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H R Taylor

Publications and source records attributed to H R Taylor.

At least 19 recordsLinked to original sources
PubMed2001

Measuring the socialization of graduate and diplomate nurses using the Corwin Role Orientation Scale.

The nature of United Kingdom (UK) nursing education has changed significantly as the responsibility has been transferred from hospitals to the University sector. More information is needed on the outcome of the Project 2000 diploma and degree courses given the rapidly changing health care context. This paper focuses on the role socialization of graduate and diploma nurses. As part of a larger study, this research investigated the role orientations of 52 nursing graduates and 28 diplomates from two different universities at three time points; on graduation and at 6 and 12 months postgraduation. The Corwin Role Orientation Scale was selected and modified for the study. It comprised of three separate scales measuring professional, bureaucratic and service orientation. The data from the two groups of nurses were examined to identify nurses' ideal role orientations and role discrepancies over the transitionary period from graduate to qualified nurse. Although the results showed observed differences between the groups over time, none of these differences were statistically significant. The findings raise a number of questions about the value of the instrument as a measure in the contemporary nursing context. Furthermore, each of the Corwin subscales had a low internal reliability. A possible explanation may be that the instrument, which was developed in the United States of America (USA) in the 1960s, and modified, for this study, has little relevance for contemporary UK nursing. The study findings are also limited by the small size of the sample. In spite of these limitations, the study suggests there are few differences between the role orientations and socialization experiences of UK nursing graduates and diplomates. Indeed, both programmes commonly take place in university settings and students receive the same amount of clinical experience. Further instrument development and exploratory research is recommended to identify the role socialization and orientations of UK nurses through larger national studies.

Education, Nursing, Baccalaureate↗
PubMed2001

Evaluation of techniques of single continuous suturing in penetrating keratoplasty.

AIM: To evaluate the three techniques of single continuous suturing-namely, torque, antitorque, and no torque in penetrating keratoplasty. METHODS: 53 eyes of 53 patients underwent penetrating keratoplasty using torque (17 patients), antitorque (18 patients), and no torque (18 patients) suturing techniques in this prospective study. Patients were followed up at 4 weeks, 3 months, and 6 months. Keratometric, videokeratographic, refractive astigmatism, and best corrected visual acuity were determined in all the three groups at each follow up visit. Post-keratoplasty suture adjustment was done at 4 weeks, if the astigmatism was >3 dioptres. RESULTS: The initial astigmatism in the torque group was higher than in the other two groups, although it was not statistically significant. Following suture adjustment, there was a significant decrease in astigmatism in all the three groups (p<0.0001). However, no significant difference in the postoperative astigmatism at 3 months and at 6 months was seen among the three groups. CONCLUSIONS: The three techniques of single continuous suturing-that is, torque, antitorque, and no torque produce a similar final astigmatic results. Suture adjustment is an effective method of reducing post-penetrating keratoplasty astigmatism.

Adult↗
PubMed2001

Vision impairment predicts 5 year mortality.

AIM: To describe predictors of mortality in the 5 year follow up of the Melbourne Visual Impairment Project (VIP) cohort. METHODS: The Melbourne VIP was a population based study of the distribution and determinants of age related eye disease in a cluster random sample of Melbourne residents aged 40 years and older. Baseline examinations were conducted between 1992 and 1994. In 1997, 5 year follow up examinations of the original cohort commenced. Causes of death were obtained from the National Death Index for all reported deaths. RESULTS: Of the original 3271 participants, 231 (7.1%) were reported to have died in the intervening 5 years. Of the remaining 3040 participants eligible to return for follow up examinations, 2594 (85% of eligible) did participate, 51 (2%) had moved interstate or overseas, 83 (3%) could not be traced, and 312 (10%) refused to participate. Best corrected visual acuity <6/12 (OR=2.34) was associated with a significantly increased risk of mortality, as were increasing age (OR=1.09), male sex (OR=1.62), increased duration of cigarette smoking (OR=2.06 for smoking >30 years), increased duration of hypertension (OR=1.51 for duration >10 years), and arthritis (OR=1.42). CONCLUSIONS: Even mild visual impairment increases the risk of death more than twofold. Further research is needed to determine why decreased visual acuity is associated with increased risk of mortality.

Adult↗
PubMed2000

A targeted, single-dose azithromycin strategy for trachoma.

OBJECTIVE: To evaluate the impact of treating children with acute trachoma and their contacts with oral azithromycin. DESIGN: Open, uncontrolled, prospective evaluation of a community-based treatment strategy. SETTING: Central Australian semi-desert Aboriginal community (1995-1996). PARTICIPANTS: 216 school- and pre-schoolchildren aged 6 months and up to 15 years. INTERVENTION: All children with acute trachoma and their contacts (co-resident siblings aged between 6 months and 15 years) received single-dose oral azithromycin suspension (20 mg/kg, to a maximum of 1000 mg). MAIN OUTCOME MEASURE: Prevalence of acute trachoma (World Health Organization trachoma diagnostic criteria). RESULTS: Trachoma prevalence at baseline was 42% (71/169) and 55% (18/33) for schoolchildren and pre-schoolchildren, respectively: 103 schoolchildren and 21 pre-schoolchildren, comprising 77 with follicular trachoma and their 47 contacts, were treated with azithromycin over an 8-week period. Acute trachoma prevalence in schoolchildren fell to 22% at 6-8 months (P < 0.0001) and was 31% at 12 months (P < 0.05 compared with baseline). Pre-schoolchildren were followed up for 6 months after treatment, and their trachoma prevalence fell from 55% to 25% (P < 0.05). Further treatment was given to children with trachoma at 12 months, and the point prevalence of trachoma for schoolchildren at 24 months was 34%. CONCLUSIONS: In contrast to mass-treatment strategies, significant reductions in trachoma prevalence at 6 months were achieved by screening 35% of community members (216) and treating 20% (124). The subsequent prevalence increases support the need for more comprehensive treatment programs, including health promotion and efforts to improve living conditions.

Acute Disease↗
PubMed2000

Age-specific causes of bilateral visual impairment.

OBJECTIVES: To describe the age-specific prevalence of common eye diseases causing bilateral visual impairment and estimate the total number of Australians with cause-specific visual impairment. METHODS: Cluster-stratified random sample of 5147 residents aged 40 years and older from urban and rural areas and aged-care facilities. Participants completed a standardized interview and eye examination. Four levels of bilateral visual impairment were defined: less than 20/40 to 20/60 and/or homonymous hemianopia (mild), less than 20/60 to 20/200 or better and/or less than 20 degrees to 10 degrees radius field (moderate), less than 20/200 to 10/200 and/or less than 10 degrees to 5 degrees radius field (severe), and less than 1O/ 200 and/or less than 50 radius field (profound). The major cause of vision loss was identified for all participants found to be visually impaired. RESULTS: Uncorrected refractive error was the most common cause of bilateral visual impairment across all decades of life, rising from 0.5% in 40- to 49-year-olds to 13% among those aged 80 years and older. Prevalence of visual impairment due to diabetic retinopathy was 0.7% in 50- to 59-year-olds and 0.8% in those older than 80 years. Visual impairment due to glaucoma had a prevalence of 0.7% among 60-year-olds and rose to 4% of those older than 90 years. The prevalence of visual impairment due to cataract (only present in those aged 70 years or older) rose from 0.6% to 11% in those older than 90 years, and the prevalence of visual impairment due to age-related macular degeneration rose from 0.8% to 16% in those older than 90 years. CONCLUSIONS: The predominant causes of visual impairment change with age. Recognition of these patterns is fundamental for early diagnosis and treatment of eye disease and, where appropriate, referral for rehabilitation.

Adult↗
PubMed2000

Pseudoexfoliation syndrome in Australian adults.

PURPOSE: To describe the prevalence and correlates of pseudoexfoliation syndrome in Australians aged 40 years and older. METHODS: Cluster, stratified sampling was employed to identify a cohort representative of the population of the state of Victoria aged 40 years and older that included urban, rural, and nursing home residents. A standardized personal interview and clinical eye examination, including intraocular pressure, were performed at locally established test sites. The presence of any pseudoexfoliation material on the iris or lens capsule was noted on dilated slit-lamp examination. Participants were classified as having pseudoexfoliation syndrome if any pseudoexfoliation material was present in either eye. Univariate analyses with t tests and chi-square were first employed to evaluate risk factors for pseudoexfoliation. Any factors with P <.10 were then fitted in a backward stepwise logistic regression model. For the final multivariate models, P <.05 was considered statistically significant. RESULTS: A total of 3,271 of the urban residents (83% of eligible), 403 nursing home residents (90% of eligible), and 1473 rural residents (92%) participated. The urban residents ranged in age from 40 to 98 years (mean = 59), and 1,511 (46%) were men. The nursing home residents ranged in age from 46 to 101 years (mean 82), and 85 (21%) were men. The rural residents ranged in age from 40 to 103 years (mean 60), and 701 (47.5%) were men. Participants with bilateral cataract extraction were excluded from further analyses. The overall rate of pseudoexfoliation syndrome in this population was 0.98% (95% confidence limit = 0.57, 1.28). The prevalence of pseudoexfoliation material in either eye increased significantly with age. No cases of pseudoexfoliation syndrome were observed in people aged 90 years and older. However, people with bilateral cataract surgery had been excluded from these analyses. After adjusting for age and cataract, only glaucoma remained significantly related to pseudoexfoliation (odds ratio = 3.80, 95% confidence limit = 1.73, 8.33). DISCUSSION: In conclusion, we found only two strong correlates of pseudoexfoliation in our population-based sample of Victorians aged 40 years and older: age and glaucoma.

Adult↗
PubMed2000

The prevalence of age-related maculopathy: the visual impairment project.

PURPOSE: To determine the prevalence of age-related maculopathy (ARM) lesions in residents of the state of Victoria, Australia. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Total of 5147 residential and institutionalized persons aged 40 years and older, living in Victoria. METHODS: Participants were recruited through a cluster, stratified, random sampling from nine urban clusters and four rural clusters. The presence of ARM lesions was graded from color stereo fundus photographs as well as slit-lamp stereo biomicroscopy according to the International Classification and Grading System. MAIN OUTCOME MEASURES: The presence of ARM lesions. RESULTS: The mean age of participants was 60.2 years, and 55% were females. Gradable fundus photographs were available for at least one eye in 4345 (92%) of the participants. The weighted prevalence of neovascular age-related macular degeneration (AMD) was 0.39% (95% confidence limits [CL] = 0.20, 0.58), atrophic AMD was 0. 27% (95% CL = 0.04, 0.50), and total AMD was 0.68% (95% CL = 0.30, 1. 1). Prevalence of AMD was strongly related to age (P < 0.001). Prevalence of early ARM was 15.1% (95% CL = 13.7, 16.4). Large drusen, 125 micrometer or more, were present in 6.3% of the participants. There was a higher prevalence of soft distinct drusen (7.5%) than soft indistinct drusen (4.3%). Retinal pigmentary abnormalities were present in 8.2% (95% CL = 7.2, 9.2). The prevalence of large drusen, soft drusen, and pigmentary abnormalities increased with age (P < 0. 001). Prevalence of retinal pigmentary abnormalities increased with increasing drusen size (P < 0.001). Soft indistinct drusen were more common in women aged 70 years or older (P < 0.001). Bilaterality of any ARM was strongly age related, and women appeared to have a higher risk of both bilateral early ARM and AMD. CONCLUSIONS: These data provide age- and gender-specific prevalence of ARM and its component lesions in an ethnically diverse Australian population. Early ARM and AMD prevalence rates increased sharply from ages 70 and 80 years, respectively, in all ethnic groups. These higher rates will continue to increase the importance of AMD as our population ages.

Adult↗
PubMed2000

Management of alkali burns : an 11-year retrospective review.

OBJECTIVE: To review the spectrum of patients with alkali burns admitted over an 11-year period and to assess the clinical outcomes after the introduction of a standard alkali burn treatment protocol. DESIGN: Retrospective nonrandomized comparative study. PATIENTS AND INTERVENTIONS: A total of 121 patient records with alkali burns (n = 177 eyes) admitted to a tertiary hospital between 1987 and 1998 were reviewed. Eyes treated with a standard alkali burn treatment protocol, which included intensive topical steroids, ascorbate, citrate, and antibiotics, were compared with eyes treated by conservative management with antibiotics, and a short course of steroids. MAIN OUTCOME MEASURES: Time to corneal reepithelialization, final best-corrected visual acuity, and time to visual recovery, length of hospital stay, and complications were analyzed. RESULTS: The standard protocol tended to delay corneal reepithelialization by one day (P: = not significant) in eyes with grade 1 burns (n = 76) and by 2 days (P: = 0.04) in grade 2 burns (n = 52), with no difference in final visual outcome. There were 37 eyes with grade 3 burns. Those treated with the standard protocol showed a trend toward more rapid corneal reepithelialization. Twenty-seven of 29 (93%) eyes with grade 3 injuries achieved a final best-corrected visual acuity of 20/40 or better compared with 3 of 6 (50%) eyes not treated according to the standard protocol (P: = 0.02). Eyes with grade 4 burns (n = 12), whether treated with the standard protocol or not, required 10 to 12 weeks for corneal reepithelialization. There was no statistically significant difference in final visual acuity. CONCLUSIONS: On the basis of our findings, a number of recommendations can be made for the management of alkali injuries. Patients with a grade 1 or 2 injury do not require routine admission and do not benefit from the use of intensive treatment with ascorbate and citrate. A trend toward more rapid healing and a better final visual outcome were apparent in grade 3 burns, but our standard protocol made no difference in grade 4 burns.

Administration, Topical↗
PubMed2000

Visual impairment and eye diseases in elderly institutionalized Australians.

OBJECTIVE: To study the prevalence and distribution of visual impairment and eye diseases by age and gender in an urban institutionalized population. DESIGN: Cross-sectional study. PARTICIPANTS: Four hundred three residents of nursing homes and hostels. METHODS: Fourteen nursing homes were randomly selected from 104 nursing homes and hostels located within a 5-km radius of each of nine clusters studied in the Visual Impairment Project (VIP) urban cohort. Participants completed a standardized orthoptic and dilated ophthalmic examination, including measurement of visual acuity and visual fields. The major cause of vision loss was identified for participants with visual impairment. MAIN OUTCOME MEASURES: Presenting visual acuity and ophthalmic diagnoses. RESULTS: The participants' mean age was 82 years (standard deviation, 9.24), with an age range of 46 years to 101 years. Women outnumbered men by 318 to 85. Seventy-one (22%) of 318 women had bilateral profound visual impairment (blindness), defined as best-corrected visual acuity <3/60 and/or visual field constriction <5 degrees compared with 10 (12%) of 85 men. However, this difference is not significant when age-standardized. Age-related macular degeneration was the principal diagnosis of vision loss in the better eye of 74 (44%) of the 167 participants with bilateral low vision (<6/18 and/or visual field constriction to <20 degrees radius). The age-adjusted rate of blindness or profound visual impairment in the VIP institutional cohort of 5.2% (95% confidence interval [CI], 1.8, 8.6) was significantly greater than in the VIP urban and rural cohorts of 0.13% (95% CI, 0, 0.25) and 0.29% (95% CI, 0, 0.57), respectively. CONCLUSIONS: Underestimation of visual impairment may occur in residential population-based studies that exclude institutional or residential nursing homes and hostels for the aged citizens. Expanded methods are required for visual assessment in institutional populations.

Age Distribution↗
PubMed2000

Community-based recruitment strategies for a longitudinal interventional study: the VECAT experience.

This article examines different recruitment strategies for the VECAT Study, a 4-year, double-masked, placebo-controlled, randomized clinical trial of vitamin E in the prevention of cataract and age-related maculopathy. Five recruitment methods were employed: newspaper advertising, radio advertising, approaches to community groups, approaches via general practices, and an electoral roll mail-out. Participants (1204) from the community in Melbourne, Australia were recruited and enrolled within 15 months (age range: 55-80 years, mean 66 years; gender ratio: 57% female, 43% male). The electoral roll mail-out and newspaper advertising were the most efficient methods of recruitment in terms of absolute numbers of participants recruited and cost per participant. Recruitment for the VECAT study was successfully completed within the planned period. Although the electoral roll mail-out and newspaper advertising were the most efficient for this study, other methods may be of value for studies with different subject selection criteria.

Aged↗
PubMed2000

A comparison of the nursing competence of graduates and diplomates from UK nursing programmes.

This paper reviews the literature on nursing competence measurement and reports the results of a comparative quantitative study of the competencies of Project 2000 diplomates and BA (Hons) Adult Nursing graduates from two UK nursing programmes. The findings reveal that graduates appear to overcome any initial limitations and become more competent than the diplomates in certain areas. Attention to social awareness and participation is necessary in both pre-registration programmes, whilst greater attention could be given to graduates' leadership and management development. Diplomates need support in their professional development if they are to achieve the same level of competence as graduates during the first post-qualifying year. There are implications for the level of support afforded to qualifying nurses in their first staff positions; preceptorship programmes could be an important means of assisting newly qualified staff to gain confidence. More research on nurse competencies with larger samples drawn from programmes across the UK is needed.

Clinical Competence↗
PubMed2000

Operated and unoperated cataract in Australia.

PURPOSE: To quantify the prevalence of cataract, the outcomes of cataract surgery and the factors related to unoperated cataract in Australia. METHODS: Participants were recruited from the Visual Impairment Project: a cluster, stratified sample of more than 5,000 Victorians aged 40 years and over. At examination sites interviews, clinical examinations and lens photography were performed. Cataract was defined in participants who had: had previous cataract surgery, cortical cataract greater than 4/16, nuclear greater than Wilmer standard 2, or posterior subcapsular greater than 1 mm2. RESULTS: The participant group comprised 3,271 Melbourne residents, 403 Melbourne nursing home residents and 1,473 rural residents. The weighted rate of any cataract in Victoria was 21.5%. The overall weighted rate of prior cataract surgery was 3.79%. Two hundred and forty-nine eyes had had prior cataract surgery. Of these 249 procedures, 49 (20%) were aphakic, 6 (2.4%) had anterior chamber intraocular lenses and 194 (78%) had posterior chamber intraocular lenses. Two hundred and eleven of these operated eyes (85%) had best-corrected visual acuity of 6/12 or better, the legal requirement for a driver's license. Twenty-seven (11%) had visual acuity of less than 6/18 (moderate vision impairment). Complications of cataract surgery caused reduced vision in four of the 27 eyes (15%), or 1.9% of operated eyes. Three of these four eyes had undergone intracapsular cataract extraction and the fourth eye had an opaque posterior capsule. No one had bilateral vision impairment as a result of cataract surgery. Surprisingly, no particular demographic factors (such as age, gender, rural residence, occupation, employment status, health insurance status, ethnicity) were related to the presence of unoperated cataract. CONCLUSIONS: Although the overall prevalence of cataract is quite high, no particular subgroup is systematically underserviced in terms of cataract surgery. Overall, the results of cataract surgery are very good, with the majority of eyes achieving driving vision following cataract extraction.

Adult↗
PubMed2000

Cataract extraction in a major ophthalmic hospital: day-case or overnight stay?

PURPOSE: Cataract surgery is increasing in Australia and represents a significant burden on limited health resources. This study examines the frequency and outcomes of cataract surgery for patients who were hospitalized overnight compared with those treated as day surgery cases. METHODS: Medical records of 671 consecutive admissions for cataract surgery at the Royal Victorian Eye and Ear Hospital were reviewed. Data analysed included demographic features, insurance status, length of hospitalization, ophthalmic conditions, medical conditions, social problems and planned surgical technique. Ophthalmic and anaesthetic complications, active ophthalmic and medical interventions were also studied. RESULTS: Of the 671 patient admissions for cataract during the study period, 226 (33.4%) were hospitalized overnight. Factors significantly associated with overnight hospitalization in univariate analyses include older age, female sex, country residence, Veterans' Affairs insurance, monocular vision status, pre-existing ischaemic heart disease, pre-existing asthma/chronic obstructive lung disease, absence of carer, transportation problems, planned extra-capsular cataract extraction technique, ophthalmic complications and active ophthalmic and/or medical interventions. After adjusting for possible confounding factors using backwards stepwise multivariate logistic regression models all except pre-existing ischaemic heart disease and ophthalmic complications were significantly associated with overnight admission for cataract surgery. In total, 14 cases (2.1%) needed active ophthalmic and/or medical interventions, 13 overnight cases and one day case. CONCLUSIONS: These data suggest that many patients who are hospitalized overnight for cataract surgery could be safely treated as day cases. Such a shift in the pattern of care for cataract surgery could provide a significant potential for health care savings.

Adult↗
PubMed2000

Examination compliance and screening for diabetic retinopathy: a 2-year follow-up study.

Early detection and timely treatment of diabetic retinopathy can preserve vision, yet many people with diabetes do not have their eyes examined regularly. The purpose of this study was to examine eye care practices of people with diabetes who had not previously accessed eye care services on a regular basis. Screening with non-mydriatic retinal photography for diabetic retinopathy was initiated in 1996, and targeted people with diabetes who did not access eye care services on a regular basis. Each test area was revisited 2 years after the initial screening. Patients that did not attend the biennial screening were followed up by mail survey. Although none of the participants in this study had been previously accessing eye care services on a regular basis, 87% did so after attending the screening. These results indicate that mobile screening with non-mydriatic photography, as an adjunct to current eye care services, has the potential to increase examination compliance for diabetic retinopathy and to achieve sustained behaviour change.

Diabetic Retinopathy↗
PubMed2000

Functional implications of vision impairment.

This study investigated the functional implications of vision impairment. A total of 508 participants in the Visual Impairment Project completed the VF-14 questionnaire, vision-related functional tasks, an interview, and the ophthalmic examination. Participants with less than 6/12 presenting acuity were more likely to report a moderate to high degree of difficulty performing VF-14 items (odds ratios from 6 to 44). They were also more likely to be unable to recognize a 10 cent coin (OR; 7.0, 95% CL; 2.6, 19.3) or correctly read a telephone number (OR; 10.1, 95% CI; 5.6, 18.1). As demonstrated by the VF-14 and the functional tasks administered in this study, visual impairment affects the ability of people to conduct a variety of common daily tasks.

Aged↗
PubMed2000

Association of presbyopic correction with changes in visual fields.

The purpose of this study was to investigate the effect of presbyopic correction on changes in visual fields caused by an alteration in outflow of aqueous humour Visual fields were compared before and after introduction of presbyopic correction in participants of the Melbourne Visual Impairment Project. Height and slope of the 'Hill of Vision' were assessed by calculating median thresholds in the four sets of three eccentric points. Analysis of 101 eyes in the study group and 101 eyes in the control group shows higher decrease of the 'Hill of Vision' height in the group of participants who started wearing presbyopic correction, than in the group without presbyopic correction (P = 0.02). Intraocular pressure measured irrespectively of participant's accommodative activity was not significantly different between the two groups at both time points. These data suggest that the use of presbyopic correction is associated with changes in the visual field.

Accommodation, Ocular↗