scholarly journals Glaucoma Screening Skills Among General Ophthalmologists-- How General Should it Be?

2021 ◽  
Author(s):  
Lisika Gawas ◽  
Avik Kumar Roy ◽  
Aparna Rao
Keyword(s):  
Visual Field ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Clinical Presentation ◽  
Clinical Findings ◽  
Field Analysis ◽  
Glaucoma Screening ◽  
Care Institute ◽  
Assessment Skills ◽  
Primary Glaucoma

Abstract Purpose: To compare the glaucoma assessment skills among general ophthalmologists in their referral patients over a span of 5 years.Methods: Details of consecutive new glaucoma patients seen in the glaucoma services of a tertiary eye care institute in 2013 and 2018 were collected from the hospital database. Details of each patient were obtained from the electronic medical records which included the clinical presentation, baseline intraocular pressure (IOP), type and severity of glaucoma, referral details, gonioscopy, HVF (humphrey visual field) data and number of medications. Results: Of 28,886 medical records screened, 211 & 568 new glaucoma patients were retrieved in 2013 & 2018 respectively. The patients presenting in 2018 were younger (58.1±15.4 years) at presentation than in 2013 (65.6±15.2 years); p<0.01 and also had higher baseline IOP (IOP ≥40mm Hg was found in 9.5% in 2018 versus 2.4% in 2013; p<0.01). The percentage of eyes with presenting visual acuity worse than 20/400 or 20/600 was higher in the patients presenting in 2018, (22.2% vs. 15.1%); p=0.03. Though primary glaucoma predominated in both periods, number of eyes referred to as disc suspects showed an increase in 2018 (4.7% to 14.4%; p<0.01). Among 195 & 517 referrals in 2013 and 2018 respectively, the documentation of clinical findings were dismally poor in both the groups in terms of absent gonioscopy (99% vs. 98.2%, p=0.4), absent disc details (89.6% vs. 91%, p=0.5) or absent visual field analysis (79.1% vs. 74.8%, p=0.2). However, the missing of IOP values was significantly better in the latter year (77.3% vs. 57.2%; p<0.01) Conclusion: The increase in number of new glaucoma patients and referrals did not show a corresponding improvement in documentation of findings except IOP recording among general ophthalmologists. Hence we need to re-emphasize on the training of general ophthalmologists on basic glaucoma evaluation to improve their referral ability.

Effectiveness of Ayurvedic intervention in Primary Open Angle Glaucoma (Kaphaja Adhimantha) - A Case Study

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Dr. Ratheesh P. ◽  
Dr. Abhayadev A. ◽  
Dr. Varsha Sumedhan ◽  
Dr. Meghna P P. ◽  
Dr. Srinivasan M ◽  
...  
Keyword(s):  
Visual Field ◽  
Structural Changes ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Treatment Protocol ◽  
Clinical Findings ◽  
Field Analysis ◽  
Open Angle ◽  
Remarkable Change ◽  
Related Disorder

Glaucoma is a diverse group of disorders affecting the eye with a common characteristic potentially progressive optic neuropathy that is determined by both structural changes and functional deficit in which IOP is a key modifiable factor. In Primary Open Angle Glaucoma (POAG), IOP independent mechanisms of glaucomatous nerve damage and visual field loss with unobstructed angle of anterior chamber is observed. The patient has reported gradual diminution of peripheral aspect of visual field (Rt. eye - 6/12 and Lt. eye - 6/12 on Snellen’s distant vision chart) in both eyes for 2 years. There was marked peripheral field defect on both confrontation test and perimetry visual field analysis test. The disease shows clinical similarity with Kaphaja Adhimantha, a disease affecting the whole eye mentioned in Susruta Samhita and Ashtanga Hrudaya. It is a chronic disease comes under life style related disorder. Dukhena Roopam Pasyathi (distorted image or constricted visual field), Sirodukha (headache), Srava (watering), Kandu (itching), Pamsupoornatha (foreign body sensation), Aviladarsana (diminished vision) and Gourava (heaviness of eye and head) are the clinical findings explained in the context of Kaphaja Adhimantha. These clinical finding mentioned in classical literature shows resemblance with POAG. The meticulous deployment of kaphaja Abhisyandha- Adhimantha treatment protocol can be used to prevent the progression of ganglionic damage and preservation of eye sight. The logical interpretation on the basis of both subjective and objective clinical findings concluded the diagnosis as Kaphaja Adhimantha and treatment principle adopted was Apatharpana, Kaphahara, Abhisyandhahara and Srothovisodhana. After treatment his vision has improved as 6/6 (Rt. Eye) and 6/6 (Lt. Eye) and remarkable change in field analysis. The study discusses about the effectiveness of Ayurvedic management in POAG.

scholarly journals Precision medicine in COPD: where are we and where do we need to go?

2018 ◽  
Vol 27 (149) ◽  
pp. 180022 ◽  
Author(s):  
Venkataramana K. Sidhaye ◽  
Kristine Nishida ◽  
Fernando J. Martinez
Keyword(s):  
Precision Medicine ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Clinical Presentation ◽  
Therapeutic Strategies ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Disease Aetiology ◽  
Precision Medicine Initiative ◽  
Integrate Data

Chronic obstructive pulmonary disease (COPD) was the fourth leading cause of death worldwide in 2015. Current treatments for patients ease discomfort and help decrease disease progression; however, none improve lung function or change mortality. COPD is heterogeneous in its molecular and clinical presentation, making it difficult to understand disease aetiology and define robust therapeutic strategies. Given the complexity of the disease we propose a precision medicine approach to understanding and better treating COPD. It is possible that multiOMICs can be used as a tool to integrate data from multiple fields. Moreover, analysis of electronic medical records could aid in the treatment of patients and in the predictions of outcomes. The Precision Medicine Initiative created in 2015 has made precision medicine approaches to treat disease a reality; one of these diseases being COPD.

scholarly journals Auditing service delivery in glaucoma clinics using visual field records: a feasibility study

2019 ◽  
Vol 4 (1) ◽  
pp. e000352
Author(s):  
Stephen R Kelly ◽  
Susan R Bryan ◽  
John M Sparrow ◽  
David P Crabb
Keyword(s):  
Visual Field ◽  
Service Delivery ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Large Scale ◽  
Health Service Delivery ◽  
Mean Deviation ◽  
Normal Limits ◽  
Field Analyser

ObjectiveThis study aimed to demonstrate that large-scale visual field (VF) data can be extracted from electronic medical records (EMRs) and to assess the feasibility of calculating metrics from these data that could be used to audit aspects of service delivery of glaucoma care.Method and analysisHumphrey visual field analyser (HFA) data were extracted from Medisoft EMRs from five regionally different clinics in England in November 2015, resulting in 602 439 records from 73 994 people. Target patients were defined as people in glaucoma clinics with measurable and sustained VF loss in at least one eye (HFA mean deviation (MD) outside normal limits ≥2 VFs). Metrics for VF reliability, stage of VF loss at presentation, speed of MD loss, predicted loss of sight years (bilateral VF impairment) and frequency of VFs were calculated.ResultsOne-third of people (34.8%) in the EMRs had measurable and repeatable VF loss and were subject to analyses (n=25 760 patients). Median (IQR) age and presenting MD in these patients were 71 (61, 78) years and −6 (–10, –4) dB, respectively. In 19 264 patients with >4 years follow-up, median (IQR) MD loss was −0.2 (−0.8, 0.3) dB/year and median (IQR) intervals between VF examinations was 11 (8, 16) months. Metrics predicting loss of sight years and reliability of examinations varied between centres (p<0.001).ConclusionThis study illustrates the feasibility of assessing aspects of health service delivery in glaucoma clinics through analysis of VF databases. Proposed metrics could be useful for blindness prevention from glaucoma in secondary care centres.

scholarly journals Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Odhran O'Donoghue ◽  
Anuraag A Vazirani ◽  
David Brindley ◽  
Edward Meinert
Keyword(s):  
Systematic Review ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Research Question ◽  
Design Development ◽  
Trade Offs ◽  
Business Application ◽  
Assessment Skills ◽  
Meta Analyses ◽  
Quality Assessments

BACKGROUND A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as “a compromise between two desirable but incompatible features.” OBJECTIVE This review’s primary research question was: “What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?” METHODS Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis. RESULTS A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture. CONCLUSIONS The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain. INTERNATIONAL REGISTERED REPOR RR2-10.2196/10994

Adolescent Substance Use Screening Integrated With Electronic Medical Records

2014 ◽  
Author(s):  
C. McKenna ◽  
B. Gaines ◽  
C. Hatfield ◽  
S. Helman ◽  
L. Meyer ◽  
...  
Keyword(s):  
Substance Use ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Adolescent Substance Use ◽  
Adolescent Substance

Computer-Aided Diagnosis in Jaundice: Comparison of Knowledge-based and Probabilistic Approaches

1996 ◽  
Vol 35 (01) ◽  
pp. 41-51 ◽  
Author(s):  
F. Molino ◽  
D. Furia ◽  
F. Bar ◽  
S. Battista ◽  
N. Cappello ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Clinical Information ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Clinical Documentation ◽  
Data Set ◽  
Knowledge Based ◽  
Number Of Patients ◽  
Support Tools ◽  
Aided Diagnosis

AbstractThe study reported in this paper is aimed at evaluating the effectiveness of a knowledge-based expert system (ICTERUS) in diagnosing jaundiced patients, compared with a statistical system based on probabilistic concepts (TRIAL). The performances of both systems have been evaluated using the same set of data in the same number of patients. Both systems are spin-off products of the European project Euricterus, an EC-COMACBME Project designed to document the occurrence and diagnostic value of clinical findings in the clinical presentation of jaundice in Europe, and have been developed as decision-making tools for the identification of the cause of jaundice based only on clinical information and routine investigations. Two groups of jaundiced patients were studied, including 500 (retrospective sample) and 100 (prospective sample) subjects, respectively. All patients were independently submitted to both decision-support tools. The input of both systems was the data set agreed within the Euricterus Project. The performances of both systems were evaluated with respect to the reference diagnoses provided by experts on the basis of the full clinical documentation. Results indicate that both systems are clinically reliable, although the diagnostic prediction provided by the knowledge-based approach is slightly better.

A Retrieval System for a Library of Pathology Reports, Slides and Kodachromes

1972 ◽  
Vol 11 (03) ◽  
pp. 152-162 ◽  
Author(s):  
P. GAYNON ◽  
R. L. WONG
Keyword(s):  
Medical Records ◽  
Operative Procedure ◽  
Clinical Findings ◽  
Free Text ◽  
X Ray ◽  
Inverted File ◽  
Natural Language Parsing ◽  
On Line ◽  
Pathology Reports ◽  
Frequency Counts

With the objective of providing easier access to pathology specimens, slides and kodachromes with linkage to x-ray and the remainder of the patient’s medical records, an automated natural language parsing routine, based on dictionary look-up, was written for Surgical Pathology document-pairs, each consisting of a Request for Examination (authored by clinicians) and its corresponding report (authored by pathologists). These documents were input to the system in free-text English without manual editing or coding.Two types of indices were prepared. The first was an »inverted« file, available for on-line retrieval, for display of the content of the document-pairs, frequency counts of cases or listing of cases in table format. Retrievable items are patient’s and specimen’s identification data, date of operation, name of clinician and pathologist, etc. The English content of the operative procedure, clinical findings and pathologic diagnoses can be retrieved through logical combination of key words. The second type of index was a catalog. Three catalog files — »operation«, »clinical«, and »pathology« — were prepared by alphabetization of lines formed by the rotation of phrases, headed by keywords. These keywords were automatically selected and standardized by the parsing routine and the phrases were extracted from each sentence of each input document. Over 2,500 document-pairs have been entered and are currently being utilized for purpose of medical education.

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