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Limitations of Telemedicine Vs. Face-to-face Eye Examination in a Patient with New Headaches
Full text linkBackground: During the emergence and rise of COVID-19, precaution directives and limitations on in-person eye examinations re-routed a significant portion of care to telemedicine and virtual modalities. While these technologies allowed for healthcare communications that otherwise could not occur during such trying times, there are major limitations to these sanctioned applications. This report will present a seemingly benign case that could have easily been re-routed from an in-person examination to a telemedicine version due to the patient’s seemingly “routine” vision complaints.
Case Report: A 50-year-old male patient contacted the eye clinic with a complaint of a minor, new, unexplained headache that he felt may have been related to a change in his vision. The patient requested a telehealth examination with the eye clinic to avoid exposure to COVID-19. After due consideration, the optometry clinic recommended an in-person eye examination despite the very heavy limitations requiring “emergency only” patients in the hospital. On examination it became evident that the cause of the headaches was a rebound hypertensive crisis and the patient did require emergency medical services to stabilize his condition.
Conclusion: This case was ultimately a serious emergency that would have been missed via a remote evaluation. The patient was fortunate to have been given a face-to-face appointment during a time of heavy restrictions and essentially emergency-only appointments. This should serve as a reminder to all eye care practitioners that new headaches are a symptom requiring an in-person evaluation, should a future event require similar clinical limitations. Despite the rarity, even a light headache in an early presbyope, as seen in this case, could be the only overt sign of an emergent condition
Voice: The Views of Informal Caregivers and the Elderly: A Qualitative Study of the Post-Hospital Experience
No full textResearch Focus The trending increase in the elderly population, inherent age-related health conditions, and hospital initiatives culminate in an increased rate of hospital-to-home transitions for the elderly population. As a result, the elderly depend on informal family care throughout their post-hospital discharge transition. Furthermore, there is empirical evidence that inadequate and misaligned transitions considerably impact elderly patients and their informal caregivers. Therefore, the healthcare industry has identified patient experience as the key indicator of quality and continuity of care.
The problem is that only quantitative surveys are the standard method for examining patient experience. Therefore, it is imperative to gain deeper insight through a qualitative exploration to understand the post-hospital discharge phenomenon from elderly patients and their informal caregivers (ICs) perspectives.
This qualitative phenomenological study aimed to gain qualitative knowledge of how post-hospital discharge to home is experienced from the patient and informal caregiver perspective. The Meleis Transitions Theory was employed as the theoretical framework as it aligns with multidimensional factors and the individuality of the post-hospital discharge (PD) phenomenon.
Research Method
The study postulated two research questions. First, how do geriatric patients describe the lived experiences of post-discharge? Second, how do informal caregivers of PD geriatric patients describe their lived experiences? The participants were selected through purposive and snowball strategies from a university in the southwest region of the United States. Narrative data were ethically obtained through one-on-one semi-structured interviews with each participant and analyzed with NVivo software. The results revealed four superordinate elderly patient themes and four superordinate informal caregiver themes.
Research Findings
The study\u27s findings affirm that the success of elderly posy-hospital discharge (PD) is heavily dependent on the involvement of informal caregivers. Furthermore, the study finds that optimal elderly PD experiences are attainable and best achieved with professional health care and informal family care. However, PD transition planning often overlooks informal caregivers and their needs resulting in stressful PD experiences for informal caregivers. This study revealed barriers and facilitators to propitious PD experiences for the elderly and informal caregivers. When the PD transition is less than optimal, the elderly and informal caregivers are impacted physically, emotionally, and psychologically.
Conclusions From Research
The study\u27s findings validate the theoretical framework that post-hospital discharge (PD) is a multifactorial transition that requires individualized transition planning to optimize patient experience and outcomes. However, this investigation identified additional associative factors that influence how elderly PD is experienced. Therefore, policymakers are encouraged to implement a mixed methods approach to collecting and measuring patient experience. Furthermore, practitioners are encouraged to engage with elderly patients and their informal caregivers and apply a biopsychosocial approach, and complete an informal caregiver profile when developing post-hospital discharge transitions for the elderly. Ultimately, the study concludes that a comprehensive and family-centered care approach is required to design post-hospital discharge transitions tailored to the needs of elderly patients and informal caregivers
Teaching Quality in South Texas: Examining the Factor Structures of the Modified Principles of Adult Learning Scale for Students at a Four-Year, Hispanic Serving Institution
Full text linkThe purpose of this survey study was to explore the factor structure of a newly adapted survey called the Modified Principles of Adult Learning Scale (MPALS) with students at a 4-year Hispanic Serving Institution. The examination of the factor structure of the new instrument was done in order to analyze student perception of professor’s instructional approach (i.e., application of Constructivist Learning Theory). The MPALS is a 44-item questionnaire that upon analysis yielded three factors, titled Student Centered, Subject Centered, and Teacher Centered, which supports its use as a student measure of instructional approach consistent with Constructivist Learning Theory. The experience of engaging this tool may provide respondents a framework for insight into their own opinions about teaching and learning as students and affect how they will teach and their personal philosophy of education and instruction. Faculty might benefit from utilizing this instrument to examine student perceptions about the nature of instruction. Administrators and other educators may explore the use of the MPALS as a tool to predict student success based on the match between student perspective of instruction and instructor practice (or perspective)
The Efficacy of Analgesic Subdissociative Dose Ketamine in Trauma Casualties Treated by U.S. Military Special Operations Medical Professionals in a Prehospital Environment
Full text linkResearch Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty data collection tool. Quantitative study inclusion criteria were adult casualties treated by U.S. military medical professionals with ketamine in a prehospital environment, had documented injury data, and had both pre- and post-ketamine pain scores. Descriptive statistics, followed by inferential statistical analyses using Shapiro-Wilkes, Wilcoxon Signed Rank, Spearman rho, and Kruskal Wallis tests were used. Additionally, phenomenology guided the analysis of two (n = 2) case studies. In vivo coding was used to develop themes and subthemes. Case studies collected from U.S. military medical professionals provided qualitative insight that reinforced the quantitative data and provided clinical validity to the study. Research Results/Findings. The study showed safe, efficacious use of analgesic sub-disociative ketamine use in prehospital trauma casualties relative to the 0–10 NRS for pain. The median reported pre-ketamine pain scale for casualties was 9.0 (IQR 2). The median post-ketamine pain scale was 0.0 (IQR 3). The mean total dosage of ketamine administered was 98.19 mg (SE = 9.545). There were 6 (12.8%) casualties who experienced side effects from ketamine that were neither permanent nor life-threatening. The case studies provided the human aspect of the study, reinforced the quantitative data, and provided clinical validity. Post-ketamine pain scores were better than pre-ketamine pain scores. Higher dosages of ketamine provided greater pain relief. No life threatening nor adverse drug reactions were found in this study. Conclusions From Research. This study demonstrated a safe, efficacious analgesic ketamine use in prehospital trauma casualties used by U.S. military special operations medical professionals relative to the 0–10 NRS for pain. The results of this study may inform medical practitioners and policymakers regarding the efficacy of analgesic ketamine in a prehospital environment, aid in making informed treatment decisions regarding trauma casualties, and provide facts for updating and improving clinical practice guidelines and policies focused on the U.S. military. Advancing the understanding to promote better prehospital pain management guidelines, procedures, and practices is essential. Education efforts will make medical professionals aware of the importance of analgesic ketamine for trauma casualties in a prehospital environment.
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The Art of Prescribing Low Amounts of Prism: Basic Clinical Applications
Full text linkExpanding the Bo
The Principal’s Role as Mentor in New Teacher Attrition Rates: The Importance of Teaching Teachers
Full text linkResearch Focus. Research tells us that it takes years of deliberate practice and ongoing coaching to become an “expert” in any field and that it can take from 3 to 7 years for a new teacher to grow into an effective educator. Yet, in America today, more than 50% of teachers quit in their first 5 years of service. In low performing economically disadvantaged schools, teachers leaving the profession in their first 3 years increases to 60%. The impact of highly effective teachers on students’ success can be seen through the increase in percentile on Math scores, moving the needle from 44th to 96th percentile. Although there are complexities surrounding the issue of teacher effectiveness measurement, we can agree on the fact that effective teachers make an extraordinary and lasting impact on their students’ lives.
Research Methods. This research utilized a constructivist grounded theory approach to conceptualize why former teachers in a low performing economically disadvantaged urban school district in San Antonio, Texas left their classroom. Additionally, this research examined how a campus principal serving as mentor might impact retention rates. The hope is that, by bridging the gap between turnover and retention, districts can better protect their most prized assets and influencers, their teachers.
Research Results/Findings. The findings broke down into two themes, the challenges of administrators and the perceived needs of teachers. While the participants discussed the role of principals as mentors, the discussion points also revolved around the challenges administrators face. While it is not too much to except administrators to serve as mentors for new teachers, all of the participants mentioned the obstacles or challenges that might prevent principals from serving as mentors. Around the challenges that administrators face, four sub-themes were identified: workload, high turnover, lack of cohesiveness/relationship and trust building, and mentorship approaches. Participants also highlighted the perceived needs of teachers and identified factors that contributed to teachers’ needs in terms of mentoring. The analysis of these factors yielded three sub-themes: support, professional development, and performance assessment.
Conclusions from Research. This research highlights the importance of mentoring new teachers. The principal as mentor serves as both a guide to accessing and understanding the curriculum as well as helping teachers adapt to the campus climate and culture. A crucial component of the mentoring process is trust and communication. The new teacher must feel safe approaching their mentor, otherwise the novice teacher may be reluctant to seek assistance. Is this role, the principal must serve as coach, cheerleader, role model, and trusted confidant, as well as appraiser and manager
Book Review: The Paradox of the Immune System: Protection, Chronic Inflammation, Autoimmune Disease, Cancer, and Pandemics
Full text linkBook Review:
Pandemics, Artificial Intelligence, Optometrists, COVID-19, Immune System Diseases, inflammatio
Equalizing Community Voice in an International Service-Learning Project: A Narrative Inquiry of a Social Entrepreneurial Peruvian Women\u27s Group
Full text linkTraditionally, international service-learning (ISL) programs are created and led by host groups, which frequently overlook the international communities’ learning process and perspectives and the long-term impact of service missions on the community. Fundamentally, ISL is meant to address community needs. With the principal focus being on enriching students’ learning, community voice is often eclipsed. The research aim was to investigate the empowerment and efficacy of an ISL project to strengthen relationships between engaged scholars and international communities and improve future service-learning trips. Using a qualitive narrative research design, I investigated a 2021-2022 ISL Based Photovoice Project applying Kolb’s Experiential Learning (EL) Cycle and Dr. Dorothy Ettling’s Process of Empowerment Model as my principal frameworks. Photovoice (Wang & Burris, 1997) is a participatory research method designed to allow often marginalized groups to document their realities, create a narrative, and heighten public awareness on a social concern. According to Buck et al. (2019), Ettling’s model was used to create capacity in disadvantaged communities globally and at UIW, to align professors’ and students’ talents and abilities with the challenges of those vulnerable communities. This study’s sample consisted of a Chimbote-native RA and six Peruvian women, ages 55 to 75, who are all members of the same social entrepreneurship organization. Data collected for the study included seven individual, semi-structured interviews, photographs, and research journal/notes. In vivo and holistic coding were used to extract codes from the data for analysis, and Braun and Clarke’s (2006) six-step approach assisted in the identification of themes. To document and construct a narrative of my study participants’ journeys through the course of the project, Dan Harmon’s Story Circle was used. Six members of the Peruvian social entrepreneurial group, Pushaq Warmi, led workshops in three surrounding communities of Chimbote, Peru, including rural areas, providing education and awareness on coping and management of mental health issues brought on or exacerbated by the COVID pandemic in addition to domestic abuse in the home, demonstrating ways to motivate and inspire their female workshop participants. Pushaq Warmi used the Photovoice method to document their workshop experiences. A public exhibition of their work in Nuevo Chimbote raised awareness of leading mental health concerns women face in Peru and reinforced their group’s mission, as stated by one Pushaq Warmi member, “to bring development and well-being to women through training to strengthen organizational and leadership capacities” (personal communication, March 8, 2020). The findings explored the transformative experiences of the participants in an ISL project. The study revealed that Ettling’s Process of Empowerment together with Kolb’s theory of EL could be integrated effectively into community directed ISL projects. The study’s qualitative methodology shows how Dan Harmon’s Story Circle may be applied to document and analyze individual and collective growth. In this ISL Photovoice project, study participants underwent a transformative change fostered by the development of five components that promote individual and group empowerment: 1. Capacity building based on professional goals and community motives; 2. Purpose through motivation, inspiration, and knowledge-sharing; 3. Self-development and awareness through exposure to service oriented projects; 4. Collaboration stemming from group work; and 5. Building self-esteem and reinvigorating a commitment to social advocacy by community impact through service work. The study demonstrated the potential of international communities as co-developers of service-learning initiatives. As co-collaborators, students and faculty of ISL projects can empower international communities by providing them with knowledge and skills on self-directed participatory methods, with the understanding that the communities may employ these techniques in a manner that makes sense to them. This was Dr. Dorothy Ettling’s true vision. My work with the study participants in an ISL project underscored their ownership and control allowing community voice to flourish. The project introduced the group to a participatory method the women then tailored to their motives/agenda. Additionally, the project’s focus on the women’s capacity development demonstrated its sustainability potential. The instruction on Photovoice will continue to be drawn from and adapted by the women of Pushaq Warmi to educate and train different communities. The women they train will then be able to train other women. It is recommended that the traditional approach of student-centered learning in ISL projects shift to one of community-based learning. Faculty should also invest in establishing long-term relationships with groups, organizations, or members of the community at service sites. New projects must also involve local authorities, community agents, leaders of social organizations, and the general population. The results of this study will assist in the development of a UIW faculty service-learning handbook, which will focus on ISL projects based on long-term relationships/partnerships, community needs, a reflective process, and sustainability potential
Central Activation of ORL-1 Receptors in Heart Failure Models
Full text linkHeart failure is a prevalent and debilitating disease associated with high morbidity and mortality rates worldwide and is the leading cause of death in the United States. While various therapeutic strategies have been developed and approved to manage heart failure, exploration of novel targets and mechanisms are essential for improving patient outcomes. This thesis investigates the therapeutic potential of the central activation of opioid receptor-like 1 (ORL-1) by nociceptin in a rodent heart failure model.
Furthermore, this study aims to elucidate the central mechanisms underlying nociceptin induced cardiovascular and renal effects in heart failure. This involves investigating neuronal pathways and neuronal and neurotransmitter systems influenced by nociceptin administration using immunohistochemical methods and urinalysis for sodium and potassium.
The findings of this thesis demonstrated greater expression of the excitatory neuromarker c-Fos in the parvocellular paraventricular nucleus (PVN) of the hypothalamus. Less expression was observed from neurons in the supraoptic nucleus and the magnocellular PVN in nearly all of the models tested. Heart failure models treated with nociceptin demonstrated less expression of c-Fos in the PVN than the untreated heart failure models. While it appears that ejection fraction was higher than anticipated and vasopressin was not fully activated in the heart failure models from the lack of c-Fos expression in the SON, these results still demonstrate decreased sympathetic nerve activity in the treated heart failure group compared to the untreated heart failure group. These results imply that the treated groups experienced reduction of heart rate, blood pressure, and a decrease in renal sympathetic nerve activity (RSNA) causing the models to excrete more fluids in the form of urine
Occult Adenocarcinoma Presenting as Presumed Periorbital Cellulitis
Full text linkBackground: Orbital tumors are uncommon entities seen by optometrists. They may initially present as common, benign conditions, but if not appropriately diagnosed can lead to devastating results.
Case Report: This case report demonstrates an atypical presentation of adenocarcinoma that was initially diagnosed as preseptal cellulitis. The patient in this case was ultimately referred for imaging and biopsy to reveal the correct diagnosis. Despite treatment, this patient died about 1 year after his clinical presentation.
Conclusion: The detection of orbital tumors and the subsequent management of patients with orbital tumors can be challenging. When considering orbital tumors as a possible diagnosis, careful examination is necessary to identify key clinical characteristics and to assist with ordering the appropriate imaging studies. Identifying these critical findings will allow an eye care provider to make a timely and appropriate referral for continued management of the patient