Prognostic indicators for open globe injury

Background: The purpose of the study is to identify factors predictive of outcome after open globe injury in 273 patients admitted to the Royal Brisbane Hospital, Queensland, Australia between 1992 and 2003. Methods: Data were collected retrospectively regarding demographic and geographical factors, injury circumstances, initial visual acuity (VA), injury parameters, details of initial and subsequent surgery, final best corrected VA and complications. Multivariate analysis using binary logistic regression was utilized to identify which factors were related to outcome. Results: 83% of patients were male, with a mean age of 38.3 years. The mean duration of follow up was 16.6 months and 58% of patients (135 of 231) achieved an overall improvement in their vision. Forty-one cases (15%) were enucleated, with half of these cases performed primarily. The prognostic factors indicating the likelihood of a VA of counting fingers or worse were poor initial VA, a large laceration > 10 mm and the presence of a relative afferent pupil defect. Rural patients had a significantly worse final VA than city dwellers and had higher rates of endophthalmitis and enucleation. Conclusions: Assessment of prognostic factors at the time of presentation of an open globe injury enables realistic expectations of final visual outcome by the doctor and the patient. In order to improve outcomes in patients from rural areas, access to specialized eye services need to be upgraded.

Can telepharmacy provide pharmacy services in the bush?

Rural and remote community pharmacies service large areas of rural Queensland, and because of the distances involved often do not meet the patients for whom they provide medication. Telepharmacy would improve the quality of pharmaceutical services provided in rural and remote areas, by allowing community pharmacists to have realtime contact with dispensing doctors, aboriginal health workers and patients via a video-phone. We used commercial (analogue) videophones to connect community pharmacists to dispensing doctors, patients in depot pharmacies (i.e. those with no pharmacist) and aboriginal health workers. However, various problems occurred and only 10 video-phone interactions were recorded during the six-month project. In all of the recorded interactions, the video-phone was actually used as a conventional telephone because a video-connection could not be established at the time of the call. (This may have been due to telephone network problems in the rural areas.) Despite these problems, all project participants showed great enthusiasm for the potential benefits of such a service.