The Impact of Axial Eye Growth on Foveal Avascular Zone Measurements in Children.

SIGNIFICANCE: Foveal avascular zone (FAZ) area is a frequently used biomarker in diseases impacting the retinal vasculature in pediatric populations. Variation in axial length between individuals results in differences in lateral image scale, which affect the accuracy of FAZ area measurements. Accordingly, changes in axial length over time within individual children would affect estimates of FAZ area change. PURPOSE: This study aimed to quantify how changes in axial length over time affect estimates of FAZ area change using optical coherence tomography angiography (OCT-A) images. METHODS: Twenty pediatric participants (<18 years old) and 40 adult participants were imaged on Optovue's Avanti system (Fremont, CA) and had axial length measurements acquired at two time points. The FAZ was segmented twice using the OCT-A image at each time point. Foveal avascular zone area was estimated at both time points using the assumed/fixed axial length of the OCT-A device (unscaled) and using the participant's axial length (scaled). Changes in FAZ area over time were compared between the pediatric and adult groups using both unscaled and scaled data. RESULTS: The average ± standard deviation follow-up time was 3.35 ± 1.66 years for the pediatric group and 2.90 ± 1.65 years for the adult group. Using unscaled data, FAZ area seemed to decrease between visits in the pediatric group (P = .004), whereas the FAZ area increased between visits in the adult group (P = .003). When correctly scaled data were used, the FAZ area still increased between visits for the adult group (P < .001), although the FAZ area no longer showed a significant change between visits for the pediatric group (P = .37). When comparing the normalized FAZ area change across visits between unscaled and scaled data, a significant difference was found between the adult and pediatric groups (P < .001). CONCLUSIONS: Scaled data should be used when measuring FAZ area in pediatric populations, especially in longitudinal studies.

Nurses', midwives' and key stakeholders' experiences and perceptions on requirements to demonstrate the maintenance of professional competence.

AIM: To present the qualitative findings from a study on the development of scheme(s) to give evidence of maintenance of professional competence for nurses and midwives. BACKGROUND: Key issues in maintenance of professional competence include notions of self- assessment, verification of engagement and practice hours, provision of an evidential record, the role of the employer and articulation of possible consequences for non-adherence with the requirements. Schemes to demonstrate the maintenance of professional competence have application to nurses, midwives and regulatory bodies and healthcare employers worldwide. DESIGN: A mixed methods approach was used. This included an online survey of nurses and midwives and focus groups with nurses and midwives and other key stakeholders. The qualitative data are reported in this study. METHODS: Focus groups were conducted among a purposive sample of nurses, midwives and key stakeholders from January-May 2015. A total of 13 focus groups with 91 participants contributed to the study. FINDINGS: Four major themes were identified: Definitions and Characteristics of Competence; Continuing Professional Development and Demonstrating Competence; Assessment of Competence; The Nursing and Midwifery Board of Ireland and employers as regulators and enablers of maintaining professional competence. CONCLUSION: Competence incorporates knowledge, skills, attitudes, professionalism, application of evidence and translating learning into practice. It is specific to the nurse's/midwife's role, organizational needs, patient's needs and the individual nurse's/midwife's learning needs. Competencies develop over time and change as nurses and midwives work in different practice areas. Thus, role-specific competence is linked to recent engagement in practice.

Research ethics application: a guide for the novice researcher.

The aim of this paper is to assist the novice researcher in the research ethics application process. The novice researcher in this context refers to any researcher negotiating a research ethics application for the first time. This may be a student or a more experienced registered nurse engaged in research activity. The paper applies ethical principles to the varied elements of a research ethics application form to explain the theoretical basis of the application criteria. The impetus for this paper arose following an internal audit of the decisions made by the research ethics committee of the nursing department at the Institute of Technology in Tralee, Ireland. The audit revealed the common reasons why full approval was not granted following initial review. This information prompted the development of a paper which would assist novice researchers in avoiding common errors and omissions in the research ethics application process. Despite the specific requirements of individual research ethics committees in different jurisdictions, the fundamental elements of research ethics approval remain unchanged. While the paper has local origins, its relevance holds a wider appeal. The paper takes a structured approach using the three ethical principles of respect for persons, beneficence, and justice, as outlined by the Belmont Report (1979) to provide a framework for discussion. Despite the advent of other frequently used frameworks for research ethics, the principles of the Belmont report remain constant as guidance for good practice in the research ethics context.

Automated image processing pipeline for adaptive optics scanning light ophthalmoscopy.

To mitigate the substantial post-processing burden associated with adaptive optics scanning light ophthalmoscopy (AOSLO), we have developed an open-source, automated AOSLO image processing pipeline with both "live" and "full" modes. The live mode provides feedback during acquisition, while the full mode is intended to automatically integrate the copious disparate modules currently used in generating analyzable montages. The mean (±SD) lag between initiation and montage placement for the live pipeline was 54.6 ± 32.7s. The full pipeline reduced overall human operator time by 54.9 ± 28.4%, with no significant difference in resultant cone density metrics. The reduced overhead decreases both the technical burden and operating cost of AOSLO imaging, increasing overall clinical accessibility.

Building capacity: getting evidence-based practice into healthcare professional curricula.

Fostering a culture of clinical effectiveness in healthcare is crucial to achieving optimum outcomes for patients. Evidence-based practice (EBP) is a cornerstone of clinical effectiveness. An EBP capacity-building project commenced in Ireland in 2016, in collaboration with the Centre of Evidence-Based Medicine in Oxford. A key part of this project, reported here, was the development of a competency framework for education in EBP and clinical effectiveness to ensure responsiveness of education standards and curricula of healthcare professionals in this area. METHODS: Following a review of national and international reports, professional guidance documents and empirical literature pertaining to clinical effectiveness education (CEE), a preliminary competency framework was developed. Stakeholder consultations were conducted over a 6-month period, which consisted of 13 focus groups (n=45) and included representatives from clinical practice, higher education and professional training sectors, regulator/accrediting bodies, the Department of Health (Ireland) and patient/service user groups. RESULTS: An overarching interprofessional competency framework for CEE was proposed and included the following domains: EBP, quality improvement processes, implementation strategies and collaborative practice: a total of 16 competencies and 60 indicators. CONCLUSION: A competency framework for CEE for health and social care professionals is presented. It is intended that this framework will provide guidance to healthcare educators and regulators in the construction and revision of curricula, learning outcomes, teaching and assessment strategies, and graduate/clinician attributes.

Noninvasive Imaging of Cone Ablation and Regeneration in Zebrafish.

Purpose: To observe and characterize cone degeneration and regeneration in a selective metronidazole-mediated ablation model of ultraviolet-sensitive (UV) cones in zebrafish using in vivo optical coherence tomography (OCT) imaging. Methods: Twenty-six sws1:nfsB-mCherry;sws2:eGFP zebrafish were imaged with OCT, treated with metronidazole to selectively kill UV cones, and imaged at 1, 3, 7, 14, 28, or 56 days after ablation. Regions 200 × 200 µm were cropped from volume OCT scans to count individual UV cones before and after ablation. Fish eyes were fixed, and immunofluorescence staining was used to corroborate cone density measured from OCT and to track monocyte response. Results: Histology shows significant loss of UV cones after metronidazole treatment with a slight increase in observable blue cone density one day after treatment (Kruskal, Wallis, P = 0.0061) and no significant change in blue cones at all other timepoints. Regenerated UV cones measured from OCT show significantly lower density than pre-cone-ablation at 14, 28, and 56 days after ablation (analysis of variance, P < 0.01, P < 0.0001, P < 0.0001, respectively, 15.9% of expected nonablated levels). Histology shows significant changes to monocyte morphology (mixed-effects analysis, P < 0.0001) and retinal position (mixed-effects analysis, P < 0.0001). Conclusions: OCT can be used to observe loss of individual cones selectively ablated by metronidazole prodrug activation and to quantify UV cone loss and regeneration in zebrafish. OCT images also show transient changes to the blue cone mosaic and inner retinal layers that occur concomitantly with selective UV cone ablation. Translational Relevance: Profiling cone degeneration and regeneration using in vivo imaging enables experiments that may lead to a better understanding of cone regeneration in vertebrates.

Evaluating a preceptorship programme in South West Ireland: perceptions of preceptors and undergraduate students.

AIM: The study sought to evaluate stakeholder perspective of preceptor preparation and attributes. BACKGROUND: In Ireland, undergraduate students are supported by a named preceptor on clinical placement. A preceptor is a registered nurse who has completed a teaching, assessment and preceptorship programme. Preceptor preparation is costly in terms of facilitation and staff release/replacement. To date, in Ireland, research has not explored the effectiveness of preceptor preparation. METHOD: An utilization-focussed approach was adopted incorporating a two-phase research process; Phase 1 being exploratory while Phase 2 aimed to validate inductions derived from the previous stage. Results The programme is effective in meeting its learning outcomes. The findings are categorized into four theme areas: the importance of preceptor characteristics, the demonstration of these characteristics, knowledge demonstrated by the preceptors and the skills demonstrated by the preceptor. CONCLUSION(S): Preceptors, to be effective within the preceptor/student relationship, need to integrate both their professional and personal attributes to effectively socialize students to the profession of nursing. IMPLICATIONS FOR NURSING MANAGEMENT: The preceptor role is invaluable within nurse education. This study supports the release of registered nurses to attend preceptor preparation programmes. It highlights the importance of nursing management in preceptor selection, release, support and monitoring in order to create an effective clinical learning environment.

Evidence-based practice education for healthcare professions: an expert view.

Internationally, evidence-based practice (EBP) is recognised as a foundational element of healthcare professional education. Achieving competency in this area is a complex undertaking that is reflected in disparities between 'best EBP' and actual clinical care. The effective development and implementation of professional education to facilitate EBP remains a major and immediate challenge. To ascertain nuanced perspectives on the provision of EBP education internationally, interviews were conducted with five EBP education experts from the UK, Canada, Australia and New Zealand. Definitive advice was provided in relation to (1) EBP curriculum considerations, (2) teaching EBP and (3) stakeholder engagement in EBP education. While a considerable amount of EBP activity throughout health profession education is apparent, effectively embedding EBP throughout curricula requires further development, with a 'real-world' pragmatic approach that engenders dialogue and engagement with all stakeholders required.