Confronted with a claim of poor vision in the absence of any apparent pathology, the ophthalmologist must consider the possibility that the patient is malingering or hysterical. The authors define four categories of such patients, and recommend diagnostic approaches for each. Specific diagnostic tests are described, as are methods of managing patients once the diagnosis of malingering or hysteria has been made.

Evoked Potentials↗

PubMedDate not supplied

Should I testify for a patient?

Many physicians are reluctant to serve in the role of expert witness in a suit whose defendant is a physician. However, by fulfilling this role in an objective, professional manner, the physician-witness can act in the best interest of both patients and the medical community.

Expert Testimony↗

PubMedDate not supplied

Effectiveness of a 'thrombolysis nurse' in shortening delay to thrombolysis in acute myocardial infarction.

OBJECTIVES: To determine whether a specialist cardiac nurse would improve delay to thrombolysis in acute myocardial infarction (MI). SUBJECTS: Patients presenting with chest pain to a district general hospital. METHOD: Comparison of: a) door-to-needle times of patients with 'definite' MI when the nurse was on and off duty (15 months) and prior to her employment (3 months); b) pain-to-needle times for definite MI; and c) door-to-needle times of patients without definite MI on first electrocardiogram (ECG) but who subsequently qualified for thrombolysis. RESULTS: Of 365 patients included in the study, 289 had definite MI. Before the appointment of a thrombolysis nurse, door-to-needle times were 0% at 30 minutes, 7% at 45 minutes and 34% at 60 minutes. Since the appointment, with the nurse on-duty, they have improved to 58%, 91% and 100% respectively, a saving of 36 minutes in median door-to-needle time (p = 0.0001). There was a median saving of 95 minutes in pain-to-needle times with the thrombolysis nurse on duty compared with off duty (p = 0.0001). Finally, with the nurse on duty there was also a saving of 36 minutes in median door-to-needle time in patients in whom the first ECG was non-diagnostic for MI (p = 0.02). CONCLUSIONS: A thrombolysis nurse produced a dramatic improvement in median door-to-needle and pain-to-needle times in patients presenting with definite MI. This would lead to an additional 41 lives saved at 30 months per 1,000 patients treated. With 24-hour thrombolysis nurse cover, this would potentially lead to 8 additional lives saved at 30 months at a cost of 12,300 Pounds each. There was also a striking improvement in door-to-needle times for patients presenting with a non-diagnostic first ECG who subsequently qualified for thrombolysis.

Emergency Service, Hospital↗

PubMedDate not supplied

Education and legislation affecting ophthalmic medical assistants.

Explore the source record for details and available documents.

Humans↗