INTRODUCTION

Optometrists, through their clinical education, training, experience,

and broad geographic distribution, have the means to provide
effective primary eye and vision care for a significant portion of the
American public and are often the first health care practitioners to
diagnose patients with myopia.
This Optometric Clinical Practice Guideline for the Care of the
Patient with Myopia describes appropriate examination and
treatment procedures for myopia and contains recommendations for
diagnosis and management of myopia. This Guideline will assist
optometrists in achieving the following goals:
1.

Accurately diagnose the different types of myopia

2.

Improve the quality of care rendered to patients with myopia

3.

Inform and educate parents, patients, and other health care

practitioners about the options of correction, control, or reduction
of myopiaDecrease visual morbidity related to higher degrees of
myopia.

Tellyourdoctorrightawayifanyoftheseunlikelybutserioussideeffectsoccur:signsofinfection
(e.g.,fever,persistentsorethroat),troublebreathing,unusualtiredness,swellingankles/feet,
burning/painful/frequenturination,decreasedsexualinterest/ability,hairloss,musclecramps/pain,See
alsoWarningsection.
Beforetakingitraconazole,tellyourdoctororpharmacistifyouareallergictoit;ortootherazole
antifungals(e.g.,ketoconazole);orifyouhaveanyotherallergies.Thisproductmaycontaininactive
ingredients,whichcancauseallergicreactionsorotherproblems.Talktoyourpharmacistformore
details.
Beforeusingthismedication,tellyourdoctororpharmacistyourmedicalhistory,especiallyof:liver
disease(orhistoryofliverdiseasewithotherdrugs),kidneydisease,heartdisease(e.g.,coronaryartery
disease,heartvalvedisease,congestiveheartfailure),severelungdisease(e.g.,chronicobstructive
pulmonarydisease
s

Tunikavaskularis(lapisuvea)merupakanlapisantengahbolamataterdiri
ataskhoroid,badansiliarisdaniris.

Tunikaneuralis(lapisretina)merupakanlapisandalambolamataterdiriatasretina.

Howtouseitraconazole
ReadthePatientInformationLeafletprovidedbyyourpharmacistbeforeyoustart
takingitraconazoleandeachtimeyougetarefill.Ifyouhaveanyquestions,consult
yourdoctororpharmacist.
Takethismedicationbymouthwithafullmeal,usuallyonceortwicedailyoras
directedbyyourdoctor.Thecapsulesmustbeswallowedwhole.
Thedosageisbasedonyourmedicalcondition,responsetotreatment,andother
medicationsyoumaybetaking.Besuretotellyourdoctorandpharmacistaboutall

Nooneeversaidthatacareerinmedicinewasgoingtobeeasy.Althoughclinicians
canandshouldshareinthejoysandthesorrowsoftheirpatientsandpracticeina
mannerthatplacesapremiumonpatientcenteredcare,itcanbedifficulttomaintain
equanimityandempathy.Everyonewhohasworkedinhealthcareforanymeaningful
lengthoftimehasexperiencedanabusivepatient.
Verbalabusefrompatientscertainlyoccursmorefrequentlyinspecifichealthcare
settings,includingthepsychiatricinpatientunit.StewartandBowersevaluatedthe
phenomenonofverbalabuseinpsychiatricunitsinastudypublishedintheApril
2013issueoftheJournalofPsychiatricandMentalHealthNursing.[1]Theresearch
focusedon522inpatientsfrom84centers.Amongthesepatients,1398incidentsof
aggressivebehaviorwerereportedduringthefirst2weeksofadmission.Halfofthe
studysamplewasverballyaggressiveatsomepointduringthisperiod.
Themostcommontypesofverballyaggressivebehavior,indescendingorderof
frequency,wereabusivelanguage,shouting,threats,expressionsofanger,andracist
comments.However,alargenumberofchartentriesdidnotspecifythetypeofverbal
aggression.Mostofthecommentsweredirectedathospitalstaffasopposedto
clinicians.Ahistoryofviolentbehaviorandsubstanceabusewerepatientvariables
mostassociatedwithverbalaggression.
Althoughnotthemostcommoncategoryofverbalaggressioninthisstudy,thedata
stillshowthatracistcommentsfrompatientsoccurwithsomeregularity.Therearea

numberofethicalandlegalissuesintreatingracistpatients,andthisisalsoacritical
areaforjobsatisfactionandburnoutamonghealthcareproviders.
SynopsisandPerspective
Itisarareminorityphysicianwhohasnotatleastonceencounteredapatientwho
refusesthephysician'scareoutofbigotry.Infact,itisoneof"medicine'sopen
secrets,"KimaniPaulEmile,JD,PhD,anassociateprofessoroflawandfaculty
codirectoroftheSteinCenterforLaw&Ethics,FordhamLawSchool,NewYork
City,toldMedscapeMedicalNews.
"Somanyphysiciansofcolorcanrecallatleastonetimeintheircareerwhenthis
cameup,"shesaid,"andtherearen'tmeaningfulguidelinesforhowtobalancethe
interestsatstakewhentheseissuesarrive."
DrPaulEmilewroteanarticlefortheUCLALawReviewaboutthisissuefromthe
legalperspectiveseveralyearsago.[2]Severalphysicianssincethenhaveaskedherto
addressitinamedicaljournal,sosheand3othersnowpresentaframeworkforhow
toconsiderthesesituationsinaperspectivepiecepublishedintheFebruary25issue
oftheNewEnglandJournalofMedicine.[3]
"Apatient'srefusalofcarebasedonthetreatingphysician'sraceorethnicbackground
canraisethornyethical,legal,andclinicalissuesandcanbepainful,confusing,and
scarringforthephysiciansinvolved,"DrPaulEmileandcolleagueswrite.
Evenifsuchasituationdoesnotoccuroften,"itcausesalotofheartachewhenit
does,"coauthorAliciaFernndez,MD,fromtheDivisionofGeneralInternal
MedicineattheUniversityofCalifornia,SanFrancisco,toldMedscapeMedical
News.DrFernndezherselfexperiencedsuchasituationasaresident.

Nooneeversaidthatacareerinmedicinewasgoingtobeeasy.Althoughclinicians
canandshouldshareinthejoysandthesorrowsoftheirpatientsandpracticeina
mannerthatplacesapremiumonpatientcenteredcare,itcanbedifficulttomaintain
equanimityandempathy.Everyonewhohasworkedinhealthcareforanymeaningful
lengthoftimehasexperiencedanabusivepatient.
Verbalabusefrompatientscertainlyoccursmorefrequentlyinspecifichealthcare
settings,includingthepsychiatricinpatientunit.StewartandBowersevaluatedthe
phenomenonofverbalabuseinpsychiatricunitsinastudypublishedintheApril
2013issueoftheJournalofPsychiatricandMentalHealthNursing.[1]Theresearch
focusedon522inpatientsfrom84centers.Amongthesepatients,1398incidentsof
aggressivebehaviorwerereportedduringthefirst2weeksofadmission.Halfofthe
studysamplewasverballyaggressiveatsomepointduringthisperiod.
\
SomewomenwithrecurrentBVmaybenefitfromevaluationortreatmentofG
vaginaliscolonizationintheirsexualpartner(controversial)

Patientsshouldbeadvisedtostopdouchingorusingbubblebathoranyother
overthecountervaginalhygieneproducts
Patientsshouldwashonlywithhypoallergenicbarsoapsornosoapatalland
shouldavoidliquidsoapsandbodywashes
Surgeryisnotindicated
Testingforotherinfections(eg,Ngonorrhoeae,Ctrachomatis,orherpessimplex
virus[HSV]1)maybeappropriate
Therapywithmetronidazoleorclindamycinmayalterthevaginalfloraand
predisposethepatienttodevelopmentofvaginalcandidiasis

GeneralprinciplesoftreatmentofBVincludethefollowing:
Antibioticsarethemainstayoftherapy
DataontheefficacyofdietarysupplementationwithLactobacillus(acidophilus)are
conflicting
AsymptomaticwomenwithGvaginaliscolonizationdonotneedtreatment
BVoccurringinpregnantwomenshouldbetreated
Treatmentbeforecesareandelivery,totalabdominalhysterectomy,orinsertionofan
IUDisalsorecommended
Uncomplicatedcasestypicallyresolveafterstandardantibiotictreatment
BVthatdoesnotresolveafteronecourseoftreatmentmaybecuredbygivinga
secondcourseofthesameagentorbyswitchingtoanotheragent(eg,from
metronidazoletoclindamycinorfromclindamycintometronidazole)

Kankermerupakanendemikyangmasihmenjadisorotanutamadibidangkedokteran.
Padatahun2008,didapatkandata12,7jutakasusbaru.Angkainsidensdantingkat
mortalitasbervariasidiberbagaibagiannegara.Kankerserviksmendudukiperingkat
ketigasebagaipenyebabkankerpadawanitadiseluruhduniadenganjumlahkasus
baru527.624dan265.672kematianpadatahun2012.Kankerserviksjugamenjadi
penyebabkankerpadawanitaberusia1544tahundiseluruhduniadenganprevalensi
14,0%.(1,2)
Rendahnyapengetahuanmasyarakatterhadapkankerserviksmenjadialasan
utamatingginyaangkakematianyangdiakibatkanolehkankerserviks.Gejalagejala
yangterdapatpadakankerserviksakanmunculbilasudahstadiumlanjut.

DosisRanitidin
Dosisdanjangkawaktupenggunaanranitidintergantungkepadakondisiyangdiobati
dantingkatkeparahannya.Padaumumnyaranitidindikonsumsisebanyak300mgper
hari.Dosisinibisadiminumsekaligusataudibagimenjadidua.Ranitidinbisa
diberikanselama212minggu,tergantungpadakondisidanresponspasienterhadap
pengobatan

Bersumberdari:PenyebabMualMuntahdanCaraMengatasinya|Mediskus.com

ApasajaPenyebabMualdanMuntah?KondisimedisataupenyakitpenyebabMual
danmuntah,antaralain:Mabukkendaraan(motionsickness)Hamilmuda(mual
terjadipadasekitar50%90%dariseluruhkehamilan,muntahpada25%55%)Obat
pencetusmuntahRasasakityangsangatStresemosional(sepertirasatakut)Makan
berlebihan(kekenyangan)Penyakitkandungempedu,misalnyaBatuEmpedu
KeracunanmakananInfeksivirussalurancerna(diare)Reaksiterhadapbautaksedap
ataubautertentuRadangtenggorokan(anakanak)SeranganjantungGegarotakatau
cederaotak
Bersumberdari:PenyebabMualMuntahdanCaraMengatasinya|Mediskus.com

Mualdanmuntahmerupakangejala,bukanpenyakityangberdirisendiri.Olehkarena
itumualdanmuntahdisebabkanolehberbagaimacamkondisimedis(penyakit)yang
mendasarinya.Mengetahuipenyebabmualdanmuntahsangatpentinguntuk
penatalaksanaanataumengatasimualmuntahdengantepat.ApasajaPenyebabMual
danMuntah?KondisimedisataupenyakitpenyebabMualdanmuntah,antaralain:
Mabukkendaraan(motionsickness)Hamilmuda(mualterjadipadasekitar50%
90%dariseluruhkehamilan,muntahpada25%55%)ObatpencetusmuntahRasa
sakityangsangatStresemosional(sepertirasatakut)Makanberlebihan
(kekenyangan)Penyakitkandungempedu,misalnyaBatuEmpeduKeracunan
makanan
Bersumberdari:PenyebabMualMuntahdanCaraMengatasinya|Mediskus.com

Mualdanmuntahmerupakangejala,bukanpenyakityangberdirisendiri.Olehkarena
itumualdanmuntahdisebabkanolehberbagaimacamkondisimedis(penyakit)yang
mendasarinya.Mengetahuipenyebabmualdanmuntahsangatpentinguntuk
penatalaksanaanataumengatasimualmuntahdengantepat.Apa
Bersumberdari:PenyebabMualMuntahdanCaraMengatasinya|Mediskus.com

DosisRanitidin
Dosisdanjangkawaktupenggunaanranitidintergantungkepadakondisiyangdiobati
dantingkatkeparahannya.Padaumumnyaranitidindikonsumsisebanyak300mgper
hari.Dosisinibisadiminumsekaligusataudibagimenjadidua.Ranitidinbisa
diberikanselama212minggu,tergantungpadakondisidanresponspasienterhadap
pengobatan.

Ranitidindalambentuktablettersediadalamukurandosis75mg,150mg,dan30mg.
Ranitidindalambentuksiruptersediadalamukurandosis15mg/ml.Sedangkan