Agreement on the use of sensory screening techniques by nurses for older adults with cognitive impairment in long-term care: a mixed-methods consensus approach.

OBJECTIVE: Based on two scoping reviews and two environmental scans, this study aimed at reaching consensus on the most suitable sensory screening tools for use by nurses working in long-term care homes, for the purpose of developing and validating a toolkit. SETTING: A mixed-methods consensus study was conducted through two rounds of virtual electronic suitability rankings, followed by one online discussion group to resolve remaining disagreements. PARTICIPANTS: A 12-member convenience panel of specialists from three countries with expertise in sensory and cognitive ageing provided the ranking data, of whom four participated in the online discussion. OUTCOME MEASURES: As part of a larger mixed-methods project, the consensus was used to rank 22 vision and 20 hearing screening tests for suitability, based on 10 categories from the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire. Panellists were asked to score each test by category, and their responses were converted to z-scores, pooled and ranked. Outliers in assessment distribution were then returned to the individual team members to adjust scoring towards consensus. RESULTS: In order of ranking, the top 4 vision screening tests were hand motion, counting fingers, confrontation visual fields and the HOT-V chart, whereas the top 4 hearing screening tests were the Hearing Handicap Inventory for the Elderly, the Whisper Test, the Measure of Severity of Hearing Loss and the Hyperacusis Questionnaire, respectively. CONCLUSIONS: The final selection of vision screening tests relied on observable visual behaviours, such as visibility of tasks within the central or peripheral visual field, whereas three of the four hearing tests relied on subjective report. Next, feasibility will be tested by nurses using these tools in a long-term care setting with persons with various levels of cognitive impairment.

A comparison of patched HOTV visual acuity and photoscreening.

Early detection of significant vision problems in children is a high priority for pediatricians and school nurses. Routine vision screening is a necessary part of that detection and has traditionally involved acuity charts. However, photoscreening in which "red eye" is elicited to show whether each eye is focusing may outperform routine acuity testing in pediatric offices and schools. This study compares portable acuity testing with photoscreening of preschoolers, kindergarteners, and 1st-graders in 21 elementary schools. School nurses performed enhanced patched acuity testing and two types of photoscreening in a portable tent. Nearly 1,700 children were screened during spring semester 2004, and 14% had confirmatory exams by community eye care professionals. The results indicate that one form of photoscreening using a Gateway DV-S20 digital camera is significantly more sensitive to children with significant vision problems, as well as being the most cost effective (85% specificity and only $0.11 per child). This suggests that the adaptation of photoscreening into a routine vision screening protocol would be beneficial for efficiently detecting vision problems that could lead to amblyopia.

Does encouragement boost visual acuity testing results?

AIM: To investigate the hypothesis: 'Patients who receive encouragement during visual acuity testing achieve better scores than patients who receive no encouragement'. METHOD: Fifty patients were randomly selected from general eye clinics with five exclusions. A quasi-experimental, non-equivalent comparison before/after design was used to consider the way patients' vision is tested using the Snellen visual acuity chart in the eye department at Kettering General Hospital. RESULTS: The results were significant (t = 5.78 df=49 p < 0.001) and supported the initial hypothesis that 'patients who receive encouragement during visual acuity testing achieve better scores than patients who receive no encouragement'. CONCLUSION: The results of the study suggest that the subjects did get better visual acuity scores when encouragement was used and recommendations were made to change the clinic protocol.

Pupil dilation and driving: guidelines for ophthalmic nurses and technicians.

Ophthalmic nurses and technicians often instill the dilating eyedrops before patients undergo ocular examination. These drops may cause some problems for patients who will be driving afterward. As professional health care providers, we have a duty to inform patients not only before the appointment but also prior to the instillation of the dilating drops that their vision may be altered due to the dilating eyedrops. It is extremely common for patients to have their pupils dilated when attending an ophthalmic outpatient appointment. This is to aid in the examination of the lens, vitreous, and fundus. The most common eyedrop used for pupil dilation in tropicamide 1%. This produces mydriasis and a small amount of cycloplegia. Mydriasis can last for several hours after instillation.

Seleção e validação de figuras para construção de optótipos / Selection and validation method for the construction of optotypes

Optótipos da escala de figuras, utilizada para verificação da acuidade visual, não se encontravam adequados à cultura cearense. Objetivou-se estabelecer um método de seleção e validação de figuras para construção de optótipos. Estudo experimental, realizado em 2001, tendo como população pré-escolares de escolas da rede pública de Fortaleza e como amostra uma instituição. A coleta de dados envolveu um contato ético e dois momentos. O primeiro foi a criação de desenhos pelas crianças e o segundo a sua análise, baseando-se na frequência e descrição. A amostra foi de 59 alunos e os bons optótipos para uma escala própria a esta região, foram o peixe, a bola, o cavalo, o telefone, a casa, a flor e o coração. O teste continua válido, necessitando adequação das figuras ao universo infantil, podendo este método ser usado em várias regiões.

Sistematizando o exame de saúde ocular nos portadores do HIV/AIDS

No inidivíduo com HIV/AIDS, observam-se comumente alteraçöes oculares, quer relacionadas à doença e suas complicaçöes, quer como fenômenos iatrogênicos determinados por sua terapêutica, podendo em alguns casos sobrevir a cegueira. Vários autores säo unânimes em afirmar que cerca de 75 por cento dos pacientes com AIDS desenvolvem alteraçöes visuais no decorrer da doença. A avaliaçäo sistemática das funçöes visuais e a integridade das estruturas oculares devem ser parte do cuidado de enfermagem para estes indivíduos...

Graves' ophthalmopathy.

Graves' disease is an inflammatory condition affecting the thyroid gland and the eye. The triad of exophthalmos, goiter, and hyperthyroidism is classic Graves' disease. Each of the signs may appear in an individual patient, although separated by weeks, months, or years. The primary cause of Graves' disease is unknown and cannot be treated satisfactorily; however, the complications may be treated.