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1.
West Indian med. j ; 49(supl. 3): 21, July 2000.
Artigo em Inglês | MedCarib | ID: med-634

RESUMO

After all the years of hard work, after all the years of planning and positioning, there comes a time when most ophthalmologists will have to adjust to the inevitable life changes that he or she will face. The preparation for this change will make the difference between contentment and frustration for many. The focus of the eye surgeon changes from decade to decade almost imperceptyibly and, while many react to the changes as they happen, others attempt to manage the change in focus. Knowing what to expect from oneself and understanding how to prepare for the diminishing years, will lead to self realization and self actualization, and for the ophthalmologist on the down slope of his years this knowledge is all important.(AU)


Assuntos
Humanos , Oftalmologia , Aposentadoria/tendências , Liberdade , Idoso , Acontecimentos que Mudam a Vida
2.
West Indian med. j ; 49(Suppl 3): 21, July 2000.
Artigo em Inglês | MedCarib | ID: med-635

RESUMO

There is a growing demand on the Caribbean Ophthalmologist to address issues of practice management in an increasingly competitive environment. The forces emanate from the patient population, information technology and the opthmalmic market place. A paradigm shift from ophthalmologist centred care delivery to patient centred delivery is necessary for success. One must remain sensitive and responsive to changes in the field. Apart from clinical acumen and surgical skill, one must understand principles of business, accounting and taxation. Some major issues at the point of delivery are: ambience, efficient appointment system, prompt follow-through, accessibility, quality information, quality support staff and appropriate technology. Group practice offers many advantages. (AU)


Assuntos
Humanos , Oftalmologia , Prática Profissional/tendências , Região do Caribe , Gerenciamento da Prática Profissional , Assistência ao Paciente/tendências , Comércio , Prática de Grupo
3.
West Indian med. j ; 49(suppl. 3): 15, July 2000.
Artigo em Inglês | MedCarib | ID: med-686

RESUMO

The twentieth century has witnessed great strides in the understanding and management of the major ophthalmic conditions. For example, the surgical treatment of cataract is being honed to perfection with only the goal of accommodative restoration remaining to complement visual clarity. Understanding of the mode of transmission of Chlamydia trachomaitis, plus the new macrolide antimicrobial, azithromycin, which can cure 80 percent of acute trachoma, offers hope in managing this infection. Similarly, the control of the vector Simulium and the microfilariacidal, Ivermectin, promise to eradicate onchocerciasis volvolus. Increasing understanding of the pathogenesis of the microangiopathy of diabetic retinopathy and the recent trials - Diabetic Control and Complication Trial and the European Prospective Study - have paved the way for the control of this condition. However, our understanding and management of chronic open angle glaucoma remains frustratingly elusive. Problems related to the early detection and monitoring progression remain imprecise and sometimes non-specific and misleading. Two cases are presented to illustrate the limitations of the visual field test and underline the fact that it should never be viewed in isolation. Further treatment modalities will dictate more precise objective tests for monitoring optic nerve function, focusing on early diagnosis and small degrees of progression.(AU)


Assuntos
Humanos , Oftalmologia/tendências , Glaucoma/complicações , Nervo Óptico/anatomia & histologia
4.
West Indian med. j ; 49(Suppl. 3): 14, July 2000.
Artigo em Inglês | MedCarib | ID: med-692

RESUMO

Amniotic membrane is gaining increasing use in ophthalmology. The amniotic membrane is obtained from the plancenta delivered by Caesarean section. Informed consent and blood tests for HIV, syphilis and hepatitis are obtained. The amnion is separated from the chorion and the amniotic membrane can be stored in a special preparatory medium. Laboratory studies have established some of the properties of this tissue. It can reduce inflammation and promote healing. Clinical studies have established the use of amniotic membranes for ocular surface reconstruction in chemical burns, and autoimmune diseases such as ocular cicatricial pemphigold and Stevens Johnson Syndrome. It has also been shown to be effective in decreasing the discomfort associated with bullous keratopathy and it promotes healing. It also reduces recurrence after removal of band keratopathy. It is used to replace conjunctiva after extensive resection in pterygium surgery. The membrane provides a matrix for growth of cells such as epithelial stem cells. Future studies will determine the best use of the membrane in ophthalmology. (Au)


Assuntos
Humanos , Âmnio/transplante , Oftalmologia/tendências , Curativos Biológicos/tendências
5.
West Indian med. j ; 49(suppl. 3): 18, July 2000.
Artigo em Inglês | MedCarib | ID: med-742

RESUMO

The use of antibiotics in opthmalmology is based on the information from sensitivity studies derived from the ocular microbiology laboratory and results of clinical studies. Because of systemic use of antibiotics, bacteria develop mechanisms of resistance over time. The organisms considered pathogens evolve to become less frequent, and unusual organisms become the primary culprit. We have found an increasing trend of gram positive organisms such as Staphylococci and a decreasing incidence of gram negatives. As the same time, the antibiotic sensitivity profile has changed. The fluoroquinolones have been the antibiotic of choice for the last decade. Current laboratory data show a decreasing sensitivity profile. Clinical data are beginning to emerge that mirror this information. Data show that aminoglycosides, penicillins and other antibiotics such as vancomycin and chloramphenicol may be more appropriate. New antibiotics such as the oxazliodones and new generation quinolones may soon become the antibiotics of choice. (AU)


Assuntos
Humanos , Antibacterianos/uso terapêutico , Oftalmologia , Resistência Microbiana a Medicamentos , Staphylococcinum , Quinolonas/uso terapêutico , Aminoglicosídeos
7.
West Indian med. j ; 48(suppl.3): 10, July 1999.
Artigo em Inglês | MedCarib | ID: med-1227

RESUMO

An Itinerant Surgeon is a physician who volunteers to work in health care systems other than his or her own. The volunteer may provide services such as consultation, special tests and surgery but, in addition, may also transmit information or goods such as books, literature, equipment and instruments. SERVICES OF AN ITINERANT OR VISITING TEAM: For any itinerant team, an advance visit is desirable to define a programme of activities. The visiting team's efforts should focus on a sustainable change in the programme for prevention of blindness in the host country through advocacy for preventitive measures, quality eye care, human resources development, infrastructure building and development of administrative proceesses.The team should work within the existing system of eye care delivery at the governmental facilities or approved non-Governmental Development Organizations(NGDOs). Any visit of foreign team is an opportunity for interviews in the media to increase public awareness in eye care, and for advocacy by the team in the governmental structure. The local eye care professionals should identify posible technical and scientific topics in which they need training, if that aspect is recognised as an important product of the visit. The World Health Organization (WHO) has developed the following guidelines for donation of equipment in order to assist donors and recipients: the donation should benefit and fully respect the wishes and authority of the recipient; the quality should be based on an expressed need by the recipient; before a donation is made: - the need for specific items and their expiration date are evaluated; - there must be assurance that it will be used for the purpose for which it is donated; - the person or group who will be responsible for receipt and distribution must be identified; - the customs regulations and shipping costs must be determined. A visiting team may also provide very valuable knowledge in organisation and establishment of processes in the different aspects of a service such as organisation of an operating room, keeping an inventory of consumable supplies, organising an appointment and record system and basic statistics. JUSTIFICATION OF A VISITING OR ITINERANT TEAM: The itinerant service should provide solutions to specific problems or gaps in: availability of services (AU) [truncated at 2500 characters]


Assuntos
Humanos , Cooperação Internacional , Guias como Assunto/normas , Oftalmologia , Organização Mundial da Saúde , Região do Caribe , Oftalmologia
8.
West Indian med. j ; 48(Suppl. 3): 23-24, July 1999.
Artigo em Inglês | MedCarib | ID: med-1524

RESUMO

The increasing use of the computer in our practice led to the development of a customised database which will allow scheduling and recalls, storage of patient data, facilitate research and generation of practice letters, and other functions. Access programme has been used to create databases for our surgery patients. These keep track of billing and permit outcomes analyses. Accounting records are kept using Quicken which covers income, expenditure, bank reconciliations and production of reports adequate for our accountant. Research and keeping up-to-date are facilitated by the Internet using such sites as Medline and the Digital Journal of Ophthalmology. Registration for conferences and hotel bookings are also done via the Internet. E-mail is checked twice daily as an average of five communications arrive each day for the medical staff and the organisations we represent. It has also been useful in accessing consultations and obtaining patient appointments at institutions abroad. Every member of staff uses the computer, with the less skilled being sent on formal training courses. This has proven to be a great morale booster for staff who generate an increasing number of patient information booklets which include graphics. We have a reasonably advanced computer system which allows networking between remote offices. However, more economical units are available for solo practices. There are tremendous possibilities for efficiency in practice without the tedium paperwork, but one must be cautious of commercial programmes which are expensive and not tailored to one's needs (AU)


Assuntos
Oftalmologia/métodos , Tomada de Decisões Assistida por Computador
9.
West Indian med. j ; 48(Suppl. 3): 18-19, July 1999.
Artigo em Inglês | MedCarib | ID: med-1542

RESUMO

With increasing globalisation and better communications the world has shrunk to the point where information of any kind is easily acceptable but not necessarily understandable by the masses. Practising ophthalmology in the West Indies, we are not immune to the effects of this phenomenon. The expectation is that we should be producing a level of care that is at least equivalent to what obtains in the developed world. We are even expected to exist at the cutting edge of medicine. The level of ophthalmology that is offered in the West Indies bears testimony to the hard work, intelligence and sacrifice that is invested in the profession. Training for ophthalmologists from the West Indies is not widely available locally. When it is sought, it is done at considerable financial and social cost. Because we must access training in foreign lands we must be satisfied with less than the best. The best is reserved for the local doctors and it is very difficult for us to ascend the ladder of training to the point of good exposure. Therefore, although our doctors may be brilliant, they are usually deficient in surgical skills and have to come home to home their skills under the guidance of seniors who themselves would have gone through the same routine. What is the answer? Training of ophthalmologists in the West Indies is the obvious way to go. This, however, needs money, and determination by the authorities in the University of the West Indies to offer a wider syllabus. Unfortunately, we ophthalmologists are partly to blame since we have not until recently given ophthalmology the attention that it deserves as a speciality. We have to influence the other branches of the profession to accept ophthalmology as an important speciality. When the speciality gets the respect that it deserves and attains the status that ranks it with the other major specialities then we can push for increasing attention to academia. Ophthalmology in the West Indies suffers from a lack of money. On the one hand, there is inadequate funding by the various governments and, on the other hand, inability of patients to compensate doctors adequately for services rendered. In the former, it leads to chaos in the hospitals and loss of initiative in the public health workers. In the latter, it leads to inadequate funding for investment in private practice (AU)


Assuntos
Oftalmologia/educação , Índias Ocidentais
10.
12.
In. Pan American Health Organization. Four decades of advances in health in the Commonwealth Caribbean. Washington, D.C, Pan American Health Organization, 1979. p.87-92.
Monografia em Inglês | MedCarib | ID: med-14603
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