山东省三级甲等医疗机构眼科现状调查

 目的 了解山东省三级甲等医疗机构眼科资源和服务能力,为全省防盲治盲工作的有效开展提供依据。设计 横断面问卷调查。研究对象 山东省28家三级甲等医院眼科。方法 以信函方式由山东省卫生厅发放中华医学会设计的《眼科基本情况调查表》,调查表由眼科负责人填写,收集后对相关数据进行分析。主要指标 医护人员数量、医护人员职称与学历、医疗设备数量、门诊量等。结果 2011年山东省28所三甲医院眼科开放床位数875张,病区47个,均为有科主任或者负责人的独立科室。眼科共统计各类设备468件。眼科医务人员总数844人,其中眼科医师、护理人员分别占51.3％和48.7%,平均每所医院的眼科医师15.5人,医师高级、中级和初级及以下职称所占比重分别为47.1%、34.9%和18.0%;省部属医疗机构眼科执业医师数量［（23.7±12.3）人］明显多于市级［（12.1±7.2）人］医疗机构（t=2.364,P=0.00）。从2008年到2010年山东省眼科平均年门诊人次从25 289人次增长为27 528人次,科室平均年出院人次从1203人次增长为1423人次,科室平均年手术人次从914人次增长为1133人次,均呈递增趋势;平均住院日从7.49日缩减为7.01日,呈递减趋势;山东省开展的眼科手术每年均以白内障手术居多,从2008年开展8155例到2010年开展10595例,每年均占总手术量的50%以上。结论 山东省眼科医疗服务水平有所提高,但是眼科资源配置不均衡,需要进一步资源整合和优化,为患者提供更高质量的眼保健服务。     

2013年河北省眼科现状调查

目的：了解河北省眼科目前的基本情况,旨在制定高效、针对性强、切合实际需要的继续教育培训计划。方法本次调查采取问卷调查方式,内容包括基本信息、所在医院及科室信息、个人业务情况、开放性问题4个大项25小项,由各地区眼科学会负责将调查表下发给辖区内所有能够开展眼科临床工作的医疗机构并回收问卷,问卷汇总后河北省眼科学分会根据遗漏情况直接进行电话、信件邮寄、电子邮箱等方式进行补漏。结果本次问卷调查覆盖了141个县市中的121个（覆盖率85.8%）,305家医疗机构,1485名眼科医师,各医院眼科医师受训比例高（84.3%）,眼科医师期待学习、提高的比例较高（94.8%）,本科以上学历比例较高（68.9%）,但博士、硕士研究生高学历人才比例不高（19.6%）,河北省内能够独立开展玻璃体切除等后节手术的人才偏少（4.1%）,不具备基本眼科设备的医疗机构比例较高（37.3%）。结论制约河北省眼科事业发展的原因包括人才和设备的缺乏,河北省眼科目前的主要矛盾是广大人民群众日益增长的对眼科治疗的需要与目前我们所能提供的眼科医疗服务水平之间的矛盾。根据调查结果,河北省眼科学分会将增加组织省内眼科医师期待和有兴趣参加的培训次数,最终达到提高全省眼科水平的目的。（中华眼科杂志,2015,51：499-504）     

西藏朗县(无眼科县)眼病初步调查和白内障手术报告

目的:探讨西藏无眼科医疗服务县朗县眼病患病情况和初次开展白内障手术情况。方法:在包括眼科医生在内的援藏医疗队工作中,记录统计就诊眼病情况和盲与低视力原因,开展白内障等眼科手术。结果:22个工作日内共有首诊患者300余例,依次为白内障、眼睑及结、角膜疾病、屈光不正、鼻泪管阻塞(慢性泪囊炎)和视网膜变性等。盲或低视力的原因依次为白内障、角膜混浊、眼球萎缩、视网膜变性、视神经萎缩和屈光不正等。62眼盲眼中,26眼(41.9%)为白内障所致。完成手术42台,白内障囊外摘除术或加人工晶状体植入27例(29眼),脱盲率93.1%,脱残率69.0%,白内障手术率2000。结论:西藏无眼科和眼科医生县眼病患病情况严重,白内障是致盲的主要原因。派遣医疗队进行1～2mo的眼科医疗工作,开展白内障手术,可在一定程度上减少盲和低视力患者,缓解无眼科县缺医少药的紧张情况。     

增强文化自觉 推动学术创新——2011年读者调查活动评析

《中华眼底病杂志》2011年读者调查活动收到的信息反馈来自28个省市自治区,我们对所有参与本次活动的读者朋友表示感谢.现将读者反馈信息整理出来与全国同道共享,并对相关信息进行简要评析,就读者朋友关心的一些问题与大家沟通和交流.1加快稿件处理周期,缩短发表时滞;合理把握稿件录用标准,正确对待发表功利从作者角度反馈信息者中,87.7％有向本刊投稿的经历.所以,他们投稿前后的思考、体验以及影响他们投稿的一些因素是具体真实而有重要参考价值的.其中,有三个方面的问题值得我们重视.第一,稿件处理周期问题.55.3％的反馈信息认为稿件处理周期太长是影响其投稿的重要因素.虽然这更多好像只是期刊层面的技术问题,但解决起来涉及因素也较多.其一是刊期和每期容量限制问题;其二是专题号报道形式问题;其三是稿件处理流程管理问题;其四是文章质量高低导致的编辑加工难度以及编辑自身的编辑加工水平问题.     

中山市2006～2007年中小学生近视调查分析

目的 探讨中山市中小学近视情况及相关因素.方法 采用随机整群抽样调查方法.在2006年至2007年期间,对中山市中小学通过随机抽样在市区和镇区6所学校(包括市区3所镇区3所)进行调查,采用问卷调查和散瞳验光检查其屈光度.各年级间及镇区与市区之间学生近视发病率采用卡方检验,近视率与用眼时间用相关系数分析.结果 此次调查对象共9379人,近视5443人,近视率58.03%,近视率从小学一年级8.04%上升到高三86.68%,市区和镇区小学近视率差异无统计学意义(P＞0.05),初中阶段市区近视率明显高于镇区(P＜0.01),高中阶段高三毕业班近视率明显高于高一高二非毕业班(P＜0.05镇区P＜0.001市区).此次调查中眼保健操对预防近视加深无明显作用(P0.05),每天看书总时间、一次持续看书时间、看课外书时间与近视发生呈正相关,相关系数分别为0.995、0.992、0.999.结论 中山市中小学生近视率较高,近视率与用眼时间密切相关.如何适当减轻学生的学习负担是预防近视的关键.     

中山市2006～2007年中小学生近视调查分析

Objective To estimate the prevalence and correlative factor of myopia in primary and middle school students in Zhongshan City. Methods An epidemiological survey was carried out by Zhongshan SuHuaChan hospital, including three schools in town, three schools in urban, apply question investigation and retinoscopy. Results In this investigation, there were 9379 persons, the prevalence of myopia (spherical equivalent, SE＞-0.50D) was 58.03%, it increased from 8.04% (first grade in primary school) to 86.68% (latest grade in senior middle school). There was no difference of the prevalence of myopia between in town primary school and in urban primary school (P＞0.05), in junior middle school it was higher in urban than in town (P＜0.01), it was higher in graduation class than in non-graduation class (P＜0.05 in town, P＜0.001 in city). In this investigation it showed that eyes exercise had not effect upon preventing myopia from increasing (P＞0.05). Total time reading in one day, time reading in one time, time reading outside of class time was close correlative to the prevalence of myopia; correlation coefficients were 0.995, 0.992 and 0.999, respectively. Conclusions The prevalence of myopia is high in primary and middle school in Zhongshan City, and it increases yearly, it is important that relieve study burden of students to prevent myopia from increasing.     

眼科检查仪器数据采集系统的研制

目的研制一套符合眼科临床需求的数字化检查仪器数据采集方案,实现检查结果统一存储、远程调阅、集中管理。方法针对眼科医疗过程中常用的临床检查手段,选取20多种不同型号、不同厂商的数字化检查仪器,对其源数据格式、仪器接口、目标数据格式进行分析、提炼、归纳。抽象出通用的数据采集模型。结果依据设计模型顺利构建出眼科数字化采集系统。在温州医科大学附属眼视光医院部署应用超过5年,其采集效果良好,具有较好的通用性和扩展性。能满足现行大多数眼科数字化检查仪器的采集需求,支持新品种仪器的扩展。结论该方案对眼科仪器的输出途径、数据格式进行归纳,建立一套通用的数据采集方案,提高了眼科信息化建设的效率,其结果数据满足大多数临床诊断需求,有效地解决了“信息孤岛”问题,实现“一处检查,全院共享”。     

普通眼科门诊青光眼认知度的调查

目的提高公众对青光眼的认知度及青光眼患者的检出率。方法采用问卷随机抽样调查646例普通眼科门诊就诊者。所有数据用χ^2检验和多因素logistic回归分析处理数据。结果66.6%的受访者表示对青光眼不了解,其中51.61%为已确诊的青光眼患者。青光眼的认知与性别、服用糖皮质激素史、高血压、糖尿病以及近视均无相关性（P〉0.05）,与年龄、教育程度、具有卫生部门工作经历、定期眼科检查、曾经接受散瞳检查、具有青光眼家族史等显著相关。心血管患者及服用降血压药物的受访者对青光眼的认知度高于其他人群。结论青光眼认知度问卷调查为青光眼患者的宣教和知识普及提供了目标人群,使早期防治有所提示。近视患者、糖皮质激素服用者、高龄人群、低教育程度者、糖尿病及高血压患者、无定期眼科保健者以及部分对青光眼缺乏认识的青光眼患者,是今后加强宣教的目标人群。     

上海市浦东新区残疾人致盲和低视力原因调查

目的调查2004年上海市浦东新区残疾人中低视力和盲的致盲原因。方法根据世界卫生组织提出的盲和低视力的分类标准,对2004年1月～12月间在我院鉴定为残疾的496例患者的低视力和盲原因进行分析。结果2004年1月～12月共检查1205人,其中残疾人496人占41%,致低视力和盲眼病依此为高度近视30.2%、视网膜色素变性11.3%、青光眼9.3%、黄斑变性6.9%、白内障6.9%、弱视5.8%、糖尿病性视网膜病变4.8%、角膜病4.0%、视网膜脱离4.0%、眼球萎缩3.0%。结论2004年上海市浦东新区的首位致残原因为高度近视,首位致盲原因为视网膜色素变性。     

贵州省眼科住院医师规范化培训现状调查

目的:通过描述贵州地区眼科住院医师规范化培训概况,以遵义医学院附属医院眼科为例具体分析评价培训内容及效果。方法:统计该地区眼科规陪学员的专业能力、就业情况、存在问题等现状,提出贵州省住院医师规范化培训保障机制的对策及建议。结果:自2006/2011年该地区共计培训学员16名,顺利毕业仅1名。结论:该地区眼科规培学员临床能力大幅提高,但保障政策是学员放弃培训的主要原因。建议医学本科生尽早考研,缩短教育成本。     

Primary eye care in rural sub-Saharan Africa

Primary eye care in rural sub-Saharan Africa is reviewed. In the context of eye care delivered by village health workers (VHW's) living in and supported by the community, such a system of health care does not exist in Africa today. There are no VHW's, and primary health care is currently a matter of experimentation and conjecture only. However, most basic eye care is rendered by non-ophthalmologists; such care consists of screening, treatment of infections and inflammations, and in some cases, cataract surgery. Lower levels of non-ophthalmic general health workers are being tasked to promote measures to prevent trachoma and xerophthalmia/nutritional blindness by intervention at the village level. Preliminary results of such programs are encouraging, and warrant further evaluation and expansion.     

Primary eye care needs and services to Aboriginal and Torres Strait Islander populations across Queensland: a ‘users' perspective

The ocular health status of the Aboriginal and Torres Strait Islander (A&TSI) population is significantly poorer than that of the wider community. This study examined the primary eye care needs of, and services to, A&TSI people from an indigenous perspective. The findings reported here are based on questionnaire-based interviews of 292 A&TSI people from three urban and three rural communities in Queensland. The level of eye care services to A&TSI people failed to meet the perceived needs of most communities, this deficiency being greater in rural than urban communities. Limited physical accessibility of optometric services, cultural barriers and education were identified as the three main issues contributing to the low utilisation rate of currently available services by A&TSI people. These findings indicate unmet needs within A&TSI communities in Queensland, both for culturally appropriate and accessible primary eye care services and for education about eye health issues.     

Toward affordable,sustainable eye care

Adapted from Keynote Addresses to the 5th General Assembly of the International Agency for the Prevention of Blindness, Berlin, Germany, May 9, 1994, and to the International Congress of Ophthalmology, Toronto, Canada, June 29, 1994.     

Coordination of outreach eye services in remote Australia

Background: This paper aims to describe models for service integration between ophthalmology and optometry when conducting outreach eye services. The effect of good coordination on clinical activity and cost‐effectiveness is examined. Design: Cross‐sectional case study based on remote outreach ophthalmology services in Australia. Participants: Key stake‐holders from eye services in nine outreach regions participated in the study. Methods: Semistructured interviews were conducted to perform a qualitative assessment of outreach eye services' levels of coordination. Records of clinical activity were used to statistically compare the effects of good coordination. Main Outcome Measures: Clinical activity (surgery and clinic consultation rates), waiting times and costs per attendance. Surgical case rate being the proportion of surgery that results from a clinic. Results: Service integration between optometry and ophthalmology resulted in an increased surgical case rate for ophthalmology clinics (R² = 0.57). There were trends towards increased clinical activity and reduced waiting times, and costs/attendance were stable. Conclusions: Coordination of eye services with better integration of ophthalmology and optometry roles may improve efficiency of services for patients. Coordination of eye services has multiple facets including facilitating engagement with the local community, eye professions and health facilities. The varied roles of eye health coordination require further definition and appropriate funding.     

西藏藏族自治区眼科医疗资源现况调查

背景 眼科医疗保健体系的不断完善是防盲治盲工作的有力保障,但目前西藏自治区的眼科医疗资源分配情况仍不能满足当地防盲治盲工作的需要.了解西藏地区眼科医疗资源现状有助于当地合理分配紧缺的医疗资源,推进防盲治盲工作的开展. 目的 对西藏自治区的眼科医疗资源分配进行调查,为尽快建立该地区的眼科医疗保健网络和有效提供资源供给提供依据. 方法 本研究组于2016年4-6月面向西藏藏族自治区各级医疗单位眼科科室负责人和眼科医生发放西藏自治区医疗机构眼科专业情况调查问卷.西藏地区21家医疗机构的21名眼科科室负责人和52名眼科医生就眼科专业情况参与调查,由经过统一培训的专职人员按照统一调查方式收集整理,以确保回答问卷的真实有效性.结果 所有调查问卷发放的全区覆盖率为100％并全部收回,问卷填写符合要求,应答率及问卷有效率均为100％.截止2016年6月,西藏自治区共有21所有眼科诊疗能力的医疗机构,按照国家统计局公布的2014年西藏人口状况计算,平均每15.1万人拥有1个眼科医疗机构,但无独立眼科专科医院.其中有眼科专科医生者19所,占90.5％,有独立眼科科室者13所,占61.9％,有眼科独立手术室11所,占52.4％.全区眼科共有病床数量120张,平均每10万人拥有眼科医生1.6名,其中硕士学历者3名,尚无主任医师;全区共有专业护士14人,其中全职和兼职者各7人.目前西藏藏族自治区具备了基本的诊断仪器和最基本的手术设备,2015年全区平均眼科手术量为326.2人次.结论 西藏藏族自治区的眼科医疗资源不足,尤其是基层乡镇卫生院和县级医院眼科医疗机构,制约当地眼科防盲治盲工作的开展.     

Utilization of eye care services in Victoria

PURPOSE: To determine baseline eye care utilization by older Victorians in order to assess change in 2 years after an eye health promotion campaign. METHODS: A letter of invitation to participate was sent to all people aged 70-79 years in randomly selected Melbourne postcode areas. A questionnaire was designed to allow gathering of eye health-related information. Eye exams included autorefraction, frequency doubling technology and non-mydriatic fundus photography. Results were compared with the Melbourne Vision Impairment Project . RESULTS: A total of 1695 people with a mean age of 74 years were recruited. The overall proportion with visual impairment was 8% (134/1695), of which 27% (36/134) was due to non-refractive causes. Only 31% (11/36) of visually impaired people knew about low-vision services, of whom 20% (7/36) had used them. Of all people with diabetes, only 52% (96/184) had a dilated eye exam within the recommended 2 years (Melbourne Vision Impairment Project 44%). CONCLUSIONS: Compliance rates with recommendations for 2-yearly eye exams for people with diabetes have not improved since the last major eye health study in Victoria 10 years ago. The same is true for the rate of undiagnosed glaucoma, suggesting that messages about eye examinations need to be promoted for older people at high risk of vision loss, for example, those with diabetes and at risk of vision loss from glaucoma.