This study aimed to identify current practices for detecting and managing depression in patients with low vision among eye health professionals and rehabilitation workers. A survey of 94 such professionals found that fewer than 40% attempted to identify depression in patients. Rehabilitation workers were more likely than eye health professionals to do so. Those who tried to identify depression reported greater confidence and fewer perceived barriers. The resources and management strategies available varied between settings, with rehabilitation agencies having the most support available. Overall, no consistent strategy for depression management was identified. The study concludes that training is needed to improve skills for addressing depression in patients with low vision.
This document is an abstract for an expert roundtable supplement on best practices in diagnosing and treating adult ADHD. It discusses key points about the epidemiology of adult ADHD, including that approximately 4% of US adults have ADHD. It also notes that adults with ADHD experience significant impairments in executive functioning and adaptive functioning. Further, most adults with ADHD have at least one comorbid psychiatric disorder, making diagnosis and treatment more complex. The roundtable aims to review epidemiology data on adult ADHD, discuss common impairments, and consider differential diagnoses and common comorbidities.
This document summarizes a presentation on physiotherapy for non-cancer chronic pain. It discusses that physiotherapy aims to restore and promote optimal physical function and quality of life for those with persistent pain. It provides an overview of evaluation processes in physiotherapy and various treatment modalities. It also summarizes evidence on approaches for common persistent pain conditions like low back pain, whiplash associated disorder, and osteoarthritis. Screening tools for risk of long-term disability are also briefly covered.
This study examined the effect of incorporating environmental distractors into a continuous performance test (CPT) on its ability to distinguish adolescents with ADHD from controls. The study found that ADHD adolescents made significantly more omission errors on a CPT when it included visual distractors or a combination of visual and auditory distractors compared to when there were no distractors. Distracting stimuli did not affect CPT performance in non-ADHD adolescents. The results suggest that including environmental distractors improves a CPT's ability to diagnose ADHD in adolescents by making the task more challenging for those with attentional difficulties.
Dr Helen McMonagle: Alcohol-Related Brain Injury in the Irish Context - Indiv...AlcoholForum.org
Dr. Helen McMonagle presented on alcohol-related brain injury (ARBI) in Ireland. She discussed how ARBI is often undiagnosed or misdiagnosed. Patients with ARBI get trapped in a cycle where their cognitive deterioration reduces their ability to seek help for their alcohol use. Dr. McMonagle advocated for a whole system approach to ARBI that focuses on primary prevention of alcohol misuse, secondary prevention through earlier detection of ARBI, and rehabilitation for those with established ARBI through coordinated multi-disciplinary care and community reintegration. There are currently gaps in services for detoxification, assessment, case coordination, and residential rehabilitation for ARBI patients in Ireland.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Pediatric Assessment Triangle (PAT) is a novel approach for the rapid evaluation of children in emergency situations. The PAT uses only visual and auditory cues to assess a child's appearance, work of breathing, and circulation to the skin. This allows clinicians to quickly determine if a child is stable or unstable, and to identify the general category of physiological abnormality. The PAT promotes standardized communication among healthcare providers and helps prioritize critical treatments in emergency pediatric assessments.
This document provides an adapted clinical practice guideline for the management of persistent non-specific low back pain from 6 weeks to 12 months in duration. It is based on a guideline originally developed by the National Institute for Health and Care Excellence in the UK. The guideline was adapted for use in Saudi Arabia using the ADAPTE process. It includes an introduction describing non-specific low back pain and available treatment options. The guideline aims to ensure episodes of low back pain do not result in long-term disability or withdrawal from normal activities. It provides recommendations for the management of non-specific low back pain through education, exercise, manual therapy, and combined physical and psychological interventions.
Sarah Purdy: What does evidence look like?Nuffield Trust
The document summarizes evidence on interventions that can reduce avoidable hospital admissions. It finds that primary care interventions with continuity of care, appropriate practitioner-to-patient ratios, and structured hospital discharges are effective. Case management works for mental health but its effects are uncertain for other groups. Specialist clinics, self-management programs, and palliative care coordination can reduce cardiac and respiratory admissions. However, the evidence on other interventions like telemedicine, medication reviews, and integrated care models is mixed. Overall, the most supported interventions emphasize traditional high-quality care, patient education, and care coordination.
This document is an abstract for an expert roundtable supplement on best practices in diagnosing and treating adult ADHD. It discusses key points about the epidemiology of adult ADHD, including that approximately 4% of US adults have ADHD. It also notes that adults with ADHD experience significant impairments in executive functioning and adaptive functioning. Further, most adults with ADHD have at least one comorbid psychiatric disorder, making diagnosis and treatment more complex. The roundtable aims to review epidemiology data on adult ADHD, discuss common impairments, and consider differential diagnoses and common comorbidities.
This document summarizes a presentation on physiotherapy for non-cancer chronic pain. It discusses that physiotherapy aims to restore and promote optimal physical function and quality of life for those with persistent pain. It provides an overview of evaluation processes in physiotherapy and various treatment modalities. It also summarizes evidence on approaches for common persistent pain conditions like low back pain, whiplash associated disorder, and osteoarthritis. Screening tools for risk of long-term disability are also briefly covered.
This study examined the effect of incorporating environmental distractors into a continuous performance test (CPT) on its ability to distinguish adolescents with ADHD from controls. The study found that ADHD adolescents made significantly more omission errors on a CPT when it included visual distractors or a combination of visual and auditory distractors compared to when there were no distractors. Distracting stimuli did not affect CPT performance in non-ADHD adolescents. The results suggest that including environmental distractors improves a CPT's ability to diagnose ADHD in adolescents by making the task more challenging for those with attentional difficulties.
Dr Helen McMonagle: Alcohol-Related Brain Injury in the Irish Context - Indiv...AlcoholForum.org
Dr. Helen McMonagle presented on alcohol-related brain injury (ARBI) in Ireland. She discussed how ARBI is often undiagnosed or misdiagnosed. Patients with ARBI get trapped in a cycle where their cognitive deterioration reduces their ability to seek help for their alcohol use. Dr. McMonagle advocated for a whole system approach to ARBI that focuses on primary prevention of alcohol misuse, secondary prevention through earlier detection of ARBI, and rehabilitation for those with established ARBI through coordinated multi-disciplinary care and community reintegration. There are currently gaps in services for detoxification, assessment, case coordination, and residential rehabilitation for ARBI patients in Ireland.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Pediatric Assessment Triangle (PAT) is a novel approach for the rapid evaluation of children in emergency situations. The PAT uses only visual and auditory cues to assess a child's appearance, work of breathing, and circulation to the skin. This allows clinicians to quickly determine if a child is stable or unstable, and to identify the general category of physiological abnormality. The PAT promotes standardized communication among healthcare providers and helps prioritize critical treatments in emergency pediatric assessments.
This document provides an adapted clinical practice guideline for the management of persistent non-specific low back pain from 6 weeks to 12 months in duration. It is based on a guideline originally developed by the National Institute for Health and Care Excellence in the UK. The guideline was adapted for use in Saudi Arabia using the ADAPTE process. It includes an introduction describing non-specific low back pain and available treatment options. The guideline aims to ensure episodes of low back pain do not result in long-term disability or withdrawal from normal activities. It provides recommendations for the management of non-specific low back pain through education, exercise, manual therapy, and combined physical and psychological interventions.
Sarah Purdy: What does evidence look like?Nuffield Trust
The document summarizes evidence on interventions that can reduce avoidable hospital admissions. It finds that primary care interventions with continuity of care, appropriate practitioner-to-patient ratios, and structured hospital discharges are effective. Case management works for mental health but its effects are uncertain for other groups. Specialist clinics, self-management programs, and palliative care coordination can reduce cardiac and respiratory admissions. However, the evidence on other interventions like telemedicine, medication reviews, and integrated care models is mixed. Overall, the most supported interventions emphasize traditional high-quality care, patient education, and care coordination.
Consensus Guidelines on Management of Childhood Convulsive Status Epilepticusmandar haval
The document provides consensus guidelines for the evaluation and management of childhood convulsive status epilepticus in India. It was developed through a multi-disciplinary consensus workshop involving experts from across India. The guidelines define status epilepticus and discuss the epidemiology in India. They emphasize the importance of early pre-hospital management to initiate treatment as soon as possible. The initial management should consist of a parenteral benzodiazepine by any feasible route. Subsequent in-hospital management is also outlined. The aim is to provide a standardized, evidence-based protocol tailored for use in India given available resources and common etiologies.
This document discusses cognitive impairment in ICU patients. It notes that approximately 36% of mechanically ventilated patients and 25-54% of all ICU patients demonstrate cognitive impairment 6-12 months after discharge. The impairment affects executive function, memory, and mental processing. Risk factors include hypoxemia, hyperglycemia, delirium duration, hypotension, and sedative use. Delirium occurs in 74-80% of ICU patients and is associated with hypoperfusion in brain regions. Prevention strategies may include exercise in ICU to reduce delirium rates and cognitive rehabilitation. Maintaining good sleep and reducing delirium are important to mitigate cognitive impairment.
How do we deliver on palliative care aspirations at the end of life in the acute setting?
Jean Clark, Karen Sheward, Joy Percy, Celine Collins, Simon Allan
Dental professionals should understand the high prevalence and underdiagnosis of psychiatric disorders and their association with increased dental problems and reduced treatment compliance. Psychiatric conditions like chronic facial pain, body dysmorphic disorder, eating disorders, dental phobia, mood disorders, psychotic disorders, substance use disorders, dementia and intellectual disabilities can all negatively impact oral health. Effective treatment requires a multidisciplinary approach including counseling, cognitive behavioral therapy, medication and referral to a psychiatrist or psychologist when needed. Dental professionals play an important role in the oral health of those with mental illness through prevention, accommodation for individual needs, and collaboration with mental health practitioners.
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes that many principles of antiepileptic drug therapy for non-disabled individuals also apply to those with developmental disabilities, but that treating physicians face additional challenges. These include a higher rate of difficult-to-control seizures, limited ability to do diagnostic testing due to cognitive impairments, and greater risk of adverse drug effects. It also discusses the trend toward deinstitutionalization and relocation of developmentally disabled individuals to community settings, increasing the need for community physicians to treat their medical issues like epilepsy. The role of legal guardians, family members, and group home staff in providing care and information is also covered.
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes higher incidence of difficult-to-control seizures and potential for adverse effects from medications in this population. It reviews factors like legal guardians, family involvement, group home staff, and challenges with diagnostic testing. It provides guidance on antiepileptic drug selection considering efficacy, side effects, and treatment of any co-morbid conditions.
Developmental Disabilities and Community LifeRoss Finesmith
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes higher incidence of difficult-to-control seizures and limited ability for testing in this population. It reviews factors like legal guardians, family involvement, group home staff, and challenges of medication administration and testing. It provides guidance on antiepileptic drug selection considering efficacy, side effects, and treating co-morbid conditions.
The document discusses shared decision making (SDM) in clinical encounters at Mayo Clinic. It describes the work of the Knowledge and Evaluation Research (KER) Unit, which designs and evaluates decision aids to facilitate SDM between clinicians and patients. Decision aids provide unbiased information on healthcare options and help patients consider what matters most to them. Studies show decision aids improve patient knowledge and involvement without increasing consultation time. The KER Unit has created over 20 decision aids covering various medical topics. Their goal is to create meaningful conversations centered around patient needs and values to improve healthcare outcomes and experience.
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes higher incidence of difficult-to-control seizures and potential for adverse effects from medications. Care is now provided in community settings like group homes rather than institutions. Physicians must work with legal guardians, family members, and caregivers to effectively manage patients' epilepsy and understand historical factors. Choosing antiepileptic drugs requires considering seizure type, psychiatric comorbidities, previous medication responses, and ability to administer medications properly in community settings. Neurodiagnostic testing can be challenging but helps identify seizure type and guide treatment.
Kimberley Haines is a senior ICU physiotherapist and the Allied Health Research Lead at Western Health. Her academic research focusses on the long term progress of ICU survivors. Here she discusses the developing puzzle of ICU outcomes.
The document compares the oral health status and treatment needs of institutionalized psychiatric patients versus non-institutionalized psychiatric patients. It finds that institutionalized patients have more extensive dental disease requiring complex treatment compared to non-institutionalized patients, though both groups have high treatment needs relative to the general population. Prevention should be the main objective to avoid complex treatment needs, and more coordination is needed between medical, dental, and social services to meet the needs of this vulnerable population.
May 19, 2015
Physicians of Ontario Neurodevelopmental Advocacy (PONDA) Network
Position Statement: A Provincial Assessment Program for All Children with Complex Neurobehavioural Needs
Letter from PONDA to Hon Todd Smith re. Beber Report
OPTCARE Neuro - Palliative care in patients with Multiple Sclerosis (MS)MS Trust
1) The document discusses a clinical trial called OPTCARE Neuro that is evaluating the effectiveness of short-term integrated palliative care (SIPC) services for people with advanced neurological conditions.
2) Previous research found SIPC improved symptom control, reduced caregiver burden, and saved costs for MS patients. However, more research is needed on how best to deliver palliative care for neurological patients.
3) OPTCARE Neuro aims to determine if SIPC is clinically and cost-effective for a broader range of neurological conditions when provided in multiple centers. The trial has recruited over 200 patients so far from sites across England and Wales.
Critical care rehabilitation is an important part of the recovery process for ICU patients. It begins with early mobilization like passive range of motion exercises and progresses to active transfers, sitting at the edge of the bed, and eventually ambulation. A multidisciplinary team approach that includes nurses, physiotherapists, and other allied health professionals comprehensively assesses patients and develops individualized rehabilitation plans and goals. Regular evaluation during the ICU stay, before discharge, and after discharge is important to optimize recovery outcomes and quality of life.
The Definitions and Demographics of low visionHossein Mirzaie
Low vision is defined as a visual impairment that cannot be fully corrected with standard glasses or contact lenses and results in visual ability below normal levels. The document discusses the various causes and demographics of low vision globally and in the UK, noting that the majority of low vision patients are elderly and conditions like age-related macular degeneration are common causes of vision loss. A multi-disciplinary approach is recommended to address the medical, rehabilitative, and social service needs of individuals with low vision.
Low vision is visual impairment that cannot be fully corrected with standard glasses or contact lenses and results in a best corrected visual acuity of worse than 6/18. Low vision rehabilitation aims to maximize functional vision through optical devices like magnifiers and non-optical aids. Common causes of low vision include age-related macular degeneration, diabetic retinopathy, and retinitis pigmentosa. A low vision assessment evaluates visual needs, prescribes optical devices, and provides counseling. Lack of low vision services has negative impacts including developmental delays in children and isolation in adults. Expanding low vision care is needed to serve the large underserved population with vision impairment.
This document provides guidance for educators on presenting information to individuals with low vision. It defines low vision as vision that is between 20/70 and 20/400 that cannot be fully corrected with glasses, contact lenses, or surgery. Common causes of low vision include macular degeneration, cataracts, glaucoma, and diabetic retinopathy. The document provides tips for making printed materials and presentations accessible, such as using large font sizes and high contrast between text and background colors.
This document discusses low vision and provides definitions, classifications, common causes, and management strategies.
[1] Low vision is defined as visual impairment even after treatment that results in visual acuity worse than 6/18 but ability to use vision. It can be caused by conditions like macular degeneration, retinitis pigmentosa, cataract, and glaucoma.
[2] Low vision affects people's ability to perform visual tasks and can cause blurry or decreased vision, loss of peripheral vision, and light sensitivity. Evaluation involves assessing vision and goals, while management includes low vision devices and counseling.
[3] Common low vision devices include telescopes, magnifiers, and electronic
Consensus Guidelines on Management of Childhood Convulsive Status Epilepticusmandar haval
The document provides consensus guidelines for the evaluation and management of childhood convulsive status epilepticus in India. It was developed through a multi-disciplinary consensus workshop involving experts from across India. The guidelines define status epilepticus and discuss the epidemiology in India. They emphasize the importance of early pre-hospital management to initiate treatment as soon as possible. The initial management should consist of a parenteral benzodiazepine by any feasible route. Subsequent in-hospital management is also outlined. The aim is to provide a standardized, evidence-based protocol tailored for use in India given available resources and common etiologies.
This document discusses cognitive impairment in ICU patients. It notes that approximately 36% of mechanically ventilated patients and 25-54% of all ICU patients demonstrate cognitive impairment 6-12 months after discharge. The impairment affects executive function, memory, and mental processing. Risk factors include hypoxemia, hyperglycemia, delirium duration, hypotension, and sedative use. Delirium occurs in 74-80% of ICU patients and is associated with hypoperfusion in brain regions. Prevention strategies may include exercise in ICU to reduce delirium rates and cognitive rehabilitation. Maintaining good sleep and reducing delirium are important to mitigate cognitive impairment.
How do we deliver on palliative care aspirations at the end of life in the acute setting?
Jean Clark, Karen Sheward, Joy Percy, Celine Collins, Simon Allan
Dental professionals should understand the high prevalence and underdiagnosis of psychiatric disorders and their association with increased dental problems and reduced treatment compliance. Psychiatric conditions like chronic facial pain, body dysmorphic disorder, eating disorders, dental phobia, mood disorders, psychotic disorders, substance use disorders, dementia and intellectual disabilities can all negatively impact oral health. Effective treatment requires a multidisciplinary approach including counseling, cognitive behavioral therapy, medication and referral to a psychiatrist or psychologist when needed. Dental professionals play an important role in the oral health of those with mental illness through prevention, accommodation for individual needs, and collaboration with mental health practitioners.
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes that many principles of antiepileptic drug therapy for non-disabled individuals also apply to those with developmental disabilities, but that treating physicians face additional challenges. These include a higher rate of difficult-to-control seizures, limited ability to do diagnostic testing due to cognitive impairments, and greater risk of adverse drug effects. It also discusses the trend toward deinstitutionalization and relocation of developmentally disabled individuals to community settings, increasing the need for community physicians to treat their medical issues like epilepsy. The role of legal guardians, family members, and group home staff in providing care and information is also covered.
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes higher incidence of difficult-to-control seizures and potential for adverse effects from medications in this population. It reviews factors like legal guardians, family involvement, group home staff, and challenges with diagnostic testing. It provides guidance on antiepileptic drug selection considering efficacy, side effects, and treatment of any co-morbid conditions.
Developmental Disabilities and Community LifeRoss Finesmith
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes higher incidence of difficult-to-control seizures and limited ability for testing in this population. It reviews factors like legal guardians, family involvement, group home staff, and challenges of medication administration and testing. It provides guidance on antiepileptic drug selection considering efficacy, side effects, and treating co-morbid conditions.
The document discusses shared decision making (SDM) in clinical encounters at Mayo Clinic. It describes the work of the Knowledge and Evaluation Research (KER) Unit, which designs and evaluates decision aids to facilitate SDM between clinicians and patients. Decision aids provide unbiased information on healthcare options and help patients consider what matters most to them. Studies show decision aids improve patient knowledge and involvement without increasing consultation time. The KER Unit has created over 20 decision aids covering various medical topics. Their goal is to create meaningful conversations centered around patient needs and values to improve healthcare outcomes and experience.
This document discusses community-based treatment of epilepsy in developmentally disabled individuals. It notes higher incidence of difficult-to-control seizures and potential for adverse effects from medications. Care is now provided in community settings like group homes rather than institutions. Physicians must work with legal guardians, family members, and caregivers to effectively manage patients' epilepsy and understand historical factors. Choosing antiepileptic drugs requires considering seizure type, psychiatric comorbidities, previous medication responses, and ability to administer medications properly in community settings. Neurodiagnostic testing can be challenging but helps identify seizure type and guide treatment.
Kimberley Haines is a senior ICU physiotherapist and the Allied Health Research Lead at Western Health. Her academic research focusses on the long term progress of ICU survivors. Here she discusses the developing puzzle of ICU outcomes.
The document compares the oral health status and treatment needs of institutionalized psychiatric patients versus non-institutionalized psychiatric patients. It finds that institutionalized patients have more extensive dental disease requiring complex treatment compared to non-institutionalized patients, though both groups have high treatment needs relative to the general population. Prevention should be the main objective to avoid complex treatment needs, and more coordination is needed between medical, dental, and social services to meet the needs of this vulnerable population.
May 19, 2015
Physicians of Ontario Neurodevelopmental Advocacy (PONDA) Network
Position Statement: A Provincial Assessment Program for All Children with Complex Neurobehavioural Needs
Letter from PONDA to Hon Todd Smith re. Beber Report
OPTCARE Neuro - Palliative care in patients with Multiple Sclerosis (MS)MS Trust
1) The document discusses a clinical trial called OPTCARE Neuro that is evaluating the effectiveness of short-term integrated palliative care (SIPC) services for people with advanced neurological conditions.
2) Previous research found SIPC improved symptom control, reduced caregiver burden, and saved costs for MS patients. However, more research is needed on how best to deliver palliative care for neurological patients.
3) OPTCARE Neuro aims to determine if SIPC is clinically and cost-effective for a broader range of neurological conditions when provided in multiple centers. The trial has recruited over 200 patients so far from sites across England and Wales.
Critical care rehabilitation is an important part of the recovery process for ICU patients. It begins with early mobilization like passive range of motion exercises and progresses to active transfers, sitting at the edge of the bed, and eventually ambulation. A multidisciplinary team approach that includes nurses, physiotherapists, and other allied health professionals comprehensively assesses patients and develops individualized rehabilitation plans and goals. Regular evaluation during the ICU stay, before discharge, and after discharge is important to optimize recovery outcomes and quality of life.
The Definitions and Demographics of low visionHossein Mirzaie
Low vision is defined as a visual impairment that cannot be fully corrected with standard glasses or contact lenses and results in visual ability below normal levels. The document discusses the various causes and demographics of low vision globally and in the UK, noting that the majority of low vision patients are elderly and conditions like age-related macular degeneration are common causes of vision loss. A multi-disciplinary approach is recommended to address the medical, rehabilitative, and social service needs of individuals with low vision.
Low vision is visual impairment that cannot be fully corrected with standard glasses or contact lenses and results in a best corrected visual acuity of worse than 6/18. Low vision rehabilitation aims to maximize functional vision through optical devices like magnifiers and non-optical aids. Common causes of low vision include age-related macular degeneration, diabetic retinopathy, and retinitis pigmentosa. A low vision assessment evaluates visual needs, prescribes optical devices, and provides counseling. Lack of low vision services has negative impacts including developmental delays in children and isolation in adults. Expanding low vision care is needed to serve the large underserved population with vision impairment.
This document provides guidance for educators on presenting information to individuals with low vision. It defines low vision as vision that is between 20/70 and 20/400 that cannot be fully corrected with glasses, contact lenses, or surgery. Common causes of low vision include macular degeneration, cataracts, glaucoma, and diabetic retinopathy. The document provides tips for making printed materials and presentations accessible, such as using large font sizes and high contrast between text and background colors.
This document discusses low vision and provides definitions, classifications, common causes, and management strategies.
[1] Low vision is defined as visual impairment even after treatment that results in visual acuity worse than 6/18 but ability to use vision. It can be caused by conditions like macular degeneration, retinitis pigmentosa, cataract, and glaucoma.
[2] Low vision affects people's ability to perform visual tasks and can cause blurry or decreased vision, loss of peripheral vision, and light sensitivity. Evaluation involves assessing vision and goals, while management includes low vision devices and counseling.
[3] Common low vision devices include telescopes, magnifiers, and electronic
The low vision examination aims to determine a patient's visual abilities and needs through assessment, history taking, and trials of low vision aids. It involves evaluating visual acuity, refractive error, visual fields, and contrast sensitivity. The examiner also considers case history details, functional abilities, independence, and psychological factors to recommend the best low vision solutions and support for each patient.
The document provides information on low vision, including definitions, causes, assessments, and aids. It defines low vision according to the WHO and Indian standards. Common causes that can benefit from low vision aids are discussed. Assessment of low vision patients involves testing visual acuity, visual fields, contrast sensitivity, and other factors. A variety of optical and non-optical low vision aids are described, including magnifiers, telescopes, illumination devices, software, and filters to reduce glare. The goals of low vision management and global prevalence of low vision are also summarized.
Aalto University School of Arts, Design and Architecture course Dynamic Visualization Design 1 group work presentation "Visual Impairments" 2012-11-08.
The document discusses how personalization and dynamic content are becoming increasingly important on websites. It notes that 52% of marketers see content personalization as critical and 75% of consumers like it when brands personalize their content. However, personalization can create issues for search engine optimization as dynamic URLs and content are more difficult for search engines to index than static pages. The document provides tips for SEOs to help address these personalization and SEO challenges, such as using static URLs when possible and submitting accurate sitemaps.
The document discusses impulse control disorders and provides information about establishing an Impulse Control Support Service in Western Australia. It notes that impulse control disorders are characterized by a failure to resist urges or impulses that may harm oneself or others. Multiple disorders feature impulsivity, including substance abuse, ADHD, antisocial personality disorder, and borderline personality disorder. The proposed service aims to provide evidence-based treatment and support for individuals with impulse control disorders to reduce social costs and improve outcomes.
This document discusses assessment of psychological problems in patients with neurological disorders. It notes that assessment may help with differential diagnosis or identifying treatable psychiatric conditions. Assessing psychological symptoms can be complicated by overlap with neurological symptoms. Clinical interviews and observations can be aided by checklists of psychological symptoms. Self-report instruments and reports from family members can also provide information, especially for patients with cognitive impairments. The document discusses several methods and instruments used to assess conditions like depression, anxiety, apathy, psychosis, and more.
This document provides information on chronic illness in adolescents including:
- Chronic illnesses are long-lasting health conditions that impact physical, mental, and social well-being. Examples include asthma, cancer, diabetes, and heart disease.
- Approximately 20-30% of adolescents in the US have a chronic illness, with 10-13% reporting substantial limitations. Depression and non-adherence to treatment plans are common issues.
- Several assessment tools are recommended to evaluate an adolescent's medical history, illness impact, depression, anxiety, quality of life, and treatment adherence.
- Suggested intervention strategies include cognitive behavioral therapy to challenge irrational thoughts and beliefs, develop coping skills, and improve treatment adherence.
Research review of Treatments for Autism in patients residing in psychiatric ...Jacob Stotler
Review of Evidence-based practice and research conducted on effective treatments with patients with Autism Spectrum Disorder (ASD) in patients residing in psychiatric facilities.
This document summarizes a project that provided education to nurses on using guided imagery with hospitalized adult patients. A pre-test showed nurses had little knowledge of guided imagery and low confidence using it. After education, a post-test found significantly improved knowledge, with most nurses correctly defining and describing how to implement guided imagery. Confidence increased from low to moderate or high levels. Results indicate the education was effective in teaching nurses about guided imagery and its benefits for reducing anxiety, stress, and pain in patients.
This document summarizes a study on professionals' perceptions of how dual diagnosis (mental illness and substance abuse) is managed in Limerick, Ireland. The study found: 1) Dual diagnosis is common, affecting 30-70% of clients, but Ireland lacks research on managing it; 2) Professionals feel services regularly refuse clients due to substance abuse and lack holistic treatment; 3) Barriers include poor communication, training, and policies between mental health and addiction services. The study concludes Ireland must establish integrated treatment guidelines and policies to effectively manage dual diagnosis.
University of Utah Health Improving Wellness: 40 Champions, 20 Projects, 12 M...University of Utah
On December 14, 2017, the Wellness & Integrative Health’s Resiliency Center, Accelerate, and the Spencer S. Eccles Health Sciences Library will presented a Faculty Wellness Poster Session. Each department in the School of Medicine highlighted the past year’s Wellness Champion projects, which were focused on personal resilience, burden reduction, and team work. The poster session demonstrated the work completed so far as the Wellness Champion program is expanded to faculty and staff across U of U Health.
University of Utah Health: Wellness Champion Poster Session 2017University of Utah
Improving Wellness: 40 Champions, 20 Projects and 12-months of Progress: The Wellness and Integrative Health’s Resiliency Center, Accelerate, and the Spencer S. Eccles Health Sciences Library presented a Faculty Wellness Poster Session. Each department in the School of Medicine highlighted the past year’s Wellness Champion projects, which are focused on personal resilience, burden reduction, and team work. The poster session demonstrates work completed so far as the Wellness Champion program is expanded to faculty and staff across U of U Health.
Running head The Critique of Ethical Consideration of Patients wi.docxtodd521
Running head: The Critique of Ethical Consideration of Patients with Dementia 1
The critique of ethical consideration of patients with dementia
8
The Critique of Ethical Consideration of Patients with Dementia
Yeni Hernandez
GCU NRS-433V
August 19, 2018
The critique of ethical consideration of patients with dementia
Introduction
Based on Pan et al. (2013) study, the severities of the behavioural and psychological symptoms that are evident for vascular dementia are clearly presented. The research focuses on the application of quantitative measures to understand the severity of the symptoms using a sample of 51 patients with vascular dementia (Pan et al., 2013). The analysis considered the fluctuation of the behavioural symptoms based on diurnal, evening, and nocturnal activities. The ageing population has been outlined as being a risk factor for the continued prevalence and rise in the cases of dementia for decades. This paper will critique the PICOT statement on the grounds of those living with dementia in their daily lives.
PICOT statement for patients with dementia
P- (problem/patient/population): the research will focus on patients living with dementia (PWD)
I- Intervention will come in the form of integrating regular exercises to dementia patients to help improve memory loss and maintain a healthy fit.
C- Comparison: if a patient cannot engage in productive and useful forms of exercises, provide a supportive environment through informal caregiving to facilitate relaxation and safety.
O- Outcome: the outcome of the study is an improved overall safety of a patient living with dementia to reduce re-hospitalizations that result from injuries.
T- Time- this will show the time required in addressing the problem of dementia among home care patients.
Background information
Dementia generally is used to refer to the symptoms shown by individuals and mostly relate to memory. There have been complaining about the existence of rare signs amongst patients who visit clinical institutions. This included the loss of memory hence reducing their ability to carry out their daily tasks appropriately. However, it had been clearly proven that there was little that was done in realizing the desired the desired solutions to help out the patients. At higher stages patients showed problems in communication and language, focusing and paying attention, perceptions relating to visions, judgment and how the patients reasoned out. This, therefore, prompted the need to carry out a qualitative and quantitative study with a major aim of presenting ethical issues that relate to patients with dementia. The study was based on scholarly articles to present appropriate information that can help curb such instances in most or all medical and clinical institutions hence saving the patients. It is evident that the lack of patient care and safety acted as the major reason as to.
This document provides information for an assignment assessing and treating patients with sleep/wake disorders. It describes a case study involving a 31-year-old male patient who presents with insomnia. The patient reports difficulty falling and staying asleep for the past 6 months following the loss of his fiancé. The assignment requires examining the case and making three decisions on pharmacologic treatment options at different points in the case. The student must justify each decision based on evidence from the literature and consider ethical factors.
This document summarizes the results of a randomized controlled trial that analyzed whether vitamin E supplementation can prevent or slow the progression of age-related macular degeneration. The trial found that daily vitamin E supplements showed no significant differences compared to placebo in the incidence of early or late macular degeneration over 4 years. Both groups were highly comparable at baseline. The results indicate that vitamin E supplementation does not prevent or slow the development of macular degeneration and are not applicable to clinical practice.
The document discusses the nursing process and its introduction, definition, steps, and importance. It provides a brief history of the development of the nursing process from the 1950s to the present. The key steps discussed in detail include assessment, nursing diagnosis, planning, implementation, and evaluation. The nursing process is presented as a systematic, problem-solving approach that directs nursing activities and provides quality nursing care.
Pain in the elderly. How to better understand and rate it.Ross Finesmith M.D.
It is often difficult to determine the amount of pain an elderly person is experiencing.This is complicated by dementia and verbal impairment. This presentation describes helpful methods to assess pain in the elderly.
This study aimed to validate the American Speech-Language-Hearing Association Functional Assessment of Communication Skills (ASHA FACS) for use with Alzheimer's patients in Brazil. The scale was translated into Portuguese and tested on 51 elderly controls without dementia, 32 patients with mild Alzheimer's, and 25 with moderate Alzheimer's. Statistical analysis found the Portuguese version of the ASHA FACS has excellent reliability and validity when compared to established cognitive tests. It can reliably distinguish levels of communication impairment in Alzheimer's patients and provides a standardized way to measure changes in functional communication over time or in response to treatment.
American academy for cerebral palsy and developmental medicine e coursesSahar Hassanein
This document provides information about online courses offered by AACPDM (American Academy for Cerebral Palsy and Developmental Medicine). It explains how to enroll in courses, system requirements, and cancellation policies. Course descriptions are provided for several upcoming courses, including ones on aspiration pneumonia, autism diagnosis challenges, spinal fusion for children with cerebral palsy, and transition to adulthood for youth with chronic needs. Learning objectives are outlined for each course.
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2. tute of Clinical Excellence recommended that screening should take
place in primary care and general hospitals for those at high risk of
depression, including patients with an illness causing disability.17
Studies from other primary and tertiary health care fields, including
oncology, heart disease, diabetes, maternal health, and stroke, have
described the processes by which depression is managed in these set-
tings and barriers to care.18–24
However, no quantitative study to date
has focused on care providers for people with vision impairment, and
itisunclearhowEHPsorRWsrecognizeandrespondtodepressionin
their patients. In addition, EHPs and RWs are diverse groups with
different professional backgrounds and work settings, and they may
also have access to different resources, hold different views, and expe-
rience different barriers.
This study therefore aimed to identify current practice of eye
care professionals and to investigate factors associated with their
responses to depression. We also investigated the barriers experi-
enced by the different professional groups, and their training
preferences to determine how best to support practitioners in
identifying and responding to depression.
METHODS
Participants and Recruitment
The study was a cross-sectional survey of EHPs and RWs across
the Australian state of Victoria. Ethical approval was received from
the Human Research and Ethics Committee of the Royal Victo-
rian Eye and Ear Hospital, and all participants gave signed consent.
Following consultations on appropriate recruitment strategies,
questionnaires were distributed to EHPs through their profes-
sional organizations and to RWs through their rehabilitation
agencies. Four weeks after the initial questionnaire distribution,
reminder packs were sent out to nonresponders.
Measures
Background
Sociodemographics and details of professional background,
training, and current work were recorded in the first section of the
questionnaire.
Current Practice
Participants were asked to outline the current resources available
to manage depression and to rate the likelihood of undertaking
nine actions if they suspect a patient to be depressed (e.g., “Provide
education and information about depression”) using a 4-point
scale (“definitely unlikely” to “definitely likely”).
Confidence in Recognizing and Responding to Depression
in People with Vision Impairment
Adapted from an existing measure to assess confidence in work-
ing with elderly people with depression.25
Participants respond to
14 items on a 4-point scale (“not confident” to “very confident”).
Summed scores range from 14 to 56 with high scores representing
greater confidence in working with depressed patients.
Barriers to Recognition, Assessment,
and Management of Depression
Adapted from an existing measure to assess barriers to work-
ing with depressed elderly patients.25
The scale includes 13
items, which are rated on a 4-point scale (“strongly disagree” to
“strongly agree”). Summed scores range from 13 to 52 with
high scores representing greater barriers to working with pa-
tients with depression.
Training Needs and Future Practice
A 10 item study-specific measure to assess (i) interest in
improving knowledge (signs and symptoms of depression and
services and resources available), (ii) use of tools (guidelines and
screening tools), (iii) interest in developing skills (communica-
tion skills and identifying depression), and (iv) interest in be-
havior change (attendance at professional development, discuss
emotional issues, refer patients, and educate patients). Partici-
pants rate each item on a 4-point scale (“strongly disagree” to
“strongly agree”).
Beliefs about Depression in Individuals with
Vision Impairment
Beliefs about depression in individuals with vision impari-
ment were assessed using an adaptation of the Illness Percep-
tions Questionnaire (Revised).26
Beliefs about the conse-
quences (six items) (e.g., “depression is a serious condition for a
person with vision impariment”), timeline (six items) (e.g., “de-
pression will last a long time for a person with vision impair-
ment”), and efficacy of treatment for depression (five items)
(e.g., “treatment can control depression in a person with vision
impairment”) were assessed using a 5-point scale (“strongly
disagree” to “strongly agree”). Scores ranged from 5 to 30 for
consequences and timeline and 2 to 25 for treatment control.
High scores represent beliefs that depression is serious, long-
lasting condition and that treatment is effective.
Analysis
Descriptive statistics were used to describe current practice and
barriers reported. Univariate analysis using t tests, analysis of variance,
andcorrelationsdeterminedfactorsassociatedwithcurrentdepression
management strategies. Analysis of variance and post hoc tests were
used to identify differences between professional groups.
RESULTS
Response Rates
Six hundred sixty-six questionnaires were sent out to optome-
trists (n ϭ 82), ophthalmic nurses (n ϭ 97), orthoptists (n ϭ 205),
ophthalmologists (n ϭ 189), and RWs (n ϭ 93). A total of 94
questionnaires were returned, giving a final response rate of 14.1%.
Responses rates were significantly higher for RWs (n ϭ 28, 30.1%)
than the EHPs: optometrists (n ϭ 12, 14.6%); ophthalmic nurses
(n ϭ 12, 12.4%); orthoptists (n ϭ 22, 10.7%); ophthalmologists
(n ϭ 20, 10.6%) [2
ϭ 24.33, degrees of freedom (df) ϭ 4, p Ͻ
Depression in Patients with Low Vision—Rees et al. 1329
Optometry and Vision Science, Vol. 86, No. 12, December 2009
3. 0.001]. Reminders had a substantial impact on the overall re-
sponse rate, with 34.0% of questionnaire returns coming after
the reminder.
Participants
Tables 1 and 2 describe the participants. The sample was largely
female aged between 23 and 69 years. The length of time the
participants had been in their current role, or eye care services in
general, ranged from less than a year to more than 35 years. Work
settings included public hospital, private practice, community set-
tings, or combinations of these and varied across professional
groups. The number of patients with vision impairment seen each
week ranged from 1 to 120, and the time spent with each patient
also varied considerably (1 to 200 min). Professional groups dif-
fered on the number of people with vision impairment reported to
be seen each week (F4,87 ϭ 7.612, p Ͻ 0.001) and the amount of
time spent with each patient (F4,87 ϭ 43.239, p Ͻ 0.001). Oph-
thalmic nurses and ophthalmologists saw significantly more pa-
tients with vision impairment than did optometrists or RWs (p Ͻ
0.05). However, RWs had significantly longer consultations with
patients than any other group (p Ͻ 0.001), and optometrists had
significantly longer consultations than ophthalmologists (p ϭ
0.005). Less than 20% (n ϭ 18) of participants reported having
ever received any training in depression. Although few participants
(n ϭ 15, 16%) reported having personally experienced depression,
more than 70% reported knowing family or friends who had.
Current Practice
Identification of Depression
Overall, 39.8% (n ϭ 37) of participants stated that they at-
tempted to identify depression as part of patient management,
with RWs significantly more likely to do so (n ϭ 17, 60.7%) than
EHPs (n ϭ 20 30.8%) (2
ϭ 7.325, df ϭ 1, p ϭ 0.007). Socio-
demographic and work-related factors including duration in eye
care services and consultation times were not associated with in-
tention to identify depression, but confidence, barriers, and beliefs
about depression were associated (p Ͻ 0.05). Compared with those
who did not attempt to detect depression, participants who aimed
to identify depression were more confident (mean ϭ 37.89, SD
7.11 vs. mean ϭ 30.12, SD 7.66; t ϭ 4.772, df ϭ 85, p Ͻ 0.001),
reported fewer barriers (mean ϭ 27.09, SD 7.47 vs. mean ϭ
33.63, SD ϭ 7.05; t ϭ Ϫ4.034, df ϭ 80, p Ͻ 0.001), and believed
depression to hold greater consequences for a person with vision
impairment (mean ϭ 26.20, SD 2.92 vs. mean ϭ 24.59, SD 3.07;
t ϭ 2.48, df ϭ 89, p ϭ 0.015).
Management of Patients Who may be Depressed
The resources available to support patient management varied
according to work setting. The majority of participants working in
public hospitals stated that they had access to a social worker (n ϭ
29, 76.3%), RWs had access to a psychologist (n ϭ 18, 60%) and
counselor (n ϭ 16, 53.3%), and were more likely to refer to these
services than EHPs (2
ϭ 34.813, df ϭ 4, p Ͻ 0.000). Resources
available in private practice were limited, with more than a third
(n ϭ 16, 38.1%) of participants working in this setting reporting
no onsite resources. Ophthalmologists were most likely to report
TABLE 1.
Sociodemographic, work, and personal characteristics of
the 94 participants
Age (yr)
Mean 42.1
Range 23.3–69.4
Sex, n (%)
Female 71 (75.5)
Male 23 (24.5)
Time in current role (yr)
Mean 8.5
Range 0.4–37
Time in eye care services (yr)
Mean 14.6
Range 0.4–42
Previous depression training, n (%)
Yes 18 (19.1)
No 76 (80.9)
Personal experience of depression,a
n (%)
Yes 15 (16.0)
No 65 (69.1)
Family or friends’ experience of depression,a
n (%)
Yes 66 (70.2)
No 27 (28.7)
a
Percentage does not total 100 due to missing data.
TABLE 2.
Work setting and number and duration of consultations with patients with vision impairment for each professional group
Professional group Most common work setting
No. patients with vision
impairment seen each
week, mean (SD)
Average time spent
with each patient
(min), mean (SD)
Ophthalmic nurse (n ϭ 12) Public hospital (n ϭ 11, 91.7%) 29.7 (32.3) 20.5 (34.05)
Optometrist (n ϭ 12) Private practice (n ϭ 7, 58.3%) 5.08 (8.9) 46.4 (15.6)
Ophthalmologist (consultant)
(n ϭ 20)
Combination of private practice and
public hospital (n ϭ 13, 65%)
37.9 (33.8) 13.0 (3.6)
Orthoptist (n ϭ 22) Private practice (n ϭ 8, 36.4%) 20.2 (17.7) 23.6 (26.7)
Rehabilitation worker (n ϭ 28) Rehabilitation agency (n ϭ 27, 96.7%) 8.3 (4.3) 98.2 (32.6)
1330 Depression in Patients with Low Vision—Rees et al.
Optometry and Vision Science, Vol. 86, No. 12, December 2009
4. that they had access to a psychiatrist both in public setting (n ϭ 8,
53.3%) and private practice (n ϭ 7, 38.9%).
Table 3 outlines the depression management strategies and
factors associated with each strategy. The most common actions
were referral to a GP (n ϭ 75, 79.8%) and referral to rehabilitation
services (n ϭ 71, 75.5%). Only a quarter (24.5%) stated that they
were likely to provide information and education about depression.
Level of confidence in managing depressed patients and barriers to
management were consistently significantly associated with a range of
actions (p Ͻ 0.05). In addition, participants’ beliefs about depression
were also associated with specific actions. For example, those with
greater belief in the effectiveness of treatment for depression in pa-
TABLE 3.
Depression management strategies and associated sociodemographic, work, and psychosocial characteristics
Depression
management
strategies
Total % of
participants
likely to use this
strategy (n ϭ 94)
Factors positively
associated with strategy
Factors negatively
associated with strategy Professional group differences
GP referral 79.8 — — 1 Ophthalmologist compared
to RWa
(F4,88 ϭ 2.756a
)
Vision rehabilitation
referral
75.5 — — —
Discussion of
feelings
74.5 Confidence (r ϭ 0.589,b
n ϭ 86) and beliefs
about consequences
(r ϭ 0.340,b
n ϭ 91)
Barriers (r ϭ Ϫ0.525,b
n ϭ 81)
No. VIP per wk
(r ϭ Ϫ0.225,a
n ϭ 92)
Duration in current
position (r ϭ Ϫ0.210,a
n ϭ 92)
—
Referral to a
self-help or
support group
50.0 Confidence (r ϭ 0.330,c
n ϭ 86) and depression
training (yes) (t ϭ
3.588,b
df ϭ 91)
Barriers (r ϭ Ϫ0.245,a
n ϭ 81)
1 RW compared with
orthoptista
(F4,88 ϭ 2.970a
)
Referral to a mental
health service
such as
counseling or a
psychologist
35.1 Time per VIP (r ϭ 0.428,b
n ϭ 89)
Confidence (r ϭ 0.317,c
n ϭ 84)
Beliefs about treatment
(r ϭ 0.267,a
n ϭ 90)
Depression training (yes)
(t ϭ 2.784,c
df ϭ 89)
Barriers (r ϭ Ϫ0.489,b
n ϭ 79)
No. VIP per week
(r ϭ Ϫ0.221,a
n ϭ 89)
1 RW compared with
ophthalmic nurse,b
ophthalmologist,b
optometrist,b
or orthoptistb
(F4,86 ϭ 12.668b
)
Referral to another
health
professional
35.1 Confidence (r ϭ 0.255,a
n ϭ 78)
Beliefs about treatment
(r ϭ 0.237,a
n ϭ 82)
— 1 Ophthalmic nurses
compared with
ophthalmologistsc
or
orthoptista
(F4,78 ϭ 4.190c
)
Provide information
and education
about depression
24.5 Confidence (r ϭ 0.417,b
n ϭ 86)
Depression training (yes)
(t ϭ 2.878,c
df 91)
Barriers (r ϭ Ϫ0.440,b
n ϭ 81)
No significant post hoc test
results (F4,88 ϭ 2.914a
)
Avoid discussing
patients’ feelings
14.9 Barriers (r ϭ 0.430,b
n ϭ 80)
Time in current position
(r ϭ Ϫ0.265,a
n ϭ 91)
Confidence (r ϭ Ϫ0.535,b
n ϭ 85)
Beliefs about consequences
(r ϭ Ϫ0.335,b
n ϭ 90)
—
Use a depression
screening
questionnaire
4.3 Beliefs about treatment
(r ϭ 0.219,a
n ϭ 91).
Barriers (r ϭ Ϫ0.275,a
n ϭ 80)
—
Confidence (r ϭ 0.217,a
n ϭ 85)
The following Likert scale was used: 1, “definitely unlikely”; 2, “probably unlikely”; 3, “probably likely”; 4, “efinitely likely.” Post
hoc comparisons for professional group differences were computed using Tukey’s honestly significant difference (HSD) test.
Significant correlations or group differences are noted using a
p Յ 0.05, b
p Յ 0.001, and c
p Յ 0.01.
Depression in Patients with Low Vision—Rees et al. 1331
Optometry and Vision Science, Vol. 86, No. 12, December 2009
5. tients with vision impairment were more likely to refer to a
mental health service (p ϭ 0.011) or other health professionals
(p ϭ 0.032) and use a depression screening tool (p ϭ 0.037).
Few work-related factors were associated with referral strategies,
except referral to a mental health service was positively associated with
consultation time (p Ͻ 0.001), and negatively associated with the
number of patients seen each week (p ϭ 0.046). Talking to patients
about their feelings was negatively associated with the number of pa-
tients seen each week (p ϭ 0.031) and duration in current role (p ϭ
0.044). Those participants who had received some form of training in
depression previously were more likely to use a range of strategies
including referral to self-help/support group, mental health service,
and providing information and education (all p Ͻ 0.05).
Barriers to Patient Management
Table 4 outlines the barriers to recognizing and responding to
depression reported by participants. Common barriers included
absence of standard procedures to follow (n ϭ 64, 68.1%); limited
knowledge about depression (n ϭ 63, 67%); and lack of training in
depression (n ϭ 59, 62.8%). Time and workload were found to be
a greater barrier for ophthalmic nurses, ophthalmologists, and or-
thoptists than RWs (all p values Յ0.002). For ophthalmologists
and orthoptists, the focus of their role on eye health was a greater
barrier than for RWs (all p values Ͻ0.05). Knowledge about what to
do when a patient may be depressed was a greater barrier for orthop-
tists compared with RWs (p ϭ 0.007). Ophthalmic nurses reported
that the environment in which they work was a greater barrier to
holding private discussions with patients compared with all other
groups (all p values Ͻ0.05), and their lack of ongoing contact with
patients was a greater barrier compared with RWs (p Ͻ0.001), or-
thoptists, or ophthalmologists (all p values Ͻ0.05).
Training Needs and Future Preferences
The majority of participants were enthusiastic about training
opportunities (Table 5). More than 90% of participants like to be
able to refer patients to appropriate services and improve their
knowledge of services and treatment options. More than 80% of
participants indicated that they would like to have more informa-
tion about signs and symptoms of depression, to be able to identify
depression more easily, and to enhance their communication skills.
Compared with all other groups, ophthalmologists were least likely
towanttoattendaprofessionaldevelopmenteventtoimproveknowl-
edge or skills for managing patients with depression (p Ͻ 0.05). Op-
tometrists had a stronger preference for information about the signs
and symptoms of depression than ophthalmologists or RWs (p Ͻ
0.05). Ophthalmic nurses were more keen to discuss patients’ feelings
than ophthalmologists or RWs (p Ͻ 0.001) and to use a depression
screeningtoolthanophthalmologists,orthoptists,orRWs(pϽ0.05).
DISCUSSION
Despite the high prevalence of depression in people with vision
impairment, little is known about how professionals working with
this patient group manage depression. In this study, we highlight
that active identification of depression is not a routine part of
patient care for EHPs, although it occurs to some extent in reha-
bilitation settings. Work-related factors, such as number of pa-
tients seen per week or consultation duration, were not related to
an interest in or intention to screen patients for depression. In-
stead, participants’ confidence, barriers, and beliefs about the con-
sequences of depression and treatment efficacy were significantly
associated with likelihood of identifying and responding to depres-
sion. This is promising because work factors may not be easily
amenable to change, whereas level of confidence and beliefs can be
effectively targeted by training programs.27–30
Our data indicate that if participants suspect depression in their
patients, they respond with a variety of strategies, although they are
often limited by resources available to them, particularly EHPs
working in private settings. Referrals to a GP or vision rehabilita-
tion service were most common and seemed to be used often by all
groups. Both pathways hold promise. In Australia, GPs have access
to Medicare-funded psychological services for depression. Vision
rehabilitation services can also include counseling services, and our
results also suggest that RWs may have more time and capacity
within their role to focus on emotional health. However, there are
two major caveats in these pathways. First, it is unclear whether
patients will use the referral. A recent study of a rehabilitation
service link to a public eye hospital in Victoria, Australia, found
that less than half of those referred attended.31
Patients with de-
pressive symptoms are even less likely to follow such a referral
through, and, if they do, research has found that they use fewer
rehabilitation services.9
Therefore, it has been suggested that it is
necessary to treat depression in people with vision impairment
before rehabilitation to improve rehabilitation outcomes.6,32–34
Second, it is unclear whether concerns about depression are dis-
cussed with the patient or if these concerns are noted as part of the
referral. Our data suggest that it is unlikely that depression is ex-
plicitly discussed with the patient. We did not ask in this survey
whether participants provided information about their concerns to
the patient as part of the referral process, although findings from
our focus groups with EHPs suggest that there are no standard
systems in place to support this.35
Given the difficulties in identi-
fying depression in primary care settings already described, it is
likely that depression may remain undetected whether the GP or
rehabilitation agencies are not made aware of the concerns of the
EHPs. There is a clear opportunity to build on these existing re-
ferral strategies by developing procedures by which concerns about
depression can be identified objectively, documented, and included as
part of the referral and providing resources and skills for EHPs and
RWs to address the issue of depression with their patients.
It is promising to see that previous training in depression is
related to increased likelihood of responding to depression and that
participants are enthusiastic about future training opportunities.
Participants expressed a strong desire to increase their knowledge
of services, treatment options, and referral strategies. This infor-
mation should be provided as clear guidelines or procedures suit-
able to particular settings. Indeed, training programs should be
developed to suit the needs and preferences of different groups.
Our results indicate that time and workload issues were most prob-
lematic for ophthalmic nurses, ophthalmologists, and orthoptists,
who would need quicker strategies suited to the context in which
they work. For ophthalmic nurses, in particular, it is important to
ensure that strategies are not dependent on ongoing contact and
are easily administered in a busy hospital setting. Ophthalmolo-
1332 Depression in Patients with Low Vision—Rees et al.
Optometry and Vision Science, Vol. 86, No. 12, December 2009
6. gists were least likely to be interested in training, possibly because
of existing knowledge from medical training. However, their sup-
port is likely to be critical in the development and implementation
of local guidelines and procedures.
Currently, Ͻ5% of participants reported to use a screening tool
withpatientstheysuspectedtobedepressedalthoughmorethan50%,
notably ophthalmic nurses, indicated a desire to do so. A range of
screening tools for depression exists and short two-item tools, which
havebeenshowntobevalid,36,37
maybeusefulinbusysettings.These
tools will be valuable in assisting EHPs and RWs to identify those
patients who may benefit further from a more detailed assessment and
in providing information to support this referral.
TABLE 4.
Barriers to depression management reported by each professional group
Barriers to working with
patients with vision
impairment
and depression
Total % of
participants who
agreed this was a
barrier (n ϭ 94)
Mean (SD)
ON OPH OPT ORT RW
Absence of standard
proceduresa
68.1 3.33 (0.65) 2.75 (0.97) 3.00 (0.74) 3.15 (0.93) 2.39 (0.92) F4,87 ϭ 3.508,
p ϭ 0.011
Limited knowledge of
depressiona
67.0 2.92 (0.90) 2.90 (0.72) 2.75 (0.75) 3.05 (0.81) 2.39 (0.79) F4,88 ϭ 2.498,
p ϭ 0.048
Lack of training to know
if a patient might be
depressed
62.8 2.83 (0.72) 2.65 (0.75) 3.00 (0.85) 2.95 (0.95) 2.54 (0.88) F4,87 ϭ 1.092,
p ϭ 0.366
Poor knowledge of what
to do if a patient could
be depressedb
56.4 2.83 (0.94) 2.60 (0.82) 2.83 (0.84) 2.90 (0.70) 2.04 (0.69) F4,88 ϭ 4.997,
p ϭ 0.001
Role limited to eye health
rather than emotional
wellbeingb
51.1 2.83 (1.12) 2.89 (.99) 2.00 (.85) 2.90 (.70) 2.00 (.94) F4,87 ϭ 5.265,
p ϭ 0.001
Patients’ reluctance to
discuss how they feela
51.1 3.27 (0.79) 2.85 (0.75) 2.25 (0.87) 2.76 (0.89) 1.75 (0.75) F4,88 ϭ 2.843,
p ϭ 0.029
Lack of time to talk with
patientsa
50.0 3.27 (0.79) 2.85 (0.75) 2.25 (0.87) 2.76 (0.89) 1.75 (0.75) F4,87 ϭ 10.425,
p Ͻ 0.001
No ongoing contact with
patients to notice
changes in moodb
47.9 3.58 (0.90) 2.55 (0.76) 2.67 (0.99) 2.48 (0.93) 1.96 (0.69) F4,88 ϭ 8.154,
p Ͻ 0.001
High workloadb
44.7 3.00 (1.0) 2.75 (0.72) 2.17 (0.84) 2.52 (0.87) 1.79 (0.74) F4,87 ϭ 6.746,
p Ͻ 0.001
Work environment is not
suitable for private
discussions about
emotional wellbeingb
35.1 3.33 (0.65) 2.10 (0.91) 1.75 (0.87) 2.33 (0.97) 1.71 (0.81) F4,88 ϭ 8.380,
p Ͻ 0.001
Management does not
believe that detecting
depression is part of
work role
31.9 2.33 (0.89) 2.12 (0.93) 1.80 (0.79) 2.33 (0.86) 1.86 (0.97) F4,83 ϭ 1.315,
p ϭ 0.271
Need to protect oneself
from involvement with
patients’ emotional
problems
21.3 3.00 (1.0) 2.75 (0.72) 2.17 (0.84) 2.52 (0.87) 1.79 (0.74) F4,88 ϭ 1.062,
p ϭ 0.181
Reluctance by
management to listen
to concerns about
depression
11.7 1.75 (0.87) 2.00 (0.89) 1.60 (0.52) 1.65 (0.75) 1.52 (0.89) F4,80 ϭ 0.921,
p ϭ 0.456
Post hoc comparisons for professional group differences were computed using Tukey’s honestly significant difference (HSD) test. The
following Likert scale was used: 1, “strongly disagree”; 2, “somewhat disagree”; 3, “somewhat agree”; and 4, “strongly agree.”
ON, ophthalmic nurses; OPH, ophthalmologists; OPT, optometrists; ORT, orthoptists; RW, rehabilitation worker.
Depression in Patients with Low Vision—Rees et al. 1333
Optometry and Vision Science, Vol. 86, No. 12, December 2009
7. Our results suggest that training should be made available to all
new and existing staff because time and extent of clinical experi-
ence were not related to behavior, and, in fact, our findings indi-
cated that staff with greater experience are more likely to avoid
discussing patients’ emotional wellbeing. Training should also be
delivered in such a way as to enhance knowledge about the signif-
icance of consequences of depression and effectiveness of treat-
ment, to enhance participants’ confidence and skills in detecting
depression, and to assist participants to overcome barriers to re-
sponding to depression. This will require active involvement in
TABLE 5.
Preferences for training and future practice reported by each professional group
Training needs and
future practice
Total % of
participants who
agreed with this
statement (n ϭ 94)
Mean (SD)
ON OPH OPT ORT RW
I would like to be able to
refer patients I am
concerned about to
appropriate services
94.7 3.67 (0.49) 3.60 (0.50) 3.50 (0.91) 3.45 (0.80) 3.54 (0.64) F4,89 ϭ 0.242,
p ϭ 0.914
I would like to improve my
knowledge and awareness
of the services and
treatment options for
people with depressiona
90.4 3.58 (0.67) 2.75 (0.72) 3.58 (0.67) 3.64 (0.49) 3.32 (0.77) F4,89 ϭ 5.366,
p Ͻ 0.001
I would like to be able to
identify depression more
easily
87.2 3.33 (0.78) 3.00 (0.46) 3.58 (0.67) 3.23 (0.61) 3.14 (0.71) F4,89 ϭ 1.731,
p ϭ 0.150
I would like more information
about the signs and
symptoms of depression in
people with vision
impairmenta
86.2 3.42 (0.67) 2.65 (0.88) 3.83 (0.39) 3.45 (0.59) 3.11 (0.79) F4,89 ϭ 6.411,
p Ͻ 0.001
I would like to enhance my
communication skills for
working with depressed
patientsa
83.0 3.42 (0.79) 2.50 (0.76) 3.42 (0.67) 3.14 (0.83) 3.29 (0.60) F4,89 ϭ 4.991,
p ϭ 0.001
I would like guidelines in my
workplace for what to do
when I suspect someone
has depressionb
78.7 3.50 (0.37) 2.63 (0.83) 3.50 (0.67) 3.27 (0.88) 3.21 (0.78) F4,88 ϭ 3.327,
p ϭ 0.014
I would like to attend a
professional development
event to improve my
knowledge and skills for
managing patients with
depressiona
76.6 3.50 (0.67) 2.20 (0.89) 3.50 (0.67) 2.91 (0.92) 3.32 (0.61) F4,89 ϭ 9.121,
p Ͻ 0.001
I would like to be able to
educate patients and their
families about depressionb
64.9 3.17 (0.72) 2.50 (0.83) 3.33 (0.65) 2.82 (0.91) 2.75 (0.79) F4,89 ϭ 2.596,
p ϭ 0.042
I would like to discuss
patients’ feelings more
oftena
58.5 3.42 (0.67) 2.30 (0.92) 2.92 (0.52) 2.68 (0.89) 2.36 (0.56) F4,89 ϭ 5.7544,
p Ͻ 0.001
I would like to use a
depression screening tool
with my patientsc
55.3 3.33 (0.65) 2.40 (0.68) 3.17 (0.72) 2.41 (0.96) 2.50 (0.88) F4,89 ϭ 4.477,
p ϭ 0.002
Post hoc comparisons for professional group differences were computed using Tukey’s honestly significant difference (HSD) test. The
following Likert scale was used: 1, “strongly disagree”; 2, “somewhat disagree”; 3, “somewhat agree”; and 4, “strongly agree.”
Significant differences between groups are noted using a
p Յ 0.001, b
p Յ 0.05, and c
p Յ 0.01.
ON, ophthalmic nurses; OPH, ophthalmologists; OPT, optometrists; ORT, orthoptists; RW, rehabilitation worker.
1334 Depression in Patients with Low Vision—Rees et al.
Optometry and Vision Science, Vol. 86, No. 12, December 2009
8. training (e.g., group discussions, case studies, and practical experi-
ence) in addition to information provision. Training should also be
supplemented with the availability of appropriate resources that are suit-
ablefordistributiontopatients.Currently,only1⁄4 ofparticipantsprovide
information and education about depression to their patients, although
there is a strong desire to do so.
To our knowledge, this is the first quantitative study to investi-
gate how EHPs and RWs manage depression in patients with
vision impairment. Despite a detailed consultation process to en-
hance recruitment, the response rate for this survey was poor.
However, the response rate is similar to other studies on EHPs,38
and the large proportion of female participants also reflects the
nature of this profession. Of more concern is that this study is likely
to have attracted those with an interest in depression and may
therefore portray an optimistic view about current practice and
desire for training. We also acknowledge that this study collected
only self-reported data and participants’ retrospective recollections
of consultations. We attempted prospective data collection in this
study by requesting that participants record details of the consul-
tations in which they suspected a patient may be depressed. We
specifically asked participants to record what had raised their con-
cerns about the patients and what actions they took. However, too
few forms were returned to be reported (a total of 18).
On the basis of our results, we are currently developing a train-
ing program for EHPs located at a tertiary eye care hospital. We
will evaluate the impact of this training on confidence, perceived
barriers, and behavior. Further work is required to determine pa-
tients’ reactions to depression screening in eye-care and vision re-
habilitation services; preferences for information and care; care
pathways following referral; and uptake and outcomes of services.
ACKNOWLEDGMENTS
We thank all participants who took part and the following bodies who worked
with us to design and disseminate the survey: Optometrists Association Aus-
tralia Victoria; Australian Ophthalmic Nurses Association; Royal Australian
and New Zealand College of Ophthalmologists; Australian Orthoptic Board;
Vision Australia; and Guide Dogs Victoria.
This work was supported by beyondblue: the national depression initiative.
Received June 17, 2009; accepted August 6, 2009.
REFERENCES
1. Burmedi D, Becker S, Heyl V, Wahl HW, Himmelsbach I. Emo-
tional and social consequences of age-related low vision. Visual Im-
pair Res 2002;4:47–71.
2. Evans JR, Fletcher AE, Wormald RP. Depression and anxiety in
visually impaired older people. Ophthalmology 2007;114:283–8.
3. Horowitz A. The prevalence and consequences of vision impairment
in later life. Top Geriatr Rehabil 2004;20:185–95.
4. Owsley C, McGwin G Jr, Scilley K, Dreer LE, Bray CR, Mason JO III.
Focus groups with persons who have age-related macular degeneration:
emotional issues. Rehabil Psychol 2006;51:23–9.
5. Teitelman J, Copolillo A. Psychosocial issues in older adults’ adjust-
ment to vision loss: findings from qualitative interviews and focus
groups. Am J Occup Ther 2005;59:409–17.
6. Rovner BW, Casten RJ, Tasman WS. Effect of depression on vision
function in age-related macular degeneration. Arch Ophthalmol
2002;120:1041–4.
7. Rovner BW, Ganguli M. Depression and disability associated with im-
paired vision: the MoVies Project. J Am Geriatr Soc 1998;46:617–9.
8. Rovner BW, Casten RJ, Hegel MT, Tasman WS. Minimal depres-
sion and vision function in age-related macular degeneration. Oph-
thalmology 2006;113:1743–7.
9. Horowitz A, Reinhardt JP. Adequacy of the mental health system in
meeting the needs of adults who are visually impaired. J Vis Impair
Blind 2006;100:871–4.
10. Rovner BW, Casten RJ. Preventing late-life depression in age-related
macular degeneration. Am J Geriatr Psychiatry 2008;16:454–9.
11. Goldman LS, Nielsen NH, Champion HC. Awareness, diagnosis,
and treatment of depression. J Gen Intern Med 1999;14:569–80.
12. Kroenke K, Taylor-Vaisey A, Dietrich AJ, Oxman TE. Interventions to
improveproviderdiagnosisandtreatmentofmentaldisordersinprimary
care. A critical review of the literature. Psychosomatics 2000;41:39–52.
13. Hodges B, Inch C, Silver I. Improving the psychiatric knowledge,
skills, and attitudes of primary care physicians, 1950–2000: a review.
Am J Psychiatry 2001;158:1579–86.
14. Speer DC, Schneider MG. Mental health needs of older adults and
primary care: opportunity for interdisciplinary geriatric team prac-
tice. Clin Psychol Sci Prac 2003;10:85–101.
15. Beisecker AE. Older persons’ medical encounters and their outcomes.
Res Aging 1996;18:9–31.
16. Crawford MJ, Prince M, Menezes P, Mann AH. The recognition and
treatment of depression in older people in primary care. Int J Geriatr
Psychiatry 1998;13:172–6.
17. National Institute for Clinical Excellence. Quick Reference Guide.
Depression: Management of Depression in Primary and Secondary
Care. NICE Clinical Guideline No. 24. London: National Institute
for Clinical Excellence; 2004.
18. Sollner W, DeVries A, Steixner E, Lukas P, Sprinzl G, Rumpold G,
Maislinger S. How successful are oncologists in identifying patient
distress, perceived social support, and need for psychosocial counsel-
ling? Br J Cancer 2001;84:179–85.
19. Fallowfield L, Ratcliffe D, Jenkins V, Saul J. Psychiatric morbidity and its
recognitionbydoctorsinpatientswithcancer.BrJCancer2001;84:1011–5.
20. Koenig HG. Recognition of depression in medical patients with heart
failure. Psychosomatics 2007;48:338–47.
21. Pouwer F, Beekman AT, Lubach C, Snoek FJ. Nurses’ recognition
and registration of depression, anxiety and diabetes-specific emo-
tional problems in outpatients with diabetes mellitus. Patient Educ
Couns 2006;60:235–40.
22. Hart S, Morris R. Screening for depression after stroke: an explora-
tion of professionals’ compliance with guidelines. Clin Rehabil 2008;
22:60–70.
23. Horwitz SM, Kelleher KJ, Stein RE, Storfer-Isser A, Youngstrom EA,
Park ER, Heneghan AM, Jensen PS, O’Connor KG, Hoagwood KE.
Barriers to the identification and management of psychosocial issues
in children and maternal depression. Pediatrics 2007;119:e208–18.
24. Heneghan AM, Morton S, DeLeone NL. Paediatricians’ attitudes
about discussing maternal depression during a paediatric primary care
visit. Child Care Health Dev 2007;33:333–9.
25. McCabe MP, Russo S, Mellor D, Davison TE, George K. Effective-
ness of a training program for carers to recognize depression among
older people. Int J Geriatr Psychiatry 2008;23:1290–6.
26. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD,
Buick D. The revised Illness Perception Questionnaire (IPQ-R). Psy-
chol Health 2002;17:1–16.
27. Jenkins V, Fallowfield L. Can communication skills training alter physi-
cians’ beliefs and behavior in clinics? J Clin Oncol 2002;20:765–9.
28. Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R. Efficacy
of a Cancer Research UK communication skills training model for
oncologists: a randomised controlled trial. Lancet 2002;359:650–6.
29. Fallowfield L, Jenkins V, Farewell V, Solis-Trapala I. Enduring im-
Depression in Patients with Low Vision—Rees et al. 1335
Optometry and Vision Science, Vol. 86, No. 12, December 2009
9. pact of communication skills training: results of a 12-month follow-
up. Br J Cancer 2003;89:1445–9.
30. Mellor D, Russo S, McCabe MP, Davison TE, George K. Depression
training program for caregivers of elderly care recipients: implemen-
tation and qualitative evaluation. J Gerontol Nurs 2008;34:8–15.
31. O’ConnorPM,MuLC,KeeffeJE.Accessandutilizationofanewlow-vision
rehabilitation service. Clin Experiment Ophthalmol 2008;36:547–52.
32. Crews JE, Jones GC, Kim JH. Double jeopardy: the effects of comor-
bid conditions among older people with vision loss. J Visual Impair
Blind 2006;100:824–48.
33. Rovner BW, Zisselman PM, Shmuely-Dulitzki Y. Depression and
disability in older people with impaired vision: a follow-up study.
J Am Geriatr Soc 1996;44:181–4.
34. HorowitzA,ReinhardtJP,BoernerK.Theeffectofrehabilitationondepres-
sion among visually disabled older adults. Aging Ment Health 2005;9:
563–70.
35. Fenwick EK, Lamoureux EL, Keeffe JE, Mellor D, Rees G. Detection
and management of depression in patients with vision impairment.
Optom Vis Sci 2009;86:948–54.
36. Kroenke K, Spitzer RL, Williams JB. The Patient Health
Questionnaire-2: validity of a two-item depression screener. Med
Care 2003;41:1284–92.
37. Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding in-
struments for depression. Two questions are as good as many. J Gen
Intern Med 1997;12:439–45.
38. Lim HY, O’Connor PM, Keeffe JE. Low vision services provided by
optometrists in Victoria, Australia. Clin Exp Optom 2008;91:
177–82.
Gwyn Rees
Department of Ophthalmology
Health Services Research Unit
Centre for Eye Research Australia
University of Melbourne
Locked Bag 8, East Melbourne
Victoria 8002, Australia
e-mail: grees@unimelb.edu.au
1336 Depression in Patients with Low Vision—Rees et al.
Optometry and Vision Science, Vol. 86, No. 12, December 2009