ObjectivesThis paper sets out to establish the numbers and titles of regulated healthcare professionals in the UK and uses a review of how continuing professional development (CPD) for health professionals is described internationally to characterise the postqualification training required of UK professions by their regulators. It compares these standards across the professions and considers them against the best practice evidence and current definitions of CPD.DesignA scoping review.Search strategyWe conducted a search of UK health and social care regulators’ websites to establish a list of regulated professional titles, obtain numbers of registrants and identify documents detailing CPD policy. We searched Applied Social Sciences Index and Abstracs (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, EMCare and Scopus Life Sciences, Health Sciences, Physical Sciences and Social Sciences & Humanities databases to identify a list of common features used to describe CPD systems internationally and these were used to organise the review of CPD requirements for each profession.ResultsCPD is now mandatory for the approximately 1.5 million individuals registered to work under 32 regulated titles in the UK. Eight of the nine regulators do not mandate modes of CPD and there is little requirement to conduct interprofessional CPD. Overall 81% of those registered are required to engage in some form of reflection on their learning but only 35% are required to use a personal development plan while 26% have no requirement to engage in peer-to-peer learning.ConclusionsOur review highlights the wide variation in the required characteristics of CPD being undertaken by UK health professionals and raises the possibility that CPD schemes are not fully incorporating the best practice.
Red-free light in applanation tonometryEDITOR,-Goldmann's applanation tonometry is generally performed using cobalt blue filter and fluorescein in order to obtain accurate localisation of the apex of the tear meniscus. 2The peak transmission value of the cobalt blue filter BG12 on the Haag-Streit slit lamp 900 BM is 0.80 at 400 nm, whereas that of the red-free filter BG39 is 0.965 at 490 nm. The peak absorption value of fluorescein in dilute aqueous solution at physiological tear pH is also at 490 nm.3 Greater intensity of fluorescence and better visibility of the tear menisci could therefore, be obtained by the use of redfree filter. We designed a study to compare intraocular pressure (IOP) measurements obtained using red-free light with those taken with the blue light.Fifty six consecutive follow up glaucoma patients attending ophthalmic clinic during February 1998 were the subjects for the study. The order of testing of the two eyes and the order of use of the filters were determined by random permuted block method. After instillation of 4% lignocaine and 0.25% fluorescein with polyvinylpyrrolidone, and with slit lamp illumination at 7.5 V, both eyes were applanated at the same sitting using both cobalt blue and red-free illumination in succession. Three readings were taken for each illumination and the average was used for statistical purpose. The mean value of IOP of 112 eyes obtained using red-free light was 17.19 (SD 5.14) mm Hg whereas using blue light it was 17.17 (6.44) mm Hg. On two tailed paired t test analysis at the 5% level of significance, the diVerence is not significant.The red-free filter does not diminish the overall light intensity as much as the blue filter. Consequently, the ocular structures are seen more clearly in the background during the procedure. At the same time the tear menisci are seen brightly fluorescent as a result of both to greater overall intensity and more appropriate wavelength of the light. Red-free light applanation tonometry, therefore, achieves optimal visualisation of the tear menisci and accurate estimation of IOP.
Our objective was to present the findings of an opt-in, school-based eye care service for children attending 11 special schools in England and use these findings to determine whether a vision screening programme would be appropriate for this population. Data from eye examinations provided to 949 pupils (mean age 10.7 years) was analysed to determine the prevalence and aetiology of visual deficiencies and reported eye care history. For 46.2% (n = 438) of pupils, a visual deficiency was recorded. 12.5% of all the children seen (n = 119) had a visual deficiency that was previously undiagnosed. Referral for a medical opinion was made for 3.1% (n = 29) of pupils seen by the service. Spectacle correction was needed for 31.5% (n = 299) of pupils; for 12.9% (122) these were prescribed for the first time. 3.7% (n = 11) of parents/carers of pupils needing spectacles chose not to use the spectacle dispensing service offered in school. Eye care history was available for 847 pupils (89.3%). Of the pupils for whom an eye care history was available, 44% (n = 373) reported no history of any previous eye care and10.7% (n = 91) reported a history of attending a community optical practice/opticians. Only one pupil from the school entry 4–5 age group (0.6% of age group n = 156) would have passed vision screening using current Public Health England screening guidelines. Children with a diagnosis of autism were significantly less likely to be able to provide a reliable measurement of visual acuity. This study supports previously published evidence of a very high prevalence of visual problems in children with the most complex needs and a significant unmet need in this group. It demonstrates routine school entry vision screening using current Public Health England guidelines is not appropriate for this group of children and very low uptake of community primary eye care services.
We report a new model of community-based secondary vision screening and demonstrate that a high proportion of children can be effectively managed in such a clinic without referral to the hospital eye service (HES). We performed a 64-month retrospective study of a secondary vision screening clinic providing the combined skills of an optometrist and orthoptist in a community setting. Particular attention was given to the diagnosis and management of children not referred to the HES. During this period, 1755 children were sent appointments and 74% (1300) attended the clinic. The community orthoptist and school nurses referred 53% of the patients and health visitors, general practitioners and community medical officers made 32% of the clinic referrals. Spectacles were prescribed for 41% of the children and 8% were prescribed patching. Sixteen per cent of the children were referred on to the HES. This model of care using the combined expertise of the orthoptist and optometrist is able to diagnose and manage the majority of children who have failed primary vision screening and avoids unnecessary referrals to the HES.
The purpose of this study was to establish if a community based model using a Hospital Optometrist and Community Orthoptist can provide a practical secondary vision screening service for children. These professionals working in an Inner London Health Centre, assessed children who had failed primary vision screening. In total 483 new patients were seen between April 1994 and March 1996 with the largest referral source being the school nurse screening programme. The majority were managed by the team with a total onward referral rate to the Hospital Eye Service of 14%. In 78% of these cases the consultant's diagnosis agreed with the reason for referral. Where the consultant's diagnosis differed the children were identified as normal or a variant of normal. This model of care provides a 'one stop service' where a child identified as having a potential visual problem at primary screening can be assessed, refracted and provided with spectacles in a local setting without hospital referral. Referrals to the Hospital Eye Service are considerably reduced and a convenient service is provided for parents and children.
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