Anatomic outcome of scleral buckling surgery in primary rhegmatogenous retinal detachment.

PURPOSE: To evaluate the factors affecting the anatomic success of treatment of retinal detachments (RD) by scleral buckling surgery. METHODS: One-hundred and two eyes of 102 patients with rhegmatogenous RD operated on by scleral buckling surgery were included in the study. Results were analyzed according to the anatomic status of the retina at the most recent follow-up examination. The chi-squared test was used to determine the relationship between preoperative and intraoperative variables and anatomic results, and the relative risk of failure was determined for each variable. RESULTS: Retinal reattachment was achieved in 85 of 102 eyes (82.5%) after initial surgery. The success rate for anatomic reattachment was 95% after two operations. After three operations reattachment was achieved for 98 eyes (96%). Predictive factors for anatomic failure (P<0.05) were the presence of grade C(1) PVR and multiple breaks. CONCLUSION: Grade C(1) PVR and multiple breaks were found to be significant risk factors for anatomic failure in rhegmatogenous RD treated by conventional buckling surgery.

Acute confusion/delirium protocol.

This abbreviated version of the Acute Confusion/Delirium Research-Based protocol provides clinical guidelines for the assessment and management of acute confusion/delirium in the elderly individual. A screening and ongoing surveillance program that is based on identified risk factors is recommended to prevent or minimize episodes of acute confusion in this age group. This protocol is part of a series of protocols developed to help clinicians use the best evidence available in the care of older adults.

Training of acute confusion resource nurses. Knowledge, perceived confidence, and role.

Most nurses function as generalists; however, some function in "expert" roles based on informal training as Resource Nurses. Training usually focuses on assessment and management of a specific problem, with the goal of creating a readily available "expert" for every unit. The primary activity of the Resource Nurse is to provide expert care, education, and consultation for patients, families, and staff. The Iowa-Veterans Affairs Nursing Research Consortium (IVANRC) addressed the need to manage acutely confused/delirious clients by training staff nurse volunteers (N = 129) from all units of the four Iowa Veterans Affairs facilities to act as unit-based acute confusion Resource Nurses (ACRNs). A day-long workshop included didactic content addressing etiology and presentation of acute confusion (AC), use of the IVANRC protocol to assess for AC, and basic information on treatment and management of AC. The nurses also participated in an efficacy-based experiential learning program on AC assessment that involved demonstrating assessment of AC and role enactment practice exercises in which ACRNs practiced the assessment. A test of knowledge of AC and perceived level of confidence in assessing acutely confused patients was administered before and after completion of the program. Paired t tests comparing pre- and posttest scores showed that knowledge and confidence significantly increased for the nurses as a result of their participation in the educational program. Eighteen months later, a second program was conducted to update current ACRNs and train additional RNs to enact this role. Pre- and posttest scores were obtained, with paired t tests showing a significant increase in knowledge for the participants. Twenty-four (49%) of the second program attendees had attended the first program. These participants had significantly higher scores on the second program pretest than those participants who had not attended the previous program, indicating a retention of knowledge from the first program.

Studying acute confusion in long-term care: clinical investigation or secondary data analysis using the minimum data set?

Clinical investigations of acute confusion have largely been initiated in the acute care setting, where no uniform patient assessment exists. No reliable estimates of the prevalence of acute confusion in long-term care (LTC) residents have been reported. Delirium indicators are present in the nursing home Minimum Data Set (MDS), suggesting that MDS assessments could be used to facilitate studies of acute confusion in LTC. Methods to study acute confusion in LTC are discussed, with an emphasis on the advantages and disadvantages of using secondary analysis of MDS assessments as one research strategy.

Acute confusion assessment instruments: clinical versus research usability.

Acute confusion (AC), also referred to as delirium (AC/delirium), is a common problem seen by health professionals who work in a variety of care settings. This is an evaluative report on the clinical usability of instruments to assess AC/delirium as a part of nursing practice. Specifically, five instruments [the Confusion Assessment Method (CAM), Delirium Rating Scale (DRS), Delirium Symptom Inventory (DSI), Mini-Mental State Examination (MMSE), and Neelon/Champagne (NEECHAM) Confusion Scale] are discussed. The work demonstrates how the cooperation of nurses in practice, education, and research can improve both patient and staff outcomes.

From book to bedside: putting evidence to use in the care of the elderly.

BACKGROUND: Infusion of research findings into clinical practice is a challenging part of the research process. Because the length of time between discovery and use of knowledge averages 20 years, methods are needed to speed translation of research findings into practice. Few efforts have been made to coordinate the generation of new knowledge with the dissemination of findings from research to improve care of the elderly. RESEARCH-BASED PRACTICE PROTOCOLS: The Research Development and Dissemination Core (RDDC) of the Gerontological Nursing Interventions Research Center (GNIRC) at the University of Iowa emphasizes development of research-based (RB) protocols, which requires collecting relevant literature, critiquing studies, and synthesizing research findings for practice. GNIRC-generated research is disseminated to nurses in practice, and the RDDC links nurses who identify clinical problems in care of the elderly with GNIRC scientists. Currently, 19 RB protocols are offered for dissemination through the RDDC, and 5 protocols are under development. Implementation and evaluation of research-based practices on "Split Thickness Skin Graft Donor Site Care" and "Nasogastric/Nasointestinal Tube Placement" are described. CONCLUSIONS: Lessons learned on the basis of experience in disseminating and implementing research-based practices include the necessity of tailoring them to the local needs of various clinical settings in which they are used, reinfusing them periodically to keep staff motivated, and making them consumer friendly. The challenge remains to integrate these practices into the fiber of organizations and to keep staff educated and motivated to carry out research-based practices to improve the care of the elderly.

Acute confusion indicators: risk factors and prevalence using MDS data.

Long-term care (LTC) Minimum Data Set (MDS) data from a Midwestern state were analyzed to validate whether components of a conceptual model developed from findings in acute care identified acute confusion risk variables in LTC. The prevalence of probable acute confusion in this sample was 13.98% (n = 324). Using a cross-sectional design, both univariate and unconditional stepwise logistic regression analyses were accomplished with presence or absence of probable acute confusion as the outcome variable (N = 2,318). Variables significantly related to acute confusion by univariate analysis were included in the logistic regression analysis. Inadequate fluid intake was the first variable to enter the stepwise equation and was highly significant (OR 3.40, 95% CI 2.99-3.81, p < .0001). Other significant variables included a diagnosis of dementia or a fall in the last 30 days. Implications for nursing practice, education and research are discussed.

Unit-based acute confusion resource nurse: an educational program to train staff nurses.

Despite the high prevalence of acute confusion among elders and the importance of its early detection, there are few reports of systematic efforts to increase staff competence. This article describes the development and evaluation of an 8-hour educational program designed to prepare staff nurses to perform in a new role, the unit-based acute confusion Resource Nurse (ACRN). Pre- and posttest scores were obtained for the 80 registered nurses who participated in the program. Paired t tests showed that knowledge and confidence significantly increased for participants as a result of their participation in the educational program. This program can serve as an effective model for geriatric staff education.

Lens lipid peroxides and glutathione concentrations in diabetic cataract.

This study aims to explore the role of reactive oxygen radicals in the genesis of diabetic cataract. Lipid peroxide (LPO) concentrations in senile (n = 30) and diabetic (n = 14) cataractous lenses, were determined as thiobarbituric acid-reactive substances (TBARS) by a method modified from Satoh and Yagi, and reduced glutathione (GSH) concentrations were measured according to Beutler. Lens LPO levels (mean, SD; nmol TBARS/g protein) were significantly higher in diabetics (107.54, 18.12) than senile cataractous subjects (53.54, 15.48) (P < 0.0001). Lens GSH levels (mean, SD; nmol/g protein) showed no significant difference between diabetics (4.29, 2.05) and senile cataractous subjects (4.68, 3.12). These results suggest that free radical damage is more effective in the genesis of diabetic cataract than in senile cataract.

Home healthcare nurses' knowledge and attitudes towards suicide.

This study identified home healthcare nurses' knowledge of and attitudes toward suicide in the elderly. Three questionnaires and a demographic data sheet were distributed to nurses who work in three community health agencies. Findings showed that subjects knew some of the signs of potential suicide. Most subjects had a middle to high degree of sympathy and empathy toward elderly persons who attempted suicide, but disagreed wit. h their suicidal actions. There was no significant relationship between knowledge of the signs of potential suicide and attitudes toward suicide in the elderly.

A nursing protocol to assess causes of delirium. Identifying delirium in nursing home residents.

Because delirium is often a harbinger of underlying physical illness in frail elders--which can cause further morbidity and functional decline--it is essential to accurately assess the causes of delirium. Nurses working in nursing homes are in the best position to make these assessments and advocate for the appropriate management of delirium. The implementation of the proposed nursing protocol may empower nurses and, thus, improve outcomes of nursing home residents suffering from delirium.

Tilt and decentration of bag-fixated intraocular lenses: a comparative study between capsulorhexis and envelope techniques.

Malposition of an intraocular lens (IOL) may cause symptoms such as glare, halos, and other visual aberrations. The purpose of this study is to determine the effect of two different anterior capsulotomy techniques on IOL tilt and decentration. Bag-fixated IOL implantation after uncomplicated extracapsular cataract extraction was performed using both envelope (65 eyes) and continuous circular capsulorhexis (CCC) technique (42 eyes). Eyes were followed-up at least 6 months postoperatively. While the mean IOL decentration after envelope technique was found to be 0.65 mm, this was 0.15 mm after CCC technique. On the other hand, the mean actual tilting angle of IOL after envelope technique was 5.66 degrees, whereas this was 1.13 degrees after CCC technique. The aforementioned differences were statistically significant (p < 0.01, and p < 0.01). Furthermore, in 17 eyes (26.1%) where envelope technique and in 29 (69.0%) eyes where CCC technique was used demonstrated no IOL tilt and decentration. This study shows that the CCC technique may result in less optical problems due to IOL malposition compared to the envelope technique.

Calming aggressive reactions--a preventive program.

1. Aggressive behavior of nursing home residents towards caregivers, specifically nurse aides, is increasingly a problem in nursing homes. 2. The C.A.R.E. Program was developed to educate nursing personnel about prevention of aggressive incidents through early identification of residents most likely to become abusive. 3. The C.A.R.E. Program utilizes didactic presentation, role playing, sharing experiences, and group support as teaching strategies. 4. A major implication for professional nurses is to assume responsibility for identifying elders at risk for aggression and to provide the nursing team with the training to best care for these residents.