bluuebunny/crossref_metadata_2025_split huggingface dataset:
A multilevel refraction protocol based on visual acuity
Authors: Orr Peggy R. , Guyton David L. 
Published: May 2014

Objective: To describe the historical development and methodology of a standard subjective refraction protocol to obtain best-corrected visual acuities in multicentre ophthalmic clinical trials. Methods: A revised, multilevel, subjective refraction protocol was developed for the Macular Photocoagulation Study (MPS) to accommodate poorer levels of vision than had previously been encountered. Results: Since its development in 1983, the multilevel refraction protocol has been adopted by several major clinical trials, is a reliable method to obtain best-corrected visual acuity among patients with a wide range of visual acuities and eye disorders, and has been shown to be more reliable than autorefraction. Among 82 participants in the MPS, 89% of repeated refractions obtained using the multilevel refraction protocol differed from each other by less than +/– 0.50 dioptre (D) and 97.5% by less than +/–1.00 D. Among 29 participants in the Submacular Surgery Trials (SST), the multilevel refraction protocol gave a spherical equivalent that averaged 1.04 D more positive than autorefraction (95% limits of agreement: 0.74, 1.34), and the visual acuity score, using the refraction protocol, was 1.5 letters better compared with autorefraction (95% limits of agreement: 0.0, 3.0). Conclusions: The multilevel refraction protocol is a reliable method of obtaining best-corrected visual acuity among patients across a wide range of visual acuities and many different eye disorders in ophthalmic clinical trials.
Dry eye disease: simple to diagnose but complex to manage
Authors: Törnquist Alba Lucia 
Published: May 2014

Dry eye disease is a multifactorial condition affecting the tears and ocular surface usually presenting with ocular discomfort and/or visual complaints. Dry eye disease is a condition that increases in prevalence with increasing age. Ocular structures involve not only the cornea but also the eyelids. The diagnosis is based on a positive questionnaire regarding symptoms and the results of a thorough ocular investigation. There are different treatment options including modification of the environment, eyelid hygiene, tear substitutes, anti-inflammatory agents, punctual occlusions, and dietary modifications. Successful treatment can dramatically improve the patient's quality of life. The main objective of this article is to present the most common clinical manifestations of dry eye disease, different investigation methods, treatment modalities and suggestions of environmental modifications.
Evaluation of reading performance in clinical settings using the Tobii 1750 Eye Tracker
Authors: Källmark Fredrik , Brautaset Rune 
Published: May 2014

Aim: To evaluate the Tobii 1750 Eye Tracker system's usefulness in evaluating reading performance. Material: Twenty healthy subjects, aged 21–33 years, were measured with the Tobii 1750 Eye Tracker while reading two texts with equal readability rating. Reading speed was measured in words read per minute (wpm) from the onset of the first page to the conclusion of the last. Comprehension was enumerated as the ratio of correct answers (%). Eye movements were recorded as time-stamped coordinates of how the eyes moved over the screen. Results: There was a significant difference in reading speed and all eye movements except the saccade/regression ratio. Furthermore there was no significant difference in comprehension between the texts. Conclusion: The results show that texts used for studying reading performance most be chosen carefully as texts of the same linguistic difficulty, fonts, size and spacing can yield differences in reading performance, i.e. readability indexes are most likely not able to differentiate texts in a sophisticated enough manner. Furthermore, the results show that the Tobii system, despite its relative low resolution and sampling frequency, is suitable for evaluation of reading eye movements.
Sight threatening pets? The tarantula tale
Authors: Tillotson Julie , Giddens Graham 
Published: May 2014

The objective of this article is to highlight potential injury to the eye from handling or keeping tarantulas and stress the importance of taking a good history and thorough eye examination. Recently two cases of ocular problems caused by tarantula hairs being lodged in the eye were seen at the Royal Bournemouth Hospital. Most tarantulas of the New World species are able to flick a mist of microscopic barbed urticating hairs from their abdomen into the face of potential predators to ward them off. These hairs can lodge in the cornea and migrate into the eye causing intraocular inflammation. This study examines the effects on the eye, highlights key information about tarantulas and looks at other published cases of injury to the eye from tarantula hairs. Injury from tarantula hairs in the eye can range from mild to fairly extensive inflammation resulting in vitreo-retinal surgery. Health professionals dealing with eye injuries need to be aware of the potential damage so that a careful history is taken and a full slit lamp examination performed. Tarantulas are becoming popular as pets kept in captivity. Customers should be warned about the risks of handling tarantulas and advised to wear eye protection if handling is essential.
Anticoagulation management in patients requiring small-gauge vitreoretinal surgery: a review of the literature
Authors: Donaldson Lisa M , Donaldson Mark J 
Published: May 2014

The management of the patient taking oral anticoagulants is a common clinical scenario in vitreoretinal surgery, where patients are often elderly and have multiple comorbidities. Performing surgery on anticoagulated patients has been associated in past studies with elevated risk of haemorrhagic complications, such as choroidal and vitreous haemorrhage. Over the past decade, the use of small-gauge sutureless vitrectomy technology has dramatically changed vitreoretinal surgery. In this article, the literature is reviewed for articles evaluating the risks of performing small-gauge sutureless vitrectomy surgery on anticoagulated patients, and the evidence-base regarding the best practice peri-operative management of these patients is reviewed. Overall, the risk of haemorrhagic complications is low in anticoagulated patients undergoing vitreoretinal surgery. There are, however, only a small number of studies that have evaluated the safety of performing this surgery while patients are on warfarin or other antiplatelet agents, and the number of patients in these studies is low. Until larger studies are performed, the clinical management of anticoagulated patients requiring vitreoretinal surgery must be individualised, taking into account the reason for anticoagulation and the risks of the particular indications for the surgery.
Pain in patients who have undergone retinal surgery: a review of a research project
Authors: Wheatley Sarah , Gibbons Helen 
Published: May 2014

Aims: This research project was used to ascertain: whether patients suffer from pain after retinal detachment surgery at Moorfields Eye Hospital, London, UK; if the care being delivered in relation to patients’ pain levels is satisfactory; if enough is being done in relation to education postoperatively regarding pain levels. Methods: A total of 40 patients were sampled and randomly selected into two groups of 20 patients. The first 20 patients (control group) were given a visual pain scoring chart and a form to fill in at certain times postoperatively to monitor their pain levels, how they controlled their pain and whether these methods were effective in pain control. Verbal information was given to them as it is at present, but they did not receive any written information. The second group of 20 patients (advice group) also received a visual pain scoring chart and a form to fill in at certain times postoperatively to monitor their pain levels, how they controlled their pain and whether these methods were effective in pain control. These patients had the same verbal information given to them as the first group, but in addition they also received detailed written information on what to do if they had any pain, with contact telephone numbers to phone for advice. Results: There was little difference in the results between the two groups, with the majority of patients reporting the surgical procedure to be less painful than they had expected. However, both groups wanted to recieve the information regarding pain prior to their admission so they could be prepared at home with the recommended pain relief. Conclusion: This research project has alerted the staff involved into preparing patients for retinal detachment surgery to ensure they have the correct knowledge regarding pain relief prior to their admission for surgery.
Evaluation of training on the use of Graseby syringe drivers for rural nonspecialist nurses
Authors: Hayes Anne , Brumley David , Habegger Lawrence , Wade Mary , Fisher John , Ashby Michael 
Published: May 2014

Aim To assess the impact of a training programme on nurse confidence in: setting up the Graseby syringe driver (GSD); explaining the GSD to patient and family; setting the rate on the GSD; putting appropriate type and dose of drugs in the GSD. Study design Training programme with pre-training, post-training and follow-up questionnaires. Sample and setting Palliative care nurse consultants presented half-day training sessions to 270 non-specialist nurses throughout the rural Grampians Health Region of Victoria, Australia. Nurses were from rural acute and sub-acute care settings, aged care facilities, and district nursing and nurse education services. Measurements Demographic details of participants, previous experience and training with GSDs, comparative analyses of the four confidence parameters and participants’ assessment of interest, new knowledge and usefulness of the training programme. Results Increases in confidence levels were found in participating nurses in relation to each of the four confidence parameters. A follow-up survey tested residual benefit 3months after the training programme. Statistically significant variations were found in nurses’ confidence levels in relation to frequency of use. Conclusions Regular use of, and/or refresher sessions about the GSD are recommended to maintain optimum confidence, effective and safe nursing use of the GSD in palliative care.
Supporting patients who have intellectual disabilities: a survey investigating staff training needs
Authors: Tuffrey-Wijne Irene , Hollins Sheila , Curfs Leopold 
Published: May 2014

Aims This article reports on a small exploratory survey aimed at establishing the perceived training needs of palliative care staff related to supporting people with intellectual disabilities.Methods Questionnaires were collected from a sample of 46 palliative care staff. Respondents were asked to describe ‘worrying issues’ about supporting a person with intellectual disabilities. Answers were analysed using content analysis.Results Most respondents (37, 80%) highlighted communication as a concern. Other major issues included assessment and symptom control, patient comprehension, empowerment and ethical issues/consent.Discussion Communication and symptom assessment can be challenging, particularly in people with limited verbal communication skills. Palliative care staff need to be aware of the range of communication methods used by people with intellectual disabilities.Conclusion There is a lack of information and training materials around intellectual disabilities for palliative care staff. This needs to be addressed. More work is needed to develop appropriate training in this area.
Parental grieving after a child dies from cancer: is stress from stem cell transplant a factor?
Authors: Drew Donna , Goodenough Belinda , Maurice Lucy , Foreman Tali , Willis Liane 
Published: May 2014

Aim To investigate psychological distress, family functioning and complicated grieving in parents whose child had died from cancer, and as a function of whether: (a) the deceased child had also received stem cell transplant (SCT) any time during curative treatment; and (b) the place of the child’s death (home or hospital). Design A cross-sectional case-match design. Sample Fifty-six Australian bereaved parents in two groups: 28 whose child had also received SCT, matched with 28 (on deceased patient variables) whose child had not received SCT. Results Parents in the ‘SCT group’ (n=28) reported relatively higher levels of depression, anxiety and stress, and – for those whose child had also died in hospital – a greater likelihood of meeting the criteria for traumatic grief than those parents whose deceased child had not received SCT. There were no significant group differences in family functioning. Conclusion Routine psychosocial screening, especially for families undergoing SCT, may contribute usefully to a proactive model of palliative care in identifying parents at risk for complicated bereavement outcomes.
The paradox of palliative care nursing across cultural boundaries
Authors: Somerville Jacqueline 
Published: May 2014

The purpose of this qualitative study, using a modified grounded theory approach, was to investigate how palliative care nurses care for people from cultural backgrounds other than their own. Ten palliative care nurses were interviewed. The semi-structured interviews were tape-recorded and transcribed verbatim. Analysis commenced as soon as data began to emerge. The findings show that palliative nursing across cultural boundaries is paradoxical. In endeavouring to treat everyone equally, nurses treated everyone as individuals. They made intense efforts to transcend both cultural and language barriers. The nurses gave of themselves when caring for the patients, but their endeavours were impeded by limited resources and a lack of education. The theory of cross-cultural endeavour in palliative nursing was developed to explain how palliative care nurses care for patients from cultures other than their own.
Making decisions about care: what it means for hospice inpatients with terminal progressive disease
Authors: Fisher Simon , Colyer Hazel 
Published: May 2014

There is very little research into patients who suffer from a terminal and progressive illness making decisions about health care in a hospice setting. What decision-making means to the inpatients in a hospice could be better understood by staff caring for this patient group. The aim of this small qualitative study was to explore the nature of decisions and the process of decision-making with patients who had been admitted to a hospice with a progressive terminal illness. A phenomenological approach was taken using a theoretical framework to explore the patients’ life world and its existential meaning, and interviews were conducted with six inpatients. The decisions that came to the fore for the participants were around the driving force behind admission, which was often pain. Beyond this often traumatic event they were able to be robust in decision-making about day-to-day issues. Other decisions related to the purpose of the admission such as symptom control, achieving independence, whether to have further treatment, communication with their families and returning to the community. Patients had an increased awareness of the fragility of their existence, which was brought into focus by the decision to be admitted to the hospice. The findings give an insight into the driving forces behind decision-making and the kind of decisions that are important to the patients in this sample, which staff caring for this patient group may find valuable.
A case history of chronic heart failure and the benefits of palliative care: a local experience
Authors: Chester Tim J 
Published: May 2014

This short case study will illustrate how collaborative working by cardiologists and specialist palliative care services can bring about positive and beneficial changes for those patients suffering from chronic heart failure. It will also demonstrate that earlier referral to palliative care will ensure that matters such as preferred place of care, can be discussed and put into place for the appropriate time. The case study will reveal that patients and their carers accept referral to palliative care services and see the benefit of earlier referral. It is further acknowledged that all referrals to specialist palliative care are a learning experience for both disciplines.
Use of dependency and prioritization tools by clinical nurse specialists in palliative care: an exploratory study
Authors: Bracken Mairéad , McLoughlin Kathleen , McGilloway Sinéad , McMahon Edith 
Published: May 2014

Aims: The principal aim was to assess the utility of three needs assessment/dependency tools for use in community-based palliative care services. Specific objectives were to assess a sample of patients receiving specialist palliative care community nursing using these tools, to assess the predictive ability of each tool, and to explore the utility of prioritizing and measuring patient dependency from a clinical nurse specialist (CNS) perspective. Method: In phase 1, 22 community-based CNSs completed the Vale prioritization tool for all patients visited during a 3-month period (n=162). They also completed either the Graves and Payne (2007) or the Birch et al (1997) dependency tool after each visit. In phase 2 a focus group (n=8) and two one-to-one interviews with CNS participants explored the perceived utility of all three tools. Results: The Vale prioritization tool appeared to be the most useful for prioritizing patient need and managing workload. Statistical analysis highlighted minimal differences between the two dependency tools, neither of which predicted length of visit. Three themes were identified from phase 2: difficulties with routine administration, points of divergence between the two dependency tools, and workload concerns. Conclusion: While the Vale prioritization tool emerged as the most useful, the findings raise questions about the overall utility and practical application of these kinds of tools with community-based palliative care patients. Further research is needed to identify/develop, adapt, and evaluate appropriate, setting-specific dependency tools for use with this population.
Barriers to cancer pain management: Jordanian nurses' perspectives
Authors: Al Khalaileh Murad , Al Qadire Mohammad 
Published: May 2014

Background: Adequate management of cancer pain is a human right. However, cancer pain is still not well medicated, and some of the barriers to achieving relief are related to nursing. Identifying these barriers would help the development of interventions to improve pain management. Aim: To explore barriers to cancer pain management among Jordanian nurses. Method: A convenience sample of 96 nurses from 3 hospitals participated in a cross-sectional survey using an Arabic translation of Ward and colleagues’ barriers questionnaire II. Results: The nurses expressed high levels of barriers on the questionnaire, with a mean score of 2.5 for the questionnaire as a whole (standard deviation (SD) 0.8). The harmful and physiological effects of medications subscales received the highest mean scores: 2.7 (SD 1.1) and 2.6 (SD 0.9) respectively. Conclusions: Many nursing-related barriers to cancer pain management were found. These barriers need to be addressed and eliminated, for example through education and training.
Retaining older staff members in care homes and hospices in England and Australia: the impact of environment
Authors: Rigby Janet , O'Connor Margaret 
Published: May 2014

Aim: To explore the views of older Australian and English care home and inpatient hospice staff on the physical environment of their workplace. Method: The paper reports on an issue that was highlighted during a larger ethnographic study of the inpatient environments in which older people receive end-of-life care. During visits to sixteen care homes and inpatient hospices—seven in England and nine in Australia—informal discussions were held with staff in which they described the challenges posed by the physical environment of their workplace. Results: Several of the staff, who were predominantly older female nurses, described the difficulties of working in a care environment that was not always fit for current purpose. For example, they found it tiring to have to walk long distances between tasks, and experienced difficulty with manoeuvring heavy equipment on unsuitable floor surfaces. Conclusions: In order to promote the health of older, experienced care home and hospice staff and encourage them to remain in employment, it is important that the physical environment of the care setting is designed in a way that meets their needs. Older staff should be included in decisions about the refurbishment and rebuilding of care environments.
How do nurses in specialist palliative care assess and manage breakthrough cancer pain? A multicentre study
Authors: Soden Katie , Ali Simone , Alloway Lara , Barclay David , Barker Stephanie , Bird Lydia , Hall Lesley , Perkins Paul 
Published: May 2014

Objective: To gain a better understanding of how registered nurses working in specialist palliative care assess and manage breakthrough cancer pain. Methods: A mixed-methodology study was undertaken in two stages—this paper reports findings from stage two. Anonymous postal questionnaires, designed based on themes identified in interviews undertaken during stage one, were sent to trained nurses working in ten specialist palliative care services in England. Results: A total of 104 questionnaires were returned. Respondents were experienced nurses mainly working in inpatient settings. Some 82% of the nurses wanted more training on the assessment of breakthrough cancer pain. Although there were inconsistencies around the use of terminology, pain management appeared to be good. Conclusion: The use of terminology in the field of breakthrough cancer pain remains variable. However, this does not appear to have a negative impact on patient management, which was broadly in line with recently published consensus recommendations. There is a desire for more education within this area of practice.
End-of-life care in neurodegenerative conditions: outcomes of a specialist palliative neurology service
Authors: Hussain Jamilla , Adams Debi , Campbell Colin 
Published: May 2014

Background People with advanced neurological conditions (ANCs) face complex problems and needs that are often unrecognised and undertreated. Their last year of life may be characterised by unplanned hospital admissions and an unexpected death. A National End-of-Life Care Programme (NEoLCP) 2010 framework made recommendations to aid timely and appropriate end-of-life care for people with ANCs. Objectives Assessment of key outcomes of a UK nurse-led palliative neurology service against the NEoLCP standards. Method A retrospective study of clinical records of patients who died from an ANC under the care of the service from December 2006 to April 2012. Results All 62 patients had multidisciplinary care coordinated by a key worker—a clinical nurse specialist (CNS) in palliative neurology. Mental capacity was assessed in 95% of cases, of which 95% had a documented advance care plan or best interest decision. The CNS had specific input regarding carer distress in 77% of cases. Mean hospital admissions were 0.9 per patient in the last year of life, compared with 3.5 nationally across all diagnoses. The service demonstrated better outcomes in other key areas, including place of death, with more patients dying at home or in the hospice compared with national figures. Conclusion This service model fulfils key NEoLCP recommendations, as well as resulting in low hospital admissions and deaths.