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CLINICAL RELEVANCE: There is now an Optometry Council of Australia and New Zealand (OCANZ) accreditation requirement for Australian and Aotearoa New Zealand optometry programs to ensure students can provide culturally safe care for First Nations Peoples. To assist programs, OCANZ developed the Optometry Aboriginal and Torres Strait Islander Health Curriculum Framework (Optometry Framework). BACKGROUND: The objective of this study was to evaluate early progress towards the implementation. METHODS: All seven Australian optometry programs were invited to complete a modified version of the OCANZ curriculum mapping tool. Where available, online unit outlines were reviewed to verify and supplement the data. Curriculum maps were synthesised using qualitative content analysis. RESULTS: None of the five participating programs had a standalone Aboriginal and Torres Strait Islander health unit; instead, programs were integrating content into core units. Only 25% of the units with relevant content had a directly related learning outcome. All programs had at least some content that was either directly or indirectly related to each of the Optometry Framework themes, and included some content related to novice and intermediate levels of learning. Four programs had content related to entry to practice levels of learning. The average total duration of directly related content in programs (excluding clinical placements) was 18 hours. Not all programs offered an Aboriginal and Torres Strait Islander health setting clinical placement opportunity. Directly related assessment was minimal in most programs, where the format was predominantly reflective journals or questions within written examinations. CONCLUSION: Progress has been made in implementing the Optometry Framework; however, further efforts are required. Programs need to integrate additional directly related learning outcomes, content (particularly entry to practice level learning), and assessment. Further curriculum enhancements will improve the likelihood of optometry students acquiring the necessary capabilities for providing culturally safe care.
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CLINICAL RELEVANCE: Aboriginal and Torres Strait Islander Peoples have the right to the highest attainable standard of health and access to health services without discrimination. To uphold these rights, it is important that optometry students are educated in Aboriginal and Torres Strait Islander health and culturally safe practice. BACKGROUND: An Aboriginal and Torres Strait Islander health curriculum framework is now mandatory for optometry programs to implement. This study explores the experiences of those involved in implementing this framework and, from their perspectives, what is and is not working. METHODS: Heads and educators involved in Aboriginal and Torres Strait Islander health curriculum at Australian optometry programs participated in a mixed-methods study. Information about pedagogy and contextual issues impacting curriculum implementation was collected through surveys and interviews. The design and analysis were underpinned by constructivist grounded theory. RESULTS: Most programs had at least partially implemented components of the curriculum framework. While partnerships were considered essential to success, this remains a work in progress. Authentic learning through clinical placement was considered a priority. Assessment was described as complex and not yet adequately addressed. Only 37% of educators felt fully prepared to teach and 6% to assess this curriculum. More workload allocation, funding and recruitment of Aboriginal and Torres Strait Islander staff and students through institutional commitment and leadership were perceived requirements. CONCLUSION: Further developing sustainable partnerships where there is reciprocity between optometry programs and Aboriginal and Torres Strait Islander educators and communities is critical to effectively implementing Aboriginal and Torres Strait Islander health curriculum. While clinical placement was considered an important learning experience, the type of experience and whether or not all students should attend require further consideration. Additionally, educators need support for professional development and sharing resources in this emerging field. This will contribute to improving culturally safe practice in optometry.
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Servicios de Salud del Indígena , Optometría , Humanos , Australia , Aborigenas Australianos e Isleños del Estrecho de Torres , Competencia Cultural/educación , Optometría/educación , CurriculumRESUMEN
BACKGROUND: We aimed to determine whether heart, stroke, and vascular disease (HSVD) prevalence and emergency primary evacuation (EPE), hospitalisation, and mortality differ by patient characteristics. METHODS: An Australian-wide incidence population based study, with prospective data collected form the 1 July 2019 to the 30 October 2020. FINDINGS: Indigenous Australians reported significantly higher prevalence of HSVD at 229.0 per-1000 as compared to 152.0 per-1000 non-Indigenous Australians: risk ratio 1.5 (95% CI 1.2-1.8). 583 remote patients received an EPE for HSVD, consisting of 388 (66.6%; 95% CI: 62.6-70.4) males and 195 (33.0%; 95% CI: 29.6-37.4) females. There were 289 (49.6%; 95% CI 45.4- 53.7) patients who identified as Indigenous, and 294 (50.4%; 95% CI 46.3- 54.6) as non-Indigenous. The mean Indigenous age during EPE was 48.0 (95% CI 45.9-50.1) years old, significantly lower than the non-Indigenous mean age of 55.6 (95% CI 53.8-57.4). Indigenous patients hospitalised for HSVD were younger, the majority younger than 65 years (n=21175; 73.7% 95% CI 73.2-74.2) as compared to non-Indigenous patients (n= 357654; 33.1% 95% CI 33.0-33.15). When adjusted for HSVD prevalence, remote Indigenous patients had a higher hospitalisation rate as compared to non-remote Indigenous patients (rate ratio: 1.6; 95% CI 1.3-2.0) and remote non-Indigenous patients (rate ratio: 1.2; 95% CI 1.0-1.5). More Indigenous patients died of HSVD before the age of 65 years (n=1875; 56.5% 95% CI 54.8-58.2) as compared to non-Indigenous patients (n= 16161; 10.6% 95% CI 10.45-10.8). INTERPRETATION: Indigenous Australians have a higher prevalence, and younger age during EPE, and hospitalisation for HSVD than non-Indigenous Australians. FUNDING: This is a self/internally-funded study, with the lead organisation being the Royal Flying Doctor Service (RFDS) of Australia. For the duration of the study period, the RFDS provided in-kind support including one full-time equivalent (FTE) and resources (office space, computer, research software, and office equipment). There was no external funding source that had a role in study design or data analysis or interpretation.
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Hidroxicloroquina/efectos adversos , Tamizaje Masivo/métodos , Enfermedades de la Retina/inducido químicamente , Antirreumáticos/efectos adversos , Australia/epidemiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Guías como Asunto , Humanos , Tamizaje Masivo/normas , Prevalencia , Enfermedades de la Retina/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND: To describe the first reported case of toxic optic neuropathy secondary to docetaxel (Taxotere®) chemotherapy. CASE PRESENTATION: A 53-year-old female presented with predominantly unilateral visual loss, but extensive bilateral visual field defects and bilateral optic nerve head swelling 2 weeks after first dose of docetaxel (Taxotere®) and trastuzumab (Herceptin®) chemotherapy for a left sided node-positive, HER2 positive breast cancer. Extensive investigation ruled out other causes of optic neuropathy. She was treated with high dose corticosteroids intravenously for 1 week then a tapering oral dose over 8 weeks. Visual field defects gradually resolved and visual acuity improved. Docetaxel chemotherapy was discontinued but targeted therapy with trastuzumab continued without further complication. CONCLUSION: Docetaxel can cause a toxic optic neuropathy possibly due to an ischemic or neurotoxic mechanism at the optic nerve head. With cessation of docetaxel therapy and treatment with systemic corticosteroids, visual recovery can occur without significant residual visual deficit.