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1.
Acta Cir Bras ; 35(2): e202000207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32320996

RESUMO

PURPOSE: To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers. METHODS: The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates' e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs. RESULTS: The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers. CONCLUSION: For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.


Assuntos
Bases de Dados Factuais , Oftalmologia/educação , Estudantes de Medicina , Adulto , Idoso , Estudos Transversais , Bases de Dados Factuais/normas , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmologia/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
2.
Eur J Ophthalmol ; 30(1): 196-200, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30474398

RESUMO

INTRODUCTION: Ergonomics in ophthalmology is neither taught during professional training nor does it readily receive consideration or priority in clinical practice. Owing to a high prevalence of musculoskeletal disorders among ophthalmologists, ergonomic awareness, and practices are vital in averting this modern epidemic. OBJECTIVE: To assess the ergonomic practices and prevalence of self-reported musculoskeletal disorders among ophthalmologists in India. METHOD: An online survey was conducted among ophthalmologists who were registered with the All India Ophthalmological Society of India using a pre-tested and validated questionnaire. RESULTS: The prevalence of self-reported musculoskeletal disorder in the 377 participants was 75.3% (284; 95% confidence interval: 70.6-79.5). Low back pain (149, 52.9%) was the most commonly reported symptom. Musculoskeletal disorder-attributed productivity loss was reported by 58.45% (166) of the respondents. Musculoskeletal disorder was most frequently associated with less than 10 years of work experience (odds ratio: 1.2; 95% confidence interval: 1.1-1.3, p = 0.01) and lack of good clinic (odds ratio: 1.7; 95% confidence interval: 1.1-2.7, p = 0.03) and operation room ergonomic practices (odds ratio: 1.8; 95% confidence interval: 1.1-2.9, p = 0.03). Only 27.9% (105) of the respondents had accessed information related to ergonomics in ophthalmic practice. CONCLUSION: The self-reported musculoskeletal disorder among ophthalmologists in India is quite high and significant enough to cause some degree of productivity loss. It is thus imperative to emphasize the implementation of good ergonomic practices, especially among relatively young ophthalmologists.


Assuntos
Ergonomia/estatística & dados numéricos , Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/epidemiologia , Oftalmologistas/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Oftalmologia/estatística & dados numéricos , Prevalência , Autorrevelação , Inquéritos e Questionários
3.
Am J Ophthalmol ; 209: 71-76, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31525356

RESUMO

PURPOSE: To analyze the academic background, scholarly achievements, and demographic characteristics of all US ophthalmology residency program directors (PDs). DESIGN: Cross-sectional study. METHODS: Online search of publicly available resources conducted from February 16, 2019, to February 26, 2019. STUDY POPULATION: 116 ophthalmology residency PDs. Main outcome measurements were demographic and academic data. RESULTS: A total of 116 program directors were analyzed. Eighty-four of 116 (72%) PDs were male. The average age was 50.0 years old. The mean age at appointment was 42.9 years old. Ninety-three percent graduated from an American medical school, and 97% received an MD degree. Twenty percent of PDs completed an additional graduate degree, most commonly a master's degree (7 of 23) and doctor of philosophy (7 of 23). Seventy-eight percent completed a fellowship, with the most frequent in glaucoma (24%), cornea and external diseases (22%), and neuroophthalmology (21%). The mean number of publications according to PubMed was 17.6 (range, 0-92). There were no significant differences between the average number of publications by male PDs and those by female PDs (19.2 ± 20.5 vs. 13.5 ± 23.1, respectively; P = 0.21). On average, the H-index was 8.7 (range, 0-35) and was higher in male than in female PDs (9.8 ± 8.3 vs. 5.4 ± 4.0, respectively; P = 0.01). CONCLUSIONS: Ophthalmology PDs are predominantly male with fellowship training in glaucoma, cornea, or neuro-ophthalmology. Women remain underrepresented, and future efforts should be aimed at addressing this disparity.


Assuntos
Sucesso Acadêmico , Internato e Residência , Oftalmologia/educação , Oftalmologia/estatística & dados numéricos , Diretores Médicos/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Educação de Pós-Graduação em Medicina , Docentes de Medicina , Bolsas de Estudo , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Revisão da Pesquisa por Pares , Médicas , Inquéritos e Questionários , Estados Unidos/epidemiologia
4.
Acta Med Port ; 32(12): 767-775, 2019 Dec 02.
Artigo em Português | MEDLINE | ID: mdl-31851886

RESUMO

INTRODUCTION: Congenital deafness or early acquired deafness affects 1 to 3 out of 1000 newborns without risk factors and 20 to 40 out of 1000 newborns with risk factors. The universal newborn hearing screening enables its early identification. Children with congenital deafness/early acquired deafness have a higher prevalence of other conditions, especially ophthalmologic and neurodevelopmental ones, and at least 30% to 40% have at least one associated comorbidity. MATERIAL AND METHODS: We carried out a cross-sectional, multicenter study in which 83% (n = 30) of the hospitals/maternity hospitals of the National Health Service participated. RESULTS: All surveyed hospitals/maternity hospitals routinely performed universal newborn hearing screening to all newborns before discharge; 63% referred children with risk factors for hearing loss to Otorhinolaryngology. All children with congenital deafness/early acquired deafness are referred to: Pediatrics in 23% hospitals/maternity hospitals. In 23 hospitals/maternity hospitals, all children with congenital deafness/early acquired deafness are referred to: Speech Therapy in 44% hospitals/ maternity hospitals; Ophthalmology in 17% hospitals/maternity hospitals; National System of Early Intervention in Childhood in 30% hospitals/maternity hospitals; 22% of hospitals/maternity hospitals refer all children with congenital deafness/early acquired deafness, with no identified cause, to Clinical Genetics clinics. The number of diagnoses of deafness in the years 2014 and 2015 was 2.5 and 1.5 per 1000 newborns, respectively, in 15 hospitals/maternity hospitals. DISCUSSION: Awareness of universal newborn hearing screening seems to be widely spread in the National Health Service. The number of children with SC / SPA, as well as the percentage of different types of deafness diagnosed, were identical to those found in other studies and shows its importance. The assessment / follow-up of these children by specialties other than the otolaryngology was heterogeneous in different health entities and revealed that not all children with risk factors for deafness follow up advised by existing standards. CONCLUSION: Results show that Portugal made an important path in the screening and follow-up of children with SC / SPA. It is important, with the ultimate aim of continually improving the care of these children, to reflect on the involvement of specialties other than otolaryngology, such as the National Early Childhood Intervention System in the follow-up of these children.


Assuntos
Surdez/diagnóstico , Perda Auditiva/congênito , Perda Auditiva/diagnóstico , Estudos Transversais , Surdez/epidemiologia , Surdez/etiologia , Intervenção Médica Precoce , Seguimentos , Serviços em Genética/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Perda Auditiva/epidemiologia , Maternidades/estatística & dados numéricos , Humanos , Recém-Nascido , Triagem Neonatal , Oftalmologia/estatística & dados numéricos , Otolaringologia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Portugal/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco
5.
J Environ Public Health ; 2019: 3813298, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31428165

RESUMO

Purpose: The aim of this study was to analyse eye health delivery in Ghana and examine the progress towards achieving VISION 2020 indicator targets. Methods: This descriptive cross-sectional study was conducted between October 2017 and May 2018. It used a mixed method approach including desk-based reviews, a questionnaire-based survey of eye facilities in Ghana, and interviews with eye health system stakeholders to collect information on eye health delivery in facilities owned by the Ghana Health Service (GHS), quasigovernmental bodies (security agencies), and Christian Association of Ghana (CHAG). The information was benchmarked against the World Health Organization (WHO) targets for achieving the goals of VISION 2020. Results: The magnitude of blindness and moderate to severe visual impairment (without pinhole) was 0.9% and 3.0%, respectively. The number of ophthalmologists available at the country level was 80.6% of the VISION 2020 target with optometrists and ophthalmic nurses exceeding targets for VISION 2020. The distribution of human resources was heavily skewed towards two out of the 10 regions in Ghana. Cataract surgical rate was low and met 25% of the WHO target. Basic equipment for refraction was available in the majority of facilities; however, there was a general lack of specialised eye care equipment across the country. Comparatively, CHAG facilities were better equipped than GHS facilities at the same level. Conclusion: The Government of Ghana should revitalize the goals of VISION 2020 beyond the year 2020 and spearhead a concerted effort to ensure equitable distribution of human and infrastructural resources across the country.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Visão Ocular , Cegueira/epidemiologia , Extração de Catarata/estatística & dados numéricos , Estudos Transversais , Assistência à Saúde/organização & administração , Gana/epidemiologia , Pesquisas sobre Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Oftalmologia/estatística & dados numéricos , Optometria/estatística & dados numéricos
6.
BMC Health Serv Res ; 19(1): 609, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464616

RESUMO

BACKGROUND: There are a number of limitations to the present primary eye care system in the UK. Patients with minor eye conditions typically either have to present to their local hospital or GP, or face a charge when visiting eye care professionals (optometrists). Some areas of the UK have commissioned enhanced community services to alleviate this problem; however, many areas have not. The present study is a needs assessment of three areas (Leeds, Airedale and Bradford) without a Minor Eye Conditions Service (MECS), with the aim of determining whether such a service is clinically or economically viable. METHOD: A pro forma was developed for optometrists and practice staff to complete when a patient presented whose reason for attending was due to symptoms indicative of a problem that could not be optically corrected. This form captured the reason for visit, whether the patient was seen, the consultation funding, the outcome and where the patient would have presented to if the optometrists could not have seen them. Optometrists were invited to participate via Local Optical Committees. Results were submitted via a Google form or a Microsoft Excel document and were analysed in Microsoft Excel. RESULTS: Seventy-five percent of patients were managed in optometric practice. Nine and 16% of patients required subsequent referral to their General Practitioner or hospital ophthalmology department, respectively. Should they not have been seen, 34% of patients would have presented to accident and emergency departments and 59% to their general practitioner. 53% of patients paid privately for the optometrist appointment, 28% of patients received a free examination either through use of General Ophthalmic Service sight tests (9%) or optometrist good will (19%) and 19% of patients did not receive a consultation and were redirected to other providers (e.g. pharmacy, accident and emergency or General Practitioner). 88% of patients were satisfied with the level of service. Cost-analyses revealed a theoretical cost saving of £3198 to the NHS across our sample for the study period, indicating cost effectiveness. CONCLUSIONS: This assessment demonstrates that a minor eye condition service in the local areas would be economically and clinically viable and well received by patients.


Assuntos
Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Determinação de Necessidades de Cuidados de Saúde , Análise Custo-Benefício , Emergências/economia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/economia , Tratamento de Emergência/estatística & dados numéricos , Inglaterra , Oftalmopatias/economia , Clínicos Gerais/economia , Clínicos Gerais/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Oftalmologia/estatística & dados numéricos , Optometria/estatística & dados numéricos , Satisfação do Paciente , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/estatística & dados numéricos
7.
Ocul Immunol Inflamm ; 27(6): 905-911, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314623

RESUMO

Purpose: To highlight the pattern and treatment outcomes of ophthalmologic disorders referred to a private specialist rheumatology clinic. Methods: Retrospective review (January 2015-December 2016) of referrals from Eye Foundation Hospital, Lagos to Arthrimed Specialist Clinic, Lagos. Case records were retrieved and relevant information extracted. Ethical standards were observed. Results: Twenty-two referrals (35 eyes) were received out of 643 patients (3.4%) seen during the study period. The majority were female (63.6%) with mean age 48.9 ± 19.3 years and bilateral disease (59%). Diagnoses included uveitis (45.5%), optic neuritis (36.4%), non-specific autoimmune eye disease (9.1%), keratoconjunctivitis sicca (4.5%), and giant cell arteritis (4.5%). Treatment was with steroids and immunosuppressive agents. Fourteen patients improved (63.6%), five remained unchanged (22.7%), while three worsened (13.6%). Conclusions: Our patients were mostly fourth-decade females with bilateral disease. Uveitis was the commonest presentation, and two-thirds of the treated patients improved after treatment. Early specialist referral and co-management of severe autoimmune eye diseases are desirable.


Assuntos
Doenças Autoimunes/epidemiologia , Oftalmopatias/epidemiologia , Hospitais Privados/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Reumatologia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/tratamento farmacológico , Oftalmopatias/diagnóstico , Oftalmopatias/tratamento farmacológico , Feminino , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Especialização/estatística & dados numéricos , Adulto Jovem
8.
Ophthalmologe ; 116(12): 1171-1176, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31338590

RESUMO

PURPOSE: Every year around New Year's Eve severe eye injuries are caused by fireworks. There is a large variety ranging from slight superficial injuries to very severe trauma necessitating extensive and sometimes repeated surgical treatment. As a consequence the patients not only suffer from functional or cosmetic impairments but also from socioeconomic problems, such as reduced capacity to work and inability to work. All firework-related eye injuries treated at the University Hospital Halle from 2008 to 2018 were retrospectively and systematically analyzed. MATERIAL AND METHODS: The patients were analyzed with respect to age, gender, injury distribution, type of injury, circumstances, form of treatment, consequences and duration of inability to work. RESULTS: From the turn of the year 2008/2009 to the turn of the year 2018/2019 a total of 144 eyes from 116 patients were treated at the ophthalmology department of the University Hospital Halle. The injuries involved 80 male patients (69%) and 36 female patients (31%), among them 44 children (38%) aged under 18 years, 81 right and 63 left eyes. In 28 patients both eyes were affected. Of the patients 44% handled the fireworks themselves and 56% were bystanders. Injuries were mostly caused by bangers (37%) and rockets (24%). Of the patients 37 had to be hospitalized, 14 eyes needed immediate surgical treatment, 2 eyes needed surgery later on in irritation-free intervals and 12 eyes needed repeated surgery. The duration of inability to work was on average 21.6 days, 2 eyes went blind because of the fireworks-related injury and 29% of the patients had visual impairments of which 43% were classified as severe impairments. CONCLUSION: Fireworks-related injuries are preventable injuries. As in most cases children, young adults and bystanders are affected by fireworks injuries, prophylactic and educational programs are urgently needed and legal regulations are necessary.


Assuntos
Traumatismos por Explosões , Traumatismos Oculares , Adolescente , Traumatismos por Explosões/epidemiologia , Traumatismos por Explosões/terapia , Criança , Traumatismos Oculares/epidemiologia , Traumatismos Oculares/terapia , Feminino , Hospitais Universitários , Humanos , Masculino , Oftalmologia/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-30974863

RESUMO

Latin American immigrants make up 49% of the total immigrant population in Spain, yet little is known about their eye health. The aim of this study is to determine if there are differences in self-perceived eye health, access to eye care specialists, and use of lenses between a sample of Latin American immigrant workers from Colombia and Ecuador, and native-born workers in Spain. We used data from the PELFI cohort (Project for Longitudinal Studies of Immigrant Families). The sample consisted of 179 immigrant workers born in Colombia or Ecuador, and 83 Spanish-born workers. The outcome variables were self-perceived eye health, access to eye specialists, and use of lenses. A descriptive analysis of the sample was carried out, and the prevalence of the three outcome variables in immigrants and natives was calculated and adjusted for explanatory variables. Random effects logistic regression models examined eye health outcomes by workers' country of birth. Immigrants are less likely to report poor self-perceived eye health than native-born (ORc 0.46; CI 95%, 0.22-0.96). Furthermore, they have less access to specialists (ORc 2.61; CI 95%, 1.32-5.15) and a higher probability of needing lenses but not having them (ORc 14.14; CI 95%, 1.77-112.69). This latter variable remained statistically significant after adjusting for covariates (ORa 34.05; CI 95%, 1.59-729.04). Latin American immigrants may not value the use of lenses, despite eye care specialists indicating that they need them. Eye health education is required to recognize the importance of using lenses according to their visual needs.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Lentes/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Grupos Populacionais/estatística & dados numéricos , Especialização/estatística & dados numéricos , Adolescente , Adulto , Colômbia , Estudos Transversais , Equador , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Espanha , Adulto Jovem
10.
J Fr Ophtalmol ; 42(5): 492-498, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-30987760

RESUMO

INTRODUCTION: Visual impairment is a handicap defined as any alteration of visual function responsible for a partial or total limitation of the activities of daily living (OMS, 2004). The objective of this study is to assess quality of life in patients before and after management of low vision. PATIENTS AND METHODS: This was a mono-centric, transverse, analytical study over a period of 6 months. Our study population included all adult patients seen in ophthalmologic consultation and followed in the low vision unit with visual acuity less than 3/10 and greater than or equal to 1/20 in the best eye with best optical correction. The National Eye Institute's quality of life questionnaire, the NEF VFQ 25, was administered to patients on site prior to management and then a month later. RESULTS: Low-vision management improved overall the dimensions of the quality of life questionnaire. Following the end-of-care assessment, the score for ocular pain was lowest (38.20), followed by the overall vision score (44.95) and near vision difficulty score (45.33). DISCUSSION: Our sample population was distinguished by a cultural mix, with diversity of beliefs and lifestyles, and also by the relatively advanced age of the subjects constituting it. This can influence the individual's perception of him- or herself within his or her environment, modifying the patient's estimation of his or her condition and therefore his or her behavior. CONCLUSION: Low-vision rehabilitation can improve the quality of life of visually impaired patients, particularly for near vision, activities of daily living and psychological health.


Assuntos
Qualidade de Vida , Baixa Visão/terapia , Atividades Cotidianas/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Pessoas com Deficiência/estatística & dados numéricos , Dor Ocular/terapia , Feminino , Nível de Saúde , Hospitais Universitários , Humanos , Masculino , Mali/epidemiologia , Pessoa de Meia-Idade , Oftalmologia/normas , Oftalmologia/estatística & dados numéricos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Baixa Visão/epidemiologia , Baixa Visão/fisiopatologia , Baixa Visão/psicologia , Acuidade Visual/fisiologia , Adulto Jovem
11.
Ocul Immunol Inflamm ; 27(6): 897-904, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31020877

RESUMO

Purpose: To describe the clinical experience with retinal vasculitis at 4 Egyptian tertiary eye centers. Methods: A multicenter retrospective chart review of all patients with retinal vasculitis encountered at 4 ocular inflammation referral clinics in Egypt between February 2013 and February 2018. Results: The study included 618 patients (327 males and 291 females). Of these, 284 patients had isolated retinal vasculitis, whereas 233 patients had an associated systemic inflammatory disease, the most frequent being Behçet's disease, followed by sarcoidosis. In 101 patients, retinal vasculitis could be attributed to an infectious etiology, and among this category, the most common was tuberculosis, followed by toxoplasmosis. Conclusion: In our Egyptian cohort, more than half the patients had their retinal vasculitis as part of a serious systemic disease, or as part of an infectious process, as tuberculosis. And in view of the significant potential morbidity of these conditions, the local ophthalmologists need to be aware of these entities when faced with patients presenting with retinal vasculitis.


Assuntos
Hospitais Especializados/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Vasculite Retiniana/epidemiologia , Atenção Terciária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Síndrome de Behçet/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Egito/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vasculite Retiniana/diagnóstico , Estudos Retrospectivos , Sarcoidose/epidemiologia , Toxoplasmose Ocular/epidemiologia , Tuberculose Ocular/epidemiologia
12.
Arch Soc Esp Oftalmol ; 94(5): 211-217, 2019 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30837174

RESUMO

OBJECTIVES: To determine the prevalence of ophthalmological emergency visits to two tertiary hospital in all age groups during years 2014 and 2015. METHODS: All patients who attended Ophthalmological Emergency Department from 1 January 2014 to 31 December 2015 were included in the study. The demographic variables studied were gender, age, place of origin, time of arrival, day of the week, month and year of the visit, the diagnosis, destination on discharge, total time of the visit and priority. Pathologies were categorised using codes from ICD-9, CM. RESULTS: A total of 39,869 visits were made between 2014 and 2015. Emergency consultations were more frequent among women, on Mondays, and from April to June. The mean age of the patients was 46.24years old, and 73.42% of visits were classified as non-emergencies. The most frequent pathology was conjunctivitis (17.28%), followed by keratitis (15.31%), and vitreous detachment (5.37%). The pathology that led to more hospital admissions was orbital cellulitis (23%). The majority of patients (94.85%) were sent to their place of residence after the visit. CONCLUSIONS: Given that the great majority of Ophthalmological Emergency visits are categorised as non-emergencies, measures need to be set up in order achieve a more effective care focused on emergency pathology without using unnecessary resources.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Distribuição por Idade , Emergências/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fatores de Tempo
13.
Ophthalmic Epidemiol ; 26(3): 189-199, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30767630

RESUMO

PURPOSE: Women bear an inequitable burden of blinding conditions compared to men primarily because they have more limited access to eye care services. This systematic review sought evidence regarding interventions to increase gender equity in eye care. METHODS: We searched MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and EBSCO CINAHL, and contacted experts to identify studies in low- and middle-income countries of health services interventions for age-related cataract, childhood cataract, and trachoma. Eligible studies could be clinical trials or observational studies, but had to present sufficient data for intervention effects to be estimated separately for women and men. RESULTS: We included four cluster RCTs and nine observational studies. All were judged to have serious risk of bias. Six studies examined interventions involving training rural community volunteers to identify, educate and assist individuals with unmet eye care needs. Interventions were associated with reduced gender inequities in all-cause blindness, clinic attendance, cataract surgery coverage and trachoma treatment coverage (low-to-very low quality evidence). Studies in Nepal and Tanzania examining a multicomponent intervention to improve follow-up after pediatric cataract surgery found reduced gender inequities in follow-up rates at 10 weeks (low quality evidence). CONCLUSION: Limited evidence exists to inform health service planners regarding interventions to reduce gender inequity in visual impairment and blindness. Training community volunteers to identify and counsel affected individuals, and empower them to circumvent or challenge socioeconomic barriers to accessing care holds promise. Future interventions ought to explicitly consider gender in their design and implementation, and incorporate high-quality evaluation efforts.


Assuntos
Países em Desenvolvimento , Equidade em Saúde/normas , Acesso aos Serviços de Saúde/normas , Oftalmologia/estatística & dados numéricos , Feminino , Humanos , Masculino , Fatores Sexuais
14.
JAMA Ophthalmol ; 137(4): 440-444, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30703202

RESUMO

Importance: Prior studies found that screening for diabetic retinopathy (DR) in primary care settings using telemedicine increased screening rates among individuals with diabetes. This finding has led to interest in expanding the use of primary care-based screening for DR. Objective: To estimate the percentages of US adults with diabetes and high-risk US adults with diabetes who have regular contact with primary care physicians and therefore could potentially receive timely screening for DR in primary care settings. Design, Setting, and Participants: The empirical analyses used data from the cross-sectional population-based 2016 National Health Interview Survey on US adults 18 years or older with self-reported diabetes (n = 3229). Based on previous research, individuals who had lower income, lower educational levels, or type 2 diabetes; who were African American or Hispanic, uninsured, or not using insulin or oral medication for diabetes; or who did not have DR were defined as being at high risk of missing recommended eye examinations. Data were collected throughout 2016 and analyzed from July 17 through November 5, 2018. Main Outcomes and Measures: Outcomes were whether an individual visited a primary care physician and whether an individual missed having a dilated eye examination in the past year. Results: The survey sample included 3229 participants. Using weighted percentages of the full sample, 15.3% (95% CI, 13.8%-17.0%) had lower income, 19.7% (95% CI, 17.8%-21.6%) had lower educational levels, 15.4% (95% CI, 13.5%-17.4%) were African American, 16.0% (95% CI, 13.7%-18.6%) were Hispanic, 6.1% (95% CI, 4.9%-7.5%) were uninsured, and 50.1% (95% CI, 47.7%-52.4%) were female; the mean age was 60.1 years (95% CI, 59.4-60.8 years). In addition, 87.7% (95% CI, 85.9%-89.3%) visited a primary care physician in the past year. Of those who did not receive a dilated eye examination in the past year, 82.2% (95% CI, 78.4%-85.4%) visited a primary care physician during the year. Except for the uninsured subgroup, more than 78% of each high-risk subgroup had visited a primary care physician in the past year. Conclusions and Relevance: Screening for DR in primary care settings has the potential to provide timely screening to a large portion of US adults with diabetes because most US adults with diabetes, including those at high-risk of missing recommended eye examinations, have regular contact with primary care physicians.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
15.
Int Ophthalmol ; 39(10): 2385-2390, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30710253

RESUMO

PURPOSE: To investigate the current practice on glaucoma care with the aim of highlighting its poise to tackle this emerging sight-threatening disease in Nigeria. METHODS: This was a cross-sectional, descriptive, population-based survey involving 88 ophthalmologists. Information on their demographic characteristics, practice profile, challenges and prospects on glaucoma care was collected using a semi-structured, self-administered questionnaire in August 2016. Data were analysed using SPSS 20. RESULTS: The participants are comprised of 46 (52.3%) males and 42 (47.7%) females, with a mean age of 42.2 ± 8.7 SD years. They were 45 (51.1%) consultants, 31 (35.2%) residents and 12 (13.6%) diplomates. Their years of practice were 8.8 ± 6.7 SD years. They worked mainly in government hospitals located at the southern part of Nigeria. The current practice was mainly comprehensive ophthalmology, 63 (71.6%). Only 2 (2.3%) had strict subspecialty practice. Others, 23 (26.1%), had combined practice. Eleven (12.5%) were glaucoma specialists and had combined practice. The majority of the participants, 57 (64.8%), were routinely diagnosed glaucoma properly. Sixty-three (71.6%) participants underwent trabeculectomy, 48 (54.5%) combined cataract surgery with trabeculectomy, 7 (8.0%) drainage implants, 5 (5.7%) laser trabeculoplasty, and 2 (2.3%) minimally invasive glaucoma surgery. Poor patients' acceptance and satisfaction, fear of complications, lengthy post-operative care and cost were the main deterrents to surgeries. Advocacy, public awareness, training of glaucoma specialists, provision of equipment and health insurance were the major recommendations on improving glaucoma care. CONCLUSION: Given the meagre number of specialists and lack of strict subspecialty practice, optimal glaucoma care in Nigeria is still far from reality.


Assuntos
Glaucoma/terapia , Oftalmologia/normas , Padrões de Prática Médica , Adulto , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Oftalmologia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Inquéritos e Questionários , Trabeculectomia/estatística & dados numéricos
16.
Ophthalmology ; 126(6): 783-791, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30664893

RESUMO

PURPOSE: With the current wide adoption of electronic health records (EHRs) by ophthalmologists, there are widespread concerns about the amount of time spent using the EHR. The goal of this study was to examine how the amount of time spent using EHRs as well as related documentation behaviors changed 1 decade after EHR adoption. DESIGN: Single-center cohort study. PARTICIPANTS: Six hundred eighty-five thousand three hundred sixty-one office visits with 70 ophthalmology providers. METHODS: We calculated time spent using the EHR associated with each individual office visit using EHR audit logs and determined chart closure times and progress note length from secondary EHR data. We tracked and modeled how these metrics changed from 2006 to 2016 with linear mixed models. MAIN OUTCOME MEASURES: Minutes spent using the EHR associated with an office visit, chart closure time in hours from the office visit check-in time, and progress note length in characters. RESULTS: Median EHR time per office visit in 2006 was 4.2 minutes (interquartile range [IQR], 3.5 minutes), and increased to 6.4 minutes (IQR, 4.5 minutes) in 2016. Median chart closure time was 2.8 hours (IQR, 21.3 hours) in 2006 and decreased to 2.3 hours (IQR, 18.5 hours) in 2016. In 2006, median note length was 1530 characters (IQR, 1435 characters) and increased to 3838 characters (IQR, 2668.3 characters) in 2016. Linear mixed models found EHR time per office visit was 31.9±0.2% (P < 0.001) greater from 2014 through 2016 than from 2006 through 2010, chart closure time was 6.7±0.3 hours (P < 0.001) shorter from 2014 through 2016 versus 2006 through 2010, and note length was 1807.4±6.5 characters (P < 0.001) longer from 2014 through 2016 versus 2006 through 2010. CONCLUSIONS: After 1 decade of use, providers spend more time using the EHR for an office visit, generate longer notes, and close the chart faster. These changes are likely to represent increased time and documentation pressure for providers. Electronic health record redesign and new documentation regulations may help to address these issues.


Assuntos
Documentação/tendências , Registros Eletrônicos de Saúde/tendências , Oftalmologia/tendências , Optometria/tendências , Centros Médicos Acadêmicos , Estudos de Coortes , Documentação/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Pessoal de Saúde , Humanos , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Oftalmologistas , Oftalmologia/estatística & dados numéricos , Optometristas , Optometria/estatística & dados numéricos , Fatores de Tempo
17.
Diabetes Care ; 42(3): 427-433, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30679304

RESUMO

OBJECTIVE: Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults, and although screening with eye exams is effective, screening rates are low. We evaluated eye exam visits over a 5-year period in a large population of insured patients 10-64 years of age with diabetes. RESEARCH DESIGN AND METHODS: We used claims data from IBM Watson Health to identify patients with diabetes and continuous insurance coverage from 2010 to 2014. Diabetes and DR were defined using ICD-9 Clinical Modification codes. We calculated eye exam visit frequency by diabetes type over a 5-year period and estimated period prevalence and cumulative incidence of DR among those receiving an eye exam. RESULTS: Among the 298,383 insured patients with type 2 diabetes and no diagnosed DR, almost half had no eye exam visits over the 5-year period and only 15.3% met the American Diabetes Association (ADA) recommendations for annual or biennial eye exams. For the 2,949 patients with type 1 diabetes, one-third had no eye exam visits and 26.3% met ADA recommendations. The 5-year period prevalence and cumulative incidence of DR were 24.4% and 15.8%, respectively, for patients with type 2 diabetes and 54.0% and 33.4% for patients with type 1 diabetes. CONCLUSIONS: The frequency of eye exams was alarmingly low, adding to the abundant literature that systemic changes in health care may be needed to detect and prevent vision-threatening eye disease among people with diabetes.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/terapia , Cobertura do Seguro/estatística & dados numéricos , Programas de Rastreamento , Adolescente , Adulto , Criança , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/economia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Retinopatia Diabética/economia , Feminino , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Humanos , Incidência , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Oftalmologia/economia , Oftalmologia/estatística & dados numéricos , Exame Físico/economia , Exame Físico/estatística & dados numéricos , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
18.
Am J Ophthalmol ; 197: 23-35, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30236775

RESUMO

PURPOSE: To compare the effect of age, sex and generation on physician practice patterns in Ontario, Canada. DESIGN: Retrospective cohort study. METHODS: Physician and patient data from 1992 to 2013 were used to calculate yearly number of physicians, distinct patients seen, patient visits, government payments, physician age, sex, specialty, and year of birth. Age-period-cohort models were used for analysis. RESULTS: There was a negligible change in the number of distinct patients for all physicians and family physicians and a 20.6% decrease for ophthalmologists. There were small declines in yearly visits for all physicians (14.2%) and family physicians (17.3%) and a 10.0% increase for ophthalmologists. There was a lower number of visits (and patients for ophthalmologists) in each succeeding recent birth cohort. For all groups and birth cohorts, male physicians had significantly greater number of visits and patients. Median payments increased over time in all groups and were less for women with an average women-to-men ratio of 0.64 for all physicians, 0.75 for family physicians, and 0.59 for ophthalmologists. After adjusting for the number of visits and patients, sex differences in payments remained significant for all physicians and ophthalmologists but were no longer significant for family physicians. CONCLUSION: Younger cohorts of Ontario physicians have greater yearly payments compared to older cohorts at the same age despite similar or slightly fewer numbers of visits and patients. The sex gap of payments was mostly explained by differences in the number of patients and visits for family physicians, but remained significant for all physicians and ophthalmologists.


Assuntos
Oftalmologia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Salários e Benefícios/estatística & dados numéricos , Adulto , Fatores Etários , Efeito de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Estudos Retrospectivos , Fatores Sexuais
19.
Ophthalmology ; 126(3): 347-354, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30312629

RESUMO

PURPOSE: To improve clinic efficiency through development of an ophthalmology scheduling template developed using simulation models and electronic health record (EHR) data. DESIGN: We created a computer simulation model of 1 pediatric ophthalmologist's clinic using EHR timestamp data, which was used to develop a scheduling template based on appointment length (short, medium, or long). We assessed its impact on clinic efficiency after implementation in the practices of 5 different pediatric ophthalmologists. PARTICIPANTS: We observed and timed patient appointments in person (n = 120) and collected EHR timestamps for 2 years of appointments (n = 650). We calculated efficiency measures for 172 clinic sessions before implementation vs. 119 clinic sessions after implementation. METHODS: We validated clinic workflow timings calculated from EHR timestamps and the simulation models based on them with observed timings. From simulation tests, we developed a new scheduling template and evaluated it with efficiency metrics before vs. after implementation. MAIN OUTCOME MEASURES: Measurements of clinical efficiency (mean clinic volume, patient wait time, examination time, and clinic length). RESULTS: Mean physician examination time calculated from EHR timestamps was 13.8±8.2 minutes and was not statistically different from mean physician examination time from in-person observation (13.3±7.3 minutes; P = 0.7), suggesting that EHR timestamps are accurate. Mean patient wait time for the simulation model (31.2±10.9 minutes) was not statistically different from the observed mean patient wait times (32.6±25.3 minutes; P = 0.9), suggesting that simulation models are accurate. After implementation of the new scheduling template, all 5 pediatric ophthalmologists showed statistically significant improvements in clinic volume (mean increase of 1-3 patients/session; P ≤ 0.05 for 2 providers; P ≤ 0.008 for 3 providers), whereas 4 of 5 had improvements in mean patient wait time (average improvements of 3-4 minutes/patient; statistically significant for 2 providers, P ≤ 0.008). All of the ophthalmologists' examination times remained the same before and after implementation. CONCLUSIONS: Simulation models based on big data from EHRs can test clinic changes before real-life implementation. A scheduling template using predicted appointment length improves clinic efficiency and may generalize to other clinics. Electronic health records have potential to become tools for supporting clinic operations improvement.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Agendamento de Consultas , Eficiência Organizacional/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Centros Médicos Acadêmicos/organização & administração , Adolescente , Criança , Pré-Escolar , Simulação por Computador , Humanos , Lactente , Recém-Nascido , Oftalmologia/organização & administração , Fatores de Tempo , Fluxo de Trabalho
20.
Ophthalmic Plast Reconstr Surg ; 35(1): 29-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29851757

RESUMO

PURPOSE: To assess the epidemiology of women and underrepresented minorities (URMs; Hispanic, African American, and Native American) in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). METHODS: An observational retrospective study of living ASOPRS members was identified through the ASOPRS member directory, search engine-driven informatics, and direct communication. Members were profiled for gender, race, geographic location, and academic rank (or not). The percentage of women and URMs in the society over time was also assessed. RESULTS: The authors identified 617 living ASOPRS members as of June 2017. Of these, 109 (17.7%) were female and 58 (9.4%) were URMs. Surgeons completed fellowships from 1961 (male) or 1973 (female) until 2015. Women members significantly increased from 7 (4.9% of the total) before 1986 to 24 (30.4%) between 2011 and 2015 (last 5 years). URMs significantly increased over time, with 0 female and 5 (3.4%) male minorities before 1985 to 5 (6.3%) females and 13 (16.5%) males within the last 5 years (p < 0.05). With only 1 female and 3 male members, African American representation was sparse. ASOPRS members were not found in 5 states and were most represented in California, New York, Florida, and Texas. Among ASOPRS members in full-time academic positions, women tended to have lower rank compared to men; however, after controlling for number of years post-fellowship, this finding was narrowly not statistically significant (p = 0.0624). There were no academic differences with URMs and nonminority groups. CONCLUSIONS: Women and URMs have increased steadily in ASOPRS, especially in recent years. Similar to the rest of ophthalmology and general medicine, there remain opportunities for ASOPRS to increase diversity.


Assuntos
Grupos de Populações Continentais , Oftalmologia/estatística & dados numéricos , Sociedades Médicas , Cirurgia Plástica/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores Sexuais , Estados Unidos
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