Validity of a visual impairment questionnaire in measuring cataract surgery outcomes.

PURPOSE: To test the validity of the Impact of Visual Impairment (IVI) questionnaire in a cataract population. SETTING: Flinders Eye Centre, Flinders Medical Centre, Flinders University, Adelaide, South Australia. METHODS: Cataract patients recruited from a hospital waiting list completed the IVI questionnaire. The scale was assessed for fit to the Rasch model. Unidimensionality, item and person fit to the model, response category performance, differential item functioning (whether different subgroups responded differently), and targeting of item difficulty to patient ability were assessed. RESULTS: Overall, the IVI questionnaire performed well; there were ordered thresholds, person separation reliability was 0.97, and it was free from differential item functioning. One item (worry about eyesight getting worse) misfit the model and was removed. There was evidence of multidimensionality, indicating that the overall IVI score should be discarded; however, the 3 subscales (reading and accessing information, mobility and independence, and emotional well-being) functioned well. Several items calibrated differently in cataract patients compared with low-vision patients, indicating different issues are important to each population and that there is a need for population-specific conversion algorithms. Targeting of the IVI items was biased toward more impaired patients. CONCLUSIONS: The 3 subscales of the IVI questionnaire functioned well in a cataract population. However, additional items targeting the less impaired patients, especially second-eye cataract patients, would improve measurement.     

Attitudes towards the care of elderly people: are they getting better?

This paper reports findings of research assessing the attitudes of both learner and trained nurses towards the elderly. At the time of the study, all subjects were employed on wards within the care of the elderly unit of a large district general hospital. Assessment of stress perceived on these wards was also made to determine its effect on learner nurses' attitudes towards the elderly. Attitudes of the learner nurses towards the elderly became slightly more negative over their training module. Stress perceptions only correlated with this change to a small extent. Trained staff were also found to be quite neutral in their beliefs about the elderly. The study pointed to the great need for further research into this area so as to prepare the health care services to meet the increasing needs of elderly people. Several implications of the research and more practical considerations are discussed.     

Fulminating varicella despite prophylactic immune globulin and intravenous acyclovir in a renal transplant recipient: should renal patients be vaccinated against VZV before transplantation?

We describe a case of fulminating varicella despite prophylactic immune globulin and intravenous acyclovir in a renal transplant recipient. This promoted a survey of all 383 adult patients awaiting a renal transplant in Scotland, which showed a low level of Varicella zoster virus (VZV) awareness but a willingness to consider vaccination if non immune. 359/363 serum samples tested were seropositive for VZV antibody giving a susceptibility to VZV of 1.2%. Although data on vaccination in adults with chronic kidney disease are limited, expert opinion is of the view that the benefits of vaccinating immunocompetent seronegative patients before transplantation are likely to outweigh the risks. We believe that adult patients awaiting a transplant in the UK should be tested for their susceptibility to VZV and that early vaccination should be offered to those who are both immunocompetent and seronegative.     

Association study of tardive dyskinesia and twelve DRD2 polymorphisms in schizophrenia patients

Tardive dyskinesia (TD) is a side-effect of chronic antipsychotic medication. Abnormalities in dopaminergic activity in the nigrostriatal system have been most often suggested to be involved because the agents which cause TD share in common potent antagonism of dopamine D2 receptors (DRD2), that notably is not balanced by effects such as more potent serotonin (5-HT)2A antagonism. Thus, a number of studies have focused on the association of dopamine system gene polymorphisms and TD. The most consistent findings have been found with the Ser9Gly polymorphism of the DRD3 gene. Although DRD2 has long been hypothesized to be the main target for antipsychotics, only a few polymorphisms in DRD2 have been investigated for their potential involvement in the aetiology of TD. In the present study, we investigated 12 polymorphisms spanning the DRD2 gene and their association with TD in our European Caucasian (n=202) and African-American (n=30) samples. Genotype frequencies for a functional polymorphism, C957T (Duan et al., 2003; Hirvonen et al., 2004), and the adjacent C939T polymorphism were found to be significantly associated with TD (p=0.013 and p=0.022 respectively). DRD2 genotypes were not significantly associated with TD severity as measured by AIMS (Abnormal Involuntary Movement Scale) with the exception of a trend for C939T (p=0.071). Both TD and total AIMS scores were found to be significantly associated with two-marker haplotypes containing C939T and C957T (p=0.021 and p=0.0087 respectively). Preliminary results indicated that C957T was also associated with TD in our African-American sample (p=0.047). Taken together, the present study suggests that DRD2 may be involved in TD in the Caucasian population, although further studies are warranted.