Validation of a vision-screening tool for use by nurses and other non-eye care health practitioners on stroke survivors.

Purpose: To validate a vision-screening tool for use by nurses and other non-eye care health practitioners (NECHP) to aid identification of visual deficits and ocular conditions in stroke survivors.Material and Methods: Stroke survivors were recruited from two metropolitan Sydney public hospitals who had no access to on-site eye care professionals. Those admitted for 3 days and who were able to provide clear responses were randomly allocated into two groups. All were assessed by a NECHP using a purposely designed bedside vision-screening tool to assess their visual function. In Group 1, the orthoptist repeated the assessment with the same vision-screening tool, in Group 2 they performed a comprehensive orthoptic assessment. Levels of agreement and sensitivity and specificity for key outcomes were assessed.Findings: Levels of agreement for most items analyzed for Group 1 reached 80%. Comparison of the screening tool to a comprehensive orthoptist assessment (Group 2), demonstrated high (88.57-91.12%) sensitivity and specificity for detecting pre-existing and acquired visual problems.Conclusion: The vision-screening tool is a valid instrument for use by NECHP, for the detection of vision defects in stroke survivors. Improved detection of eye conditions may facilitate timely identification and management of visual conditions in stroke survivors, potentially improving patient care and rehabilitation outcomes.

Towards gaining the best information about vision to assist the recovery of a patient with stroke.

AIM: The aim of this paper is to report on the development and evaluation of a tool, to be used by any healthcare practitioner, to screen for the presence of eye issues and problems in patients who have been diagnosed to have had a stroke. Practitioners caring for patients with stroke often detect stroke-related vision defects but miss pre-existing eye diseases, the need for glasses, and reduced acuity. In stroke units where orthoptists are employed the detection of eye conditions is high (83%) . The availability of orthoptists to work in stroke units is limited, so affected patients are likely to have undetected vision-based problems that may decrease the responsiveness to rehabilitation or prevent adaptations being made that can assist the patient with tasks. RESEARCH DESIGN: A retrospective study using patient data collected from 100 patient case histories. METHODOLOGY: The tool is a single page, tick-box checklist. It has 3 sections, each with actions to be implemented as required. The sections are: a. questions about ocular history and symptoms b. observation of ocular conditions (red eye, ptosis) c. tests requiring responses that could be affected by vision defects (ability to fix and follow) The tool was tested against 100 case histories of patients admitted to hospital following a stroke, comparing the ocular information noted by nonorthoptic healthcare practitioners and information from the orthoptic assessment. RESULTS: Of the 498 ocular conditions found by the orthoptic assessment, the tool identified 309 (62%). Nonorthoptic healthcare practitioners identified 85 (17%) ocular conditions. CONCLUSION: In the absence of orthoptic services, the tool has the capacity to enable improved detection of vision conditions resulting in improved management as well as enhancing the response for rehabilitation. The study has at all times followed the principles as outlined in the Declaration of Helsinki.

On-road assessment of driving performance in bilateral vestibular-deficient patients.

This study measured on-road driving behavior in subjects with bilateral vestibular loss (BVL). Data included point-of-regard (what the driver is looking at and attending to), gaze stability (the performance of the vestibulo-ocular reflex), and head movement, during complex maneuvers such as changing lanes, cornering, pulling into traffic, and parking. Subjective and objective measures showed few differences between BVL subjects and age-matched controls, and that it is possible to drive well with little or no peripheral vestibular function. This has important implications for driver licensing, road-safety policy, and for the potential successful rehabilitation of vestibular patients. Patients with unilateral vestibular dysfunction may have more difficulty driving than their bilateral counterparts.

Validity and reliability of the on-road driving assessment with senior drivers.

The on-road driving assessment is widely regarded as the criterion measure for driving performance despite a paucity of evidence concerning its psychometric properties. The purpose of this study was 2-fold. First, we examined the psychometric properties of an on-road driving assessment with 100 senior drivers between 60 and 86 years (80 healthy volunteers and 20 with specific vision deficits) using Rasch modeling. Second, we compared the outcome of the gestalt decision made by trained professionals with that based on weighted error scores from the standardized assessment. Rasch analysis provided good evidence for construct validity and inter-rater reliability of the on-road assessment and some evidence for internal reliability. Goodness of fit statistics for all items were within an acceptable range and the item hierarchy was logical. The test had a moderate reliability index (0.67). The best cut off score yielded sensitivity of 81% and specificity of 95% compared with the gestalt decision. Further research is required with less competent drivers to more fully examine reliability. Healthy senior drivers failed to check blind spots when changing lanes and made errors when asked to report road markings and traffic signs as they drove. In addition unsafe drivers had difficulty negotiating intersections and lane changes.

Current licensing authority standards for peripheral visual field and safe on-road senior aged automobile driving performance.

BACKGROUND: The current licensing authority's (Austroads) visual field standards are met when a person demonstrates an intact visual field extending horizontally at least 120 degrees within 10 degrees above and below the horizontal midline. A person cannot be licensed unconditionally if they have a hemianopia, quadrantanopia or any significant visual field loss (scotoma) that is likely to impede driving performance. Despite fairly rigorous implementation of these vision standards by licensing authorities, there is little scientific evidence available to demonstrate that a driver will or will not be safe on road depending on the extent of their visual field. METHODS: This study was developed to examine if the current licensing authority vision standards predict safe on-road driver performance in a cohort of 100 senior drivers. The study consisted of four stages in which participants underwent on-road assessment by a multidisciplinary team including a driving instructor, orthoptist and occupational therapist; off-road occupational therapy cognitive skills assessment using the Visual Recognition Slide Test (VRST-USyd); off-road orthoptic assessment including history, visual acuity and visual fields; and feedback from the team regarding the participant's visual and driving status. Visual fields were assessed using both the Goldmann and Esterman tests. Correlations were calculated to determine the relationship between visual field results and on-road driving performance. RESULTS: Generally it was found that visual field test results did not predict driving performance accurately for both participants with and without visual field loss. CONCLUSION: The results bring into question the current Austroads visual field standards for safe driving.

Harnessing a university to address rural health workforce shortages in Australia.

OBJECTIVE: To describe the efforts of health faculties at the University of Sydney to contribute to the recruitment and retention of rural health professionals and examine for opportunities that would benefit from an institutional-led response. DESIGN: Cross-sectional survey. SETTING: The University of Sydney as a leading institution for health science education in New South Wales, which produces approximately 40% of all health science graduates in the state each year. PARTICIPANTS: Staff responsible for course coordination within the faculties of Dentistry, Medicine, Nursing and Midwifery, and Pharmacy; and eight disciplines of the Faculty of Health Sciences. RESULTS: Of the two educational strategies associated with future rural employment, more progress has been made with rural placements, which were offered by all but one of the health courses. Efforts aimed at the other key strategy of attracting and supporting rural origin students were not well developed. Dentistry, Medicine, Pharmacy and only one Faculty of Health Sciences programs had more than 0.2 full-time equivalent staff to support rural initiatives. CONCLUSION: Despite the significant government investment in rural health education, the University of Sydney experience demonstrates that this does not necessarily translate into adequate internal resources available for every course or program to optimise performance for rural health workforce outcomes. In an environment of competing priorities, benefits are likely to accrue from strategies that draw on the existing resource base and operate through greater collaborative action, coordinated at the institutional level.