published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

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M.Cur. / Daar is nie genoeg effektiewe, bekostigbare oogsorgdienste in Suid-Afrika nie. Suid-Afrika beskik oor meer geregistreerde verpleegkundiges as algemene praktisyns, oftalmoloe of optometriste. Daar bestaan reeds 'n goedgekeurde kursus in oftalmologiese verpleging en daarom is geregistreerde verpleegkundiges die mees geskikte vir opleiding in oftalmologie. Dit sal meer kosteeffektief wees om 'n verpleegkundige in primere oogsorg aan te wend. Tans is daar 'n groot aanvraag vir oogsorg op primere vlak. In Suid-Afrika, wat gedeeltelik 'n derdewereldland en gedeeltelik 'n eerstewereldland is, is primere oogsorg nog heeltemal ontoereikend, aangesien die meeste van die oogsorgdienste in die hoofstede gesentreer is. Dit veroorsaak dat die oftalmologiese departemente heeltemal oorlaai word deur oogtoestande wat op primere vlak gehanteer kan word. Navorsing het getoon dat 85% van pasiente wel op primere of sekondere vlak gehanteer kan word (Community Eye Health Workshop, 1996). Die persentasie mense met belemmerde visie (tydelik of permanent) word jaarliks meer, en die beste manier om dit te verhoed is die vroegtydige opsporing van daardie pasiente op primere vlak. In Suid-Afrika word die dienste van oftalmologiese verpleegkundiges nog nie ten voile benut nie, terwyl hulle, as gevolg van hul opleiding, 'n groot rol behoort te speel in die voorkoming van belemmerde visie. Dit geld veral op plattelandse gebiede, waar die oftalmologiese verpleegkundige die eerste kontakpersoon is. In stedelike gebiede, waar daar lang waglyste is by openbare gesondheidsorghospitale, behoort die oftalmologiese verpleegkundige ook aangewend te word om waglyste te verkort. Die vraag ontstaan dus: Wat is die rol van die oftalmologiese verpleegkundige in primere oogsorg?

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Bakgrund: Synen är ett av våra viktigaste sinnen för att samla information om omgivningen. Under 2023 vårdades ca 6000 personer i Sverige med respiratorbehandling på intensivvårdsavdelningar. Upp till 40% av dessa patienter drabbas av ögonkomplikationer. Många patienter på intensivvårdsavdelningar förlorar ögonens normala funktioner, inklusive tårproduktion och blinkreflex, vilket kan leda till skador. Faktorer som sugning av luftväg, PEEP, sederande läkemedel och muskelrelaxantia kan bidra till detta i större utsträckning i samband med respiratorbehandling.  Syfte: Att beskriva intensivvårdssjuksköterskors erfarenheter av ögonvård hos patienter med respiratorbehandling.  Metod: För studien användes en kvalitativ metod med deskriptiv design. Totalt intervjuades 10 deltagare rekryterade genom ett ändåmålsenligt urval. En kvalitativ innehållsanalys har använts vid dataanalysering. Huvudresultat: Intensivvårdssjuksköterskor beskrev att de initialt hade begränsad erfarenhet av ögonvård, men införandet av en vårdrutin om ögonvård ökade uppmärksamheten kring ämnet. Deltagarna beskrev en medvetenhet om riskfaktorer för ögonkomplikationer, men påpekade att bristen på tydligt synliga symtom ibland kunde påverka följsamheten. Utmaningar identifierades i att utföra ögonvård, särskilt gällande prioritering, hög arbetsbelastning och vid speciella behandlingsmetoder, såsom bukläge. Intensivvårdssjuksköterskorna uttryckte en efterfrågan om ytterligare utbildning och förståelse för ögonvårdens betydelse vid respiratorbehandling.  Slutsats: För att möta utmaningarna som intensivvårdssjuksköterskorna står inför vid behandling av patienter med respiratorbehandling och för att fördjupa förståelsen kring ögonvårdens betydelse, behövs utbildningsinsatser. Väl implementerade vårdrutiner kan även bidra till att säkerställa att ögonvården utförs korrekt och kan därigenom leda till att minska vårdlidandet bland intensivvårdspatienterna. / Background: Vision is one of our most important senses for gathering information about our surroundings. In 2023, approximatley 6000 individuals received respiratory treatment in intensive care units in Sweden. Up to 40% of these patients suffer from eye complications. Many patients in intensive care units lose normal eye functions, including tear production and the blink reflex, which can lead to injuries. Factors such as airway suctioning, PEEP, sedative medications, and muscle relaxants may contribute to this in connection with respiratory treatment.  Aim: To describe intensive care nurses experiences of eye care for patients undergoing respiratory treatment.  Method: A qualitative method with a descriptive design was used for the study. A total of 10 participants were interviewed, recruited through purposive sampling. Qualitative content analysis was used for data analysis. Main Results: Intensive care nurses described initially having limited experience in eye care, but the implementation of a care routine for eye care increased attention to the subject. Participants described an awareness of risk factors for eye complications, but pointed out that the lack of clearly visible symptoms could sometimes affect compliance. Challenges were identified in performing eye care, especially regarding prioritization, high workload, and in special treatment methods, such as prone positioning. Intensive care nurses expressed a demand for further education and understandning of the importance of eye care during respiratory treatment.  Conclusion: To meet the challenges faced by intensive care nurses in treating patients undergoing respiratory treatment and to deepen the understanding of the importance of eye care, educational efforts are needed. Well-implemented care routines can also contribute to ensuring that eye care is performed correctly and can thereby potentially reduce patient suffering among intensive care patients.

Yes / Purpose: Although urgent primary eye care schemes exist in some areas of England, their current safety is unknown. Accordingly, the aim of the present study was to quantify the clinical safety and effectiveness of a COVID-19 Urgent Eyecare Service (CUES) across Luton, Bedford, Hull, East Riding of Yorkshire and Harrogate. Methods: Consenting patients with acute onset eye problems who had accessed the service were contacted to ascertain what the optometrist’s recommendation was, whether this worked, if they had to present elsewhere and how satisfied they were with the CUES. Results: 27% (170/629) and 6.3% (28/445) of patients managed virtually and in person, respectively, did not have their acute eye problem resolved. Regression analysis revealed that patients who attended a face-to-face consultation were 4.66 times more likely to be correctly managed (Exp (β) = 5.66), relative to those managed solely virtually. Optometrists phone consultations failed to detect conditions such as stroke, intracranial hypertension, suspected space occupying lesions, orbital cellulitis, scleritis, corneal ulcer, wet macular degeneration, uveitis with macular oedema and retinal detachment. Of referrals to hospital ophthalmology departments, in total, 19% were false-positives. Patients, however, were typically very satisfied with the service. Uptake was associated with socio-economic status. Conclusion: The present study found that a virtual assessment service providing optometrist teleconsultations was not effective at resolving patient’s acute-onset eye problems. The range and number of pathologies missed by teleconsultations suggests that the service model in the present study was detrimental to patient safety. To improve this, optometrists should follow evidence based guidance when attempting to manage patients virtually, or in person. For example, patients presenting with acute-onset symptoms of flashing lights and/or floaters require an urgent dilated fundus examination. Robust data collection on service safety is required on an ongoing basis. / The full-text of this article will be released for public view at the end of the publisher embargo on 10 Nov 2022.

MPH / Department of Public Health / See the attached abstract below

Previous research has reported that inequalities exist in uptake of NHS sight tests in relation to socio-economic status, and that community optometric services have potential to improve system efficiency. The current research found inequalities in sight test outcome related to socio-economic status and the type of practice that a patient visits (multiple, or independent). Patients attending multiples were more likely to receive a ‘new or changed prescription’ relative to ‘no prescription’ compared to patients that attended independent opticians (36-71% more likely). Those living in the least deprived areas were also less likely to receive a new prescription (1-12%) and those aged <16 years were less likely to be referred (9%). The study examining the need for a Minor Eye Condition Service in Leeds and Bradford found it would produce theoretical cost savings, whilst maintaining high patient satisfaction. Subsequently, a MECS was commissioned in Bradford. The study attempting to collect data from MECS across all areas of England found that data is not routinely collected, or shared. The limited data available typically showed that 73-83% of patients were retained in optometric practice with 12-18% receiving a hospital referral. A prospective evaluation of a COVID urgent eye care service found that teleconsultations frequently did not resolve patients’ eye problems (27%). These telephone consultations failed to detect some serious conditions such as scleritis, wet macular degeneration, retinal detachment. The results from the thesis support the view that the current method of delivering eye care in England is contrary to the public health interest.

Bibliography : leaves 251-277. / viii, 295 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines the epidemiology of eye disease in Anangu Pitjantjatjara people of South Australia. The ethical issues of research in Aboriginal communities is discussed with reference to the handling and ownership of data. / Thesis (M.D.)--University of Adelaide, Dept. of Community Medicine, 1994

Bibliography : leaves 251-277. / viii, 295 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines the epidemiology of eye disease in Anangu Pitjantjatjara people of South Australia. The ethical issues of research in Aboriginal communities is discussed with reference to the handling and ownership of data. / Thesis (M.D.)--University of Adelaide, Dept. of Community Medicine, 1994