Diabetes and cataract surgery: preoperative risk factors and positive nursing interventions.

PURPOSE: In the United States, approximately three million cataract surgeries are performed annually. Although cataract surgery has been demonstrated to improve vision in up to 95% of patients, those with diabetes may be at increased risk of complications and poor visual outcomes. Preoperative risk factors such as age, retinal diseases, hypoglycemic medications, and hemoglobin A1C (Hgb A1C) levels may play a role in patient outcomes following cataract surgery. Furthermore, intraoperative risk factors such as the use of pupillary expanders, trypan blue staining, and additional procedures such as anterior vitrectomy may also be considered as a challenge for diabetic patients. This article will describe preoperative risk factors associated with visual outcomes for diabetic patients undergoing cataract surgery and appropriate nursing interventions for these patients. METHODS: Literature review of risk factors and cataract surgery outcomes in terms of complications, visual acuity, and visual functioning of diabetic patients was undertaken. Preoperative risk factors (i.e., age, retinal diseases, advanced macular disease [AMD], hypoglycemic medications, and Hgb A1C levels) and postoperative complications, including inflammation and cystoid macular edema (CME), were also examined. To emphasize evidence of best practices, the role of the nurse as educator and advocate was further explored in terms of their impact on diabetes management of the patient to improve visual results. RESULTS: Diabetic patients of advanced age, with a history of diabetic retinopathy who are taking insulin and have elevated Hgb A1C levels, may have an increased risk of intraoperative and postoperative complications and decreased postoperative visual acuity and visual functions that may affect their quality of life. CONCLUSIONS: High-risk factors should be identified in diabetic patients when developing a perioperative patient education plan to help reduce their risk of cataract complications and improve their visual outcomes.

Development of the Veterans Healthcare Administration (VHA) Ophthalmic Surgical Outcome Database (OSOD) project and the role of ophthalmic nurse reviewers.

Currently, ophthalmic surgical cases are not included in the Veterans Administration Surgical Quality Improvement Project data collection. Furthermore, there is no comprehensive protocol in the health system for prospectively measuring outcomes for eye surgery in terms of safety and quality. There are 400,000 operative cases in the system per year. Of those, 48,000 (12%) are ophthalmic surgical cases, with 85% (41,000) of those being cataract cases. The Ophthalmic Surgical Outcome Database Pilot Project was developed to incorporate ophthalmology into VASQIP, thus evaluating risk factors and improving cataract surgical outcomes. Nurse reviewers facilitate the monitoring and measuring of these outcomes. Since its inception in 1778, the Veterans Administration (VA) Health System has provided comprehensive healthcare to millions of deserving veterans throughout the U.S. and its territories. Historically, the quality of healthcare provided by the VA has been the main focus of discussion because it did not meet a standard of care comparable to that of the private sector. Information regarding quality of healthcare services and outcomes data had been unavailable until 1986, when Congress mandated the VA to compare its surgical outcomes to those of the private sector (PL-99-166). 1 Risk adjustment of VA surgical outcomes began in 1987 with the Continuous Improvement in Cardiac Surgery Program (CICSP) in which cardiac surgical outcomes were reported and evaluated. 2 Between 1991 and 1993, the National VA Surgical Risk Study (NVASRS) initiated a validated risk-adjustment model for predicting surgical outcomes and comparative assessment of the quality of surgical care in 44 VA medical centers. 3 The success of NVASRS encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care, thus developing the National Surgical Quality Improvement Program (NSQIP) in 1994. 4 According to a prospective study conducted between 1991-1997 in 123 VA medical centers by Khuri et al., the 30-day mortality and morbidity rates for major surgeries had decreased by 9% and 30%, respectively. 5 Recently renamed the VA Surgical Quality Improvement Program (VASQIP) in 2010, the quality of surgical outcomes has continued to improve among all documented surgical specialties. Ophthalmic surgery is presumed to have a very low mortality rate and therefore has not been included in the VASQIP database.

Self-reported body shape and bone mineral density in a sample of African-American women.

Osteoporosis is a chronic disease that increases the risk of fractures. There are demonstrated ethnic differences in the risks and consequences of osteoporosis. Body shape, defined as either android or gynoid, might be linked to the physiological changes that are associated with menopause, which are a time of worsening bone loss and increased risk for osteoporosis. This study investigated the associations between self-reported body shapes and clinically measured hip neck and lumbar spine bone mineral density (BMD) in a group of peri-menopausal African-American women. Data from 71 women (N = 71) were gathered from a previously conducted parent study on the risks for osteoporosis and hormone replacement therapy (HRT). A multivariate regression model demonstrated that there was a positive association between self-reported android body shape and a higher hip neck BMD among study participants. The multivariate regression model was adjusted for demographics and for other risk factors.

The impact of goal attainment on behavioral and mediating variables among low income women participating in an Expanded Food and Nutrition Education Program intervention study.

This study examined the relationships between participant goal attainment and changes in mediating variables and food choice outcomes from a modified curriculum for the Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthy home food environments and parenting skills related to obesity prevention. EFNEP participants in 54 intervention classes received a goal sheet after each of 6 classes. Participants recorded goal attainment and returned at the next class, Diet and mediating variables were measured at baseline, immediate post, and 4 months later. Mixed model regression analysis over time assessed whether goal attainment was associated with the outcomes at post or follow-up, controlling for baseline assessment. Participants who reported attaining more goals reported greater self-efficacy for planning/encouraging fruit and vegetable consumption and making fruit and vegetables available, menu planning skills, improvement in the food preparation practices and higher home availability for regular vegetables. At post, those who reported attaining more fiber, vegetable, and water goals reported consuming more of these items. Goal attainment was related to some changes in food choice and mediating variables in an at risk population. Further research into the use and efficacy of goal setting and attainment in this population is warranted.

Creating healthful home food environments: results of a study with participants in the expanded food and nutrition education program.

OBJECTIVE: To evaluate a modified curriculum for the 6-session Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthful home food environments and parenting skills related to obesity prevention. DESIGN: Two-group randomized control trial; intervention versus usual EFNEP curriculum. SETTING: Texas EFNEP classes. PARTICIPANTS: 1,104 EFNEP clients in 100 classes. INTERVENTION: Six short videos, with goal setting, problem solving, guided discussion, and handouts, incorporated into existing EFNEP classes. MAIN OUTCOME MEASURES: Body mass index (BMI), diet, psychosocial variables with baseline measurements, immediately post, and 4 months later. ANALYSIS: Mixed-model repeated measures analysis of variance. RESULTS: 100 classes were randomized (54 intervention/46 comparison), with 1,006 participants at baseline (582 intervention, 424 comparison, 97% women, 89% Hispanic). Significant improvements over time were found for both groups' consumption of most food items and nutrients, and nearly all psychosocial variables, regardless of study group. Only the intervention group had a significant BMI decrease at post. Fidelity to the intervention class session structure was high, and comments from intervention staff and clients were positive. CONCLUSION AND IMPLICATIONS: Existing EFNEP programs in local communities could have a significant impact on family dietary behaviors for populations at risk of obesity. Replication with similar populations is warranted.

Osteoporosis among perimenopausal African-American women: the relationship between sources of information and levels of knowledge about osteoporosis.

The aim of this study is to increase awareness of the occurrence of osteoporosis in perimenopausal African-American women. This quantitative study was designed to measure African-American women's knowledge of osteoporosis and to determine on what sources of information about osteoporosis African-American women rely Aside from demographic variables, other data were collected to determine which sources of information about osteoporosis African-American women use, whether they know that osteoporosis is a preventable disease, and whether there is a relationship between sources of information and the level of knowledge about osteoporosis among these women. Participants consisted of 45 perimenopausal African-American women from 42 to 52 years of age residing in Houston, Texas Data were utilized from an ongoing research project. Analysis of the data presented suggests that there is an association between specific sources of information and the level of knowledge about osteoporosis in this age group of African-American women.