The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Madhavan S Rajan - One of the best experts on this subject based on the ideXlab platform.
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quality indicators in a community Optometrist led cataract shared care scheme
Ophthalmic and Physiological Optics, 2018Co-Authors: Oliver M B Bowes, Poonam Shah, Mrinal Rana, Sarah Farrell, Madhavan S RajanAbstract:Purpose Cataract shared care schemes involving community Optometrists show wide variation in practice. We report on defined key performance indicators (KPIs) which improve accountability between stakeholders. Methods In this prospective study over nine months at a UK public hospital, we evaluated the outcomes of consecutive direct cataract referrals from community Optometrists against two KPIs agreed under a service-level agreement between the Hospital Eye Service and community Optometrists: (1) 85% of patients listed for cataract listing at first consultation; and (2) 90% postoperative feedback return rate on patients discharged to community Optometrists. A detailed analysis on referral triage, surgical listing and postoperative form return rate is reported in this study. Results A total of 733 direct cataract referrals were received using a designated referral form of which 86% were listed for cataract surgery. The predominant reason for not listing was a failure to reach the visual threshold set by the local clinical commissioning guidelines. Out of 569 cataract surgical episodes, 402 (71%) patients were discharged on the same day of surgery to community Optometrist follow up. Completed postoperative feedback was returned from 374 patients (93%). Conclusion Direct cataract referrals from accredited community Optometrists led to a majority of patients receiving a definitive clinical decision during first consultation. Postoperative community follow up reduced hospital visits and allowed for convenient consultation closer to home following uncomplicated cataract surgery. A service-level agreement with an accreditation scheme measured against KPIs enhances the accountability of stakeholders involved in the cataract shared care scheme.
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cambridgeshire cataract shared care model community Optometrist delivered postoperative discharge scheme
British Journal of Ophthalmology, 2014Co-Authors: George Voyatzis, Jonathan Keenan, Harry W Roberts, Madhavan S RajanAbstract:Background/aims To evaluate a community Optometrist-delivered postoperative discharge scheme in patients who underwent same day discharge from the hospital eye service (HES) following cataract surgery. Methods A service-level agreement (SLA) was agreed between the HES, primary care trust and community Optometrists in Cambridgeshire regarding community follow-up after cataract surgery. Patients undergoing uncomplicated surgery with no significant ocular comorbidity were eligible for same day discharge to community Optometrists. Feedback return rate and unintended medical interventions were assessed using an electronic medical record system. Results Over a 23-month period, a total of 1492 of 2461 (60.6%) Cambridgeshire patients were discharged to the community on the day of cataract surgery. Complete postoperative feedback was available in 96.85% of these patients. Uneventful postoperative recovery was recorded in 93.77% of patients with 2.95% of patients re-referred. Rates of cystoid macular oedema, uveitis and raised intraocular pressure were 0.6%, 1% and 0.1%, respectively. No patients had sight-threatening complications in this study. Conclusions Postcataract surgery follow-up by community Optometrists provides the advantages of care closer to home and avoids unnecessary hospital visits for patients undergoing uncomplicated cataract surgery.
Rupert R A Bourne - One of the best experts on this subject based on the ideXlab platform.
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the false negative rate and the role for virtual review in a nationally evaluated glaucoma referral refinement scheme
Ophthalmic and Physiological Optics, 2015Co-Authors: Gokulan Ratnarajan, Jane Kean, Karen French, Mike Parker, Rupert R A BourneAbstract:Purpose To establish the safety of the CHANGES glaucoma referral refinement scheme (GRRS). Methods The CHANGES scheme risk stratifies glaucoma referrals, with low risk referrals seen by a community based specialist Optometrist (OSI) while high risk referrals are referred directly to the hospital. In this study, those patients discharged by the OSI were reviewed by the consultant ophthalmologist to establish a ‘false negative’ rate (Study 1). Virtual review of optic disc photographs was carried out both by a hospital-based specialist Optometrist as well as the consultant ophthalmologist (Study 2). Results None of these 34 discharged patients seen by the consultant were found to have glaucoma or started on treatment to lower the intra-ocular pressure. Five of the 34 (15%) were classified as ‘glaucoma suspect’ based on the appearance of the optic disc and offered a follow-up appointment. Virtual review by both the consultant and Optometrist had a sensitivity of 80%, whilst the false positive rate for the Optometrist was 3.4%, and 32% for the consultant (p < 0.05). Conclusions The false negative rate of the OSIs in the CHANGES scheme was 15%, however there were no patients where glaucoma was missed. Virtual review in experienced hands can be as effective as clinical review by a consultant, and is a valid method to ensure glaucoma is not missed in GRRS. The CHANGES scheme, which includes virtual review, is effective at reducing referrals to the hospital whilst not compromising patient safety.
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cambridge community optometry glaucoma scheme
Clinical and Experimental Ophthalmology, 2015Co-Authors: Keith R Martin, Jonathan Keenan, Humma Shahid, Andrew White, Rupert R A BourneAbstract:Background With a higher life expectancy, there is an increased demand for hospital glaucoma services in the United Kingdom. Design The Cambridge community Optometry Glaucoma Scheme (COGS) was initiated in 2010, where new referrals for suspected glaucoma are evaluated by community Optometrists with a special interest in glaucoma, with virtual electronic review and validation by a consultant ophthalmologist with special interest in glaucoma. Participants 1733 patients were evaluated by this scheme between 2010 and 2013. Methods Clinical assessment is performed by the Optometrist at a remote site. Goldmann applanation tonometry, pachymetry, monoscopic colour optic disc photographs and automated Humphrey visual field testing are performed. A clinical decision is made as to whether a patient has glaucoma or is a suspect, and referred on or discharged as a false positive referral. The clinical findings, optic disc photographs and visual field test results are transmitted electronically for virtual review by a consultant ophthalmologist. Main Outcome Measures The number of false positive referrals from initial referral into the scheme. Results Of the patients, 46.6% were discharged at assessment and a further 5.7% were discharged following virtual review. Of the patients initially discharged, 2.8% were recalled following virtual review. Following assessment at the hospital, a further 10.5% were discharged after a single visit. Conclusions The COGS community-based glaucoma screening programme is a safe and effective way of evaluating glaucoma referrals in the community and reducing false-positive referrals for glaucoma into the hospital system.
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can a community Optometrist based referral refinement scheme reduce false positive glaucoma hospital referrals without compromising quality of care the community and hospital allied network glaucoma evaluation scheme changes
Eye, 2010Co-Authors: Karen French, Rupert R A Bourne, L Chang, A D Borman, Melanie Hingorani, Wendy NewsomAbstract:Can a community Optometrist-based referral refinement scheme reduce false-positive glaucoma hospital referrals without compromising quality of care? The community and hospital allied network glaucoma evaluation scheme (CHANGES)
B T Parkin - One of the best experts on this subject based on the ideXlab platform.
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Optometrist referrals for cataract and action on cataracts guidelines are Optometrists following them and are they effective
Ophthalmic and Physiological Optics, 2006Co-Authors: Stephen C Lash, C P Prendiville, A Samson, K Lewis, R Munneke, B T ParkinAbstract:Purpose: To assess the information included in Optometrist referrals for cataract to the Hospital Eye Service with reference to the recommendations made by the Department of Health in ‘Action on Cataracts’ and the resultant surgical listing rates. Methods: We prospectively collected and analysed the information included in three different types of Optometrist referrals for cataract over 8 weeks. Referrals containing ‘full information’ as recommended in ‘Action on Cataracts’ confirmed cataract as the cause of visual loss with a detrimental effect on the patient's lifestyle, and a willingness for surgery. The referral outcomes were assessed in terms of listing rate and the reasons for not listing, for each type of referral form. Results: A total of 412 referrals were analysed. Of these, 50% (208) were ‘conventional’ referrals via the general practitioner (GP) [39% (n = 162) using the General Ophthalmic Services (GOS) 18 referral form and 11% (n = 46) an Optometrist's custom letter]; 35% (n = 143) were direct referrals and 15% (n = 61) were GP referrals with no Optometrist information (these results were excluded from further analysis). The listing rates for optometric referrals were 78% (n = 272) overall, 83% (n = 119) for direct and 74% (n = 153) for conventional referrals. ‘Full information’ was included in 17% (n = 8) of letter referrals and 10% (n = 16) of GOS 18 referrals. The listing rates were 83% for referrals with full information and 73% for referrals specifying only that cataracts were the cause of visual loss. The listing rates for referrals with partial information were 78% for ‘cataract’ plus ‘effect on lifestyle’ and 67% for ‘cataract’ plus ‘willingness for surgery’. The most common reason for not listing a patient for surgery was ‘no effect on lifestyle’, accounting for 42% (n = 32). Conclusion: We recommend that all referrals for cataract should confirm a detrimental effect on lifestyle and the patient’s willingness for surgery, in addition to confirming cataract as the main cause of visual loss.
Leat Susan - One of the best experts on this subject based on the ideXlab platform.
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2020 CAO Clinical Practice Guideline: Optometric Low Vision Rehabilitation Executive Summary
'University of Waterloo', 2020Co-Authors: Leat SusanAbstract:The purpose of the Low Vision Clinical Practice Guideline is to assist Canadian Optometrists in the provision of the best rehabilitative care for patients with low vision. The guideline is based on current available best evidence, interpreted by an expert panel. The writing group includes Optometrists from academia and private practice, representing various regions across Canada. The guideline will aid Optometrists to identify patients who require low vision rehabilitation and recommends appropriate assessment and management
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2020 CAO Clinical Practice Guideline: Optometric Low Vision Rehabilitation FULL GUIDELINES
'University of Waterloo', 2020Co-Authors: Leat SusanAbstract:The purpose of the Low Vision Clinical Practice Guideline for Canadian Optometrists is to assist them in providing the best level of care in the management of patients with low vision. The guideline is based on current best evidence regarding optometric low vision rehabilitation as interpreted by an expert panel. The writing group includes Optometrists from academia and private practice, representing various regions across Canada. This guideline will aid Optometrists in identifying patients who require low vision rehabilitation and recommends appropriate assessment and management. As primary eye care providers, Optometrists are optimally trained and qualified to identify and manage patients who would benefit from low vision rehabilitation. Optometrists, based on their geographical presence in local communities, are also well positioned to provide initial rehabilitation in a timely, effective manner, and to initiate referral for more comprehensive rehabilitation if required
Jonathan Keenan - One of the best experts on this subject based on the ideXlab platform.
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cambridge community optometry glaucoma scheme
Clinical and Experimental Ophthalmology, 2015Co-Authors: Keith R Martin, Jonathan Keenan, Humma Shahid, Andrew White, Rupert R A BourneAbstract:Background With a higher life expectancy, there is an increased demand for hospital glaucoma services in the United Kingdom. Design The Cambridge community Optometry Glaucoma Scheme (COGS) was initiated in 2010, where new referrals for suspected glaucoma are evaluated by community Optometrists with a special interest in glaucoma, with virtual electronic review and validation by a consultant ophthalmologist with special interest in glaucoma. Participants 1733 patients were evaluated by this scheme between 2010 and 2013. Methods Clinical assessment is performed by the Optometrist at a remote site. Goldmann applanation tonometry, pachymetry, monoscopic colour optic disc photographs and automated Humphrey visual field testing are performed. A clinical decision is made as to whether a patient has glaucoma or is a suspect, and referred on or discharged as a false positive referral. The clinical findings, optic disc photographs and visual field test results are transmitted electronically for virtual review by a consultant ophthalmologist. Main Outcome Measures The number of false positive referrals from initial referral into the scheme. Results Of the patients, 46.6% were discharged at assessment and a further 5.7% were discharged following virtual review. Of the patients initially discharged, 2.8% were recalled following virtual review. Following assessment at the hospital, a further 10.5% were discharged after a single visit. Conclusions The COGS community-based glaucoma screening programme is a safe and effective way of evaluating glaucoma referrals in the community and reducing false-positive referrals for glaucoma into the hospital system.
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cambridgeshire cataract shared care model community Optometrist delivered postoperative discharge scheme
British Journal of Ophthalmology, 2014Co-Authors: George Voyatzis, Jonathan Keenan, Harry W Roberts, Madhavan S RajanAbstract:Background/aims To evaluate a community Optometrist-delivered postoperative discharge scheme in patients who underwent same day discharge from the hospital eye service (HES) following cataract surgery. Methods A service-level agreement (SLA) was agreed between the HES, primary care trust and community Optometrists in Cambridgeshire regarding community follow-up after cataract surgery. Patients undergoing uncomplicated surgery with no significant ocular comorbidity were eligible for same day discharge to community Optometrists. Feedback return rate and unintended medical interventions were assessed using an electronic medical record system. Results Over a 23-month period, a total of 1492 of 2461 (60.6%) Cambridgeshire patients were discharged to the community on the day of cataract surgery. Complete postoperative feedback was available in 96.85% of these patients. Uneventful postoperative recovery was recorded in 93.77% of patients with 2.95% of patients re-referred. Rates of cystoid macular oedema, uveitis and raised intraocular pressure were 0.6%, 1% and 0.1%, respectively. No patients had sight-threatening complications in this study. Conclusions Postcataract surgery follow-up by community Optometrists provides the advantages of care closer to home and avoids unnecessary hospital visits for patients undergoing uncomplicated cataract surgery.