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Biomedical subjects

D K Newman

Publications and source records attributed to D K Newman.

At least 37 records · Page 2Linked to original sources
PubMed2000

Prevalence of amblyopia among defaulters of preschool vision screening.

The prevalence of amblyopia among screening defaulters is an important determinant of the efficacy of amblyopia detection by preschool vision screening. A retrospective cohort study was therefore performed to assess an orthoptist-based preschool vision screening programme. The preschool vision screening status of children in the cohort was determined by reviewing their Community Child Health records. The prevalence of amblyopia among screening defaulters was determined by reviewing each child's school entry vision test (performed at 5.5 years of age), with retesting if a Snellen line acuity of 6/6 in each eye had not been documented. For comparison, the prevalence of amblyopia among screening attenders was also determined. The preschool vision screening status was known for 86.0% (772/898) of the cohort. The attendance rate at preschool vision screening was 79.2%. The prevalence of amblyopia among screening defaulters was 1.3% (95% CI 0.2% to 4.5%). The prevalence of amblyopia among screening attenders was 2.5% (95% CI 1.4% to 4.1%). There was no significant difference in the prevalence of amblyopia between screening defaulters and screening attenders (P=0.53). The efficacy of amblyopia detection by preschool vision screening is therefore highly dependent on its attendance rate. Preschool vision screening programmes with a low attendance rate will fail to detect a significant proportion of children with amblyopia.

Amblyopia↗
PubMed2000

Pelvic disorders in women: chronic pelvic pain and vulvodynia.

Chronic pelvic pain and vulvodynia are frustrating pelvic disorders seen in young adult women. In the medical literature, these two conditions are linked together under the category of "chronic pelvic pain syndromes." Underlying pathophysiology is not well understood, and relatively scant research is available on successful treatment options. Patients often seek the help of specialists who provide nonsurgical treatments for incontinence and related pelvic disorders. This article provides an overview of the clinical presentation of both chronic pelvic pain and vulvodynia. Specific evaluation techniques, including abdominal, pelvic, bimanual rectal-vaginal, and neurologic examinations, are described. Several practical treatments, such as dietary interventions, vitamin supplementation, muscle relaxation training, biofeedback therapy, and electrical stimulation are discussed as options in a private practice setting.

Chronic Disease↗
PubMed1999

Eyelid foreign body mimics an intraocular foreign body on plain orbital radiography.

Localization of a foreign body detected on plain orbital radiography may be achieved by comparing radiographs taken with the eyes in upgaze and downgaze. Movement of the foreign body with ocular rotation is considered to indicate localization either within the globe itself or within the soft tissues of the orbit closely related to the globe. A case is reported that demonstrates that this radiologic feature may also occur when a foreign body is located within an eyelid because the position of the eyelids also changes on vertical eye movements. An eyelid foreign body may therefore mimic an intraocular foreign body on plain orbital radiography.

Adult↗
PubMed1999

Primary vitrectomy for pseudophakic and aphakic retinal detachments.

PURPOSE: To evaluate primary vitrectomy for the treatment of pseudophakic and aphakic retinal detachments. Primary vitrectomy may enable better identification of retinal breaks than scleral buckling procedures. METHODS: A prospective study was performed of primary vitrectomy for the treatment of 25 consecutive cases of pseudophakic and aphakic retinal detachment. RESULTS: The primary retinal reattachment rate was 84% (21 eyes). Surgical failure resulted from new/missed retinal breaks (2 eyes) and proliferative vitreoretinopathy (2 eyes). The final retinal reattachment rate with further surgery was 96% (24 eyes). There were 7 macula-on detachments which all retained their presenting visual acuity. A visual acuity of 6/18 or better was achieved by 56% of the 18 macula-off detachments. Visualisation of the peripheral retina was impaired in 17 eyes and procedures to improve visualisation were performed in 7 eyes. Retinal breaks were detected in 16 eyes at surgery that had not been identified pre-operatively. Raised intraocular pressure was the most common complication, affecting 10 eyes in the early post-operative period. CONCLUSIONS: Primary vitrectomy offers certain advantages in the treatment of pseudophakic and aphakic retinal detachments. A controlled study is required to determine whether primary vitrectomy achieves a better outcome than scleral buckling procedures for these retinal detachments.

Adult↗
PubMed1999

Preschool vision screening: negative predictive value for amblyopia.

BACKGROUND/AIMS: Single optotype tests of visual acuity are widely used for preschool vision screening in order to optimise cooperation with testing. These tests may, however, underestimate the visual acuity deficit in amblyopia because they lack visual crowding. This study assessed the resultant negative predictive value (NPV) for amblyopia. METHODS: Cohort study of 936 children in the Cambridge Health District selected by date of birth. The presence of amblyopia among children who had passed preschool vision screening was determined using Snellen line acuity as the reference test. Preschool vision screening was conducted at 3.5 years of age by community orthoptists. The screening assessment comprised Sheridan-Gardiner single optotype test of visual acuity (referral criterion 6/9 or worse in either eye), cover test, ocular movements, 20(Delta) prism test, and TNO stereotest. RESULTS: The overall NPV of preschool vision screening for amblyopia was 100% (95% CI 99.4% to 100%). Most children with amblyopia were detected by the Sheridan-Gardiner single optotype test of visual acuity, but the other screening tests were necessary to prevent any false negatives. In isolation, the Sheridan-Gardiner single optotype test of visual acuity has a NPV for amblyopia of only 99.6% (95% CI 98.7% to 99.9%). CONCLUSION: Preschool vision screening using a single optotype test of visual acuity does achieve a high NPV for amblyopia, but only under certain conditions. These comprise a low threshold for referral (6/9 or worse in either eye) and the inclusion of a cover test and tests of binocular function in the screening assessment.

Amblyopia↗
PubMed1999

Continence for women: evidence-based practice.

Approximately 20% of women ages 25-64 years experience urinary incontinence. The symptoms increase during perimenopause, when 31% of women report that they experience incontinent episodes at least once per month. Bladder training and pelvic muscle exercise are the recommended initial treatment and can be taught effectively in the ambulatory care setting. Bladder training enables women to accommodate greater volumes of urine and extend between-voiding intervals. Pelvic muscle exercise increases muscle strength and reduces unwanted urine leakage. Accumulated research results provide evidence-based guidelines for nursing practice. The Association of Women's Health, Obstetric and Neonatal Nurses has identified continence for women as the focus of its third research utilization project. This article presents the rationale, evidence base, and educational strategies compiled by the Research Utilization 3 Nurse Scientist Team. Nurses can enable women to incorporate these noninvasive techniques into self-care.

Adult↗
PubMed1999

Incontinence and PPS: a new era.

Urinary incontinence (UI) is a prevalent and costly problem in nursing homes. Assessing residents with incontinence is necessary to determine the pathophysiologic causes and associated factors that can interfere with self-toileting. Nurses can perform this assessment at the bedside. Guideline tools have been developed to assist nursing home staff through the evaluation of UI and intervention. Treatment techniques, specifically behavioral interventions and toileting assistance programs, can be readily incorporated into nursing practice. Most nursing home staffs can easily implement interventions such as bowel and nighttime voiding management and dietary modifications. Nursing home research has demonstrated the effectiveness of toileting assistance programs; however, very little of this research and documented techniques has been used by nursing home staff. Scheduled toileting and bladder training programs can be successfully implemented in nursing home residents. The key to the success of these programs is identifying residents who should be targeted for each specific program. Staff education remains an ongoing issue, as caregivers must be aware of attitudes and beliefs about the aging process and its impact on the genitourinary system in order to provide effective care. Under the Prospective Payment System, nursing homes need to change business as usual and remain abreast of new innovations and research in different behavioral interventions and continence technology.

Aged↗
PubMed1998

Severe capsulorhexis contracture after cataract surgery in myotonic dystrophy.

A 42-year-old woman with myotonic dystrophy developed bilateral severe capsulorhexis contracture after uneventful phacoemulsification cataract surgery with implantation of 1-piece poly(methyl methacrylate) intraocular lenses (IOLs). The anterior capsular opening in her right eye constricted to a diameter of 0.7 mm, reducing visual acuity to counting fingers. Complete closure of the capsulorhexis with IOL encapsulation developed in her left eye, reducing visual acuity to hand movements. Surgical anterior capsulectomies restored visual acuity to 6/9 in both eyes. Myotonic dystrophy may predispose to the development of severe capsulorhexis contracture after cataract surgery.

Adult↗
PubMed1998

Glaucoma screening by optometrists: positive predictive value of visual field testing.

PURPOSE: Visual field testing is increasingly being performed by optometrists in order to improve glaucoma detection. The aim of this study was to assess the positive predictive value (PPV) of visual field testing as currently practised by optometrists. METHODS: A retrospective study was performed of referrals for suspected glaucoma to an ophthalmology department during a 3 month period. The PPV for glaucoma was determined according to the reason for referral. RESULTS: There were 86 referrals for suspected glaucoma. Isolated field loss accounted for 12% of these referrals but no cases of glaucoma detection. These subjects were either false positive referrals or had field defects of nonglaucomatous aetiology (tilted optic disc and porencephalic cyst). The PPV for glaucoma among referrals with isolated field loss was significantly less than that among referrals with field loss in association with corroborative abnormalities (0 vs. 60%, p = 0.005). No such difference was found for referrals with raised intraocular pressure (43% vs. 57%, p = 0.38) or suspicious discs (25% vs. 53%, p = 0.60). CONCLUSIONS: Visual field testing is currently leading to unnecessary referrals to the hospital eye service with no detectable improvement in the accuracy of glaucoma suspect referrals. It is important that optometrists perform visual field testing in accordance with validated screening methodology.

Adult↗
PubMed1998

Managing indwelling urethral catheters.

An indwelling urethral (Foley) catheter is a closed sterile system that is inserted through the urethra to allow for bladder drainage. In the 1930's Frederick Foley designed a rubber tube with a separate lumen used to inflate a balloon which holds the catheter in place in the bladder. Historically, indwelling catheters primarily have been used in chronic, medically compromised elderly patients. As the number of elderly patients continues to increase, particularly in such settings as home care, the use of indwelling catheters is increasing. Nurses caring for patients with urinary incontinence, neurogenic bladder, and/or urinary retention manage these catheters. However, most nurses will agree that managing this type of system poses multiple medical and nursing care problems. In fact, Foley catheters are associated with several complications and side effects that increase patient morbidity and mortality. This article reviews current strategies for providing good catheter management as well as steps for retraining the patient following catheter removal.

Aged↗
PubMed1997

Dissimilatory arsenate and sulfate reduction in Desulfotomaculum auripigmentum sp. nov.

A newly discovered arsenate-reducing bacterium, strain OREX-4, differed significantly from strains MIT-13 and SES-3, the previously described arsenate-reducing isolates, which grew on nitrate but not on sulfate. In contrast, strain OREX-4 did not respire nitrate but grew on lactate, with either arsenate or sulfate serving as the electron acceptor, and even preferred arsenate. Both arsenate and sulfate reduction were inhibited by molybdate. Strain OREX-4, a gram-positive bacterium with a hexagonal S-layer on its cell wall, metabolized compounds commonly used by sulfate reducers. Scorodite (FeAsO42. H2O) an arsenate-containing mineral, provided micromolar concentrations of arsenate that supported cell growth. Physiologically and phylogenetically, strain OREX-4 was far-removed from strains MIT-13 and SES-3: strain OREX-4 grew on different electron donors and electron acceptors, and fell within the gram-positive group of the Bacteria, whereas MIT-13 and SES-3 fell together in the epsilon-subdivision of the Proteobacteria. Together, these results suggest that organisms spread among diverse bacterial phyla can use arsenate as a terminal electron acceptor, and that dissimilatory arsenate reduction might occur in the sulfidogenic zone at arsenate concentrations of environmental interest. 16S rRNA sequence analysis indicated that strain OREX-4 is a new species of the genus Desulfotomaculum, and accordingly, the name Desulfotomaculum auripigmentum is proposed.

Arsenates↗