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Empowering nursing faculty and students for community service.

As the health care delivery system moves from acute care settings to community-based services, nursing education must examine the experiences that increase students' abilities to function within a changing system. Currently, students receive community-based experiences that involve teaching health promotion concepts. However, students are not routinely prepared with specialized screening skills to use in the community. Using a train-the-trainer model, faculty and students were taught four specialized screening skills: Early and Periodic Screening, Diagnosis, and Treatment, Denver II Developmental Screening, vision screening, and hearing screening. Initially, faculty obtained certification as trainers for these specialized skills. Then, faculty educated students and provided enhanced, guided community experiences. Undergraduate, RN-to-BSN, and graduate family nurse practitioner students participated in this community-based experience. Project outcomes were evaluated based on the number of students and faculty who were certified and participated in these community activities.

Attitude of Health Personnel↗

Sensitivity of screening tests for detecting vision in preschoolers-targeted vision disorders when specificity is 94%.

PURPOSE: To compare the sensitivity of 11 preschool vision screening tests administered by licensed eye care professionals for the detection of the 4 Vision in Preschoolers (VIP)-targeted vision disorders when specificity is 94%. METHODS: This study consisted of a sample (n = 2588) of 3- to 5-year-old children enrolled in Head Start programs, 57% of whom had failed an initial Head Start vision screening. Screening results from 11 tests were compared with results from a standardized comprehensive eye examination that was used to classify children with respect to the four VIP-targeted vision disorders: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). With overall specificity set to 94%, we calculated the sensitivity for the detection of each targeted vision disorder. RESULTS: With the overall specificity set to 94%, the most accurate tests for detection of amblyopia were noncycloplegic retinoscopy (NCR) (88% sensitivity), the SureSight Vision Screener (80%), and the Retinomax Autorefractor (78%). For detection of strabismus, the most accurate tests were the MTI Photoscreener (65%), the cover-uncover test (60%), the Stereo Smile II stereoacuity test (58%), the SureSight Vision Screener (54%), and the Retinomax Autorefractor (54% in year 1, 53% in year 2). The most accurate tests for detection of significant refractive error were NCR (74%), the Retinomax Autorefractor (66%), the SureSight Vision Screener (63%), and the Lea Symbols VA test (58%). For detection of reduced VA, the most accurate tests were the Lea Symbols Distance VA test (48%), the Retinomax Autorefractor (39%), and NCR (38%). CONCLUSIONS: Similar to the previously reported results at 90% specificity, the screening tests vary widely in sensitivity with specificity set at 94%. The rankings of the sensitivities for detection of the 4 VIP-targeted vision disorders are similar to those with specificity set to 90%.

Amblyopia↗

Children unable to perform screening tests in vision in preschoolers study: proportion with ocular conditions and impact on measures of test accuracy.

PURPOSE: To examine the relative prevalence of ocular conditions among children who are unable to perform preschool vision screening tests and the impact on measures of screening test performance. METHODS: Trained nurse and lay screeners each administered a Lea Symbols visual acuity (VA) test (Good-Lite, Inc., Steamwood, IL), Stereo Smile II test (Stereo Optical, Inc., Chicago, IL), and Retinomax Autorefractor (Right Manufacturing, Virginia Beach, VA), and SureSight Vision Screener (Welch Allyn, Inc., Skaneateles Falls, NY) examinations to 1475 children who later received a comprehensive eye examination to identify amblyopia, strabismus, significant refractive error, and unexplained reduced VA. The outcomes of the examination for children for whom screeners were unable to obtain results (Unables) were compared to the outcomes of children who passed and children who failed each screening test. When estimating sensitivity, specificity, and positive and negative predictive values (PPV and NPV), Unables were classified as either screening failures or screening passers. RESULTS: Less than 2% of children were classified as Unables for each test. The percentage with an ocular condition was at least two times higher for Unables than for screening passers for six of the eight modes of screening (P < 0.05). Considering Unables as screening failures, rather than screening passers, increased the estimate of sensitivity by 1% to 3% (depending on test) and decreased the estimate of specificity by 0% to 2%; PPV decreased by 0% to 4% for most tests, whereas NPV increased by <1%. CONCLUSIONS: Preschool children who are unable to perform VIP screening tests are more likely to have vision disorders than are children who pass the tests. Because < or =2% of children were unable to do each test, referring these children for an eye examination had little impact on the PPV and NPV of the tests, as administered in VIP.

Allied Health Personnel↗

Screening for congenital colour vision defects. A comparison between the Ohkuma and Ishihara plates.

A prospective comparison between the Ohkuma and Ishihara pseudoisochromatic (PIC) plates was carried out in a group of 400 patients attending a general ophthalmology practice. The sensitivity of the Ohkuma test was compared to the Ishihara test, and the specificity of both was determined by reference to anomaloscopy as a gold standard. Both tests correctly identified the same group of 24 patients as having a red/green confusion axis, and the Ohkuma test was equally as sensitive as the Ishihara. The grading plates in both tests are unreliable, but the Ohkuma test is quicker, easier to administer, gives less ambiguous responses and has a clearer cut-off score for abnormality. On the basis of this experience the Ohkuma test is recommended as more appropriate for routine colour vision screening than either the 24 or 38 plate Ishihara tests.

Adolescent↗

[Screening of vision disorders in young children].

Twenty pediatricians conducted a study for the detection of ophtalmological defects in children aged 36 to 54 months using a protocol designed by the Groupe Romand d'Etudes en Pédiatrie Ambulatoire (GREPA) and by an ophthalmologist. After a pilot test run for correcting the protocol and the testing procedure, visual acuity was assessed using the Scholatest, stereoscopy using the Lang test and ocular deviation using the Hirschberg test. A total number of 1243 children were examined, some of which needed to be tested twice. The visual acuity assessment provided an abnormal result in 241/1387 tests (17.4%); stereoscopy defects were detected in 39/1371 tests (2.8%) and strabismus in 41/1446 tests (5.7%). The test system allowed for detection of ophtalmological abnormalities in 14.7% of all children. This first Swiss study on detection of ophtalmological defects in preschool age children has established the feasibility of the testing procedure in ambulatory pediatrics during a routine examination. This procedure allows earlier detection of defects as well as earlier treatment with a better outcome. Early detection of ophtalmological defects has obvious Public Health implications.

Child, Preschool↗

Clinical testing of the Ultra-Vision screen-film system for maxillofacial radiography.

The Ultra-Vision screen (Du Pont, Towanda, Pa.) contains a yttrium tantalate phosphor-emitting ultraviolet light and eliminates the crossover effect. Increased resolution has been proven in vitro and the purpose of the present study was to test these findings in a clinical situation. Fifteen pairs of skull radiographs were produced with the use of Du Pont Ultra-Vision Rapid screens and Kodak Lanex (Eastman Kodak, Rochester, N.Y.) screens both belonging to speed class 400. Objects were a cadaver head, a 3M phantom head (3M Corp., St. Paul, Minn.), and patients who were serially radiographed as controls in a dental implant study. The radiographs had identical densities, but contrast was varied deliberately. Twelve observers judged the radiographs blindly. Ninety-two percent of the ratings with respect to resolution favored the Ultra-Vision system. However, great doubt was expressed regarding contrast. The agreement between the observers was tested by a Cochran's Q test. The results confirm that the Ultra-Vision system exhibits an improved resolution compared with the Lanex system. Ultra-Vision is recommended whether improved resolution of the radiographs or an expected reduced patient dose is preferred.

Dental Implants↗

Pre-school vision screening-a pilot study.

The importance of early vision screening in children is well known, but also are the difficulties of choosing a satisfactory programme and its implementation. This paper describes the reasons for the programme being implemented and discusses the method by examination and the co-operation required to carry it out. More than 10,000 children were screened by more than 350 voluntary family doctors. The examinations were carried out throughout Queensland in pre-school centres. The family doctors were fundamental in the success of the programme, as they had the considerable task of examining the children. The scheme was made possible by the co-operation of the family doctors through the help of the Royal Australian College of General Practitioners, The Family Medicine Programme and the Australian Medical Association. These organisations, together with the Division of School Health, Queensland, and The Royal Australian College of Ophthalmologists were responsible for the organisation of the scheme. The results of the Pilot Study and the requirements for an on-going programme are discussed.

Amblyopia↗

Low vision: physician screening helps to improve patient function.

Low vision is a common problem of older patients. As a primary care practitioner, you are not expected to treat most ocular problems, but you can play an important role by identifying patients with visual impairment. Familiarize yourself with the normal visual changes that occur with aging as well as the more common age-related ocular diseases, including glaucoma, cataracts, age-related macular degeneration, and diabetic retinopathy. You can identify patients with visual problems with a careful history and basic in-office tests of visual acuity. Refer patients found to have visual impairment to an eye care specialist for further evaluation.

Activities of Daily Living↗

Screening infant vision with paraxial photorefraction.

Early screening for refractive errors is highly desirable. Techniques for doing this must be usable with noninstructable subjects (infants), noninvasive, and relatively easy to use. Photorefraction has been used to examine infants' refractive status. However, unless cycloplegia is used, the results can be difficult to evaluate, inasmuch as the subject's plane of focus is not known. This paper describes a photorefraction system that is being used for routine screening of young infants, without cycloplegia and without using highly skilled personnel. The major innovation is the systematic presentation of attractive targets at distances that present a range of demands to accommodation. Changes in the fundal reflections, seen in the photographs taken as the infant views the different targets, can be interpreted unequivocally to identify severe myopia and hyperopia, anisometropia, heterotropia, and anisocoria. The results can also be quantified and are compared with retinoscopic refractions.

Clinical Protocols↗

A re-appraisal of screening for colour vision impairments.

Screening for colour vision impairments (CVI) has been carried out in schools in the UK since 1934, but little is known about its yield or value. A survey was conducted among Sheffield schoolboys, school nurses and optometrists to determine the benefits of CVI screening. The results indicated that between 4.2 and 5.2% of boys had been identified as having a CVI, compared with the expected prevalence of 8%. Boys were ill-informed about the significance of CVI for careers planning but recognized the potential importance of having this information before making decisions about choice of subjects and examinations. Possible reasons for the low yield of screening are reviewed and alternative strategies are discussed.

Adolescent↗

Vision in athletes with intellectual disabilities: the need for improved eyecare.

BACKGROUND: Special Olympics provides sporting opportunities for people with intellectual disabilities (ID), and Lions Clubs International Opening Eyes GB offers vision screening for athletes at Special Olympics Games. METHODS: Opening Eyes GB screened the vision of 505 UK athletes at its inaugural event in 2001. The results were analysed and are presented here. RESULTS: Results showed that athletes do not differ from other people with ID in being at high risk of ocular and visual defects and many are not accessing eyecare. 15% reported never having an optometric eye examination, and yet 19% of these athletes had a significant refractive error, 32% had ocular anomalies and 6% were visually impaired. Overall, findings confirmed the high prevalence of refractive errors and strabismus amongst people with ID. 40% of athletes had ocular abnormalities, including 15.6% with blepharitis, a readily treatable condition that causes discomfort. 9% had lens opacities, of which half were probably impairing sight. An important finding was that many athletes have reduced vision and 14% could be classified as visually impaired (WHO definition) even when refractive errors were fully corrected. CONCLUSIONS: Special Olympics athletes should be encouraged to have regular eye examinations (as indeed, should all people with ID), and educators, carers and coaches need appropriate information about the visual status of their charges.

Adolescent↗

[Validity of a web-based color vision test for screening examinations of color vision].

BACKGROUND: With standardized examination conditions, a web-based color vision test using pseudoisochromatic color plates can deliver test results comparable to those yielded by conventional color vision tests. The aim of the study is to analyze to what extent a web-based color vision test can be used as a screening test on the internet after visual monitor calibration. METHODS: A German-language web-based color vision test with 25 pseudoisochromatic color plates based on the color plates of Velhagen and Broschmann and of Ishihara was developed, which can be seen at http://www.farbsehtest.de. Volunteers were recruited by means of specific information distributed on the internet, in various print media, and on the radio. RESULTS: Over a period of 12 months, 2,126 of the initial volunteers [541 women and 1,588 men; mean age 34.27 (+/-14.1) years] with a valid test result for 25 color plates performed the web-based color vision test, 1,700 (506 women and 1,194 men) of whom passed it. Of the 426 volunteers who did not pass the test, 32 were women and 394, men. Counter-testing was performed on 101 volunteers (34 women and 67 men) with a mean age of 36.74 (+/-11.6) years. CONCLUSIONS: The results recorded in the patients who underwent counter-testing suggest that, if handled correctly, the web-based color vision test can be used as a color vision screening test on the internet.

Adolescent↗

Vision testing and the elderly driver: is there a problem meriting policy change?

BACKGROUND: The number of elderly drivers is increasing. The primary purpose of public policy requiring vision screening for driver's license renewal is to identify, and, when necessary, restrict drivers with functional vision impairments. Because of age-related ocular conditions, elderly drivers, as a group, have a higher incidence and prevalence of functionally impaired vision. To date, there is no empirical evidence of a significant predictive relationship between changes in vision function and automobile crashes. METHODS: Most states require vision screening for driver's license renewal, whereas some do not. Among those states requiring vision screening, there is considerable variation in the frequency and level of testing. Efforts to determine the role of vision in driving, while suggestive, have not been useful in identifying at-risk older drivers. RESULTS: Researchers have observed that older drivers are often aware of their decreased functional capacity and voluntarily adjust their driving patterns by driving less frequently, for shorter distances, during daylight hours, more slowly, and during non-rush hours. However, although not statistically significant, the decline in the mean annual traffic fatality rates with increased state vision screening requirements suggests a possible beneficial effect of vision screening. CONCLUSIONS: Because older drivers are at risk for sight-threatening conditions, they are most affected by vision screening requirements for driver's license renewal. Since a loss of driving privileges represents a major loss of mobility and independence, there is a pressing need to better understand the relationship between age-related vision changes and the frequency and severity of traffic crashes.

Accidents, Traffic↗

Effects of preschool screening for vision and hearing on prevalence of vision and hearing problems 6-12 months later.

In order to determine whether children screened 6-12 months previously for vision and hearing had fewer vision and hearing problems than a non-screened cohort, a trained nurse-tester examined 763 screened and 743 non-screened kindergarten children matched for age, sex, and socioeconomic status. The screened cohort had significantly fewer vision problems (10%) than the unscreened (15%). The difference for moderately severe problems (visual activity 20/50 or worse) was also significant. 58% more screened than unscreened children were wearing glasses. The screened cohort had more hearing problems (16.8%) than the non-screened group (14%), but the difference was not statistically significant. There was a marked seasonal variation in prevalence of hearing problems, the frequency in November and December being twice that in April, presumably a result of increased frequency of upper respiratory problems in those months. Preschool hearing screening, unlike vision screening, is not associated with improved end results.

Child, Preschool↗