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Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination
Get PDFRepublished with the written permission granted from the American Optometric Association, October 2, 2020.
Developed by the AOA Evidence-Based Optometry Guideline Development Group
Approved by the AOA Board of Trustees February 12, 2017
Diane T. Adamczyk, O.D., Chair – State University of New York, College of Optometry, New York, New York
John F. Amos, O.D., M.S. – University of Alabama at Birmingham School of Optometry, Birmingham, Alabama, Dean and Professor Emeritus
Felix M. Barker, II, O.D., M.S. – W. G. (Bill) Hefner VAMC, Salisbury, North Carolina
Benjamin P. Casella, OD – Private Practice – Casella Eye Center, Augusta, Georgia
Linda M. Chous, O.D. – United HealthCare Services, Inc., Minneapolis, Minnesota
Lynn D. Greenspan, O.D. – Salus University, Pennsylvania College of Optometry, Elkins Park, Pennsylvania
Lori L. Grover, O.D., Ph.D. – Health Policy, King-Devick Technologies, Inc., Oakbrook Terrace, Illinois
Tina R. MacDonald, O.D. – The Center for the Partially Sighted, Culver City, California
Harue J. Marsden, O.D., M.S. – Southern California College of Optometry, Marshall B. Ketchum University,
Fullerton, California David K. Masihdas, O.D. – Utah Eye Associates - The Diabetic Eye Center, Salt Lake City, Utah
Bennett McAllister, O.D. – Western University of Health Sciences, College of Optometry, Pomona, California
Trennda L. Rittenbach, O.D. – Palo Alto Medical Foundation/Sutter Health, Sunnyvale, California
Carl J. Urbanski, O.D. – Private Practice, Family Vision Care of Kingston, Kingston, Pennsylvania
Multidisciplinary and Patient Stakeholders
Ida Chung, O.D. – Western University of Health Sciences, College of Optometry, Pomona, California
Beth T. Dessem – Patient Advocate; Missouri CASA Association, Columbia, Missouri
David E. Hartenbach, M.D. – Pediatrician; Creve Coeur Pediatrics, Creve Coeur, Missouri
Janet Hughes – Patient (parent); Vision First Foundation, Lemont, Illinois
Mitchell M. Scheiman, O.D. – Salus University, The Eye Institute of Pennsylvania College of Optometry, Elkins Park, Pennsylvania
Non-voting Members
Stephen C. Miller, O.D., Chief Editor - Innovative Writing Works, St. Louis, Missouri
Beth A. Kneib, O.D., AOA Director of Clinical Resources, American Optometric Association, St. Louis, Missouri
Andrew Morgenstern, O.D., AOA Consultant for Evidence-Based Optometry, American Optometric Association, Alexandria, VA
Danette Miller, AOA Manager of Quality Improvement, American Optometric Association, St. Louis, Missouri
Alisa G. Krewet, AOA Quality Improvement Coordinator, American Optometric Association, St. Louis, Missour
Is Anybody Listening?: Factors Affecting Pain Management in Veterans Within an Acute Care Rehab Setting
Get PDFBackground: In the United States, pain is a widely discussed issue due to the opioid epidemic stemming from a history of pain mismanagement. Clinical guidelines for successful pain management techniques are readily available for providers to incorporate into the individualized patient care plan.
Purpose: The purpose of this project is to improve pain management through implementation of the VA pain management guidelines and improved interdisciplinary team communication.
Objectives: This project aims to decrease the number of patients reporting moderate to severe pain, enhance staff/provider communication, and improve the provider’s overall process for managing pain with an individualized treatment plan.
Interventions: Implementation of the practice guidelines included engaging staff in training, implementing new pain management tools, implementing a provider-initiated pain template, collaborative communication, and supplemental education for the patients and staff.
Results: The results of the project showed improved provider/staff knowledge of pain assessment and management, maintenance of greater than 95% in pain medication effectiveness documentation, compliance with individualized pain template initiation and reassessment in weekly team meetings, and lastly a reduction in the number of veterans reporting moderate to severe pain.
Implications for Practice: The significance of this project lies in its ability to highlight the providers’ accountability for managing pain in patients and their role as leaders to ensure the continued assessment and evaluation of patients experiencing pain in this unique and vulnerable population
Implementation of Comprehensive Foot Exams in Primary Care: A Quality Improvement Project
Get PDFThe purpose of this quality improvement project was to increase performance and documentation of provider comprehensive foot exams (CFEs) by 50% among patients with Type 2 diabetes (T2DM) in a small clinic in the southwestern United States.
The project leader assessed clinic systems including the electronic health record (EHR) to identify means to increase CFE completion and documentation rate for patients with T2DM being seen for a chronic disease management (CDM) appointment. A process was created to incorporate a hardcopy CFE documentation form into the EHR and create a pop-up care reminder notification system. Staff and the provider were educated on the new process, supplies were obtained, and the project leader implemented this project in the spring of 2020. The project leader monitored outcomes through a formative and summative evaluation plan and addressed barriers as they were identified. The COVID-19 pandemic impacted clinic practices in March 2020 and led to modification of project outcomes as the platform for appointments changed from in person to telehealth.
The project outcome was achieved as 52% of patients with T2DM who were seen during a CDM appointments received a CFE that was documented completely. The average increase in appointment time was 10 minutes. Including CFEs in CDM appointments can support the identification of foot ulcers at an early stage and prevent or delay lower extremity amputations. EHR systems should be evaluated for the capacity to support electronic tracking and documentation of these assessment
Establishing a Structured Mentorship Program for Novice Advanced Practice Registered Nurses in the Veterans Health Care System
Get PDFBackground. Mentorship is an age-old strategy still widely sought after to increase integration into the workforce. Employers of new APRNs must be aware that newly graduated APRNs are inexperienced. To maximize the employers’ investment, training on proper integration should be a high priority. This Doctor of Nursing Practice (DNP) project addressed this quality improvement issue through the implementation of a structured mentorship program to improve the overall transitioning of newly hired APRNs in the Veterans Health Care System (VHCS). Problem. The VHCS lacks a formalized, structured mentorship program for newly graduated APRNs entering the VA System. Intervention. Seven APRN mentors and 10 newly hired APRN mentees in their first 8 to 10 weeks of employment were identified for the APRN mentorship program. The participants met monthly face to face and weekly by email. Monthly goals, objectives, strengths, and weaknesses were identified. Project objectives were: 1) All NPs within the VHCS who met mentor criteria would be identified, 2) Fifty percent of identified NPs would be recruited as mentors, 3) All newly hired NPs would be assigned a mentor, 4) All mentor-mentee pairs would establish at least one short-term goal with objectives, 5) Eighty percent of mentees would meet short-term goal, and 6) Fifty percent of mentor-mentee pairs would establish a second short-term goal. The Mentor Competency Assessment (MCA) and the Centers of Excellence in Primary Care Education (CoEPCE) were used to measure progress. Results. Mentor Competency Assessment scores increased from a median value of 5.88 (moderately skilled) in May to 6.65 (extremely skilled) in July. Composite scores from the Centers of Excellence in Primary Care Education (CoEPCE) assessment improved during the study period, increasing from a mean value of 275.5 in May to 327.1 in July. Mentees’ self-reported satisfaction scores increased from a mean of 4.44 in May to 4.94 in July. Implications for Practice. This quality improvement initiative provides a promising basis for improving the transition of newly hired APRNs in the VHCS, thereby improving overall retention of these providers
Free Battered Texas Women: Survivor-Advocates Organizing at the Crossroads of Gendered Violence, Disability, and Incarceration
Get PDFThis article recaps my symposium presentation, where I argue that feminist organizing strategies are central to healing our society and creating restorative justice from my perspective as a survivor of occupational injury, battering, and criminalization for self-defense. This includes the creation of Free Battered Texas Women. We prefer to think of ourselves as survivor-advocates who use a variety of tactics to empower ourselves, incarcerated battered women, and citizens. These strategies include pedagogy; poetry and other written forms; art; and legislative advocacy. I blend this grassroots activism with feminist disability theory, radical feminist theory, feminist ethnography, and feminist criminology
The Effect of Faculty Leadership Style on the Results of Student Evaluation of Teachers
Get PDFHigher education administrations use Student Evaluation of Teacher (SET) frequently as a performance metric for instructors and professors. Many decisions are being at least partially made based on SET results such as recruiting, retention, and promotion decisions. SET has been subject of many studies but just recently leadership style is being studied as a factor affecting SET. Research shows instructors’ transformational leadership in classrooms can lead to more effective and efficient classrooms, which in turn yields higher student satisfaction and academic gains. In this Study, the relationship between SET and transformational/transactional leadership style has been examined using structural equation modeling. The leadership data has been collected using infamous MLQ questionnaire. Testing the construct validity of the MLQ factors used in this study, using confirmatory factor analysis indicated that the original construct proposed by developers of MLQ cannot be applied in a higher education setting. The results indicate that the perception of undergraduate student from leadership style of instructors has no significant effect on SET. However, the difference between student and instructor perception from the (self) leadership style of the instructor can significantly define SET
Pregnancy Bridge Program for Psychiatric Patients
Get PDFThe National Institute of Mental Health (2017) estimates that 9.2 million people age 18 years and older are diagnosed with bipolar disorder in the United States. Research has shown pregnancies in women with mental health problems have higher rates of poor outcomes and complications (Epstein et al., 2014; Freeman, 2007; Rusner et al., 2016; Scrandis, 2017). Aim. The purpose of this scholarly project is to provide standardized patient education, increase urine human chorionic gonadotropin screening rates, and to set up a gynecologic care bridge for patients considering pregnancy and are diagnosed with bipolar disorder. Evidence. The Centers for Disease Control and Prevention (2019b) estimates 51% of pregnancies are unplanned and recommends planning for pregnancy ahead of time. The American College of Obstetricians and Gynecologists (2019) recommends a multidisciplinary care team for patients that plan on pregnancy. Mood-stabilizing and anti-psychotic medications are known human teratogens (Bodén et al., 2012; Mittal et al., 2015; Stahl, 2017). Method. Female patients with bipolar disorder, ages 18-65 years, received standardized medication and contraception education. These patients were screened for pregnancy intentions or human chorionic gonadotropin. Patients that met criteria were connected with a gynecologic provider. Results. 158 patients were screened for pregnancy and offered education over ten weeks. 37 patients had recent pregnancy tests. 50 patients were indicated for follow up. Implications. Medication safety is of paramount importance for this high-risk population. Data captured during this project provides a snapshot. This process should be continuous and championed by health care organizations