BOOK REVIEW

Book reviewed in this article: OLD AGE: A REGISTER OF SOCIAL RESEARCH 1985–1990. Ed by G. Crosby, Information Service, Centre for Policy on Ageing, UK, 1991.     

Screening for diabetic retinopathy in primary care with a mobile fundal camera--evaluation of a South African pilot project.

BACKGROUND AND AIMS: In South Africa diabetes makes a significant contribution to the burden of disease. Diabetic retinopathy is a leading cause of adult blindness, and screening can reduce the incidence. This project aimed to implement and evaluate a new service for retinal screening that uses a non-mydriatic mobile fundal camera in primary care. This is the first time such a service has been evaluated in an African primary care context. METHODS: The service was implemented as an operational research study at three community health centres and data were collected to evaluate the operational issues, screening, reporting and referral of patients. RESULTS: Out of 400 patients screened 84% had a significantly reduced visual acuity, 63% had retinopathy (22% severe nonproliferative, 6% proliferative and 15% maculopathy), 2% of eyes could not be screened and 14% of patients required dilatation. Referral was necessary in 27% of cases for cataracts, in 7% for laser treatment and in 4% for other specialist services. Repeat photography was needed in 8% and urgent follow-up in 12%. A SWOT analysis of the pilot project was completed and recommendations were made on how to integrate it into the district health system. CONCLUSION: Screening with a fundal camera improved the quality of care for diabetic patients and is feasible in the South African public sector, primary care setting. A single technician should be able to photograph almost 10,000 patients a year.     

Preservice early childhood students' perceptions of written feedback on their essays

Lecturer feedback on students' essays is important to the quality of the experience students have at university (Norton & Norton, 2001). The aim of the present study was to investigate whether early childhood students at one university actually read lecturer feedback on their essays and, if they did, what they found helpful and not helpful to their learning. Feedback was defined as 'giving students information on how well or how poorly they are doing in their academic work' (Hounsell, 1987, p. 109). Using the Vygotskian concept of learning as a socially shared activity, qualitative data were collected from second-year students from a four-year early childhood degree programme via an anonymous survey and four focus groups. Major findings were that, in contrast with studies of students in other programmes, early childhood students read lecturer feedback on their essays and used feedback that was detailed and explanatory as a learning tool. Types of feedback students found to be most and least useful were identified.     

Ischaemic peripheral polyneuropathy in the upper limb as a result of steal phenomenon in an arteriovenous malformation

We present the case of a 38-year-old right-hand-dominant female with a longstanding extensive high flow arteriovenous malformation (AVM) affecting the left hand and forearm. The patient’s main complaints were altered sensation in the left hand and difficulty with co-ordination. Clinical examination revealed reduced global sensibility in the hand and evidence of a vascular steal phenomenon resulting in a cold thumb and small finger without trophic changes. Subsequent nerve conduction studies identified peripheral neuropathy affecting the median, ulnar and radial nerves. There was no evidence of entrapment neuropathy and the findings were attributed to nerve ischemia as a result of the steal phenomenon. This case represents an unusual complication of an AVM of the upper limb which has not been reported previously to our knowledge. Patients with complex AVMs presenting with atypical peripheral neuropathies should be assessed for the possibility of steal phenomenon.Level of Evidence: Level V, risk/prognostic study.     

Healthcare practitioners’ personal and professional values

Personal and professional values of healthcare practitioners influence their clinical decisions. Understanding these values for individuals and across healthcare professions can help improve patient-centred decision-making by individual practitioners and interprofessional teams, respectively. We aimed to identify these values and integrate them into a single framework using Schwartz’s values model. We searched Medline, Embase, PsycINFO, CINAHL and ERIC databases for articles on personal and professional values of healthcare practitioners and students. We extracted values from included papers and synthesized them into a single framework using Schwartz’s values model. We summarised the framework within the context of healthcare practice. We identified 128 values from 50 included articles from doctors, nurses and allied health professionals. A new framework for the identified values established the following broad healthcare practitioner values, corresponding to Schwartz values (in parentheses): authority (power); capability (achievement); pleasure (hedonism); intellectual stimulation (stimulation); critical-thinking (self-direction); equality (universalism); altruism (benevolence); morality (tradition); professionalism (conformity); safety (security) and spirituality (spirituality). The most prominent values identified were altruism, equality and capability. This review identified a comprehensive set of personal and professional values of healthcare practitioners. We integrated these into a single framework derived from Schwartz’s values model. This framework can be used to assess personal and professional values of healthcare practitioners across professional groups, and can help improve practitioners’ awareness of their values so they can negotiate more patient-centred decisions. A common values framework across professional groups can support shared education strategies on values and help improve interprofessional teamwork and decision-making.     

Evidenced based nephrology care

This paper highlights the importance of evidenced-based practice (EBP) and its implications to patient and health professionals working within nephrology. The need to ensure that practice is based upon best evidence should be a concern for all health care professionals. Confusion sometimes surrounds the concept of EBP and the potential impact this may have upon patient outcomes. It is the intention of this paper to firstly demystify the process of EBP highlighting the important factors to be considered in moving towards EBP in nephrology care. Secondly, the paper draws upon a number of well-conducted research studies, which have important implications for nephrology care. These selected examples of best evidence will highlight further where ongoing work could be focused. Whilst there is much published within current literature concerning research within nephrology it is essential that practitioners are encouraged to develop the skills to critically search literature, appraise and evaluate its usefulness in developing appropriate and meaningful evidence to enhance practice and patient care.     

Development and Psychometric Properties of a New Questionnaire to Assess Mental Health and Concerning Behaviors in Children and Young People with Autism Spectrum Disorder (ASD): The Assessment of Concerning Behavior (ACB) Scale

Journal of Autism and Developmental Disorders - Although 70% of autistic children and young people meet criteria for co-occurring psychiatric conditions, there are few screening measures...