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dc.contributor.authorCabrera Aguas, Maria Paulina
dc.date.accessioned2020-02-14T03:33:45Z
dc.date.available2020-02-14T03:33:45Z
dc.date.submitted2019
dc.identifier.urihttps://hdl.handle.net/2123/21845
dc.description.abstractIntroduction Herpes simplex keratitis (HSK) is one the major causes of unilateral blindness in the developed world. Evidence-based recommendations for HSK had not been properly translated into practice. The overall aim of this thesis was to develop, implement, and evaluate a local HSK treatment guideline at the Sydney Eye Hospital. Methods The Registered Nurses’ Association of Ontario (RNAO) Toolkit: ‘Implementation of Best Practice Guidelines’ was utilised to develop, implement, and evaluate the guideline at the Hospital. A retrospective review was conducted to determine the knowledge gap. All HSK patients prescribed with antivirals, aged 18 years and above, from 2012 to 2013 were included. To assess the response to the guideline, an audit of all HSK patients aged 18 and over presenting during 6-months post-guideline implementation was conducted. A web-based survey assessed clinician awareness, usage and level of knowledge of the guideline. Patients were identified from viral swab results, pharmacy records, and hospital coding data. Results 296 patients were included in the retrospective review and 85 patients in the audit. The dose of prescribed antiviral medications was in alignment with the local guideline in 80% (51/64) of patients compared to 73% prior to implementation (p = 0.331). Post-implementation alignment was found in 72% (26/36) of patients with epithelial HSK vs 89% prior to implementation (124/139), p = 0.009. With SHSK-U, 33% (1/3) vs 9% (2/22), p = 0.3. With endothelial HSK, 67% (2/3) vs 33% (6/18), p = 0.5. With HSK prophylaxis, 100% (22/22) on prophylaxis vs 70% (31/44), p = 0.003. The web-based survey was sent to 95 clinicians, 41 (43%) responded. Of these, 35 (85%) were aware of the guidelines, 31 (75%) accessed them through the hardcopy and electronic versions available. Conclusions Most clinicians were aware of and adhered to the implemented local HSK treatment guideline. The guideline aided clinicians, mainly trainees, in prescribing antivirals for HSK according to the evidence to improve clinical outcomes.en_AU
dc.publisherUniversity of Sydneyen_AU
dc.publisherFaculty of Medicine and Healthen_AU
dc.publisherCentral Clinical Schoolen_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectHerpes simplex virusen_AU
dc.subjectkeratitisen_AU
dc.subjectanti-viralsen_AU
dc.subjecttherapyen_AU
dc.subjectevidence-based medicineen_AU
dc.subjectclinical guidelinesen_AU
dc.titleDevelopment, implementation and evaluation of evidence-based treatment guidelines for herpes simplex keratitisen_AU
dc.typePhD Doctorateen_AU
dc.type.pubtypeDoctor of Philosophy Ph.D.en_AU


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