Stories of Surviving through Hardship in Elder Sikh Punjabi Women

Hardship and adversity are a part of life for all. However, dominant Western psychological discourses about mental health, illness and recovery can de-contextualise the social, political and spiritual nature of hardship, suffering and liberation, subjugating narratives that do not fit within this framework. Sikh Punjabi people have many stories of survival and liberation from collective historical and continuing hardships. Elder women are often positioned in Sikh Punjabi communities as storytellers and community activists, sharing knowledge and working towards collective liberation, but are rarely included in psychological research, particularly if they do not speak English. Storytelling is a naturalistic method of making sense of the world, yet narrative methods are also rarely used in psychological research. This means that psychological professionals are limited to rigid frameworks for understanding emotional suffering and healing, that are not shared by all. This ethno-poetic narrative analysis therefore explored how elder Sikh Punjabi women in the UK storied and made sense of surviving through hardship, and the liberatory potential in their narratives and narration. Participants appeared to story hardships in social, spiritual and political contexts, and survival through moving narratives of resistance, conscious Oneness, constructivism, and through the act of storytelling. Furthermore, narratives of collective liberation and social change were interdependent and weaved into personal narratives of survival. The relevance and implications of these findings are discussed for clinical psychology theory, practice, training, research and wider policy

Smartphone ophthalmoscopy: patient and student practitioner perceptions

It can take several years to become proficient at direct ophthalmoscopy; the instrument’s single eyepiece allows only one individual to view the image at a time, which is considered disadvantageous during teaching. The introduction of smartphone ophthalmoscopes enables groups of teachers and students to view images together which could encourage peer-to-peer learning. In addition, the technology is significantly cheaper than the direct ophthalmoscope. User acceptability and engagement is essential to the success of any (medical) technological innovation. We sought to understand student opinions of a new commercially-available smartphone device for fundus examination, and compare usability to the traditional ophthalmoscope, from the perspective of both student practitioners and patients. Fifty-four undergraduate optometry students with prior experience of the traditional direct ophthalmoscope were asked to examine at least one eye with the D-EYE smartphone ophthalmoscope and also given an opportunity to experience the D-EYE from a patient’s perspective. Minimal instructions were provided and all examinations conducted through undilated pupils. Participants completed an opinion survey to feedback on aspects such as the ease of handling and working distance. Compared to the direct ophthalmoscope, 92% of students preferred the (longer) working distance of the D-EYE; 77% felt it was easier to handle; and 92% preferred the patient experience with the D-EYE. Despite the positive feedback, only 43% of students preferred the D-EYE when assuming the role of the practitioner. Free text responses indicated that students felt the D-EYE may be most useful as a teaching tool. Student opinions indicated that smartphone ophthalmoscopes are an effective training tool for students as an accompaniment to learning the traditional ophthalmoscope method

Telling and Re-Telling Stories: Staff Witnessing Narratives from People Diagnosed with Dementia

People navigate an array of emotive and competing narratives which construct the landscape of dementia in the UK. Dominant narratives include biomedical explanations of behaviour and the economic burden of old age. Narratives of person-centred care are equally inflated with emphasis on staff ability and ambivalent definitions of good care. These dynamics risk undermining the heterogeneity of alternative stories from people associated with the label as well as for the people around them. In the current study, the narrative approach of outsider witnessing practice (OWP) was utilised to explore the social location it offered in hearing subjugate narratives of identity from people with a diagnosis of dementia (PDwD) and the narratives of the impact of hearing these from staff. Two PDwD and two staff members were recruited from a dementia day centre, seven stories were produced and analysed. The methodology of narrative analysis was employed to specifically focus on the presence of the wider dominant narratives, experiential stories and interactions in the storytelling constructions of identity. Analysis revealed the significance of social interaction in the constructions of identities for PDwD within OWP, verbal biographical stories weighed significantly in producing shared values and cultural norms, however the interactional elements co-constructed and validated identities of humour, privacy, empathy, determination and many more. Individual staff interviews revealed the pressures faced in providing good support, however OWP offered validation in staff’s more relationship focused approaches in working with PDwD. Implications of the current study include the role of OWP in clinical practice as a space to elicit counter narratives in dementia and health settings as well as raising awareness of professional’s contributions to identity constructions of the people who use services. Moving pressures off of individual staff to provide person centred care and hear staff’s personal and relational narratives of care which can help expand understanding of how best to support each person most meaningfully. Finally, targeting the wider political and societal assumptions by bringing spaces for alternative narratives to be heard more readily in the public realm can diversify the narratives of dementia

Changes in forward light scatter parameters as a function of refractive error in young adults

Background/aims Some aspects of visual performance worsen with increasing myopia. Whilst the underlying causes are not always clear, reduction in retinal image quality is often attributed to structural changes in the posterior myopic eye. Forward light scatter, originating principally from the cornea and lens, is known to produce veiling glare which subsequently reduces retinal image contrast. It is therefore of interest to investigate whether forward light scatter varies with refractive error. Methods Thirteen young-adult subjects (18–25 years), with mean spherical errors (MSE ± sd, D) RE, − 1.69 ± 2.02 (range 0.38 to − 4.75); LE, − 1.91 ± 1.94 (range 0.50 to − 4.63) underwent binocular assessment of forward light scatter using the AVOT light scatter test. Five glare annuli, with effective eccentricities ranging from 2 to 10°, were used to estimate parameters, k and n, which define the light scatter function of the eye. These were then used to calculate the area under the light scatter function (k′) and the total volume of light scatter (k″). Results Significant correlation was found between increasing myopia and k′ values (RE, p  0.05 for both eyes). Axial length was also not correlated with any of the light scatter parameters measured. Conclusion The preliminary data from this study provide evidence that some light scatter parameters may be correlated with refractive error. Further studies are needed to characterize how changes in the anterior media of the eye, and inclusion of a wider range of refractive errors, may affect forward light scatter

Closing the educational gap: Implementing a LPN introduction/scope optimization framework

A large health authority serving specialty patient populations, referred to hereafter as Organization M, is hiring Licensed Practical Nurses (LPNs) in the place of Registered Nurses due to nursing shortages. LPNs are not educationally prepared to work in specialty patient populations. As a problem of practice, LPNs need additional education and skills training to work in Organization M. Literature reveals that the level of education nurses possess impacts the quality of patient care and safety (Needleman, 2017). This Organizational Improvement Plan (OIP) focuses on identifying the additional education/skills training LPNs need and how Organization M can provide this. A critical organizational analysis identifies that there are many drawbacks to Organization M hiring LPNs and not providing them with the additional education/skills training they need. The analysis identifies multiple factors that leaders must consider prior to hiring LPNs or optimizing their scope. The OIP recognizes that Organization M identifying and providing LPNs with the additional education/skills training is the only feasible solution. A LPN Introduction/Scope Optimization (LISO) framework is created to provide guidance to leaders of the factors necessary to judiciously hire LPNs or optimize their scope. The aim of the LISO framework is to ensure LPNs in Organization M receive the additional education/skills training they need. Through the implementation of the LISO framework LPNs will be able to work to their optimal scope while providing safe and competent care when working with specialty patient populations

Causes of congenital corneal opacities and their management in a tertiary care center.

PURPOSE: To evaluate causes and management of congenital corneal opacities (CCO) diagnosed in a tertiary care eye center and to compare the data with a previous study at the same institution. METHODS: Computerized medical records in all patients with congenital corneal opacities diagnosed in the Cornea Service at Wills Eye Hospital (Philadelphia, PA) between January 1, 2007, and December 31, 2015, were retrospectively reviewed. Children aged 12 years and younger at the first visit were included in the study. Patients\u27 demographics, ocular diagnosis, laterality, associated ocular abnormalities, other ocular surgery performed prior or subsequent to the first visit, and their treatment were extracted from the medical records. RESULTS: A total of 77 eyes in 56 patients were examined. The mean age at presentation was 32.8 ± 44.2 months, with the mean follow-up period of 26.7 ± 30.1 months. The most frequent diagnosis was Peters anomaly (53.2%), followed by limbal dermoid (13.0%), aniridia with glaucoma and microphthalmos (6.5%), sclerocornea and congenital glaucoma (5.2%), idiopathic (3.9%), Axenfeld-Rieger anomaly and Hurler syndrome (2.6%), and microcornea (1.3%). Primary keratoplasty was performed in 26 eyes, with the outcome rate in the clear cornea of 76.0% during the follow-up. CONCLUSION: Peters anomaly is the most common cause of congenital corneal opacities encountered at our institution. Penetrating keratoplasty is the most frequent choice of corneal surgery to treat congenital corneal opacities. Additional interventions during penetrating keratoplasty were moderately positively correlated with graft failure. This study also shows the rates of some etiologies of that changed over the recent decades in our tertiary care Cornea Service. Although Peters anomaly remains the most common presenting reason for congenital corneal opacities, its rate appears to be increasing over the recent decade. Congenital corneal opacities due to birth trauma, which is one of the preventable causes, were observed in a previous study in our clinic; however, no new cases were noted in this study

Neonatal Orogastric & Nasogastric Tube Placement: Evidence Based Improvement Prospectus

Problem: Variation in gastric tube placement practice has resulted in incorrect placement depth, resulting in four gastric tube perforations in a level III neonatal ICU within the last year. Gastric perforations have increased infant length of stay, increased surgical interventions, delay in oral feeding, increased hospital cost, and potentially lower family satisfaction with care. Context: IHI’s 5 Why’s: Finding the Root Cause identified a lack of standardization in policy and practice and lack of consistent staff education as the primary reason for misplaced gastric tubes. Additionally, a cost-benefit analysis projected the estimated cost of additional infant length of stay for gastric perforations to be between $3,000 to$138,000, which does not include surgical cost or additional treatment costs for gastric perforation-related complications. Interventions: Infant measurements were collected by measuring infants from the corner of the mouth to the earlobe for orogastric tubes, insertion site nare to the earlobe for nasogastric tubes, earlobe to the xiphoid process, and xiphoid process to umbilicus. Infant x-rays were assessed to determine appropriate gastric tube placement. They were then compared to the most appropriate insertion method for placement, including NEX, NEX +1, NEX +2, NEMU, and weight-based methods. Measures: The primary measure of the gastric tube initiative is to have zero gastric perforations and see an improvement in gastric tube placement on x-rays on the initial insertion attempt. Results: Since initial gastric tube insertion method education, it was identified that 42.6% of gastric tubes were incorrectly placed. Thus, a weight-based trend identified the need to use a different gastric tube insertion method for each weight class. The NEMU method presented too deep for infants less than one kilogram, and the NEX method was too shallow for infants weighing more than two kilograms. Additionally, the weight-based formula for gastric tube insertion proved to place tubes in 92.6% of insertion attempts incorrectly. Conclusion: The proposed gastric tube measurement guidelines include using the NEX method for infants weighing less than one kilogram, using the NEX +1 method for infants weighing between one to two kilograms, and using the NEMU method of infants weighing more than two kilograms. At this time, the weight-based method should not be used to guide practice as there is insufficient evidence to support the correct placement of orogastric tubes, and infants on oxygen therapy and intravenous therapy have been excluded from previous studies

Myopia: structural and functional correlates

Ocular dimensions are widely recognised as key variants of refractive error. Previously, accurate depiction of eye shape in vivo was largely restricted by limitations in the imaging techniques available. This thesis describes unique applications of the recently introduced 3-dimensional magnetic resonance imaging (MRI) approach to evaluate human eye shape in a group of young adult subjects (n=76) with a range of ametropia (MSE= -19.76 to +4.38D). Specific MRI derived parameters of ocular shape are then correlated with measures of visual function. Key findings include the significant homogeneity of ocular volume in the anterior eye for a range of refractive errors, whilst significant volume changes occur in the posterior eye as a function of ametropia. Anterior vs. posterior eye differences have also been shown through evaluations of equivalent spherical radius; the posterior 25% cap of the eye was shown to be relatively steeper in myopes compared to emmetropes. Further analyses showed differences in retinal quadrant profiles; assessments of the maximum distance from the retinal surface to the presumed visual axes showed exaggerated growth of the temporal quadrant in myopic eyes. Comparisons of retinal contour values derived from transformation of peripheral refraction data were made with MRI; flatter retinal curvature values were noted when using the MRI technique. A distinctive feature of this work is the evaluation of the relationship between ocular structure and visual function. Multiple aspects of visual function were evaluated through several vehicles: multifocal electroretinogram testing, visual field sensitivity testing, and the use of psychophysical methods to determine ganglion cell density. The results show that many quadrantic structural and functional variations exist. In general, the data could not demonstrate a significant correlation between visual function and associated measures of ocular conformation either within or between myopic and emmetropic groups