Expert opinion on the management and follow-up of uveitis patients during SARS-CoV-2 outbreak

ABSTRACT

Introduction

Routine medical and ophthalmic care is being drastically curtailed in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Uveitis patients require particular attention because of their theoretical risk of viral infection, in the context of therapeutic immunosuppression.     

Using holistic interpretive synthesis to create practice‐relevant guidance for person‐centred fundamental care delivered by nurses

Nursing policy and healthcare reform are focusing on two, interconnected areas: person‐centred care and fundamental care. Each initiative emphasises a positive nurse–patient relationship. For these initiatives to work, nurses require guidance for how they can best develop and maintain relationships with their patients in practice. Although empirical evidence on the nurse–patient relationship is increasing, findings derived from this research are not readily or easily transferable to the complexities and diversities of nursing practice. This study describes a novel methodological approach, called holistic interpretive synthesis (HIS), for interpreting empirical research findings to create practice‐relevant recommendations for nurses. Using HIS, umbrella review findings on the nurse–patient relationship are interpreted through the lens of the Fundamentals of Care Framework. The recommendations for the nurse–patient relationship created through this approach can be used by nurses to establish, maintain and evaluate therapeutic relationships with patients to deliver person‐centred fundamental care. Future research should evaluate the validity and impact of these recommendations and test the feasibility of using HIS for other areas of nursing practice and further refine the approach.     

Achievement orientation and fear of success in Asian American college students

One hundred eighty-five Asian American undergraduates participated in a study designed to examine the relationships among gender, acculturation, achievement orientation, and fear of academic success. Acculturation was modestly correlated with achievement orientation. Endorsement of Asian and Anglo values were significantly related to individual-oriented achievement. Marginal significance, however, was obtained for endorsement of Asian values and beliefs to social-oriented achievement. These findings suggest that persons with a bicultural identity tend to adopt a multifaceted achievement style. Achievement orientation, in turn, predicted fear of academic success, with gender and perceived discrepancies from parental achievement values contributing minimal additional variance. Social-oriented achievement was related to high fear of academic success, whereas an individualistic orientation buffered against such conflicts. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 97–108, 1998.     

Can pulsatile ocular blood flow distinguish between patients with and without diabetic retinopathy?

Purpose: Our aim was to determine if pulsatile ocular blood flow (POBF) measurements could distinguish between type 2 diabetes mellitus (DM) subjects with and without diabetic retinopathy (DR). Methods: Ninety‐eight DM subjects were recruited. POBF was measured using an Ocular Blood Flow tonometer and retinopathy was assessed using retinal digital photography. The duration of diabetes, blood pressure, glycosylated haemoglobin and plasma glucose level were also recorded. Results: Seventy‐two subjects had no DR and 26 subjects exhibited mild to moderate non‐proliferative DR. POBF was higher in those subjects with non‐proliferative DR but did not reach significance. Those subjects receiving insulin treatment had a significantly longer duration of DM, higher HbA1c and plasma glucose levels and greater incidence of non‐proliferative DR compared to subjects receiving oral hypoglycaemic agents, who in turn demonstrated higher levels of these parameters than those who were controlled by diet alone (ANOVA p < 0.05 in all cases). POBF was found to increase with level of management but not significantly so. Conclusions: A single measurement of POBF does not distinguish between subjects with and without mild/moderate non‐proliferative DR.     

Trauma, dissociation, and antiretroviral adherence among persons living with HIV/AIDS

Background

There are approximately 1,000,000 persons living with HIV/AIDS (PLH) in the United States; to reduce rates of new infection and curb disease progression, adherence to HIV medication among PLH is critical. Despite elevated trauma rates in PLH, no studies to date have investigated the relationship between dissociation, a specific symptom of trauma, and HIV medication adherence. We hypothesized that Post-Traumatic Stress Disorder (PTSD) symptoms would be associated with lower adherence, and that dissociation would moderate this relationship.

Methods

Forty-three individuals with HIV were recruited from community-based clinics to participate in a cross-sectional study. The relationship of trauma, dissociation, and their interaction to the probability of antiretroviral adherence was assessed using a hierarchical binary logistic regression analysis.

Results

Among 38 eligible participants, greater PTSD was associated with lower odds of adherence (OR = .92, p < .05). Dissociation moderated the effect of PTSD on adherence, resulting in lower odds of adherence (OR = .95, p < .05). PTSD symptoms were significantly associated with lower odds of adherence in individuals reporting high levels of dissociation (OR = .86, p < .05) but not in those reporting low levels of dissociation (OR = 1.02, p > .05).

Conclusions

This is the first study to demonstrate a relationship between dissociation and medication adherence. Findings are discussed in the context of clinical management of PLH with trauma histories and the need for interventions targeting dissociative symptomatology to optimize adherence.     

The effect of post prandial glucose changes on oscillatory potentials in subjects with type 2 diabetes mellitus

Purpose: To investigate the effect of elevated plasma glucose levels on oscillatory potentials (OPs) in patients with diabetes mellitus. Method: 15 patients with type 2 diabetes mellitus, with no ophthalmoscopically visible signs of diabetic retinopathy (NDR), were recruited, mean (SD) age 65.1 (10.91) years and duration 5.95 (4.95) years. Plasma glucose levels and OPs were recorded before, during and after a meal tolerance test (MTT), at times 0, 90 and 210 min. OPs were recorded following 5 min adaptation to a blue mesopic background (1.17 cd m^–2), and elicited using a white 5 ms stimulus flickering at 5 Hz frequency over the blue background. Results: Plasma glucose increased significantly from 0 to 90 min during the MTT. This corresponded with an increase in mean amplitude of OP1–4, and a significant increase in the summed amplitudes. Summed OP amplitudes were 14.52 v and 18.38 v at time 0 and 90 min respectively. Between times 90 and 210 min plasma glucose levels decreased significantly back to baseline. OP1 and OP2 amplitudes increased slightly and OP3 and OP4 amplitudes decreased markedly, resulting in a non-significant reduction of the summed amplitudes. No significant changes in latencies were seen. Conclusions: Summed OP amplitudes, which are known to reflect the efficiency of the retinal circulation, increased with elevated plasma glucose. This effect was not immediately reversible. Latencies appear not to be affected.     

Disrupting White racial dominance: How White antiracists challenge the racial status quo in interpersonal relationships

As White activists are growing the racial justice movement, their antiracism frequently disrupts the racial hierarchy, which features whiteness in a dominant role, especially in interpersonal relationships. We investigate how White antiracists disrupt whiteness in interpersonal relationships. We interviewed 16 White antiracists who had experienced significant relationship distance due to their antiracism. We conducted thematic analyses to understand the conflicts that emerged between antiracists and their White counterparts as activists challenged White racial dominance. Antiracists disrupted whiteness by exercising social power to punish racist offenders. In response, their White counterparts resisted these challenges by exerting their instruments of power to sanction antiracists. The conflict with White people led antiracists to build greater personal and social capacity for antiracist activism. This study illustrates how conflicts can emerge during social change efforts even at the microlevel as parties exercise power to contest or support the status quo.