Vision problems following stroke: developing a best practice statement

An estimated 15 million people worldwide suffer a stroke each year, and in developed countries, survival is increasing. Of those who survive 30 days or more after their first event, many experience stroke-related vision and visual problems. Although screening for such problems after diagnosis of stroke is recommended, no standard method for complying with this recommendation is available. As visual problems are not always recognised by the sufferer, or obvious to others, they can be overlooked. Undetected problems result in distress to the individual and the people important to them, and may result in longer stays in hospital or repeat admissions. Health professionals in the acute care setting need to be aware that there is a risk of visual problems after stroke and have access to best practice guidance for screening, assessment and management of stroke-related visual problems. This paper describes the process used by a multidisciplinary team to develop a best practice statement for screening, assessment and management of vision problems during the acute phase of stroke

Best Practice Statement for Screening, Assessment and Management of Vision Problems in the First 30 Days after an Acute Stroke

No abstract available

Health locus of control in patients undergoing coronary artery surgery – changes and associated outcomes: a seven-year cohort study

Introduction: Health locus of control is a measure of an individual’s beliefs in factors that are thought to determine health experiences. Scores are generated and form a graduated linear scale from external to internal control, with respect to their views on health causality. Health locus of control has been considered to be a relatively stable entity. However, it is not clear if this status changes in the advent of serious health challenges, such as coronary artery bypass graft surgery. The aim of this study is to explore the variability of health locus of control and its association with postoperative health in this context. Methods: In a longitudinal cohort study of patients undergoing coronary artery bypass graft surgery, a purposive sample (n=215) were recruited from the waiting list and followed up postoperatively, at approximately one year and seven years later. Results: Patients undergoing coronary artery bypass graft surgery demonstrated marked fluctuations in health locus of control in their peri-operative and rehabilitative phases. Mean health locus of control became more external (often associated with poorer outcomes) peri-operatively, and more internal (generally associated with better health outcomes) in the rehabilitative period. Conclusions: Health locus of control scores were shown to be changeable during a major health care intervention, with possible consequences for patient outcomes and care needs. The significant health belief upheaval demonstrated in this cohort should be considered in assessing patients preoperatively, and managed as part of the patients’ clinical journey by both acute and rehabilitation staff. It is likely to have particular importance in individualised assessment and management of future prevention advice for patients

Summary of a Best Practice Statement for Screening, Assessment and Management of Vision Problems in the First 30 Days After an Acute Stroke

No abstract available

A Case Study of Organizational Change Strategies and Outcomes:

The restructuring and reorganization of governmental organizations is a frequent occurrence in the human service sector. During the past decades, the literature has indicated that numerous states located throughout the nation have been reforming their human service delivery systems (Annie E. Casey Foundation; Frumkin, Imershein, Chackerian, & Martin, 1983; Polivka, Imershein, White & Stivers, 1981; Ragan, 2003; Ragan with Nathan, 2002; Rockefeller Institute for Government). In 2004, the Vermont Agency of Human Services (AHS) joined this trend and began a reorganization effort of its own. This dissertation examines one aspect of the larger restructuring effort: the creation of a Field Services Division (FSD) within AHS. The organization of the FSD included placement of key leadership positions, known as Field Services Directors in each of the 12 regions of Vermont. This new management structure was intended to provide AHS leadership at the local level, and assist with transformation of AHS’ human services delivery system towards a model of service integration. This study explores the perspectives of the policy executives and field directors who were charged with visioning and implementing human service reforms in Vermont. The research employs a mixed-method, user-focused evaluative case study and survey approach (Patton, 2002; Russ-Eft & Preskill, 2001) to examine the organizational change strategies, processes, and perceived outcomes related to the FSD initiative. Findings indicate there have been successes and challenges associated with the initiation of a FSD within AHS. While field directors were designated as agents of change, data suggests that without further structural and system supports, service integration will not be easily achieved. Service coordination, consumer participation and development of community supports appear to offer the most promising practices in improving outcomes. This study also reveals that a local level of leadership offers promise in devising and implementing policy changes to improve human service delivery. The study informs future evaluations about the opportunities, challenges and paradoxes in human service reform efforts. The project contributes to the literature regarding organizational change and human service integration and suggests areas for future research. In addition, the analysis provides a framework to assist AHS in understanding the limitations and possibilities associated with this organizational change effort. Finally, it provides descriptive research with which to support continued improvement in the delivery of human services in Vermont. This dissertation research was supported by the Vermont Research Partnership; an endeavor which aims to study and improve the effectiveness of the collaborative, community-based initiatives of the Agency of Human Services, the Department of Education, the University of Vermont and the Vermont Association of Regional Partnerships

Pressure Sores: An Investigation Into the Clinical Nursing Management of the Prevention and Management of Pressure Sores Within an Acute Hospital Trust

Pressure sores are a common problem throughout all health care settings. A number of risk assessment scales have been developed in an endeavour to help carers recognise the individuals most at risk of developing pressure sores, and to identify the factors which contribute to that risk in order to guide appropriate and individualised plans of care. Waterlow (1991) suggests that a care plan relating specifically to the prevention and management of pressure sores may be beneficial. However, no study has investigated if the results of risk assessment are used to plan patient care or if a pressure sore care plan is advantageous. This two-phase correlational study was conducted to identify whether there was an association between risk assessment, as defined by the Waterlow Risk Assessment Scale, severity of sore, as defined by the Stirling Pressure Sore Severity scale, and management of care. In addition, two care plan systems were compared to determine if a care plan specifically for the prevention and treatment of pressure sores facilitated the systematic management of patient care. The study was conducted in an acute hospital trust. Thirty Registered Nurses were interviewed using a structured interview schedule and 327 patient records were reviewed. A comparison was made between two different care plan systems in use. Data were analysed using chi-squared, Spearman's correlation co-efficient, and McNemar's test. Level of significance was set at p<0.05 The relationship between Waterlow score and mobilisation (chi2=3.2,df=4,p=0.530) was not significant. Significant relationships were detected between Waterlow score and pressure relief (chi2 =32.92,df=2,p<0.001), Waterlow score and education (chi2=6.04, df =2,p<0.05), Waterlow score and severity of sore (rs=0.46, p<0.001). Also between care plan type and pressure relief (chi2=38.3,df=2,p<0.01), care plan type and mobilisation (chi2=12.1,df=2,p<0.016) and between care plan type and education (chi2 40.8, df=2,p<0.01). The clinical significance of the results suggest that Waterlow Risk Assessment Scale is invalid when used in routine practice and that regardless of care plan type, individual risk factors are not being taken into account when planning patient care

Validity of self-reported smoking status: comparison of patients admitted to hospital with acute coronary syndrome and the general population

Many studies rely on self-reported smoking status. We hypothesized that patients with acute coronary syndrome (ACS), a smoking-related condition, would be more prone to misclassify themselves as ex-smokers, because of pressure to quit. We compared patients admitted with ACS with a general population survey conducted in the same country at a similar time. We determined whether ACS patients who classified themselves as ex-smokers (n = 635) were more likely to have cotinine levels suggestive of smoking deception than self-reported ex-smokers in the general population (n = 289). On univariate analysis, the percentage of smoking deceivers was similar among ACS patients and the general population (11% vs. 12%, p = .530). Following adjustment for age, sex and exposure to environmental tobacco smoke, ACS patients were significantly more likely to misclassify themselves (adjusted OR = 14.06, 95% CI 2.13-93.01, p = .006). There was an interaction with age whereby the probability of misclassification fell significantly with increasing age in the ACS group (adjusted OR = 0.95, 95% CI 0.93-0.97, p&lt;.001), but not in the general population. Overall, smoking deception was more common among ACS patients than the general population. Studies comparing patients with cardiovascular disease and healthy individuals risk introducing bias if they rely solely on self-reported smoking status. Biochemical confirmation should be undertaken in such studies