[Basic psychosomatic care in ophthalmology. Relevance, training and case examples]. / Psychosomatische Grundversorgung in der Augenheilkunde. Relevanz, Ausbildung, Fallbeispiele.

BACKGROUND: The incidence of psychosomatic disorders and their impact on society are increasing. Many patients suffer from psychosomatic symptoms. Medical studies and most notably medical training for ophthalmologists do not sufficiently cover these topics and do not adequately prepare doctors for dealing with patients suffering from psychosomatic disorders. OBJECTIVE: Training in basic psychosomatic care can be absolved by all physicians irrespective of specialization. The structure, benefits and importance of this professional training are explained. MATERIAL AND METHODS: The curriculum of the German Medical Association forms the basis of training in basic psychosomatic care. The personal experiences of the authors after completing the training as well as case studies are presented. RESULTS AND CONCLUSION: Training in basic psychosomatic care conveys practical skills for dealing with patients with psychosomatic symptoms, which are often not acquired during medical training for ophthalmologists, where technical procedures predominate. Thus the professional ability is broadened with an immediate positive effect not only on the physician-patient relationship but also on the professional and private environment. Training in basic psychosomatic care should be obligatory in the specialist training of ophthalmologists.

Review of clinical medicine and religious practice.

The purpose was to evaluate faith-based studies within the medical literature to determine whether there are ways to help physicians understand how religion affects patients' lives and diseases. We reviewed articles that assessed the influence of religious practices on medicine as a primary or secondary variable in clinical practice. This review evaluated 49 articles and found that religious faith is important to many patients, particularly those with serious disease, and patients depend on it as a positive coping mechanism. The findings of this review can suggest that patients frequently practice religion and interact with God about their disease state. This spiritual interaction may benefit the patient by providing comfort, increasing knowledge about their disease, greater treatment adherence, and quality of life. The results of prayer on specific disease states appear inconsistent with cardiovascular disease but stronger in other disease states.

[Role of community pharmacist in the management of patients in ophthalmology]. / Place du pharmacien de ville dans la prise en charge des patients en ophtalmologie.

OBJECTIVES: To assess the role of community pharmacists in ophthalmology, to evaluate the frequency of giving patients advice, and to report their difficulties in daily practice. MATERIAL AND METHODS: An anonymous questionnaire consisting of 13 questions was sent to 620 community pharmacists of Burgundy (France). Pharmacists were asked about their ophthalmic products, their ophthalmic activity in giving patients advice on ocular symptoms, and patients' expectations. For analysis, community pharmacies were separated into three groups: pharmacies in rural areas (under 2000 inhabitants), pharmacies in an urban zone with fewer than 10,000 inhabitants, and pharmacies in an urban zone with more than 10,000 inhabitants. RESULTS: The response rate was 46.9%. Ophthalmic products were mainly glasses for presbyopia (84.5%), eye care hygiene products (76.0%), and contact lens solutions (55.3%). Ophthalmic vitamin supplements were sold by 36.8% of pharmacists, mainly in urban areas. On average, the pharmacist was consulted for ocular problems seven times a week. Acute benign symptoms were most frequent. Advice on prescriptions came next. Then, information on contact lenses and chronic ocular disease were given (cataract, glaucoma, visual acuity loss, age-related maculopathy). Finally, the pharmacist either sold the patient an ocular treatment or oriented the patient to an ophthalmologist when needed. DISCUSSION: The pharmacist and his staff are active players in providing advice on ocular diseases and taking care of patients. Moreover, pharmacists have to manage ocular therapeutics, urgent symptoms, and chronic diseases. However, in our study, 46.0% of pharmacists felt confident with their knowledge on ophthalmology, 36.4% did not give their opinion, and 7.0% were uncomfortable with some questions. Most community pharmacists mentioned a lack of continuing education from pharmaceutical companies and postgraduate education on ocular diseases and treatment, mainly for age-related maculopathy.

Physicians' role in eye care of patients with diabetes mellitus--are we doing what we need to?

CONTEXT: The American Diabetes Association and the American Academy of Ophthalmology recommend that a dilated eye examination be performed on patients with diabetes mellitus during an initial assessment and at least annually there-after. OBJECTIVES: (1) To determine the extent to which patients with diabetes mellitus are aware that their condition can lead to ocular problems; (2) to determine the percentage of patients with diabetes mellitus who receive annual dilated eye examinations; (3) to discover reasons why patients with diabetes mellitus may not receive annual dilated eye examinations; and (4) to raise awareness among patients with diabetes mellitus of the importance of controlling their condition and of receiving frequent dilated eye examinations. METHODS: A 9-question oral survey of individuals with type 2 diabetes mellitus was administered in 2 clinical medical settings and 1 community setting in Harrison County, West Virginia, between April 7, 2007, and May 15, 2007. Questions covered participant knowledge of diabetes mellitus complications, frequency of receiving eye examinations, and other aspects of diabetes mellitus. Responses were statistically analyzed for correlations between participant knowledge and receiving eye examinations in the past year. RESULTS: A total of 147 individuals with diabetes mellitus participated in the survey. Among the various conditions that diabetes mellitus can lead to, the surveyed individuals were most aware that diabetes mellitus can lead to eye disease, followed by kidney problems, ulcers, and heart problems. Approximately 70% of survey respondents received a dilated eye examination in the past year. The most common reasons given by the 30% of respondents who did not receive an eye examination were-in order of frequency-procrastination, having never been told it was necessary, and financial issues. CONCLUSION: Roughly 1 of every 4 surveyed patients with diabetes mellitus in this West Virginia study who did not receive an annual dilated eye examination was not aware of the need to do so. As osteopathic physicians, we can do more to optimize compliance with current recommendations for good health by continually educating our patients with diabetes mellitus about the need for eye examinations.

Specific attentional impairments and complex visual hallucinations in eye disease.

OBJECTIVE: To test the prediction by the Perception and Attention Deficit (PAD) model of complex visual hallucinations that cognitive impairment, specifically in visual attention, is a key risk factor for complex hallucinations in eye disease. METHODS: Two studies of elderly patients with acquired eye disease investigated the relationship between complex visual hallucinations (CVH) and impairments in general cognition and verbal attention (Study 1) and between CVH, selective visual attention and visual object perception (Study 2). The North East Visual Hallucinations Inventory was used to classify CVH. RESULTS: In Study 1, there was no relationship between CVH (n=10/39) and performance on cognitive screening or verbal attention tasks. In Study 2, participants with CVH (n=11/31) showed poorer performance on a modified Stroop task (p<0.05), a novel imagery-based attentional task (p<0.05) and picture (p<0.05) but not silhouette naming (p=0.13) tasks. Performance on these tasks correctly classified 83% of the participants as hallucinators or non-hallucinators. CONCLUSIONS: The results suggest that, consistent with the PAD model, complex visual hallucinations in people with acquired eye disease are associated with visual attention impairment.

A different type of medicine: women's experiences with ophthalmic diseases in rural and urban Tamil Nadu, India.

I conducted a study to understand how urban and rural women conceptualized eye diseases in Tamil Nadu state(1). I chose to examine eye diseases because ailments such as cataracts, glaucoma, refractive error, and diabetic retinopathy rank among the most serious diseases of Indian women. I collected observational, survey, and interview data to compare women from rural and urban areas. In line with my expectations, rural women were more likely to rely upon non-medical means of treatment than their urban counterparts. Contrary to expectations, however, I found that urban and rural Tamil women's overall dependence on nonmedical means was not excessive. Based on the study's findings, it appears that both urban and rural women express a marked preference for both traditional and modern medical treatments - a phenomenon that is known as medical pluralism. Rural participants expressed a greater interest in medical pluralism than their urban counterparts. The results of the study lead me to believe that medical pluralism may be associated with the patient's geographic residence. I conclude this article with a discussion of the consequences of medical pluralism for women's health and overall societal development in Tamil Nadu.

Perception of blindness and blinding eye conditions in rural communities.

PURPOSE: The purpose of this qualitative study was to explore the causes and management of blindness and blinding eye conditions as perceived by rural dwellers of two Yoruba communities in Oyo State, Nigeria. METHODS: Four focus group discussions were conducted among residents of Iddo and Isale Oyo, two rural Yoruba communities in Oyo State, Nigeria. Participants consisted of sighted, those who were partially or totally blind and community leaders. Ten patent medicine sellers and 12 traditional healers were also interviewed on their perception of the causes and management of blindness in their communities. FINDINGS: Blindness was perceived as an increasing problem among the communities. Multiple factors were perceived to cause blindness, including germs, onchocerciasis and supernatural forces. Traditional healers believed that blindness could be cured, with many claiming that they had previously cured blindness in the past. However, all agreed that patience was an important requirement for the cure of blindness. The patent medicine sellers' reports were similar to those of the traditional healers. The barriers to use of orthodox medicine were mainly fear, misconception and perceived high costs of care. There was a consensus of opinion among group discussants and informants that there are severe social and economic consequences of blindness, including not been able to see and assess the quality of what the sufferer eats, perpetual sadness, loss of sleep and dependence on other persons for daily activities. CONCLUSION: Local beliefs associated with causation, symptoms and management of blindness and blinding eye conditions among rural Yoruba communities identified have provided a bridge for understanding local perspectives and basis for implementing appropriate primary eye care programs.

The placebo effect.

Placebos have been traditionally regarded as deceptive therapies and have not been understood in the broader context of social symbols and of interpersonal factors that surround the healing process itself. Although the power of inert substances to heal is well recognized, the placebo effect also influences the outcome of conventional therapies. The role of the placebo in modern medicine is poorly defined because of a lack of a common understanding of what the placebo effect is and because of the negative connotions associated with its use. The response rate to placebo varies by illness. The natural course of disease and patient or physician bias can be misinterpreted as a placebo response. In research, the placebo effect is therapeutic noise to be removed by placebo-controlled trials. Few studies are designed to measure the placebo response rate directly. Placebos are a reminder of how little is known about mind-body interaction. The placebo effect may be one of the most versatile and underused therapeutic tools at the disposal of physicians.

[Experiences of a psychiatrist in cooperation with ophthalmologists]. / Erfahrungen eines Psychiaters in der Zusammenarbeit mit Ophthalmologen.

This paper reports on cooperation between ophthalmologists and psychiatrists as seen from the latter's standpoint, primarily with regard to psychosomatic medicine and work in Balint groups. Ophthalmological experience both in a general Balint group and in a special Balint group mainly for ophthalmologists is described. The "general" part is mainly devoted to a discussion of everyday language associated with eyes and sight, since everyday language usually gives clues to psychophysical relationships. The main advantage of participating in Balint groups is that the practitioner learns to integrate himself, as a diagnostic instrument, with regard to his feelings and experiences. This results in a new relationship between patient and practitioner which could be defined as "relationship diagnostics" and "relationship therapy".