Meika Close, MD

• Department of Emergency Medicine
• Mount Sinai School of Medicine
• New York, New York

The patient/representative is responsible for completing the other sections and mailing or delivering the form to the ministry prostate cancer 9th stage buy proscar mastercard. No fee can be charged to either the patient or the ministry for the completion of the form prostate cancer nomogram buy proscar 5mg without prescription. My patient has reported his or her red and white card stolen/lost but has not received a replacement health card yet prostate cancer books discount proscar 5 mg free shipping. A Transaction Record with the version code of the new card is issued to clients during their visit to a ServiceOntario centre to process their new/replacement photo health card define androgen hormone order proscar online now. The Transaction Record is to be used to obtain medical services prior to receipt of their new photo health card prostate lower back pain best proscar 5 mg. My patient went to a ServiceOntario centre to renew his or her photo health card but has not received a new health card prostate oncology youtube best purchase for proscar. The patient has presented their previous health card with a hole punched in it as well as a transaction record that does not have a version code indicated on it. A Transaction Record without a version code or a hole-punched health card indicates that a health card has been issued, but the new version code is not active yet. A claim should be submitted under the old version code on the hole punched health card. What should I do if I suspect that one of my patients is no longer living in the province and returns to Ontario only when in need of medical servicesfi Kiosks are similar to automated teller machines and provide extended hours of service seven days a week. Your patient will need their health card and the health cards of all members of their family as well as their new address and postal code. The ministry appreciates your assistance in reminding patients that they must notify the ministry of any change in address information. If your patient plans to travel outside of Ontario, it is strongly recommended they obtain additional private medical insurance and fully understand what the policy covers. The Emergency Health Services Branch achieves this by: Overseeing air and land ambulance services, as well as the communications centres responsible for dispatching those ambulance services; Managing and regulating the land ambulance services provided by upper tier municipalities and District Social Services Administration Board, as well as providing administrative, operational, and technical support of ambulance services; Establishing standards for the management, operation, and use of ambulance services and assuring compliance with those standards; Maintaining close working relationships with the municipalities and designated delivery agents responsible for the proper provision of land ambulance services; with health care providers and facilities; with ambulance communications centres, and with other ministries and system stakeholders; October 2015 6 4 Version 2. Devices covered by the program are intended to give people increased independence and control over their lives. They may allow them to avoid costly institutional settings and remain in a community living arrangement. Staff at the centres, provide information and coordinate professional, personal support and homemaking services for people living in their own homes and for school children with special needs, and make arrangements for admission to long-term care facilities. Cancer Care Ontario releases standards and guidelines for care, services provided, prevention methods, wait time lists and information on breast, cervical and colorectal screening. It has gradually expanded its role to address the issue of health human resources in southern communities. The program is administered by Health Care Programs Division, North Region Branch, to enhance access to health care services in designated rural and remote areas of the province, which have difficulty attracting and retaining health care professionals. It offers a variety of components aimed at attracting and retaining health care providers to underserviced areas in Ontario. The program encourages community living by offering a housing alternative to institutional care. The contents are regularly reviewed and are founded upon best practice and the appropriate evidence base. It is therefore for use only between the dates clearly printed on the front cover. It consists almost exclusively of Clinical Guidelines, with occasional Policies. For each section: the Clinical Sponsor is Dr C Rimmer Definitions Clinical Guideline this is a systematically developed statement to assist practitioner and patient decisions about appropriate health care for specific circumstances. They sit alongside, but do not replace, the knowledge and skills of experienced health professionals. When following protocols you will be expected to document reasons for deviations from the detailed plan for clinical, ethical and legal purposes. Policy this is a statement of intent that an organisation will follow a particular course of action. High quality communication with children; parents, carers and colleagues accurate and complete written records of care / Medway entries 2. Accurate pathology sample / request form information especially for request to cross match blood. Prevention of Cross Infection Hand washing (right time, place and technique) Management of invasive devices All the above have written standards and will be subject to audit and incident reports of non compliance. However, parents often become very anxious about the condition of their child, even if the child is not seriously ill or injured. Be aware of the parent who insists that there is something wrong with their child. There are paediatric medical, surgical, orthopaedic and anaesthetic doctors on-call within the hospital. These teams include Gastroenterology Neurology / Epilepsy Immunology Allergy Diabetes / Endocrine Respiratory Metabolic Rheumatology C. Diagnosis / Problem Treatment / Care Plan Investigation / Referral Review / Evaluation / Discharge Drug therapy record Record of information given to patients / parents, both written and verbal. On discharge or transfer of patient, check and complete the computer clinical details, (Medway) including the time patient left the Department (if you are the last member of staff to deal with the patient). It is updated regularly and should not be used either a) outside of the effective dates clearly stated in the footer of each page or b) outside of the environment to which it relates i. If, for example, you take this book with you to your next training post and rely upon it there for clinical decision making, we cannot be held responsible for any problems that arise as a result. It is essential to take responsibility for finding out which teaching sessions you are supposed to attend, where these are and for turning up on time. This can range from the initial design, through data identification, collection and analysis, to the preparation of final reports and presentation materials. Taxis can be provided by the hospital only if there is a valid medical indication. If a taxi is medically indicated the family will need a letter to support this from the doctor. Callers contacting the Emergency Department directly should similarly be advised to speak to 111. If an enquiry is related to an obvious emergency that either requires attendance to the Emergency Department or the need to call for an ambulance, then the parent should be advised to call 999, we cannot do this for them. If a detailed discharge note is required, make use of the free text box within this section of Medway. If matters are more urgent, the discharge letter can be printed off directly via Medway at the time of discharge and posted or sent with the patient. This pathway is a useful way of allowing patients to appropriately re-enter the primary care system when they may have become stuck re-attending the Emergency Department for problems that should be managed in a General Practice setting. All discharge letters from Medway are notified to the health visitor (under 5s) and school nurses (over 5s) (Section 1. Information may be given to the police if the patient with capacity and/or the parent/carer consents or without consent only if this would be in the public interest. In all cases consent to release information should be requested unless it is impractical to do so, or when it would undermine the purpose of the disclosure (ref 5). The genuine identity of the police officer making the request should be confirmed. If the police contact the department on the telephone about a patient then you need to confirm their identity which involves calling them back via their switchboard. The information may only be given to a police officer of the rank of inspector or above by the senior doctor in the department, after the Consultant or senior doctor available has agreed to release the information. This will usually be limited to the minimum, or relevant, information, to satisfy the request. In practical terms this is usually only a statement of whether the child has attended and was admitted or discharged, and no more. It should be noted that there are specific statutory requirements for disclosures to the police, for example, under the Road Traffic Act (1988), the Prevention of Terrorism Act (2000), Female Genital Mutilation Act (2003) (ref 5, 6). Police Statements As a general rule, signed parental permission should be obtained before medical details are released in a police statement (see section 1. All these cases should be referred to the Consultant in charge of the case in question prior to the release of information. The doctor should provide such treatment as is immediately necessary ranging from sutures / dressing to the more serious cuts / wounds. The doctor should take the immediate steps medically necessary to contain the situation and delay the less urgent measures until the parents have been consulted. The clinician should offer information about the consequences of refusal and offer a further opportunity. If they refuse treatment, particularly treatment that could save their life or prevent serious deterioration in their health, this presents a challenge that needs careful consideration (Ref 1) and should always involve the Emergency Department Consultant. Parents cannot override the competent consent of a young person to treatment that you consider is in their best interests (Ref 1). In such situation it is advised to seek legal advice if you think treatment is in the best interests of a competent young person who refuses (Ref 1). Any person with parental responsibility may act alone, except in a way which is incompatible with an order. If the child is the subject of a court order, you must find out the directions of the court. This rule of access applies to anyone making an enquiry including other clinicians, Trust employees, Governance Department / Risk, the Police etc. Requests must be in writing and should be forwarded to the Trust Head of Risk Management in a sealed envelope. It has a different ring tone to the rest of the department phones and should not be ignored if you are the only person available to answer it. It is a form designed primarily for trauma cases but is used also for the medical cases phoned through. Document this and hand it to the most senior medical member of staff in the department. This involves the additional input of the surgeons who may be key in helping to reverse the cause of the initial arrest. Designate a team leader and prepare team badges, available on entry into resus from the Nurses station. During the day when more members, and more senior staff, are on duty, it may be appropriate to wait until the patient arrives to assess the situation. The yellow Patient Record Form that the crew fill out has a place to sign and time the handover process and this should be filled in wherever possible. Remember prioritisation is not needed when there is a doctor or nurse practitioner immediately available to see the child. However, some children will still benefit from a brief assessment (generally illness presentations) where they are weighed and base line observations recorded. This should include a brief assessment and referral to the on-call Speciality team. Post-operative wound infections, orthopaedic frames concerns, plastic surgery wound dressing issues and ongoing medical conditions are good examples of this. Triage of walk-in patients is unnecessary when streaming is in operation and there is no queue. Triage / Assessment nurse will assess suitability of children to be included in the stream (quick visual assessment only if no queues). The treatment nurse can select patients for stream when the triage nurse is busy or there is a queue for triage. Staff in dedicated stream will not be allocated other duties or moved unless exceptional circumstances arise, i. During busy times for streaming, extra staff can be asked to help see patients / do treatments, if majors are quiet. The room should be set up with scales / dressing trolley (fully stocked), to ensure treatments can be carried out in the room. Any case in the Resuscitation Room when the Consultant is not in the building where you require advice or support. Any cases causing concern which are not being addressed by the medical staff in the hospital 5. Any matters which need a Consultant, which concern you enough and which cannot wait until the next working day. You should inform the Consultant on-call the following morning of: Child protection cases. Inform the nurse coordinator each shift who is providing the medical co-ordinator role. In general, this role is about deflecting interruptions away from the rest of the team to maximise their efficiency.

For varied reasons prostate cancer karyotype discount 5mg proscar mastercard, these patients are more prone to the side effects including worsening irritability and aggression prostate and bladder buy generic proscar. Treatment of bipolar disorders is usually focused on maintaining the safety of the patient while assessing the severity of manic or hypomanic symptoms prostate one a day buy proscar with paypal. Atypical antipsychotics man health zinc order proscar in united states online, lithium carbonate prostate cancer lancet oncology purchase 5mg proscar, and sodium valproate are usually the first choices prostate cancer ketogenic diet buy genuine proscar line. Anxiety disorders: these disorders usually present with sudden deterioration in functioning, compulsions, rituals, phobias, and repetitive behaviors. Because of the ego-dystonic nature of these disorders, they are easier to diagnose in autistic indi viduals with preserved language abilities. Both typical and atypical antipsychotic medications can be used to target these symptoms. Hyperactivity and inattentive symptoms are commonly associated with autistic disorder. Behavioral management and stimulant medications are the mainstay of the treatment. Alpha agonists are also commonly used, as some children with autism are unusually sensitive to stimulant medications. Conclusions With better understanding of the diagnostic criteria and symptom checklists, diag nosing autism spectrum disorder is far less than a daunting task. Attention should be paid to the associated comorbid disorders and advocating for the child to receive appropriate educational and community services. Some symptoms can be better managed by behavioral interventions than by psychopharmacological management. A good working knowledge of the available services in the community is important to achieve this goal. Acknowledgments Author gratefully acknowledges the editorial contributions by Dr Michael Liepman in the preparation of this manuscript. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2006 Principal Investigators. Repetitive and stereotyped behaviors in children with autism spectrum disorders in the second year of life. Autism: Caring for children with Autism spectrum disorders: A resource toolkit for clinicians. Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. Management involves psychological therapy often in conjunction with pharmacologic treatment. The emphasis in this chapter is on the pharmacologic approach that includes psychostimulants, antidepressants, alpha-2 agonists, and a norepinephrine reuptake inhibitor. Management of these patients should emphasize a multimodal approach with careful long-term follow-up by the clinician. In the early twentieth century England, this condition was linked to hyperactivity and unruly behavior typically in boys and sometimes involved in the juvenile court system [2]. Management involves psychological and pharmacologic strate gies and in 2006, 5 million persons in the United States were prescribed stimulant medication that included 3. This is the criteria used in this chapter, though there are others, such as that used by the International Classification of Diseases, 10th ed. Many decades of research have observed the potentially severe impairment in social skills attainment, 8 Attention Deficit Hyperactivity Disorder 113 Table 8. It is a neurobehav ioral and neurodevelopmental disorder as demonstrated by modern neuroimaging. Previous evaluations and testing from other physicians, psychologists, and others may be useful. A number of mechanisms may account for such comor bidity including shared noradrenergic system dysregulation and genetic factors. As noted, there is much overlap between the various comorbidities that include various neurodevelopmental disorders. Chronic lack of proper sleep that develops a major sleep debt will worsen or stimulate the development of various psychiatric disorders in these patients [24]. This child or adolescent should be in the proper school or class placement to help with any additional learning problems. Behavior therapy is important along with others as needed, such as speech therapy, occupational therapy, and/or physical therapy depending on the individual needs of the child or adolescent. However, it also verified the efficacy of combining a pharmacologic approach with psychological therapies as well. Other drug classes are also beneficial, including antidepressants, alpha-2 agonists, and norepinephrine reuptake inhibitors. The clinician should avoid focusing only on medication in the clinical encounter, which implies to families that medication use alone should be the remedy to all problems. It further implies that when things are not going well, the problem must be with the choice or dose of medication. This shifts responsibility for problems completely to the clinician who must then urgently find the right medication 2. Wait for the patient/family to approve of a trial medication period before embarking on medication management. Educate the patient/family about potential side effects of medications and how you will deal with them; follow these patients on a regular basis to monitor efficacy and adverse effects 6. Provide a thorough evaluation of the patient and family to determine possible comorbidities that may benefit from other medications 7. Begin with a low dose and increase slowly until identified target symptoms are sufficiently improved; stop the medication(s) if side effects are unacceptable or upper medication levels are reached without amelioration of target symptoms 9. Specific medications and doses may vary from patient to patient and are identified by careful trial and error. Medication(s) that are helpful may change as the child emerges to adolescence and adulthood 10. Adolescents may require a medication dose higher than needed for adults because of increased renal clearance of drugs, lower body fat percentage, increased liver metabolism, or idiosyncratic medication metabolism 11. Strive to achieve complete syndrome remission if feasible (rather than settling for symptom improvement) 12. Share responsibility explicitly by clearly stating what issues the family must work on, the school must work on, the child or adolescent must work on, and the physician must work on Source: Modified with permission from Greydanus and Pratt et al. It is a non-amphetamine sympathomimetic chemical that has mild central nervous system stimulant effects because of brain stimulation and cortical arousal system activation [60, 61]. A number of assessment instruments have been developed to assist in measurement of drug benefit and these include patient/parent interviews, ratings of parents or guardians, and reports of school teachers (including grades and written documents) [62]. There is no unbiased research that is currently available to guide clin icians in which of these products are best [64, 65]. Thus, a trial and error technique is used often based on personal clinician preference as well as insurance acceptability. Some researchers conclude that there is better compliance with longer acting (extended-release) stim ulants versus short-acting stimulants [67]. For example, studies note that at least half of adolescents prescribed stimulants are not compliant, though long-acting medications may improve adherence in these youth [15]. This chemical is classically produced as dextroamphetamine sul fate (the dextro isomer of D,L-amphetamine sulfate) or as mixed amphetamine salts. Lisdexamfetamine dimesylate is an inactive, water-soluble prodrug in which D-amphetamine is bonded to L-lysine and after oral ingestion, it is metabolized into L-lysine and active D-amphetamine [70]. However, as noted with other long-acting stimulants, its actual advantage or differ entiation over other available long-acting products remains unclear [72]. There are rare reports of sudden death of pediatric and adult patients on stim ulants, some of which seem to be due to underlying cardiovascular conditions; thus, stimulants are avoided in those patients with significant structural heart con ditions, symptomatic heart disorders. Based on rare but well-known reports of significant cardiovascular side effects in children, adolescents, and adults on stimulants, United States Food and Drug Administration has required the placement of a strong warning on stimulant labels that alert clinicians and patients to this possibility. Stimulant Side Effects Potential adverse effects of stimulants are listed in Table 8. Nausea and emesis associated with stimulant use may be relieved by taking the medication with meals. Dizziness is typically worse with short-acting versus long-acting stimulants; also, if dizziness occurs, correct for any associated dehy dration and observe for blood pressure alterations. Stimulant-associated headaches may be noted at peak plasma levels or at times of medication withdrawal; switching to another formulation may be beneficial in such cases. Most children grow normally on stimulants though controversy in this regard has raged for many years [86]. Some growth delay may be due to reduced food intake due to the anorexia side effect noted with stimulants, though most will attain their genetically directed ultimate adult height. Children and adolescents who are not growing well and do not have a primary growth condition may benefit from taking them off stimulants for a period of time. Tolerance is a well-known phenomenon that may arise with use of stimulant and typically can be seen in those on high-stimulant doses or who chronically abuse these medications. If rebound occurs, try using a lower dose of immediate-release stimulant in the afternoon or prescribed a sustained-released for mulation. Thus, provide a thorough evaluation for sleep problems in these children or ado lescents and treat any primary or secondary problems that may arise; see Chapter 11 on Sleep Disorders in this text [24, 34]. Sometimes the insomnia will improve over time if other insomniac causes are not present. Additional measures that can be considered including giving the last stimulant dose earlier in the day, reducing the amount of the last dose, or use a long-acting product in the morning only. One should remember that most currently available long-acting stimulants exert effects for up to 12 h or more [71]. Resent research suggests that the combination of melatonin or extended-release guanfacine (see later in this chapter) with stimulants appears to be safe and potential effective in promoting sedation [61]. Supratherapeutic doses of dextroamphetamine may also worsen tics and should be avoided [92]. Monitoring Patients on Stimulants There is no research regarding long-term use of stimulants, though there is none to suggest this practice is harmful and is accepted practice if the medication continues to be helpful. Those on stimulants should have monitoring of blood pressure and pulse at each visit, since these are often mildly increased when on stimulants. Those on long-term stimulant use also should have a periodic complete blood count that includes a differential and platelet count. Atomoxetine can be prescribed for oral use in various capsule dosages: 10, 18, 25, 40, 60, 80, and 100 mg. If the patient weighs over 70 kg, an initial dose of 40 mg/day is suggested that is titrated up to 80 mg/day (single to over two doses) not to exceed 100 mg/day. There is no increase in tic, cardiovascular complications, drug diversion, or drug addiction for those taking atomoxetine [92, 99]. Since there is a heightened risk for mydriasis, it should be not prescribed for patients with narrow-angle glaucoma. Children and adolescents who are on atomoxetine should be monitored for increased Table 8. There is also a warning regarding potential hepatotoxicity and thus baseline and periodic liver func tion testing are necessary for those taking atomoxetine. It is an alpha2-adrenergic agonist that stimu lates alpha2-adrenoreceptors in the brainstem and induces a reduction in central nervous system outfiow. Careful titration is needed for building up and stopping this medication and the dosage range is usually 0. Avoid sudden cessation since this may lead to severe rebound hypertension, cerebrovascular accidents, and even sudden death. Patients taking clonidine should be observed for hypotension and rebound hypertension. The patch formulation provides clonidine effects over several days and may result in less sedation than noted with the oral form, thus potentially improving compli ance with some patients. Dermatitis may occur as noted with any patch formulation; if dermatitis develops, local application of hydrocortisone and changing the patch site are usually effective. Stop the patch formulation if severe skin reactions occur; in such cases, do not then try oral clonidine since this may lead to a generalized dermatological reaction such as angioedema or acute urticaria. In general, side effects are similar to that seen with clonidine, though more agitation and headaches are noted with the short-acting formulation. It should be remembered that rebound hypertension is well known with immediate-release alpha-2 agents. It can lead to some cardiovascular changes (mild heart rate and blood pressure reduction); thus, vital signs should be monitored and it should be avoided in patients with significant cardiovascular disease [102].

Nurse specialist treatment of eye emergencies: Five year follow up study of quality and effectiveness man health 9 news generic 5 mg proscar with mastercard. Leading causes of certification for blindness and partial sight in England and Wales prostate xl5 order 5mg proscar with amex. The Implementation of Prompted Retinal Screening for Diabetic Eye Disease by Accredited Optometrists in an Inner city District of North London: a Quality of Care Study mens health quinoa recipe discount proscar line. Impact of direct electronic optometric referral with ocular imaging to a hospital eye service androgen hormone migraine proscar 5 mg overnight delivery. Comparing costs of monitoring glaucoma patients: hospital ophthalmologists versus community optometrists androgen female hormones buy proscar 5mg lowest price. Optometric and ophthalmic contact in elderly hip fracture patients with visual impairment mens health nz buy discount proscar 5 mg. Streamlining the patient journey: the interface between community and hospital-based eye care. Paediatric community vision screening with combined optometric and orthoptic care: a 64-month review. Patient pathways for macular disease: what will the new optometrist with special interest achievefi Reliability of ophthalmic accident and emergency referrals: a new role for the emergency nurse practitionerfi Changing the Delivery of Patient Care: Shared Care of Patients with Ocular Hypertension. Optometric glaucoma referrals measures of effectiveness and implications for screening strategy. Referrals for cataract surgery: variations between different geographic areas within a Welsh Health Authority. The Bristol shared care glaucoma study validity of measurements and patient satisfaction. Health for All Children: Guidance on Implementation in Scotland A draft for consultation. Improving diabetic eye care in the community: the use of an eye care co-operation card. Screening for prevention of optic nerve damage due to chronic open angle glaucoma. Evaluation of a district wide screening programme for diabetic retinopathy utilizing trained optometrists using slit-lamp and Volk lenses. Sensitivity and specificity of two glaucoma case-finding strategies for optometrists. Cost effectiveness analysis of screening for sight threatening diabetic eye disease. Trends in blind registration in the adult population of the Republic of Ireland 1996-2003. Glaucoma screening by optometrists: positive predictive value of visual field testing. Community Eye Care Services: Review of Local Schemes for Low Vision, Glaucoma and Acute Care. Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension. A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy. The Kettering Diabetic Monitoring Programme: twelve months experience of an optometric practice based scheme. Effectiveness of optometrist screening for diabetic retinopathy using slit-lamp biomicroscopy. A guide to low vision services and the low vision aids available for children in Wales. Royal College of Ophthamologists (2004) the Future of Ophthalmic Primary Care, Primary care subcommittee meeting 2004. Randomised controlled trial of an integrated versus an optometric low vision rehabilitation service for patients with age-related macular degeneration: study design and methodology. An evaluation of the change in activity and workload arising from diabetic ophthalmology referrals following the introduction of a community based digital retinal photographic screening programme. The content of optometric eye examinations for a presbyopic patient presenting with symptoms of flashing lights. Glaucoma detection: the content of optometric eye examinations for a presbyopic patient of African racial descent. Cataract assessment and direct referral: Stockport optometrists take the initiative. Novel optometrist led all Wales primary eye-care services: evaluation of a prospective case series. Ten years of glaucoma blindness in Fife 1990-99 and the implications for ophthalmology, optometry and rehabilitation services. Effectiveness of screening older people for impaired vision in community setting: systematic review of evidence from randomised controlled trials. The Bristol shared Care Glaucoma Study: reliability of community optometric and hospital eye service test measures. Comparison of optometry vs digital photography screening for diabetic retinopathy in a single district. The Future of Optometric Services in Primary Care In Wales: a consultation document. Coverage of screening for diabetic retinopathy according to screening provision: results from a national survey in England and Wales. General Information Study number First 6 words of title Authors Occupation/role of Optometrist fi Researcher/Academic fi main authors Ophthalmologist fi Other . Publication date (year) Journal Institution of authors If in a hospital, which dept/ clinic (if listed)fi Professional groups studied and numbers if given Eye specialists (list) Optometrists fi Number surveyed . Methodological Details: study details Focus of study Organisation of services fi Shared care fi Other (describe). Eye condition Glaucoma fi Cataracts fi studied Low Vision fi Diabetic retinopathy fi Vision pathway fi Childhood eye problems fi Range of eye conditions fi Other . Key words given on paper Dates data collected Duration of study Method and place of recruitment (if any) Patient population. Possible to Yes fi Partly fi Unsure fi No fi implement the initiative in another area (from the data presented)fi Reviewer Notes Summarise main results: Key recommendations for future working: References to checkfi G P referral 113 patientswere H igh levelsofpatient Personalcommunication onanew G P referral sch eme to seeninth e firstyear satisfaction with th e auth oralso sch eme (G Ps accredited suggestspatients referringtoth e local optometristsin perceive greater accredited th e community convenience inth e optometrist) optometristpractice based A z uaro 2007 Scotland Comparisonofth e Case note coh ort N o. Th e case 295 (case notes) H igh false positive rate accuracyby note analysis noteswere (36%). N otapplicable N otapplicable conceptof optometristswith in th e primarycare context. N otapplicable G ilch ristarguesth at conventionaluse of diagnosesare gained specificityand onlyonth ose patients sensitivityas wh oare referred,and measurementsfor th erefore th e disease th e effectivenessof statusofth ose not screening referredremains unknown. A n patientsreceivingan operationcard additional133 were examinationinth e foundforth e second precedingtwoyears. Th e effectiveness Th e resultssuggested Dataofth iskind studiesfrom effectivenessof datawasderived th atsystematicscreening suggestsonly L iverpooltoascertain systematic from twoL iverpool ismore cost-effective systematicscreening th e cost ph otograph ic studies,th e firstwith th anopportunistic. F urth ermore,47% of referralsforcataractlater resultedinth ese patients beinglistedforcataract surgery,representinga somewh atlower proportionth anth e later studyin2006. Th ose underth e Th e reportdoesnot commencementofa recruitedaccordingto treatmentofth e G P presentanyresults collaborative study th e H ealth A uth ority orh ospitalwere not h owever,anditisunclear fundedbyBrixton list. Th e wouldlike totrainto optometricarea registered vastmajorityfelt become accredited ofprescribing. O ptometrists inh ospitalwere also more likelytomanage acute sigh t-th reatening diseases. W aitingtimesdropped Cambridgesh ire referralsch eme referrals(direct from 15 to3 month sfor referrals)compared th e entire cataract with anoth er100,non path way,beingth e directreferrals nationaltargetderived from th e Departmentof H ealth (A ctionon Cataracts,2000,DoH). Th e smallauditof referrals(100 direct referralscomparedwith 100 non-directreferrals) sh owedsimilarlevelsof post-operative visual acuityandpost-operative refractionlevelsinboth routes. F urth ermore,it wasconcludedth ata review ofacoh ortof patientstoch eck optometricsensitivity andspecificityby oph th almologistswas necessaryforfuture working. Cataract wash oweverth e most frequentlystated diagnosisbyth e optometrists(in27% of referralcases) 112 A uth ors Date L ocation Description Design N ew initiative Participants/ O utcome Comments/notes numberofcase wh ere applicable notes Prasad etal. Th ispaperdescribedth e furth erresearch is traditionalh ospital Randomisedto designandmeth odology, requiredregardingth e basedeye care studyarm anddoesnotpresent outcome ofL V sh ared service with an conventional, dataregardingth e care services. Th is anyfloatersinh isvision, designisused 66% alsorecommended th rough outallSh ah et fundoscopyscreening al. Scotland Surgeryauditdata paperin2000,one-stop (2004)maysuggesta from 1997 inF ife was cataractclinicswere needtoreview th e use usedtoprovide th e h avingamassive impact ofoptometrictime with nationalcomparison. H ospital referralsfor reviewedfrom 60s(22/87 and th e use ofallth ree types accuracyimprovedas suspectedglaucoma optometristsfrom 24/87 respectively). Th e measureswere not takenbetweenth e time pointsandalso representrelativelyold data. Sensitivityfell geograph icalareath e screenedduringth e somewh atsh ortofth e sch eme couldbe viewed studyperiod. Th e are inplace,andth isis toth e assessment research team dependentuponth e andmanagementof receivedresponses referralroute. Th ere wasalsomore doublingoftestingwith in optometrysch emes, th ough such sch emes alsorecommendearly referralforuncertain cases. The optometrist conducts a sight test, diagnoses the cataract and discusses this with the patient. The risks and benefits of surgery are discussed and if the patient wishes to proceed, information regarding the surgery is provided. A pre-assessment with a nurse also happens at this stage, and cataract surgery is agreed/ arranged. The patient is advised and given information and further appointments made where necessary. They are also provided with counselling and advice on employment and education if required. Spectacles, Low Vision Aids and advice with regard to lighting, contrast and size and home adaptations are discussed and made available where appropriate. A referral to other areas of health and social care are also made where necessary, including certification of partial sight. The patient has follow up visits when required, and the visits can take place in the patients home or elsewhere, and the visit will be by an appropriate member of the low vision team. They contain a tear-off form that the patient can fill in and send to their local social services to request an assessment. Type 2 diabetes:N ationalclinical H ealth G uidelines Includesth e treatmentofeye conditionsassociatedwith guideline formanagementinprimary diabetes. Th e report essentiallycritiquesth e currentsystem forscreening ch ildren,andpointstoalack oforth opticservices. A nnualEvidence Update on Research evidence summary Th isarticle summarisesth e evidence regardingglaucoma G laucoma-Service Provision from anacademicperspective. K ent-G laucomareferralrefinement Primarycare resource pack Th isprimarycare resource pack isth e documentsubmitted sch eme inordertodevelopth e K entglaucomasch eme involving optometristco-managementofth e condition. G O C (G eneralO pticalCouncil)(1) G O C Bulletin N ewsletter Th isnewsletterisforallwh oreadth e G O C updates.

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