Professional Documents
Culture Documents
1,2
However,despitetherecordeduseofconvexlensesforpresbyopiainthelate13thcenturyinFlorence,
Italy,thecorrectionofmyopicrefractiveerrorhadtoawaitthedevelopmentofconcavelensesinthe
mid16thcentury.
Myopiamaybeclassifiedasschoolmyopiaoradultonsetmyopia.3Schoolmyopiadevelops
duringtheschoolageandstabilisesaround1517yearsofage,whileadultonsetmyopiadevelopsin
youngadults.Theaetiology,pathogenesis,andtreatmentofmyopiahavebeenhotlydebatedinthe
ophthalmiccommunityfordecades.4Thereareseveraltheoriesonthemechanismofdevelopmentof
myopiaarisingfromdisruptionoftheemmetropisationprocess.Emmetropisationisachievedwhenthe
opticalpoweroftheeyematchestheaxiallength,resultinginafocusedimageofadistantobjectonthe
retinawithoutaccommodativeeffort.5Ithasbeenproposedthatoveractingintraocularmusclesmay
resultinexcessiveaccommodationandinfluenceemmetropisation.6Thetwobasicmechanismsby
whichanimalmyopiamay
INTRODUCTION
Optometrists, through their clinical education, training, experience,
and broad geographic distribution, have the means to provide
effective primary eye and visison care for a significant portion of the
American public and are often the first health care practitioners to
diagnose patients with myopia.
This Optometric Clinical Practice Guideline for the Care of the
Patient with Myopia describes appropriate examination and
2.
3.
Tellyourdoctorrightawayifanyoftheseunlikelybutserioussideeffectsoccur:signsofinfection
(e.g.,fever,persistentsorethroat),troublebreathing,unusualtiredness,swellingankles/feet,
burning/painful/frequenturination,decreasedsexualinterest/ability,hairloss,musclecramps/pain,See
alsoWarningsection.
Beforetakingitraconazole,tellyourdoctororpharmacistifyouareallergictoit;ortootherazole
antifungals(e.g.,ketoconazole);orifyouhaveanyotherallergies.Thisproductmaycontaininactive
ingredients,whichcancauseallergicreactionsorotherproblems.Talktoyourpharmacistformore
details.
Beforeusingthismedication,tellyourdoctororpharmacistyourmedicalhistory,especiallyof:liver
disease(orhistoryofliverdiseasewithotherdrugs),kidneydisease,heartdisease(e.g.,coronaryartery
disease,heartvalvedisease,congestiveheartfailure),severelungdisease(e.g.,chronicobstructive
pulmonarydisease
s
Tunikavaskularis(lapisuvea)merupakanlapisantengahbolamataterdiri
ataskhoroid,badansiliarisdaniris.
Tunikaneuralis(lapisretina)merupakanlapisandalambolamataterdiriatasretina.
Howtouseitraconazole
ReadthePatientInformationLeafletprovidedbyyourpharmacistbeforeyoustart
takingitraconazoleandeachtimeyougetarefill.Ifyouhaveanyquestions,consult
yourdoctororpharmacist.
Takethismedicationbymouthwithafullmeal,usuallyonceortwicedailyoras
directedbyyourdoctor.Thecapsulesmustbeswallowedwhole.
Thedosageisbasedonyourmedicalcondition,responsetotreatment,andother
medicationsyoumaybetaking.Besuretotellyourdoctorandpharmacistaboutall
Nooneeversaidthatacareerinmedicinewasgoingtobeeasy.Althoughclinicians
canandshouldshareinthejoysandthesorrowsoftheirpatientsandpracticeina
mannerthatplacesapremiumonpatientcenteredcare,itcanbedifficulttomaintain
equanimityandempathy.Everyonewhohasworkedinhealthcareforanymeaningful
lengthoftimehasexperiencedanabusivepatient.
Verbalabusefrompatientscertainlyoccursmorefrequentlyinspecifichealthcare
settings,includingthepsychiatricinpatientunit.StewartandBowersevaluatedthe
phenomenonofverbalabuseinpsychiatricunitsinastudypublishedintheApril
2013issueoftheJournalofPsychiatricandMentalHealthNursing.[1]Theresearch
focusedon522inpatientsfrom84centers.Amongthesepatients,1398incidentsof
aggressivebehaviorwerereportedduringthefirst2weeksofadmission.Halfofthe
studysamplewasverballyaggressiveatsomepointduringthisperiod.
Themostcommontypesofverballyaggressivebehavior,indescendingorderof
frequency,wereabusivelanguage,shouting,threats,expressionsofanger,andracist
comments.However,alargenumberofchartentriesdidnotspecifythetypeofverbal
aggression.Mostofthecommentsweredirectedathospitalstaffasopposedto
clinicians.Ahistoryofviolentbehaviorandsubstanceabusewerepatientvariables
mostassociatedwithverbalaggression.
Althoughnotthemostcommoncategoryofverbalaggressioninthisstudy,thedata
stillshowthatracistcommentsfrompatientsoccurwithsomeregularity.Therearea
numberofethicalandlegalissuesintreatingracistpatients,andthisisalsoacritical
areaforjobsatisfactionandburnoutamonghealthcareproviders.
SynopsisandPerspective
Itisarareminorityphysicianwhohasnotatleastonceencounteredapatientwho
refusesthephysician'scareoutofbigotry.Infact,itisoneof"medicine'sopen
secrets,"KimaniPaulEmile,JD,PhD,anassociateprofessoroflawandfaculty
codirectoroftheSteinCenterforLaw&Ethics,FordhamLawSchool,NewYork
City,toldMedscapeMedicalNews.
"Somanyphysiciansofcolorcanrecallatleastonetimeintheircareerwhenthis
cameup,"shesaid,"andtherearen'tmeaningfulguidelinesforhowtobalancethe
interestsatstakewhentheseissuesarrive."
DrPaulEmilewroteanarticlefortheUCLALawReviewaboutthisissuefromthe
legalperspectiveseveralyearsago.[2]Severalphysicianssincethenhaveaskedherto
addressitinamedicaljournal,sosheand3othersnowpresentaframeworkforhow
toconsiderthesesituationsinaperspectivepiecepublishedintheFebruary25issue
oftheNewEnglandJournalofMedicine.[3]
"Apatient'srefusalofcarebasedonthetreatingphysician'sraceorethnicbackground
canraisethornyethical,legal,andclinicalissuesandcanbepainful,confusing,and
scarringforthephysiciansinvolved,"DrPaulEmileandcolleagueswrite.
Evenifsuchasituationdoesnotoccuroften,"itcausesalotofheartachewhenit
does,"coauthorAliciaFernndez,MD,fromtheDivisionofGeneralInternal
MedicineattheUniversityofCalifornia,SanFrancisco,toldMedscapeMedical
News.DrFernndezherselfexperiencedsuchasituationasaresident.
Nooneeversaidthatacareerinmedicinewasgoingtobeeasy.Althoughclinicians
canandshouldshareinthejoysandthesorrowsoftheirpatientsandpracticeina
mannerthatplacesapremiumonpatientcenteredcare,itcanbedifficulttomaintain
equanimityandempathy.Everyonewhohasworkedinhealthcareforanymeaningful
lengthoftimehasexperiencedanabusivepatient.
Verbalabusefrompatientscertainlyoccursmorefrequentlyinspecifichealthcare
settings,includingthepsychiatricinpatientunit.StewartandBowersevaluatedthe
phenomenonofverbalabuseinpsychiatricunitsinastudypublishedintheApril
2013issueoftheJournalofPsychiatricandMentalHealthNursing.[1]Theresearch
focusedon522inpatientsfrom84centers.Amongthesepatients,1398incidentsof
aggressivebehaviorwerereportedduringthefirst2weeksofadmission.Halfofthe
studysamplewasverballyaggressiveatsomepointduringthisperiod.
\
SomewomenwithrecurrentBVmaybenefitfromevaluationortreatmentofG
vaginaliscolonizationintheirsexualpartner(controversial)
Patientsshouldbeadvisedtostopdouchingorusingbubblebathoranyother
overthecountervaginalhygieneproducts
Patientsshouldwashonlywithhypoallergenicbarsoapsornosoapatalland
shouldavoidliquidsoapsandbodywashes
Surgeryisnotindicated
Testingforotherinfections(eg,Ngonorrhoeae,Ctrachomatis,orherpessimplex
virus[HSV]1)maybeappropriate
Therapywithmetronidazoleorclindamycinmayalterthevaginalfloraand
predisposethepatienttodevelopmentofvaginalcandidiasis
GeneralprinciplesoftreatmentofBVincludethefollowing:
Antibioticsarethemainstayoftherapy
DataontheefficacyofdietarysupplementationwithLactobacillus(acidophilus)are
conflicting
AsymptomaticwomenwithGvaginaliscolonizationdonotneedtreatment
BVoccurringinpregnantwomenshouldbetreated
Treatmentbeforecesareandelivery,totalabdominalhysterectomy,orinsertionofan
IUDisalsorecommended
Uncomplicatedcasestypicallyresolveafterstandardantibiotictreatment
BVthatdoesnotresolveafteronecourseoftreatmentmaybecuredbygivinga
secondcourseofthesameagentorbyswitchingtoanotheragent(eg,from
metronidazoletoclindamycinorfromclindamycintometronidazole)