ABSTRACT
BACKGROUND: Standard treatment for tuberculosis (TB) in children and adults includes an initial two-month course of ethambutol, a drug that in rare cases can cause optic neuropathy and irreversible vision loss. There is a lack of clear guidance on what vision assessments are needed before and during treatment with ethambutol, with the Royal College of Ophthalmologists, National Institute for Health and Care Excellence, British National Formulary and British Thoracic Society offering different guidance. We aimed to assess how vision is routinely tested in patients treated with ethambutol in TB services across England. METHODS: An online survey developed by Public Health England was sent to all TB services in England in 2018 to assess current practice and inform the development of best practice recommendations for visual assessment of patients treated with ethambutol for TB. RESULTS: Sixty-six TB professionals from across England responded, a response rate of 54%. The results showed variations in practice, including when to omit ethambutol from treatment, the timing and frequency of visual assessment, the type of visual assessment, referral processes and management of visual changes. CONCLUSION: This national survey highlights the need for clear guidelines on the testing of vision for patients taking ethambutol at recommended doses, before and during treatment. We suggest a pragmatic approach to visual assessment to reduce variation in practice, proposing a stepwise pathway for patients on standard TB treatment for local adaptation.
Subject(s)
Optic Nerve Diseases , Tuberculosis , Adult , Child , Humans , Ethambutol/adverse effects , Antitubercular Agents/adverse effects , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Optic NerveABSTRACT
Eye health is an integral part of well-being that may be at increased risk when health service delivery is affected by sudden-onset disasters, complex humanitarian events, or conflict in resource-scarce environments. This study proposes a design plan for a mobile eye hospital to support health systems between the initial emergency response and recovery of health infrastructure in resource-scarce environments of low- and middle-income countries. The facility benefits from high mobility and modularity, it can be assembled and operated by minimal personnel, and easily expanded as necessary. It has capacity to host high-volume ophthalmological services without the logistical complexity of large-scale emergency medical team responses or military operations. The design provides a medium-term service that can either operate from a fixed location or be redeployed in-country with ease. Mobile eye hospitals may provide a useful facility for local governments suffering damaged health systems, or as a way to complement current eye health provision. The design may also be used by charitable nongovernmental organizations during an initial emergency response, with the ability to quickly deploy to a target location and establish eye services.
Subject(s)
Disasters , Mobile Health Units , Humans , Government Programs , Organizations , IncomeSubject(s)
COVID-19/therapy , Health Services Needs and Demand , Home Care Services/organization & administration , Pneumonia, Viral/therapy , Primary Health Care/organization & administration , Telemedicine , COVID-19/epidemiology , Humans , Mass Screening/methods , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2Subject(s)
Blast Injuries , Eye Injuries , Blast Injuries/epidemiology , Explosions , Eye , Eye Injuries/epidemiology , Eye Injuries/etiology , Humans , IncidenceSubject(s)
Fat Necrosis , Hypercalcemia , Skin Diseases , Fat Necrosis/complications , Humans , Hypercalcemia/etiology , Infant, Newborn , Necrosis , Subcutaneous FatSubject(s)
Altitude Sickness , Expeditions , Mountaineering , Acetazolamide/therapeutic use , Acute Disease , Humans , Tanzania , United KingdomABSTRACT
We present a rare case of tuberculous mastoiditis in a 2-month-old infant. The patient presented with facial nerve palsy, fever and otorrhoea and was subsequently confirmed to have a Mycobacterium tuberculosis infection. Mastoiditis was confirmed with a CT scan of the head, and gastric aspirate analysis with the Xpert MTB/RIF assay (Cepheid, USA) rapidly confirmed tuberculosis (TB), allowing prompt initiation of anti-TB therapy. The patient is now recovering, with the initial facial nerve palsy resolved.
Subject(s)
Facial Paralysis/etiology , Mastoiditis/diagnosis , Mycobacterium tuberculosis/isolation & purification , Tuberculosis/diagnosis , Antibiotics, Antitubercular/therapeutic use , Humans , Infant , Mastoiditis/microbiology , Tuberculosis/drug therapySubject(s)
After-Hours Care , Education, Medical, Undergraduate , Primary Health Care , Students, Medical , COVID-19 , Humans , United KingdomSubject(s)
Coronavirus Infections/epidemiology , Education, Medical/organization & administration , Organizational Innovation , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Communicable Disease Control/methods , Coronavirus Infections/transmission , Humans , Pandemics , Pneumonia, Viral/transmission , SARS-CoV-2 , Staff Development/organization & administration , Teaching/organization & administration , United KingdomSubject(s)
Coronavirus Infections , Curriculum , Education, Medical/standards , Medical Missions , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Global Health , Humans , Poverty Areas , SARS-CoV-2 , Students, Medical , TravelSubject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , Students, Medical , Volunteers , Betacoronavirus , COVID-19 , Humans , Primary Health Care , SARS-CoV-2 , United KingdomABSTRACT
BACKGROUND: In the UK there is limited coverage of antimicrobial stewardship across postgraduate curricula and evidence that final year medical students have insufficient and inconsistent antimicrobial stewardship teaching. A national undergraduate curriculum for antimicrobial resistance and stewardship is required to standardize an adequate level of understanding for all future doctors. OBJECTIVES: To provide a UK national consensus on competencies for antimicrobial resistance and stewardship for undergraduate medical education. METHODS: Using the modified Delphi method over two online survey rounds, an expert panel comprising leads for infection teaching from 25 UK medical schools reviewed competency descriptors for antimicrobial resistance and stewardship education. RESULTS: There was a response rate of 100% with all 28 experts who agreed to take part completing both survey rounds. Following the first-round survey, of the initial 55 descriptors, 43 reached consensus (78%). The second-round survey included the 12 descriptors from the first round in which agreement had not been reached, four amended descriptors and 12 new descriptors following qualitative feedback from the panel members. Following the second-round survey, a total of 58 consensus-based competency descriptors within six overarching domains were identified. CONCLUSIONS: The consensus-based competency descriptors defined here can be used to inform standards, design curricula, develop assessment tools and direct UK undergraduate medical education.
ABSTRACT
There is little information on the provision of ophthalmic services and the eye health system in Yemen. Using the WHO framework for analysing health systems, we aim to assess what is known about the current eye health system in Yemen with ongoing conflict. Financial constraints, transportation difficulties and security instability are barriers for many of Yemen's people in need of healthcare. The most recent cataract surgical rate reported in 2012 is 2473 operations per million population, with an increase in operations performed in charity eye camps and the private sector. We identify many governorates of Yemen have inadequate ophthalmic resources. We describe the need for short-term solutions to reduce the backlog prevalence of blindness while local infrastructure is rebuilt, and the importance of long-term reconstruction and transition to local ownership with a sustainable workforce and health service as peace is restored.
ABSTRACT
Through a series of Freedom of Information requests to NHS Resolution on claims made from 2005/2006 to 2017/2018 we have analysed trends of UK litigation in ophthalmology, identifying the most common causes and primary injuries for closed (settled) claims resulting in payment of damages during this 13-year period. We assess the most common causes of litigation in ophthalmology with respect to previous rulings in clinical negligence and provide a case example for discussion.