Some cataracts stop progressing after a certain point. Cataracts are never reversible, however, even after eliminating factors (such as drugs or illnesses), which might have promoted their development. If extensive and progressive cataracts are left untreated they can cause blindness. In fact, cataracts are the leading cause of blindness among adults age 55 and older.
However, many cases of cataracts never require treatment other than a change in one's eyeglass prescription. If surgery is required, the success rate is very high. More than 90 percent of patients experience improved vision.
A number of studies have shown that cataracts are associated with shortened lifespan. Some studies have specifically suggested poorer survival in patients with nuclear or mixed cataracts but not in those with cataracts in the cortex or capsule. In any case, nuclear cataracts are highly associated with smoking and diabetes, although some studies have found lower survival rates in patients with nuclear cataract regardless of these health risks.
Also, if vision impairment does result, it may also affect many daily functions such as driving, working, reading and general independence.
http://health.nytimes.com/health/guides/disease/cataract/prognosis.html
http://www.faqs.org/health/Sick-V1/Cataracts.html
http://adam.about.com/reports/000026_3.htm
Showing posts with label PCL07. Show all posts
Showing posts with label PCL07. Show all posts
Friday, August 29, 2008
Thursday, August 28, 2008
PCL 07- Doctor advertising issues
Ø Guidelines that prohibit medical practice advertisment(The Medical Practice Act 1994, Section 64)[1]
n is or is intended to be false, misleading or deceptive (Trades Practices Act 1974 also agrees with this); or
n offers a discount, gift or other inducement to attract patients to a medical practitioner unless the advertisement also sets out the terms and conditions of that offer; or
n refers to uses or quotes from testimonials or purported testimonials; or
n creates an unreasonable expectation of beneficial treatment.
Ø More specifically
n No before and after (visual) comparisons
n Gifts as incentives
Ø The guideline is set to
n Reduce risks of receiving false medical services and their harmful consequences
n Stop unrealistic expections about the benefits
Ø Consequences of breaching the guideline
n Prosecution by Magistrates’ Court of Victoria and a financial penalty
n May be required to receive counselling, further education, restrictions or suspension of the practitioner’s registration
Ø Advantages and disadvantages
n Pro
u “In the decision making process, the role of advertising was to create initial awareness about the kinds of procedures that existed and to prompt further investigation.” [2]
u Competitive advantage over other businesses that provide the health services
u Promote new therapies that are potentially more effective
l The patient plays the role of the “salesperson”
n Cons
u False advertising (with modified imagery, testimonies…)
u Lost of trust from patients with any medical treatment if the result does not satisfy the expections they have set
CATARACT SURGERY -- COMPLICATIONS & PROGNOSIS
Complications & Prognosis:
1. Capsular rupture & Vitreous loss (common, potentially serious)
- Not every patient will suffer a poor outcome
- Can retain excellent vision if complication is managed well
- Incidences is decreasing with more complex surgeries made available
2. Endopthalmitis (rare, devastating)
- Endophthalmitis involves inflammation of the intraocular cavities (i.e., the aqueous or vitreous humour) usually caused by infection.
-The 2 types of endophthalmitis are endogenous (i.e., metastatic) and exogenous. Endogenous endophthalmitis results from the hematogenous spread of organisms from a distant source of infection (eg, endocarditis). Exogenous endophthalmitis results from direct inoculation as a complication of ocular surgery, foreign bodies, and/or blunt or penetrating ocular trauma.
-Most feared complication of intraocular surgery
-In most European studies, Staphylococcus epidermidis is the most common infecting microorganism. This bacterium is found in normal eyelid skin and conjunctiva, and it enters the eye during surgery.
-In South India, Nocardia species were the commonest cause of infection.
3. Inflammation
4. Infection
5. Bleeding
6. Swelling
7. Retinal detachment
8. Glaucoma
9. Second cataract
Preventing Complications:
1) Follow up with patient’s condition before and after the surgery
2) Meticulous sterilisation of all surgical instruments and fluids and careful aseptic techniques
Managing complications:
With all complications, including capsular rupture and vitreous loss, and even endophthalmitis, the prognosis is better if the complication is managed effectively.
For endopthalmitis -- Early recognition and prompt treatment with intravitreal vancomycin and either ceftazidime or amikacin seems to offer the best hope of visual recovery. With immediate use of intravitreal antibiotics, some eyes will recover useful vision.
For Posterior Capsular Rupture -- If the tear leaks vitreous, then an anterior vitrectomy is performed à Anterior vitrectomy can be automated (using a probe called ocutome) or mechanical, which entails applying sponges on the wound then pulling them out and cutting any sticking vitreous strands.
For Expulsive haemorrhage (due to acute drop in intraocular pressure) – A surgeon will rapidly close the wound and give intra-venous osmotic agents to lower the intra-ocular pressure. Steroids should be given post-op to decrease the inflammation. Drainage of the blood should take place after two weeks when clots start liquefying. The visual prognosis is usually dismal.
http://www.eyeweb.org/cataract_surgery.htm
www.emedicine.com/emerg/topic880.htm
www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2377378
www.mayoclinic.com/health/cataract-surgery/EY00014
1. Capsular rupture & Vitreous loss (common, potentially serious)
- Not every patient will suffer a poor outcome
- Can retain excellent vision if complication is managed well
- Incidences is decreasing with more complex surgeries made available
2. Endopthalmitis (rare, devastating)
- Endophthalmitis involves inflammation of the intraocular cavities (i.e., the aqueous or vitreous humour) usually caused by infection.
-The 2 types of endophthalmitis are endogenous (i.e., metastatic) and exogenous. Endogenous endophthalmitis results from the hematogenous spread of organisms from a distant source of infection (eg, endocarditis). Exogenous endophthalmitis results from direct inoculation as a complication of ocular surgery, foreign bodies, and/or blunt or penetrating ocular trauma.
-Most feared complication of intraocular surgery
-In most European studies, Staphylococcus epidermidis is the most common infecting microorganism. This bacterium is found in normal eyelid skin and conjunctiva, and it enters the eye during surgery.
-In South India, Nocardia species were the commonest cause of infection.
3. Inflammation
4. Infection
5. Bleeding
6. Swelling
7. Retinal detachment
8. Glaucoma
9. Second cataract
Preventing Complications:
1) Follow up with patient’s condition before and after the surgery
2) Meticulous sterilisation of all surgical instruments and fluids and careful aseptic techniques
Managing complications:
With all complications, including capsular rupture and vitreous loss, and even endophthalmitis, the prognosis is better if the complication is managed effectively.
For endopthalmitis -- Early recognition and prompt treatment with intravitreal vancomycin and either ceftazidime or amikacin seems to offer the best hope of visual recovery. With immediate use of intravitreal antibiotics, some eyes will recover useful vision.
For Posterior Capsular Rupture -- If the tear leaks vitreous, then an anterior vitrectomy is performed à Anterior vitrectomy can be automated (using a probe called ocutome) or mechanical, which entails applying sponges on the wound then pulling them out and cutting any sticking vitreous strands.
For Expulsive haemorrhage (due to acute drop in intraocular pressure) – A surgeon will rapidly close the wound and give intra-venous osmotic agents to lower the intra-ocular pressure. Steroids should be given post-op to decrease the inflammation. Drainage of the blood should take place after two weeks when clots start liquefying. The visual prognosis is usually dismal.
http://www.eyeweb.org/cataract_surgery.htm
www.emedicine.com/emerg/topic880.htm
www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2377378
www.mayoclinic.com/health/cataract-surgery/EY00014
PCL 07 - Cultural factors affecting Aboriginal access - Fern
From the 2008 Global Health Conference Indigenous Health workshop, stream 2 manual:
“Aboriginal and Torres Strait Islander populations experience serious and persistent disadvantage across a range of areas resulting in poorer health and nutrition status than the general population, including higher rates of poverty and unemployment, lower attendance at school, serious maternal and child health problems, inadequate living conditions, and high levels of incarceration, discrimination and experiences of racism. The impact of historical and social factors such as colonisation, loss of land, removal of children from families, community dislocation and high levels of trauma and grief, has been devastating and pervasive on many levels.”
2008 GHC manual, referencing the Social Justice Report, 2006, ATSI Social Justice Commissioner, report no. 1/2007.
“Reasons for under-utilisation of services in urban areas [relative to the non-Indigenous population]:
- Some mainstream services are planned and delivered so as to meet the requirement of the most common users (therefore do not allow for the special needs of Indigenous peoples)
- Some requirements for accessing services do not take into consideration the lifestyle of Indigenous people
- Financial barriers can constrain access to some services
- People living in the outer suburban fringes of urban centres with limited public transport infrastructure can experience difficulties in gaining physical access to services
- Workforce issues experienced by service providers can restrict Indigenous peoples’ access to services, i.e. staff are not always trained to work in a cross-cultural context or in an environment where they experience the complex problems Indigenous people can often face
- Legacies of history and unpleasant previous experiences with mainstream services can reduce Indigenous use of facilities
- Some services are not delivered in a culturally-safe manner and can make Indigenous people feel uncomfortable when they access them
- There may be poor links between complementary services”
Strategies to combat this:
- Aboriginal Healthcare Workers
- Aboriginal Community Controlled Health Services
- Cultural Safety Training
“Aboriginal and Torres Strait Islander populations experience serious and persistent disadvantage across a range of areas resulting in poorer health and nutrition status than the general population, including higher rates of poverty and unemployment, lower attendance at school, serious maternal and child health problems, inadequate living conditions, and high levels of incarceration, discrimination and experiences of racism. The impact of historical and social factors such as colonisation, loss of land, removal of children from families, community dislocation and high levels of trauma and grief, has been devastating and pervasive on many levels.”
2008 GHC manual, referencing the Social Justice Report, 2006, ATSI Social Justice Commissioner, report no. 1/2007.
“Reasons for under-utilisation of services in urban areas [relative to the non-Indigenous population]:
- Some mainstream services are planned and delivered so as to meet the requirement of the most common users (therefore do not allow for the special needs of Indigenous peoples)
- Some requirements for accessing services do not take into consideration the lifestyle of Indigenous people
- Financial barriers can constrain access to some services
- People living in the outer suburban fringes of urban centres with limited public transport infrastructure can experience difficulties in gaining physical access to services
- Workforce issues experienced by service providers can restrict Indigenous peoples’ access to services, i.e. staff are not always trained to work in a cross-cultural context or in an environment where they experience the complex problems Indigenous people can often face
- Legacies of history and unpleasant previous experiences with mainstream services can reduce Indigenous use of facilities
- Some services are not delivered in a culturally-safe manner and can make Indigenous people feel uncomfortable when they access them
- There may be poor links between complementary services”
Strategies to combat this:
- Aboriginal Healthcare Workers
- Aboriginal Community Controlled Health Services
- Cultural Safety Training
PCL07 - Cataract Surgery Myat
Cataract surgery, usually an outpatient procedure, takes an hour or less to perform. Eyedrops placed in your eye dilate your pupil. You'll have local anesthetics to numb the area, and you may be given a sedative to help you relax. If you're given a sedative, you may be awake but groggy during surgery. Rarely does anyone require general anesthesia for cataract surgery.
Typically, two things happen during cataract surgery
- The clouded lens is removed
- A clear artificial lens is implanted
In some cases however a cataract may be removed without implanting artificial lens.
Surgical methods used to remove cataracts include:
Phacoemulsification:
In phacoemulsification, your surgeon removes the cataract but leaves most of the back layer of the lens (lens capsule) in place. To do this, your surgeon makes a small incision — about 1/8 inch, or 3 millimeters (mm), long — where the cornea meets the conjunctiva and inserts a needle-thin probe. Your surgeon then uses the probe, which transmits ultrasound waves, to break up (emulsify) the cataract and suction out the fragments. The lens capsule remains in place to provide support for the lens implant.
Extracapsular cataract extraction:
If your cataract has advanced to the point where phacoemulsification can't break up the clouded lens, your surgeon may do an extracapsular cataract extraction. This procedure requires a larger incision, about 2/10 inch (10 mm), where the cornea and sclera meet. Through this incision your surgeon opens the lens capsule, removes the center (nucleus) of the lens in one piece and vacuums out the softer outer lens, leaving the capsule in place. Once the cataract has been removed by either phacoemulsification or extracapsular extraction, a clear artificial lens is implanted into the empty lens capsule. This implant, known as an intraocular lens.
Intraocular Lens (IOL)
IOLs are rigid plastic and implanted through an incision that requires several stitches (sutures) to close. However, many IOLs are flexible, allowing a smaller incision that requires no stitches. The surgeon folds this type of lens and inserts it into the empty capsule where the natural lens used to be. Once in place the lens unfolds to about 1/4 inch (6 mm) in diameter. Recent advances in IOLs include blue-blocking lenses, which filter out ultraviolet light. Other types of IOLs provide multifocal vision — being able to see things both near and at a distance. Multifocal lenses offer reasonably good near and distance vision. However, vision at the intermediate range is sometimes less than satisfactory. Glare is reportedly a problem with multifocal lenses, but design improvements are ongoing.
ResultsCataract surgery successfully restores vision in the majority of people who have the procedure done.
Months to years after cataract surgery, you have a 25 percent risk of developing a condition known as posterior capsule opacification (PCO), or second cataract. This happens when the back of the lens capsule — the part of the lens that wasn't removed during surgery and that now supports the lens implant — becomes cloudy and impairs your vision. The gradual clouding is the result of cell growth on the back of the capsule.
To treat PCO, you need a painless, five-minute outpatient procedure called YAG (yttrium-aluminum-garnet) laser capsulotomy. In YAG laser capsulotomy, a laser beam is used to make a small opening in the clouded capsule to let light pass through.
After the procedure, you typically stay in the doctor's office for about an hour to make sure your eye pressure doesn't increase — a potential complication if you have glaucoma or are extremely nearsighted. Other complications are rare but can include swelling of the macula and retinal detachment.
http://www.mayoclinic.com/health/cataract-surgery/EY00014
Definition - Penny
Cataract: an opacity that develops in the lens of the eye, causing blurred or double vision and sensitivity to light.
Incidence: currently around 2% currently have them and 400,000 new cases each year in the USA
Risk Factors:
female gender
sunlight exposure
myopia
brown irises
cigarette smoking
steroid use
diabetes
trauma
http://www.medterms.com/script/main/art.asp?articlekey=2645
http://www.wrongdiagnosis.com/c/cataracts/prevalence.htm
Incidence: currently around 2% currently have them and 400,000 new cases each year in the USA
Risk Factors:
female gender
sunlight exposure
myopia
brown irises
cigarette smoking
steroid use
diabetes
trauma
http://www.medterms.com/script/main/art.asp?articlekey=2645
http://www.wrongdiagnosis.com/c/cataracts/prevalence.htm
Signs/symptoms
-double or blurred vision
-sensitivity to light and glare (which may make driving difficult)
-less vivid perception of color
-frequent changes in eyeglass prescriptions
>Ben
Sorry I wasnt sure if there was much else needed.
-sensitivity to light and glare (which may make driving difficult)
-less vivid perception of color
-frequent changes in eyeglass prescriptions
>Ben
Sorry I wasnt sure if there was much else needed.
Issues regarding driving - Eunice
Issues regarding driving
- Legal limit for holding a private driver’s license: visual acuity of 6/12 or better. If glasses or contact lenses are required to read the 6/12 line, a condition will be imposed on the driver’s license, requiring him or her to wear the corrective lenses whenever he or she is driving
- Legal obligations:
“The laws require drivers to report to the driver licensing authority if they have any permanent or long-term illness that is likely to affect their ability to drive safely.
As the relationship between patient and health professional is confidential, the health professional will not normally communicate directly with the driver licensing authority. They will provide the patient with advice about their ability to drive safely as well as a letter, or report, to take to the authority (except in South Australia and the Northern Territory, where legislation currently requires the health professional to report directly to the licensing authority if they are concerned about the impact of the patient’s health on their ability to drive safely).“
- If the doctor is aware that the patient is not complying with advice and is continuing to drive and thus endangering other road users and themselves: notify the driver licensing authority directly (VicRoads in Victoria)
http://www.austroads.com.au/aftd/hp.html
http://www.vicroads.vic.gov.au/Home/RoadSafety/SafetyForRoadUsers/OlderDrivers.htm#MC
http://austroads.com.au/aftd/downloads/fitness2dfactsheet1.pdf
http://www.vicroads.vic.gov.au/NR/rdonlyres/B15A81F1-2047-45B0-821C-7AB3317029B6/0/victorianolderdrivershandbook5.pdf
- Legal limit for holding a private driver’s license: visual acuity of 6/12 or better. If glasses or contact lenses are required to read the 6/12 line, a condition will be imposed on the driver’s license, requiring him or her to wear the corrective lenses whenever he or she is driving
- Legal obligations:
“The laws require drivers to report to the driver licensing authority if they have any permanent or long-term illness that is likely to affect their ability to drive safely.
As the relationship between patient and health professional is confidential, the health professional will not normally communicate directly with the driver licensing authority. They will provide the patient with advice about their ability to drive safely as well as a letter, or report, to take to the authority (except in South Australia and the Northern Territory, where legislation currently requires the health professional to report directly to the licensing authority if they are concerned about the impact of the patient’s health on their ability to drive safely).“
- If the doctor is aware that the patient is not complying with advice and is continuing to drive and thus endangering other road users and themselves: notify the driver licensing authority directly (VicRoads in Victoria)
http://www.austroads.com.au/aftd/hp.html
http://www.vicroads.vic.gov.au/Home/RoadSafety/SafetyForRoadUsers/OlderDrivers.htm#MC
http://austroads.com.au/aftd/downloads/fitness2dfactsheet1.pdf
http://www.vicroads.vic.gov.au/NR/rdonlyres/B15A81F1-2047-45B0-821C-7AB3317029B6/0/victorianolderdrivershandbook5.pdf
Cultural Issues - Bryn
Sorry if this isn't much.
In indigenous culture cataracts, or more generally blindness, along with cancer are the two most feared illnesses. This is due to the increased incidence of eye problems in the indigenous communities and poor information about eye problems.
In indigenous culture stigma attached to blindness is uncommon. For example Geoffrey Gurrumul Yunuping a famous indigenous musician (Yothu Yindi and Saltwater band) was born blind.
Other Cultural medical issues
Indigenous culture has a strong emphasis on the important of trained Medical specialists, prior to colonisation tribes and clans had their own "spiritual doctors" who dealt with medical and spiritual matters holistically.
However Aboriginal and Torres Strait Islander health services are now heavily dependent on overseas-trained doctors. These OTDs are increasingly from countries with variable English language. Issues in dealing with indigenous culture, may discourage indigenous people from seeking help.
Sources:
http://www.mja.com.au/public/issues/186_10_210507/ark10209_fm.html
http://www.aboriginalartonline.com/culture/medicine.php
http://www.nirs.org.au/index.php?option=com_content&task=view&id=113&Itemid=11
http://www.iht.com/articles/2008/04/22/asia/musician.php?page=1
In indigenous culture cataracts, or more generally blindness, along with cancer are the two most feared illnesses. This is due to the increased incidence of eye problems in the indigenous communities and poor information about eye problems.
In indigenous culture stigma attached to blindness is uncommon. For example Geoffrey Gurrumul Yunuping a famous indigenous musician (Yothu Yindi and Saltwater band) was born blind.
Other Cultural medical issues
Indigenous culture has a strong emphasis on the important of trained Medical specialists, prior to colonisation tribes and clans had their own "spiritual doctors" who dealt with medical and spiritual matters holistically.
However Aboriginal and Torres Strait Islander health services are now heavily dependent on overseas-trained doctors. These OTDs are increasingly from countries with variable English language. Issues in dealing with indigenous culture, may discourage indigenous people from seeking help.
Sources:
http://www.mja.com.au/public/issues/186_10_210507/ark10209_fm.html
http://www.aboriginalartonline.com/culture/medicine.php
http://www.nirs.org.au/index.php?option=com_content&task=view&id=113&Itemid=11
http://www.iht.com/articles/2008/04/22/asia/musician.php?page=1
Subscribe to:
Posts (Atom)