Purpose The conventional patching/ occlusion treatment for amblyopia sometimes gives disappointing results for a number of reasons: it is unpopular, prolonged, frequently resulting in poor or noncompliance, and also disrupts fusion. The aim of this research was to develop a novel virtual-reality (VR)-based display system that facilitates the treatment of amblyopia with both eyes stimulated simultaneously. Methods We have adopted a multidisciplinary approach, combining VR expertise with a team of ophthalmologists and orthoptists to develop the Interactive Binocular Treatment (I-BiT TM ) system. This system incorporates adapted VR technology and specially written software providing interactive 2D and 3D games and videos to the patient via a stereo (binocular) display, and a control screen for the clinician. Results We developed a prototype research system designed for treatment of amblyopia in children. Conclusions The result is a novel way to treat amblyopia, which allows binocular treatment. It is interactive, and as it is partially software based, can be adapted to suit the age/ability, and needs of the patient. This means that the treatment can be made captivating and enjoyable. Further research is on-going to determine the efficacy of this new modality in the treatment of amblyopia.
Improvements in vision were demonstrable within a short period of time, in some children after 1 h of treatment. This system is an exciting and promising application of VR technology as a new treatment for amblyopia.
Objective: Randomised controlled trials have shown the benefits of Early Supported Discharge (ESD) of stroke survivors. Our aim was to evaluate whether ESD is still beneficial when operating in the complex context of frontline healthcare provision. Design:We conducted a cohort study with quasi experimental design. A total of 293 stroke survivors (transfer independently or with assistance of one, identified rehabilitation goals) within two naturally formed groups were recruited from two acute stroke units: 'ESD' n=135 and 'Non ESD' n=158 and 84 caregivers. The 'ESD' group accessed either of two ESD services operating in Nottinghamshire, UK. The 'Non ESD' group experienced standard practices for discharge and onward referral. Outcome measures (primary: Barthel Index) were administered at baseline, 6 weeks, 6 months and 12 months. Results:The ESD group had a significantly shorter length of hospital stay (P=0.029) and reported significantly higher levels of satisfaction with services received (P<0.001). Following adjustment for age differences at baseline, participants in the ESD group ( n=71) had significantly higher odds (compared to the Non ESD group, n=85) of being in the ⩾90 Barthel Index category at 6 weeks (OR = 1.557, 95% CI 2.579 to 8.733), 6 months (OR = 1.541, 95% CI 2.617 to 8.340) and 12 months (OR 0.837, 95% CI 1.306 to 4.087) respectively in relation to baseline. Carers of patients accessing ESD services showed s ignificant improvement in mental health scores (P<0.01). Conclusion:The health benefits of ESD are still evident when evidence based models of these services are implemented in practice.
Introduction: Information is currently lacking on the provision of occupational therapy for care home residents with stroke. The aim of this study was to identify current routine occupational therapy practice for this stroke population. Method: A questionnaire targeting qualified occupational therapists with work experience in a care home setting was designed, piloted, and transferred to an online survey. An invitation to participate was distributed via three of the College of Occupational Therapists Specialist Sections, social networking sites, and flyers at conferences. Findings: Responses were analysed from 114 respondents representing the United Kingdom, the majority (72%) of whom were employed by the National Health Service. Ninety-two respondents (81%) had delivered occupational therapy to a care home resident with stroke in the last year but only 16% were ‘stroke specialists’. The most common aims of intervention were to: maintain participation in activities of daily living, improve posture and positioning, and provide training. Non-standardized assessment was the most common form of assessment used. The functional approach was most frequently adopted. The most frequently provided intervention was ‘seating and positioning’. Conclusion: Occupational therapy is available to some stroke survivors in care homes; however, interventions are not commonly evidence based and are not routinely delivered by stroke specialists.
A Cochrane systematic review showed that Early Supported Discharge (ESD) following a stroke is both a safe and cost-effective alternative to continued in-patient management. Currently it is unclear whether the health and cost benefits established in the research literature still apply when ESD services are implemented in practice. Our study aims to evaluate the implementation of stroke ESD across three counties in the UK (Nottinghamshire, Derbyshire, Lincolnshire), and offers an innovative approach to facilitate the translation of stroke rehabilitation research into clinical practice. Phase one of our study was to establish the key components of a successful ESD team based on the research literature. We used a modified Delphi approach with ten ESD trialists, who contributed to the Cochrane review, to produce a consensus document. This provides core guidelines for the implementation of an evidence-based ESD service. The second ongoing phase of our study involves the evaluation of ESD services in practice. The evaluation looks at changes in patients' functionality over time, using a range of standardised questionnaires and robust statistical analysis. Such methods can be used by ESD teams in evaluating their effectiveness. Designing an evaluation of an established ESD team has raised some important methodological issues; these include the variability in the length of hospital stay prior to referral to ESD when compared to trials in the Cochrane review, and the subsequent difficulty in defining the optimal baseline time to consent patients. The findings from our research will help inform the implementation and delivery of evidence based ESD services in the UK and abroad.
<p>Submarine groundwater discharge (SGD) is recognized to supply nutrient elements nitrogen and phosphorus to coastal waters. In some cases, these nutrients are essential for biological productivity; in other cases, the nutrients are in excess or change relative proportions such that they impact community structure and/or increase algal blooms. Often overlooked is the role of reducing substances in salty SGD such as H<sub>2</sub>S, NH<sub>4</sub><sup>+</sup>, CH<sub>4</sub>, and DOM, which create a direct demand for dissolved oxygen (DO) and lower its concentration in estuarine and coastal waters. We call this SGD-Oxygen Demand or SGD-OD. These reduced substances primarily result from the oxidation of carbon in aquifers and aquicludes by seawater sulfate. Thus, coastal aquifers transitioning from freshwater to seawater due to seawater intrusion are most vulnerable. Saturated seawater DO concentrations are on the order of 200 &#181;M; reducing DO in coastal waters to <150 &#181;M induces biological stress on many organisms; reducing DO to <60 &#181;M (hypoxic conditions) can be deadly. Studies have directly correlated DO depletion with increased SGD off the coast of South Carolina and Mississippi, USA, and in the Yangtze delta, China. These depletions initially affect near-bottom dwelling organisms and may be recognized by sudden fish kills. In this talk we will review a data base of reducing substances in coastal groundwaters and illustrate how the discharge of this water could impact estuaries and coastal waters. We will show additional examples where we hypothesize SGD-OD is occurring in hopes others will have the resources to investigate these areas. &#160;</p>
Adverse childhood experiences (ACEs) are reported in most children, and significant ACEs are associated with neurological changes and chronic conditions. Despite this, routine screening for early identification and intervention is rare. To increase screening frequency, education for providers including nurse practitioners is critical. This project provided asynchronous education on ACEs for family nurse practitioner (FNP) students with preeducation and posteducation survey links. The survey items focused on three key areas: knowledge, skills, and attitudes (KSAs). T-tests were run to determine improvements in knowledge and skills questions and for Likert scale ratings on the attitude questions. Statistical significance was found in skills questions and in knowledge questions for one implementation site, and overall increases were seen in all areas from preeducation to posteducation results. This improvement in KSAs toward ACEs for FNP students showed that increased knowledge and understanding of skills also increased the reported willingness to screen patients in primary care to improve overall health outcomes.
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