Medicine and Health Sciences Commons^™

Burnout In Optometry.....How Do We Compare?, Jeffrey L. Weaver Od, Mba

Optometric Clinical Practice

Letter to the Editor

Book Review: Visual Secrets For School Success, Paul B. Freeman Od

Optometric Clinical Practice

Book Review

Herpes Simplex Keratitis After Prk, Joshua Graf Od

Optometric Clinical Practice

Background: Herpes simplex virus (HSV) is a double stranded DNA virus that infects much of the world’s population. The World Health Organization estimates 67% of people under the age of 50 have HSV-1 and 11% of people under the age of 50 have HSV-2. While most systemic infections remain inactive and do not cause symptoms, the activation and appearance of ocular HSV can be a destructive and vision-threatening issue. HSV keratitis can be epithelial, stromal or a combination. Patients who have recently undergone photorefractive keratectomy (PRK) have a higher risk of HSV keratitis. Because of this, HSV keratitis should be …

Effectiveness Of Escoop® Lenses On A Select Group Of Veterans, Connie Chronister Od, Denise T. Wilcox Od, Stanley Hatch Od, Mph

Optometric Clinical Practice

Purpose: The purpose of this study was to perform a retrospective chart review to see if the use of EScoop® lenses improved the referred veterans' contrast acuity and subjective visual discomfort of glare, photophobia, or difficulty with night driving. Methods: We retrospectively reviewed examinations of 23 veterans aged 36 to 91 who chose EScoop ® for their spectacle prescription. The EScoop ® set available in our clinic included two shades, yellow or orange, two center lens thicknesses (LT), 6 or 9 mm, and with or without 4 prism diopters yoked base up (BU) prism. Results: The largest diagnostic group tested …

Results Of A Vosh Trip To Panama, Raelyn Ottenbreit Od, Aubrey Breithaupt Od, Allan Mccleary Od, Timothy Wingert Od, Emily Burnette Od

Optometric Clinical Practice

Background: Optometric services in many parts of the world are unavailable, or when available, limited to those individuals who have the resources and proximity to gain access to them. Recognizing this disparity in availability of eyecare services, teams from developed countries have been volunteering to provide eyecare in these areas with such a need for many years. Over time, these groups have also adopted a mission of enhancing the local infrastructure to create long-term improvement. Method: All records from a VOSH clinical trip to Panama were retrospectively analyzed to determine the prevalence of ocular conditions diagnosed. Results: As expected, the …

Headache And Vision Loss As Initial Symptoms For An Acute Invasive Rhino-Orbital-Cerebral Mucormycosis, Thanh Le Od, Gregg Wentworth Od

Optometric Clinical Practice

Background: Acute invasive rhino-orbital-cerebral mucormycosis (ROCM) is a rare fungal infection commonly caused by Rhizopus species. It occurs in immune- compromised individuals who have acquired immune deficiency syndrome (AIDS), leukemia, uncontrolled diabetes mellitus, or organ transplant patients who are on immunosuppressive therapy. Diagnosing invasive ROCM is challenging because its clinical presentation can be nonspecific, and it is not frequently observed in ophthalmic practices. Case Report: A 66-year-old Hispanic male with poorly controlled diabetes mellitus presented with the complaint of severe headache and retrobulbar pain in the right eye. An ophthalmic examination revealed normal ocular health in both eyes. Computerized tomography …

Expanding Your Professional Experience Through The Fulbright Program, Timothy Wingert Od

Optometric Clinical Practice

Expanding the Box

Sometimes There Is More To Reading Than Reading!, Paul Freeman Od

Optometric Clinical Practice

Editorial

Dental Caries Screening For Food Insecure Children, John Joseph Kane

Doctor of Nursing Practice

Background. Dental caries is the most common childhood disease, disproportionally impacting minorities, and socio-economically disadvantaged children. Food insecurity impacts 23.6% of children in Texas; the majority being African American and Hispanic. Food insecurity screening rates are abysmal. Dental caries and food insecurity are significantly correlated and likely syndemic. Purpose. Implement oral examination and the “Hunger Vital Sign” screening tool in detecting dental caries and food insecurity at an urban pediatric urgent care center. Evidence. Food insecure children experience adverse health outcomes, impaired long-term health outcomes, developmental and cognitive delays, psychosocial delays, and oral health deficiencies including caries and malabsorption of …

A Quality Improvement Project To Improve The Management Of Group A Streptococcalpharyngitis Among Children, Tara Denise Gutierrez

Doctor of Nursing Practice

Group A Streptococcal (GAS) pharyngitis is one of the most common pediatric illnesses and accounts for more than ten million yearly medical visits. GAS is commonly misdiagnosed due to overlapping symptoms. The health care provider needs to distinguish which criteria warrant testing for GAS and the recommendations for management and treatment.

The purpose and objectives of this quality improvement project were to improve adherence to the 2021 Canadian guidelines for the management and treatment of GAS pharyngitis in a small community urgent care clinic. Anticipated outcomes for this project included a decrease in unnecessary testing for GAS pharyngitis, a decrease …

Program Development And Expansion Of A Clinician-Driven Wound Care Program At An Outpatient Wound Care Center, Zhenhai Niu

Doctor of Nursing Practice

Problem. Patients with chronic wounds often present with additional physical and emotional problems because healing of chronic wounds may require months to resolve. Practitioners develop treatment plans based on their own training and clinical expertise, but unfortunately, there are no universal guidelines to inform the management of chronic wounds. Expanding multi-factorial assessments and interventions could improve patient outcomes. The purpose of this project was to implement a wound care protocol for outpatient wound care clients based on a nutritional and psychological self-assessment. Methods. A patient-completed checklist, done on arrival to the clinic, triggered clinician-driven protocol interventions addressing mental health and …

Implementation Of The Mood Disorder Questionnaire In A Psychiatric Inpatient Facility, Sandy Ann Harris

Doctor of Nursing Practice

Background. Bipolar disorder is a combination of multiple mood disorders associated with high suicide rates. The mood disorder questionnaire is a reliable, cost-effective, and time-effective screening tool to aid in diagnosing bipolar disorder (Carvalho et al., 2015; Miller & Black, 2020). Purpose. To implement the mood disorder questionnaire during admission to improve the accuracy of diagnosing bipolar disorder among providers in patients without a history of bipolar disorder. Goal. To increase the utilization of the mood disorder questionnaire thereby increasing bipolar disorder diagnosis accuracy. Objectives. 100% of the team will attend an in-service on the project; 60% of patients without …

Improving Post-Discharge Engagement Of Mental Health Patients In The Veterans Affairs South Texas Healthcare System, Nneoma Lewis

Doctor of Nursing Practice

Discharge from a hospital is a high-risk period for mental health patients, as 20% experience an adverse event within 30 days of discharge. Poor discharge engagement can lead to complications for recovery, which include an increased risk for readmissions, longer length of stay, increased risk for suicide, and death. Hospital stays cost the United States $377.5 billion dollars per year; there is pressure for hospitals, health plans, and providers to examine the admission and discharge processes to improve healthcare delivery, transition of care, and patient health outcomes. At a South Texas VA, 67.66% of mental health patients attended all their …

Utilizing A Validated Screening Tool And Treatment Protocol For Managing Agitation And Violence In A Psychiatric Emergency Services Unit, Zarah Ashcroft

Doctor of Nursing Practice

Background and Significance. Agitation is a significant concern in psychiatric units. If not detected early, agitated individuals are at high risk for becoming aggressive and violent, potentially causing harm to themselves, hospital staff, and property. The Psychiatric Emergency Services unit receives agitated and violent patients with psychiatric illnesses and substance use disorders. Purpose/Goal/Objectives. This quality improvement project aimed to implement a treatment protocol using the Broset Violence Checklist (BVC) to promote the early identification and management of potential for patient violence and aggression. Methods/Key Activities. Staff education for the nurses and providers on assessing patients at risk for aggression and …

Setting Goals For Patients With Type 2 Diabetes In Primary Care, Courtney Renee Padilla

Doctor of Nursing Practice

Background. Type 2 diabetes is prevalent amongst the Hispanic population and increases the risk of developing chronic serious health issues (CDC, 2022, April 4). Setting attainable and realistic goals for patients with type 2 diabetes is foundational in achieving glycemic control and improving quality of life (ElSayed et al., 2023a). Purpose. To increase goal setting in patients with type 2 diabetes in the primary care setting. Goal. To promote self-management in patients with type 2 diabetes. Objectives. 100% of staff and providers will attend an in-service on goal setting using a self-management goal tool; 75% of patients will choose to …

Central Activation Of Orl-1 Receptors In Heart Failure Models, Jeffrey Angell

Theses & Dissertations

Heart failure is a prevalent and debilitating disease associated with high morbidity and mortality rates worldwide and is the leading cause of death in the United States. While various therapeutic strategies have been developed and approved to manage heart failure, exploration of novel targets and mechanisms are essential for improving patient outcomes. This thesis investigates the therapeutic potential of the central activation of opioid receptor-like 1 (ORL-1) by nociceptin in a rodent heart failure model.

Furthermore, this study aims to elucidate the central mechanisms underlying nociceptin induced cardiovascular and renal effects in heart failure. This involves investigating neuronal pathways and …

Anxiety Screening At A Psychiatric Inpatient Facility: A Quality Improvement Project, Irene Akwitti

Doctor of Nursing Practice

Background. Generalized anxiety disorder is characterized by persistent anxiety and uncontrollable worry occurring more days than not for a minimum of 6 months (Patriquin & Mathew, 2017). Presently, anxiety screening and evidence-based practice treatment for adults are suboptimal. It is impossible to overemphasize the importance of early diagnosis and prompt treatment of generalized anxiety disorder in patients. Purpose. The purpose of this quality improvement project was to implement the Generalized Anxiety Disorder-7 (GAD-7) screening tool, a validated, evidence-based instrument, in a psychiatric inpatient facility to improve early detection and treatment of anxiety disorders in patients. Methods. Staff members were educated …

Preserving The Force: A Quality Improvement Project To Reduce The Risk Of Opioid Use Disorder In The Military, Lecreshia S. Shields

Doctor of Nursing Practice

Military service members incur combat and noncombat related injuries which may lead to acute or chronic pain. Treatment of these conditions with opioids may place them at risk for opioid use disorder (OUD). Opioid related overdoses among the military community increased by 50% from 2010 to 2019. The Sole Provider Program (SPP) is recommended to address the risks of OUD among Veterans receiving care at military installations. The goal of this evidence-based project was to ensure that all persons who receive opioid prescriptions at a military facility were evaluated for inclusion into a SPP and prescribed naloxone. Objectives included: 1) …

A Quality Improvement Project To Screen For Food Insecurity In Adults With Anxiety Or Depression, Kelsie Evelyn Kroll

Doctor of Nursing Practice

Background Food insecurity is the limited availability and inconsistent accessibility of healthy foods (Coleman-Jensen et al., 2022a). Food insecurity contributes to mental health problems. Individuals with food insecurity have greater odds of screening positive for depression and anxiety (Wolfson et al., 2021). The Hunger Vital Sign™ screening tool is a 2-questions evidence-based tool used to identify food insecurity (Hager et al., 2010). Purpose. Implement the Hunger Vital Sign™ tool at a non-profit behavior health clinic to identify food insecurity in adults who screened positive for anxiety or depression, offer resources for them to obtain nutritious food, and provide additional information …

Idiopathic Intracranial Hypertension: A Case Report, Christopher Bugajski Od

Optometric Clinical Practice

Background: Optic nerve head edema is a serious finding for which multiple etiologies need to be considered. When optic nerve head edema is observed bilaterally, among the top differentials is idiopathic intracranial hypertension (IIH), also known as primary pseudotumor cerebri. An emergent magnetic resonance image with and without contrast as well as venography and lumbar puncture with opening pressure measurement must be performed to diagnose and determine management. Case Report: This case specifically features a 30-year-old Caucasian female with bilateral optic disc edema secondary to IIH. In addition to discussing the details regarding this patient’s case, this report …

Pituitary Adenoma Hidden By Comorbid Cataract, Len Koh Od, Megan E. Mcchesney Od, Chad E. Gosnell Od

Optometric Clinical Practice

Background: A pituitary adenoma is an abnormal growth in the pituitary gland. Pituitary adenomas are the most common cause of sellar masses accounting for approximately 10% of all intracranial neoplasms. Early visual symptom of pituitary adenoma can be hidden by comorbid cataract in elderly patients. Case Report: A 74 y.o. male presented to the eye clinic with blurry vision at all distances and has trouble with glare from lights. His best corrected visual acuity (BCVA) was 20/20^-1 OD, 20/25^-2 OS, but subjectively of poor quality. Slit lamp exam confirmed mild nuclear sclerotic cataract OU and normal fundus exam. …

Sagging Eye Syndrome--An Overlooked Diagnosis, Zachary Tlumak Od, Theresa Zerilli-Zavgorodni Od, Nancy Shenouda-Awad Od

Optometric Clinical Practice

Abstract

Background: Sagging Eye Syndrome (SES) is a relatively unknown cause for binocular distance diplopia. SES presents with an acquired comitant or non-comitant small angle esotropia and/or hypotropia commonly occurring in the elderly population. Inferior displacement of the lateral rectus secondary to age-related degeneration of orbital connective tissue and extraocular muscles appears to be responsible for the ocular misalignment. SES patients often present with new onset or progressively worsening distance diplopia, typically warranting neuroimaging. However, through understanding SES, eye care practitioners may identify these cases, avoiding unnecessary imaging studies. Case Report: A 90-year-old male presented with complaints of intermittent horizontal …

Autosomal Dominant Optic Atrophy Plus Syndrome, Aaron W. Case Od, Lovelee E. Sayomac Od, Matthew J. Anderson Od

Optometric Clinical Practice

Background: Dominant optic atrophy (DOA) is the most commonly encountered hereditary optic neuropathy in clinical practice and is the result of a mutation in the OPA1 or OPA3 genes encoding mitochondrial membrane proteins. The resultant mitochondrial dysfunction causes a distinct set of ophthalmic findings and may progress to extra-ocular systems known as OPA plus syndrome. We present a case of late-onset OPA plus syndrome encompassing both typical ophthalmic findings and the rarer extra-ocular findings. Case Report: A 41 year-old Caucasian male presents for a second opinion regarding a previously diagnosed traumatic optic neuropathy. Examination revealed decreased best-corrected acuities, …

Diagnosis And Management Of A Patient With Methicillin-Resistant Staphylococcus Aureus Conjunctivitis, Michael Chocky Od

Optometric Clinical Practice

Background : Methicillin-resistant Staphylococcus aureus (MRSA) infections are becoming more common. These infections can cause various ocular conditions including conjunctivitis. Conjunctival cultures are an important tool to assist with proper diagnosis and treatment of these infections. Case Report : A 61-year-old African American male presented with the complaint of redness and drainage from his eyes. With the assistance of conjunctival cultures, he was diagnosed with MRSA conjunctivitis. Treatment with vancomycin ultimately led to resolution of the condition. Conclusion : MRSA conjunctivitis should always be considered when a conjunctivitis is not responding to empirical therapy. Eye care professionals should be aware …

Pupil Involving Oculomotor Palsy- Examination, Cause And Outcome, Robert Binkley Od, Karen Neal Od

Optometric Clinical Practice

BACKGROUND: A patient with a third cranial nerve (CN III) palsy can be a stress inducing event for an optometrist due to the potentially life-threatening etiologies and infrequency of their presentation. The pathogenesis of a CN III palsy can vary from innocuous to life threatening. Palsy of the third cranial nerve results in an impairment of eye movement and / or pupillary response to light depending on the extent of the palsy. CASE REPORT: This case reviews a recent onset of a complete right oculomotor palsy. Literature of similar cases detail the likelihood of variable causes, and while a diagnostic …

The Art Of Prescribing Low Amounts Of Prism: Basic Clinical Applications, Leonard J. Press Od

Optometric Clinical Practice

Expanding the Box

It's How You Ask The Question....., Paul Freeman Od

Optometric Clinical Practice

Letter from the Editor

The Importance Of Contrast Sensitivity, Color Vision, And Electrophysiological Testing In Clinical And Occupational Settings, Frances Silva

Theses & Dissertations

Visual acuity (VA) is universally accepted as the gold standard metric for ocular vision and function. Contrast sensitivity (CS), color vision, and electrophysiological testing for clinical and occupational settings are warranted despite being deemed ancillary and minimally utilized by clinicians. These assessments provide essential information to subjectively and objectively quantify and obtain optimal functional vision. They are useful for baseline data and monitoring hereditary and progressive ocular conditions and cognitive function. The studies in this dissertation highlight the value of contrast sensitivity, color vision, and cone specific electrophysiological testing, as well as the novel metrics obtained with potential practical clinical …

The Efficacy Of Analgesic Subdissociative Dose Ketamine In Trauma Casualties Treated By U.S. Military Special Operations Medical Professionals In A Prehospital Environment, Darin Schwartz

Theses & Dissertations

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty …

Medicare Shared Savings Performance: Three-Year Pandemic Analysis, Bryan Adams

Theses & Dissertations

The Centers for Medicare and Medicaid's (CMS) Office of Actuary predicts that U.S. national health expenditures will surpass U.S. gross domestic product per capita by 1.1% annually until 2028, totaling $6.2 trillion in healthcare spending. A significant portion of this spending, 36%, is attributed to Medicare and Medicaid. To address this issue, CMS has implemented the Medicare Shared Savings Program (MSSP) to assist Accountable Care Organizations (ACOs) in reducing healthcare costs and improving the quality of care for beneficiaries. The main objectives of this dissertation are twofold. Firstly, it aims to investigate the relationship between various factors, such as quality …