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1.
Cochrane Database Syst Rev ; 12: CD010790, 2022 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-36508693

RESUMO

BACKGROUND: Sickle cell disease (SCD) includes a group of inherited haemoglobinopathies affecting multiple organs including the eyes. Some people with SCD develop ocular manifestations. Vision-threatening complications are mainly due to proliferative sickle retinopathy, which is characterised by proliferation of new blood vessels. Laser photocoagulation is widely applicable in proliferative retinopathies. It is important to evaluate the efficacy and safety of laser photocoagulation in the treatment of proliferative sickle retinopathy (PSR) to prevent sight-threatening complications. OBJECTIVES: To evaluate the effectiveness of various techniques of laser photocoagulation therapy in SCD-related proliferative retinopathy. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 4 July 2022. We also searched the following resources (26 June 2022): Latin American and Caribbean Health Science Literature Database (LILACS); WHO International Clinical Trials Registry Platforms (ICTRP); and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials comparing laser photocoagulation to no treatment in children and adults with SCD. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligibility and risk of bias of the included trials; we extracted and analysed data, contacting trial authors for additional information. We assessed the certainty of the evidence using the GRADE criteria. MAIN RESULTS: We included three trials (414 eyes of 339 children and adults) comparing the efficacy and safety of laser photocoagulation to no therapy in people with PSR. There were 160 males and 179 females ranging in age from 13 to 67 years. The trials used different laser photocoagulation techniques; one single-centre trial employed sectoral scatter laser photocoagulation using an argon laser; a two-centre trial employed feeder vessel coagulation using argon laser in one centre and xenon arc in the second centre; while a third trial employed focal scatter laser photocoagulation using argon laser. The mean follow-up periods were 21 to 32 months in one trial, 42 to 47 months in a second, and 48 months in the third. Two trials had a high risk of allocation bias due to the randomisation method for participants with bilateral disease; the third trial had an unclear risk of selection bias. One trial was at risk of reporting bias. Given the unit of analysis is the eye rather than the individual, we chose to report the data narratively. Using sectoral scatter laser photocoagulation, one trial (174 eyes) reported no difference between groups for complete regression of PSR: 30.2% in the laser group and 22.4% in the control group. The same trial also reported no difference between groups in the development of new PSR: 34.3% of lasered eyes and 41.3% of control eyes (very low-certainty evidence). The two-centre trial using feeder vessel coagulation, only presented data at follow-up for one centre (mean period of nine years) and reported the development of new sea fan in 48.0% in the treated and 45.0% in the control group; no statistical significance (P = 0.64). A third trial reported regression in 55% of the laser group versus 28.6% of controls and progression of PSR in 10.5% of treated versus 25.7% of control eyes. We graded the evidence for these two primary outcomes as very low-certainty evidence. The sectoral scatter laser photocoagulation trial reported visual loss in 3.0% of treated eyes (mean follow-up 47 months) versus 12.0% of controlled eyes (mean follow-up 42 months) (P = 0.019). The feeder vessel coagulation trial reported visual loss in 1.14% of the laser group and 7.5% of the control group (mean follow-up 26 months at one site and 32 months in another) (P = 0.07). The focal scatter laser photocoagulation trial (mean follow-up of four years) reported that 72/73 eyes had the same visual acuity, while visual loss was seen in only one eye from the control group. We graded the certainty of the evidence as very low. The sectoral scatter laser trial detected vitreous haemorrhage in 12.0% of the laser group and 25.3% of control with a mean follow-up of 42 (control) to 47 months (treated) (P ≤ 0.5). The two-centre feeder vessel coagulation trial observed vitreous haemorrhage in 3.4% treated eyes (mean follow-up 26 months) versus 27.5% control eyes (mean follow-up 32 months); one centre (mean follow-up nine years) reported vitreous haemorrhage in 1/25 eyes (4.0%) in the treatment group and 9/20 eyes (45.0%) in the control group (P = 0.002). The scatter laser photocoagulation trial reported that vitreous haemorrhage was not seen in the treated group compared to 6/35 (17.1%) eyes in the control group and appeared only in the grades B and (PSR) stage III) (P < 0.05). We graded evidence for this outcome as low-certainty. Regarding adverse effects, only one occurrence of retinal tear was reported. All three trials reported on retinal detachment, with no significance across the treatment and control groups (low-certainty evidence). One trial reported on choroidal neovascularization, with treatment with xenon arc found to be associated with a significantly higher risk, but visual loss related to this complication is uncommon with long-term follow-up of three years or more. The included trials did not report on other adverse effects or quality of life. AUTHORS' CONCLUSIONS: Our conclusions are based on the data from three trials (two of which were conducted over 30 years ago). Given the limited evidence available, which we assessed to be of low- or very low-certainty, we are uncertain whether laser therapy for sickle cell retinopathy improves the outcomes measured in this review. This treatment does not appear to have an effect on clinical outcomes such as regression of PSR and development of new incidences. No evidence is available assessing efficacy in relation to patient-important outcomes (such as quality of life or the loss of a driving licence).  Further research is needed to examine the safety of laser treatment compared to other interventions such as intravitreal injection of anti-vascular endothelial growth factors (VEGFs) . Patient-important outcomes as well as cost-effectiveness should be addressed.


Assuntos
Anemia Falciforme , Neovascularização de Coroide , Terapia a Laser , Masculino , Adulto , Criança , Feminino , Humanos , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Qualidade de Vida , Neovascularização de Coroide/etiologia , Terapia a Laser/efeitos adversos , Injeções Intravítreas , Transtornos da Visão , Anemia Falciforme/complicações
2.
Indian J Otolaryngol Head Neck Surg ; 74(2): 225-233, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35813773

RESUMO

The Interprofesional collaborative practice (IPCP) is the need of the hour for improved patient care. The procedure of tracheotomy is a life saving procedure and the implementation of the Interprofessional collaborative practice module for the same comprising of the ENT surgeon, Physiotherapist, Nursing staff, OT and Trauma technician decreases the number of complications. This study was carried out to develop and evaluate the Interprofessional collaborative practice module for Tracheostomy. The project has been carried out as a prospective before and after study with the departments of ENT, nursing and Allied health sciences. The facilitators were from the above departments.They were sensitized and developed the Interprofessional education (IPE team),which then collaborated to develop the IPCP module.This IPE team after faculty meetings developed the module with learning objectives, teaching learning methods and methods of assessment. Standardized Readiness scale for Interprofessional Learning Scale (RIPLS), was adopted for the module. The questionnaires for assessment and the module were structured and validated.The template of reflection was compiled for the execution of the module. The students training comprised of the demonstration session, baseline Team OSCE, practice sessions and the final Team OSCE. The baseline and final Team OSCE scores,reflections and RIPLS scores were compared. Team OSCE scores baseline vs Final for IPCP competencies i.e. Competency 1-Values and Ethics for Interprofessional Practice, Competency 2-Roles and Responsibilities, Competency 3-Interprofessional Communication, Competency 4-Teams and Teamwork during Pretracheostomy (PreT),Tracheostomy(T) and PostTracheostomy (PostT) were calculated. Faculty observations: TOSCE scores (pre T/T/postT) significantly improved for all the four IPCP competencies (p < 0.001). Self evaluation did not get any significant improvements in PreT and T but significant improvement (P < 0.001) in competency 2 for Post T. Peer evaluation there was significant improvement for the competencies 1 & 2 and overall as well (p < 0.001) during preT, competency 2 during T and competency 2, 3, 4 during PostT. The reflections had a highly significant change from baseline to final (p < 0.001).On final evaluation for the Readiness scale for Interprofessional learning the faculties and students had significant changes in opinions in all the items of the readiness scale (p < 0.05). The project was able to achieve a motivated IPE team which could successfully structure and effectively conduct the IPCP module for the procedure of tracheostomy.

3.
Int J Appl Basic Med Res ; 12(1): 4-8, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35265473

RESUMO

Background: Interprofessional education (IPE) helps preparing the learners in all healthcare professions to work effectively in collaborative teams. This study was undertaken to assess the readiness and perception of IPE of preuniversity health professional students even before they enter their health professional courses. Methods: The preuniversity health professional students along with final-year medical and dental students were recruited for the study. The readiness for interprofessional learning scale was used to measure the student's readiness toward IPE before the interprofessional-related activity session. The preuniversity students also completed the IEPS scale after their interaction with final-year medical and dental students. Results: Most of the aspiring health professional students during their foundation year expressed positive attitude toward readiness for IPE. Most preuniversity students realized that by learning with various professional students would make them effective member of healthcare team. The students had positive perception toward competence and autonomy, perceived need for cooperation, perception of actual cooperation, and understanding other's value, which were significantly higher from score 3 of somewhat disagree (P < 0.001). Conclusion: Most of the aspiring health professional students in their preuniversity year expressed positive attitude toward readiness for IPE although were not prepared to take roles and responsibility within the interprofessional group. They could well perceive the need for cooperation, perception of actual cooperation, and understanding other's value while working in an IP team.

4.
J Educ Health Promot ; 8: 231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31867395

RESUMO

BACKGROUND: Cancer cervix is caused by human papillomavirus (HPV), oncogenic virus and has vaccines and screening as its preventive measures. This study analyzes the change in awareness and attitudes of nonmedical students toward the condition following the use of an educational module. METHODOLOGY: The study design was quasi-experimental. The interprofessional (IP) team implemented an educational module and analyzed the difference in awareness of young individuals toward the cancer cervix. A pretest and posttest written questionnaire, customized for both genders, was administered with the intervention of the educational module in between. The module consisted of a short educational presentation along with a group activity. A follow-up survey was also done after 2 months to check the attrition of awareness. The statistical analysis was done using MacNemar test using SPSS 12 IBM software and significance of differences were determined. RESULTS: There was a significant improvement of knowledge and awareness on linkage between HPV and cervical cancer (P < 0.001). There was also significant change with regard to attitudes toward cervical cancer vaccination (P = 0.004). The knowledge of HPV linkage to the malignancy was maintained after 2 months of gap. The subjects also wished for more future awareness program. CONCLUSIONS: There is improved awareness in the dental and foundation in science students, and this improved awareness will ensure favorable attitudes toward cervical cancer vaccines or will attend regular screening programs. Awareness program must be held at regular intervals at different locations to enhance the knowledge dissemination of this common yet preventable genital malignancy of females. The IP collaboration and practices will help in reducing the disease burden of the society in future.

5.
MedEdPublish (2016) ; 8: 94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-38089353

RESUMO

This article was migrated. The article was marked as recommended. Background To provide the reliable and immediate feedback on the medical students' professionalism during the OSCE, we developed a modified Medical Students' professionalism assessment scale (MSPAS) which is relevant in the history taking and physical examination OSCE stations. Methods We developed two sets of questionnaires, Medical Students' Professionalism Assessment Scale- History taking (MSPAS-H) and Medical Students' Professionalism Assessment Scale- Physical Examination (MSPAS-PE).The Cronbach's alpha correlation coefficient was calculated to determine the internal consistency and exploratory factor analysis was carried out. Results The Content validity index was calculated by using the expert's rating on relevance and all the 12 items in the MSPAS had above 0.85 of CVI. Reverse scoring was required for item No 4 (MSPAS-H) and item No 5 (MSPAS-PE). The Cronbach's alpha was calculated for reliability and found to have 0.87 for MSPAS-H and 0.92 for MSPAS-PE. Discussion All the 6 items in the history taking and 6 items in the physical examination were loaded in each scale with the factor loading of 0.5 and above for all the items. This MSPAS is short and simple scale, it can be completed in a short time period if the simulated patients are provided the proper training on this assessment.

6.
Korean J Med Educ ; 30(2): 109-118, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29860777

RESUMO

PURPOSE: This intervention was aimed to analyse the effect of academic writing and journal critiquing as educational approaches in improving critical thinking and collaborative learning among undergraduate medical students. METHODS: A research proposal writing format was created for the 4th year medical students of Melaka Manipal Medical College, Malaysia during their ophthalmology clinical postings. The students worked in small groups and developed research protocols through an evidence based approach. This was followed by writing reflective summaries in academic portfolios about the activity undertaken. A mixed methods study was designed to explore the possible role of collaborative research proposal writing in enhancing critical thinking and collaborative learning. RESULTS: Analysis of reflections submitted by 188 medical students after the intervention indicate that majority of them found an improvement in their skills of critical thinking and collaborative learning as a result of research protocol writing. All participants agreed that the model helped in applying concepts to new situations in the form of designing their own study, which reflected in enhanced higher order cognitive skills. CONCLUSION: This study shows that the introduction of a structured module in the core medical curriculum that focuses on research writing skills embedded with collaborative and reflective practices can enhance collaborative learning, critical thinking, and reasoning among medical students.


Assuntos
Comportamento Cooperativo , Currículo , Educação de Graduação em Medicina , Aprendizagem , Modelos Educacionais , Resolução de Problemas , Estudantes de Medicina , Pensamento , Feminino , Humanos , Práticas Interdisciplinares , Malásia , Masculino , Competência Profissional , Pesquisa , Ensino , Redação
7.
Malays J Med Sci ; 25(1): 96-100, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29599639

RESUMO

The purpose of this study was to determine the association of well-being and cognitive impairment with primary open angle glaucoma (POAG) patients attending a tertiary care hospital in Malaysia. Fifty-four individuals were recruited for study as cases were matched with 60 individuals as the control subjects, and data were collected using the WHO well-being index and the validated 6-item cognitive impairment test dementia test. The results showed that there was no significant association between gender, ethnicity, socioeconomic status and POAG. Patients with POAG had significantly lower well-being index scores (mean 67.93) than the control group (mean 81.60) with P-value < 0.001. Similarly, patients with POAG had a significantly higher score of cognitive impairment (CIT test) (mean 6.15) compared to the control group (mean 0.40) with P-value < 0.001. Consequently, POAG is likely to be associated with higher cognitive impairment and lower well-being index.

8.
Malays J Med Sci ; 25(6): 121-126, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30914885

RESUMO

BACKGROUND: A poster presentation is an experiential learning activity that stimulates curiosity and interest among students. Moreover, it encourages exploration and integration of concepts and provides students with a novel way to demonstrate their understanding of scientific principles. This pilot projects aimed to analyse views of participants on the academic benefits and learning of medical sciences via poster presentations. METHODS: This cross-sectional study used the sequential exploratory type of mixed methods design in which quantitative data analysis was performed via survey-based questionnaires and qualitative study. For this purpose, we performed a thematic analysis of semi-structured interview questions that were administered to all participants using the self-interview technique. RESULTS: A majority of students were of the opinion that the process of making poster preparation acted as an opportunity to promote deep learning. Moreover, a majority expressed that making these presentations required teamwork, which gave them an insight into collaborative learning. CONCLUSION: Our study revealed that poster presentations, when used effectively as an assignment, can facilitate a learner's critical and reflective thinking and promoting active learning. Previous generic guidelines for making posters were found to be an important step that led to a systematic scientific approach amongst learners as well as for integrating basic science and medical knowledge.

9.
Int J Appl Basic Med Res ; 6(3): 166-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27563580

RESUMO

BACKGROUND: To know the individual's current level of readiness and to manage self-directed learning (SDL) not only help learners but also the instructors. The objectives of this study were to find SDL readiness among 4(th) year medical student and to analyze the effect of weekly assessment of SDL topics. METHODOLOGY: This was a cross-sectional study to analyze the effect of weekly assessment of SDL topics in fostering SDL. The 51 4(th) year students during a clinical posting in ophthalmology participated for this study. Each recruited student was tested for SDL readiness through the SDL readiness scale (SDLRS) developed by Lucy Guglielmino (1978), which was validated in our local setting and responses were collected from students on the 1(st) day of the clinical posting. The students chose SDL topics which were assessed on a weekly basis in the form of scenario-based multiple choice questionnaires. Written feedback was collected from each student regarding such activity during their clinical posting, especially to know the actual utilization of SDL hours provided in teaching schedule, satisfaction on the type of questions and motivation for SDL. RESULTS: The mean SDLRS score in male students were 214.15 ± 19.73 and in female 207.95 ± 17.983, which falls under average score as defined in Guglielmino scale. The majority of study population expressed better utilization of SDL study hours because of weekly assessment than when they had no assessment for SDL. CONCLUSIONS: Majority of the study population were found to be ready for SDL. The weekly assessment of SDL topics was found to stimulate proper utilization of SDL slots in teaching schedule thereby fostering SDL habits.

10.
Cochrane Database Syst Rev ; (10): CD010790, 2015 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-26451693

RESUMO

BACKGROUND: Sickle cell disease includes a group of inherited haemoglobinopathies affecting multiple organs including the eyes. Some people with the disease develop ocular manifestations due to vaso-occlusion. Vision-threatening complications of sickle cell disease are mainly due to proliferative sickle retinopathy which is characterized by proliferation of new blood vessels. Laser photocoagulation is widely applicable in proliferative retinopathies such as proliferative sickle retinopathy and proliferative diabetic retinopathy. It is important to evaluate the efficacy and safety of laser photocoagulation in the treatment of proliferative sickle retinopathy to prevent sight-threatening complications. OBJECTIVES: To evaluate the effectiveness of various techniques of laser photocoagulation therapy in sickle cell disease-related retinopathy. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 21 September 2015.We also searched the following resources (24 March 2015): Latin American and Carribean Health Science Literature Database (LILACS); WHO International Clinical Trials Registry Platforms (ICTRP); and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials comparing laser photocoagulation to no treatment in children and adults. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial eligibility, the risk of bias of the included trials and extracted and analysed data. We contacted the trial authors for additional information. MAIN RESULTS: Two trials (341 eyes of 238 children and adults) were included comparing efficacy and safety of laser photocoagulation to no therapy in people with proliferative sickle retinopathy. There were 121 males and 117 females with an age range from 13 to 67 years. The laser photocoagulation technique used was different in the two trials; one single-centre trial employed sectoral scatter laser photocoagulation using an argon laser; and the second, two-centre trial, employed feeder vessel coagulation using argon laser in one centre and xenon arc in the second centre. The follow-up period ranged from a mean of 21 to 32 months in one trial and 42 to 47 months in the second. Both trials were at risk of selection bias (random sequence generation) because of the randomisation method employed for participants with bilateral disease. One study was considered to be at risk of reporting bias.Using sectoral scatter laser photocoagulation, one trial (174 eyes) reported that complete regression of proliferative sickle retinopathy was seen in 30.2% in the laser group and 22.4% in the control group (no difference between groups). The same trial reported the development of new proliferative sickle retinopathy in 34.3% of laser-treated eyes and in 41.3% of eyes given no treatment; again, there was no difference between treatment groups. The second trial, using feeder vessel coagulation, did not present full data for either treatment group for these outcomes.There was evidence from both trials (341 eyes) that laser photocoagulation using scatter laser or feeder vessel coagulation may prevent the loss of vision in eyes with proliferative sickle retinopathy (at median follow up of 21 to 47 months). Data from both trials indicated that laser treatment prevented the occurrence of vitreous haemorrhage with both argon and xenon laser; with the protective effect being greater with feeder vessel laser treatment compared to scatter photocoagulation.Regarding adverse effects, the incidence of retinal tear was minimal, with only one event reported. Combined data from both trials were available for 341 eyes; there was no difference between the laser and control arms for retinal detachment. In relation to choroidal neovascularization, treatment with xenon arc was found to be associated with a significantly higher risk, but visual loss related to this complication is uncommon with long-term follow up of three years or more.Data regarding quality of life and other adverse effects were not reported in the included trials. AUTHORS' CONCLUSIONS: Our conclusions are based on the data from two trials conducted over 20 years ago. In the absence of further evidence, laser treatment for sickle cell disease-related retinopathy should be considered as a one of therapeutic options for preventing visual loss and vitreous haemorrhage. However, it does not appear to have a significant different effect on other clinical outcomes such as regression of proliferative sickle retinopathy and development of new ones. No evidence is available assessing efficacy in relation to patient-important outcomes (such as quality of life or the loss of a driving licence). There is limited evidence on safety, overall, scatter argon laser photocoagulation is superior in terms of adverse effects, although feeder vessel coagulation has a better effect in preventing vitreous haemorrhage. Further research is needed to examine the safety of laser treatment compared to other interventions such as intravitreal injection of anti-vascular endothelial growth factors. In addition, patient-important outcomes as well as cost-effectiveness should be addressed.


Assuntos
Anemia Falciforme/complicações , Fotocoagulação a Laser/métodos , Lasers de Gás/uso terapêutico , Neovascularização Retiniana/cirurgia , Adolescente , Adulto , Idoso , Criança , Neovascularização de Coroide/etiologia , Feminino , Humanos , Fotocoagulação a Laser/efeitos adversos , Lasers de Gás/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Neovascularização Retiniana/etiologia , Transtornos da Visão/prevenção & controle , Hemorragia Vítrea/diagnóstico
11.
Int J Appl Basic Med Res ; 5(Suppl 1): S29-31, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26380205

RESUMO

BACKGROUND: Although lecture handouts are commonly given to students during theory lectures, students' perception, as well as their performance, can vary depending on the type of handouts they receive for information processing. METHODOLOGY: This is a quasi-experimental study involving 6(th) semester medical students. The study was conducted during theory lectures on ophthalmology. The two types of notes given to the students were comprehensive handout and a skeleton handout, which included some lecture notes but required substantial annotation by the students. Pre-test and post-test in the form of multiple choice questions were conducted before and after the lecture session, respectively. RESULTS: There was a significant difference of mean score of pre- and post-test between skeletal handout (pre = 1.85 ± 1.275, post = 4.85 ± 0.363) and full handout (pre = 1.92 ± 1.09 post = 2.61 ± 0.771) with P < 0.001. However, the students' responses to questionnaires indicated a strong preference for much detailed handouts as essential to preparation for examinations. CONCLUSION: The student can improve their performance during examination while working on skeletal handouts during theory lectures in spite of showing a preference for complete handouts.

12.
Artigo em Inglês | MEDLINE | ID: mdl-26065348

RESUMO

OBJECTIVES: The aims of this study were to identify the attitude of peer tutors (PTs) toward peer-assisted learning (PAL) and to explore the perceived benefits of PAL by PTs and peer learners (PLs). DESIGN: A qualitative and quantitative research study. METHODS: This study involved fourth-year medical undergraduates during their clinical posting in ophthalmology. One PAL session was conducted in each of the 4-week clinical postings. Peer tutors were selected during the first week and were briefed on PAL. Premultiple and postmultiple choice questions were distributed to PLs before and after each PAL session. One focus group discussion was conducted with PLs to explore their perception. Peer tutors were requested to give feedback in the form of structured Likert scale statements with 2 open-ended questions. RESULTS: A total of 104 students, 6 PTs and 98 PLs, participated in this study. Both tutor and learner groups expressed positive attitudes toward PAL. Peer learners preferred having PAL in a clinical setting. There were some issues related with PAL that emerged from both groups. Success in PAL depends on the teaching ability of PTs. CONCLUSIONS: Students have positive perceptions toward PAL. Most of the students believed PAL was beneficial to them.


Assuntos
Educação de Graduação em Medicina/métodos , Oftalmologia/educação , Grupo Associado , Ensino/métodos , Adulto , Atitude do Pessoal de Saúde , Competência Clínica , Docentes de Medicina , Feminino , Grupos Focais , Humanos , Masculino , Pesquisa Qualitativa , Adulto Jovem
13.
Asia Pac J Ophthalmol (Phila) ; 4(3): 166-70, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26065504

RESUMO

PURPOSE: This study was undertaken to determine the risk factors and the point at which posterior capsule rupture (PCR) with/without vitreous loss occurred after cataract surgery and the precautions to be taken to avoid it in the future. DESIGN: A retrospective study. METHODS: Patients who underwent cataract surgery from January 2011 to December 2012 in a hospital in Malaysia were studied. The data were obtained from the National Eye Database of Malaysia. RESULTS: Of 80.4% eyes (2519) that had undergone phacoemulsification, it was found that 3.06% (77) of the cases had PCR as one of the complications. The largest number of PCRs happened during cortical removal (35.2%), followed by segment removal (25.4%), cracking (8.5%), and aspiration of the oculoviscodevice (8.5%). It has been found that the rupture most often occurred during cortex removal by consultants, whereas most PCRs occurred during segment removal by specialists. CONCLUSIONS: This study reveals that around 3% of patients had PCR during phacoemulsification. It is important to recognize PCR and presence of vitreous loss intraoperatively to prevent further complications of cystoid macular edema and endophthalmitis.


Assuntos
Hospitais Gerais , Complicações Intraoperatórias/epidemiologia , Cápsula do Cristalino/lesões , Facoemulsificação/efeitos adversos , Acuidade Visual , Corpo Vítreo , Idoso , Feminino , Humanos , Incidência , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ruptura
14.
Cochrane Database Syst Rev ; (2): CD010009, 2015 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-25686158

RESUMO

BACKGROUND: Diabetic cystoid macular oedema (CMO) is a condition which involves fluid accumulation in the inner portion of the retina. It often follows changes in retinal blood vessels which enhance the fluid to come out of vessels. Although it may be asymptomatic, symptoms are primarily painless loss of central vision, often with the complaint of seeing black spots in front of the eye.It is reported that CMO may resolve spontaneously, or fluctuate for months, before causing loss of vision. If left untreated or undiagnosed, progression of CMO may lead to permanent visual loss.It has been noted that patients with diabetic retinopathy have elevated inflammatory markers, and therefore it is likely that inflammation aids in the progression of vascular disease in these patients. Several topical non-steroidal anti-inflammatory drugs (NSAIDs) such as ketorolac 0.5%, bromfenac 0.09%, and nepafenac 0.1%, have therefore also been used topically to treat chronic diabetic CMO. Hence this review was conducted to find out the effects of topical NSAIDs in diabetic CMO. OBJECTIVES: To assess the effects of topical non-steroidal anti-inflammatory drugs (NSAIDs) for diabetic cystoid macular oedema (CMO). SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2015), EMBASE (January 1980 to January 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 12 January 2015. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs investigating the effects of topically applied NSAIDs in the treatment of people with diabetic CMO aged 18 years of age or over. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial eligibility and screened all available titles and abstracts for inclusion. There were no discrepancies and we did not have to contact trial investigators for missing data. MAIN RESULTS: We did not identify any RCTs matching the inclusion criteria for this review. AUTHORS' CONCLUSIONS: The review did not identify any RCTs investigating the effects of topical NSAIDs in the treatment of diabetic CMO. Most of the studies identified through the electronic searches had been conducted to analyse the effect of topical NSAIDs for pseudophakic CMO.In the absence of high quality evidence, clinicians need to use their clinical judgement and other low level evidence, such as observational non-randomised trials, to decide whether to use topical NSAIDs in cases of diabetic CMO.More research is needed to better understand the cause of this condition and its pathophysiology. This systematic review has identified the need for well designed, adequately powered RCTs to assess possible beneficial and adverse effects of topical NSAIDs in people with diabetic CMO. Future trials should aim to include a large sample size with an adequate follow-up period of up to one year.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Retinopatia Diabética/complicações , Humanos , Edema Macular/etiologia
15.
Malays J Med Sci ; 21(4): 51-3, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25977622

RESUMO

This study was done to correlate the occurrence of posterior capsule rupture among patients with pseudoexfoliation during phacoemulsification. This was a retrospective audit of patients who underwent phacoemulsification type cataract surgery from January 2011 to December 2012 in a tertiary hospital in Malaysia. Data was obtained from the National Eye Database (NED) of Malaysia. The data was analysed using SPSS version 21.0. By using logistic regression analysis, it was found that there was no significant increase in the occurrence of posterior capsule rupture among patients with pseudoexfoliation. Hence, we concluded that there was no correlation between the occurrence of posterior capsule rupture and the presence of pesudoexfoliation among patients who underwent phacoemulsification.

16.
Asia Pac J Ophthalmol (Phila) ; 2(5): 282-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-26107029

RESUMO

PURPOSE: One of the major challenges lies in the use of strategies to assess students working in small groups. The assessment by tutors and peers, and self-assessment by students appear to be integral parts of problem-based-learning (PBL) tutorials. Our study aimed to analyze the formative assessment scores by students themselves, their tutor and peers during undergraduate ophthalmology tutorials. DESIGN: A cross sectional study. METHODS: One hundred undergraduate students' self-assessment made during ophthalmology PBL tutorials were compared with that made by their tutor and student peers. At the end of every session, each student and student peers were given an assessment form dealing with criteria like responsibility, information processing, communication, critical analysis and self-awareness. The questionnaires were filled using the 5-point Likert scale. The tutor's assessment was made using the same criteria. RESULTS: There were significant positive correlations between self-assessment and tutor assessment in regard to participation in PBL session (P = 0.01), punctuality for each session (P ≤ 0.001) and bring new information (P = 0.001). There was a positive correlation between self-assessment and peer assessment regarding active participation (P = 0.02) and bringing new information (P = 0.003). However, there was no significant correlation between the overall scores given by selves and those by peers and the tutor. CONCLUSIONS: Students tended to overrate themselves. The self-assessment scores were generally higher than those given by their tutor and peers. To foster evidence-based practice of ophthalmology, the information acquisition skills need to be improved.

17.
Malays J Med Sci ; 17(1): 12-6, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22135520

RESUMO

BACKGROUND: Although around 70% of HIV+ cases used to have ocular manifestations, the late reporting of cases often results in severe forms of ocular morbidity that would otherwise have been prevented. The objective of this study was to describe the ocular manifestations of HIV and AIDS-related patients who had been admitted to TM Jafferji Hospital, Dar-es-Salaam, Tanzania. METHODS: Proven cases of HIV were recruited in this study. Detailed slit lamp examination and fundoscopy using a +90D lens were carried out in all cases after thoroughly dilating the pupil with 1% Tropicamide eye drops. RESULTS: Around 90% of the recruited cases were in clinical stage III and IV HIV. The notable ocular manifestations included micro-vasculopathy of the retina in 25%, uveitis in 8%, CMV retinitis in 7%, neuro-ophthalmic manifestation in 6%, Herpes zoster ophthalmicus in 5%, Kaposi's sarcoma in 3% and conjunctival carcinoma in 2% of cases. Fifty-three percent of the cases had other anterior segment disorders like conjunctivitis, blepharitis and corneal ulcers. CONCLUSION: Most of the cases recruited in our study were in the late stages of HIV. A significantly high number of cases (70%) had ocular manifestations. Around 53% had additional anterior segment disorders like conjunctivitis, blepharitis and corneal ulcers.

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