy:
Anterior segment to r/o 2° causes- shallow anterior
chamber, pxf, inflammation
Fundus evaluation to rule out lesions which can
cause visual field defects
AT, DVT
15. • CCT > 555µm: false high IOP
< 540µm: false low IOP
• Gonioscopy
• Perimetry: Automatic static threshold perimetry
• Provocative Tests: Water drinking test
16. OPTIC NERVE HEAD CHANGES
• Asymmetry of CDR >0.2
• A localized notch or thinning of NRR.
• Enlarged CDR >0.5 in vertical axis
• Superficial disc hemorrhages
• Shift of vessels to nasal side
19. Non-specific signs of glaucomatous damage. (A) Inferior baring of circumlinear blood vessels;
(B) inferior bayoneting; (C) collaterals; (D) loss of nasal neuroretinal rim; (E) lamellar dots; (F)
disc haemorrhage
20. ANDERSON’S CRITERIA
On static perimetry, glaucomatous field loss is considered
significant if:
1. Analysis of glaucoma hemi-field test is abnormal in 2
consecutive occasion
2. 3 contiguous non-edge points on the pattern deviation
plot within Bjerrum area have a probability of < 5% of
being in normal population, one of which have a
probability of < 1%
3. Pattern standard deviation (PSD) should have a
probablity of < 5% confirmed on two consecutive tests
21. VISUAL FIELD ABNORMALITIES
• Initially observed in Bjerrum area, 10- 25° from fixation
• Correlate with abnormalities seen on optic nerve head
• Field defects:
1. Paracentral scotomas
2. Nasal step
3. Siedel scotoma
4. Arcuate scotoma
5. Double arcuate or ring scotoma
6. End-stage or near total defect with only
a residual temporal island of vision
29. PRINCIPLE OF TREATMENT
• Usually start with MEDICAL THERAPY.
• Before starting the treatment - Assess each eye
individually, inform patients
• Start treatment in worse eye first
• Set TARGET PRESSURE
30. TARGET IOP DEPENDS UPON
• IOP at which damage has occurred
• Severity of Visual Field damage
• Rate of progression of damage
• Age and Life Expectancy
31. CLASSIFICATION
• Drugs decreasing AQUEOUS PRODUCTION
Beta-blockers
Alpha-2-agonists
CAI
• Drugs increasing TRABECULAR OUTFLOW
Parasympathomimetics
Non selective agonists
Prostamides
• Drugs increasing UVEOSCLERAL OUTFLOW
Alpha-2-agonists
PG & PM
38. RATIONALE FOR DRUGS COMBINATIONS
• Do not combine drugs of same pharmalogical group
• More than two drugs usually not recommended
• If first line of drugs is not effective or tachyphylaxis occurs-
change drug rather than adding another drug
39. LASERS IN POAG
• Outflow Enhancement
• Laser Trabeculoplasty
• Inflow reduction
• Cyclophotocoagulation (in end stage disease)
40. LASER TRABECULOPLASTY
• Uncontrolled glaucoma despite maximal tolerated medical
therapy particularly in elderly
• Avoidance of polypharmacy
• Avoidance of surgery
• Poor compliance
41. SURGERY IN POAG
Indications:
• Failure of medical therapy
• Anticipated progressive damage or intolerably high IOP
• Combined with cataract procedure (phacotrabeculectomy)
• Primary therapy
43. RECENT ADVANCES IN GLAUCOMA SURGERIES
I. The Ex-Press mini glaucoma shunt
II. Nonpenetrating Ab Externo Schlemm’s Canaloplasty
III. Ab Interno Devices: The Trabectome and Micro-bypass
Stent
IV. The Gold Microshunt: A Suprachoroidal Device