History of ophthalmic dispensing (Dr Narendra Kumar)
Armati of Italy in 1285 is supposed to be the inventor of spectacles. Since the first lenses were plus or convex, these were used as reading glasses. Concave lenses (-) were developed in 16th century for the correction of myopia. Toric lenses for the correction of astigmatism were developed in 19th century. In 1784, Benjamin Franklin made the first bifocals by splitting a pair of distance glasses and reading glasses
Around 1800, Accommodation and Refraction of the Eye by Donders improved opticians' knowledge and ability in sight testing. Two classes of opticians then evolved: (i) prescription opticians, and (ii) refracting opticians.
In 1873, Cuignet developed the procedure of retinoscopy, which hindered the action of ciliary muscle and retarded accommodation through the use of a drug; that also dilated the pupil, enabling the physician to better view the retina and easily diagnose diseases of the eye.
Refracting opticians chose the name of optometry for their profession. By 1930, optometry (without the use of drugs) was legalized in USA. The remaining opticianry group (prescription opticians) were to supply eyeglasses prescribed by physicians, and were eventually called dispensing opticians.
Optometry was introduced in India in 1958 with the dual aim of (i) lessening the burden of refraction on the already busy ophthalmologist and (ii) taking over scientific dispensing of spectacles.
"Doctor, doctor, I've lost my memory.
When did it happen?
When did what happen? "
Multiple consultations (Error of the day)
A lady with accelerated hypertension, cholecystitis and lower abdominal pain was admitted in the medicine ward. She was advised anti hypertensives and paracetamol for her fever by the intern on duty who also requested for surgical and gynecological opinions. The surgeon added an antibiotic and a pain killer for cholecystitis. The gynae also added an antibiotic and a pain killer for the pelvic inflammatory disease. For 2 days the patient was on three antibiotics and three pain killers. She subsequently developed Gl bleed.
It is a common mistake. In this case none of the doctors checked the prescription of the other doctor. The mistake is at every level, the nurse on duty, the doctor on duty and the consultant incharge of the case. The cause of mistake is multiple brand names and multiple drugs available for the same condition. There are instances where a patient ends up getting three doses of the same pain killer but with different brands.
Letters to the editor
1. Respected Sir, It has been established beyond doubt that the initiative which you have taken is revolutionary in our country. For the first time all who have had some form of education in our country, are having access to a daily update on the current in clinics and legalities in managing a hospital. It was never done before and I pray that this lasts for ever. Sir, my humble submission is that in addition to the latest on the various studies cited in reputed journals, the E medinews also must educate us regarding the Evidence base for various forms of common problems in disease diagnosis and their management. This humble submission is considering the changing scenario all over the world regarding approach to medicine. As now there is a high degree of importance given all over the world to the Evidence gathered from various meta analysis for optimal management of various cases. Warm Regards, Yours sincerely: Prashant
Emedinews comments: we will start a column of evidence based practice.
2. With reference to your advice regarding intra cardiac adrenaline, I fail to understand why it should not be tried as a last resort in cardiac arrest. A dead patient is not bothered about any injury caused. Intra cardiac adrenaline injection is recommended even in life threatening anaphylaxis. American Heart Association ACLS says intra cardiac injection may be given in desperate situations when I.V is not feasible . Intra cardiac injection has been show to be effective in restoring cardiac contractions in asystloe where IV epinephrine was ineffective. Whether the needle stick or the drug itself was effective has not been resolved. The major hazard of intra cardiac injection is the need to interrupt CPR. Although uncommon, complications may follow intra cardiac injection.
JAMA 1980:240:1110-1111 and Harrison's Principles of Internal Medicine 16th Edition -1622 column 11, para 4. Dr. Vinay Bhasin
Emedinews response: You have given the answer already. It is not to be given as the first step and interruption of CPR is more dangerous and more over IV adrenaline is as effective. Keep it as a last resort. I agree that a dead pt is not bothered about the injury but our purpose of CPR is to revive him and once he is revived the cardiac injury may affect the chances of further survival.
Thanks for the prompt reply. In the scenario of the case qouted by you, the doctor administered it after eliciting no response with repeated doses of adrenaline and atropine. Is he safe medico legally. VB
Emedinews response: Yes. IV is as effective as intra cardiac. There is no need for intra cardiac if IV line is available. It is as per standard guidelines.
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