Nurses' perceptions of the impact of a computerized information system on a critical care unit.

Critical care nurses work in complex environments and encounter a vast amount of information daily. To learn how a computerized information system (CIS) impacted nursing practice on a critical care unit, this foundational research was conducted before and after implementation of a CIS. Qualitative methods using interviews and open ended questions were employed. Results showed that nurses felt positive overall about the implementation of a bedside CIS. Nurses liked the readability of the information and having the CIS near the bedside. They disliked the periodic slowness or downtime. Broad themes of reflection, questioning and action emerged from the content analysis. The themes were in accord with the theoretical framework that guided the study. Recommendations for future research included exploring nursing medication documentation, use of hand held devices, and having resource databases within the CIS.

Actualizing theory to practice: preparing for computerized information system research on a critical care unit.

In preparation for conducting research on the work of nurses before and after the installation of a computerized information system on a critical care unit, an actualizing process was applied. This process, derived from Actualizing Theory, provided the researchers with an opportunity to study congruence and appropriateness among the components of the intended research. Actualizing Theory uses twelve main strategies to assist in linking theory to a concrete situation. These strategies were employed as the research proposal was being developed and helped both to clarify the fitness of the main components of the research and in representing them in operational form.

Electronic communication to promote consensus-building skills: an innovative teaching strategy.

EMail and a local BBS were used as vehicles to promote consensus-building skills of doctoral nursing students. The strategy was implemented into a course that dealt with knowledge-structuring by incorporating content on the use of information along with a synthesizing process. During the last class an evaluative survey was administered, focusing on the students' satisfaction regarding the goals of the assignment, the instructions, and the electronic format. The majority of positive comments support continued use of EMail and a BBS to strengthen consensus-building skills. Based on survey feedback, increased time to learn the computer aspect of the assignment will need to be considered for classes in the future. Electronic technology should be incorporated as a teaching strategy in graduate curricula. Only then will tomorrow's nurse educators be prepared to assume a leadership role in managing information in health care and academic settings.

Sorsby's fundus dystrophy. A clinical study.

A survey was undertaken of a family known to have Sorsby's fundus dystrophy. Fifty members were reviewed, and 14 were found to be affected. Many of Sorsby's original conclusions were confirmed, including the pattern of inheritance and age of visual loss. Yellow material was present at the level of Bruch's membrane early in the course of the disease. However, the earliest phenotypic marker was delayed filling of the choriocapillaris. Abnormalities of choroidal perfusion became more profound and extended centrifugally with time. The loss of central vision was commonly due to atrophy of the outer retina and choroid. Subretinal neovascularization was a rare occurrence. The homology between this dystrophy and age-related macular disease underlines the importance of the clinical findings in this family.

A clinical, psychophysical, and electroretinographic survey of patients with autosomal dominant retinitis pigmentosa.

We have surveyed 104 patients (44 families) with autosomal dominant retinitis pigmentosa. The range of the survey includes clinical history, ocular examination, documentation of genetic history, Goldmann kinetic perimetry with IV/4 and I/4 white targets, two-colour static perimetry, and scotopic and photopic electroretinography. Comparison of interfamilial and intrafamilial patterns in the static perimetry data strongly suggests there may be at least two genetic subgroups within the disease characterised by the pattern of loss of rod function: in subgroup D (13 patients, 4 families) this is diffuse and severe, while in subgroup R (28 patients, 13 families) it is regional. In both D and R loss of cone function is regional, and in R it coincides with loss of rod function. In D patients the rod electroretinogram is absent; in all but two R cases it is present and usually substantial. All D patients were aware of night blindness before the age of 10, but most R patients not until after the age of 20. Many of the patients could not be classified because their disease was so advanced. The effect of disease duration on visual acuity and visual field area is described for all patients.

A genetic linkage study of a kindred with X-linked retinitis pigmentosa.

A large kindred with X-linked retinitis pigmentosa (XLRP) was investigated clinically and by means of genetic linkage with a view to developing methods of carrier detection and early diagnosis. A restriction fragment length polymorphism, identified by recombinant DNA probe L1.28, showed close genetic linkage to XLRP in this kindred and is a potentially useful marker for the purposes of genetic counselling.

Photopic flicker sensitivity losses in simplex and multiplex retinitis pigmentosa.

Psychophysical tests for flicker sensitivity were conducted on a group of retinitis pigmentosa patients classed as either simplex or multiplex on the basis of the familial incidence of this disease. The results were compared with those obtained from normal observers. A similar pattern of losses, predominantly at high temporal frequencies, was shown by all patients. The pattern cannot be reproduced in normal observers by reducing the luminances of the test stimuli; nor can it be explained by a simple reduction in the signal-to-noise ratio of the visual system.

Recurrences of acute posterior multifocal placoid pigment epitheliopathy.

Acute posterior multifocal placoid pigment epitheliopathy recurred in seven patients (all men, ranging in age from 25 to 43 years). In all seven cases swelling of the pigment epithelium resolved rapidly but left a permanent pigmentary disturbance. Loss of choriocapillaris occurred in six cases. Three patients had severe unilateral visual loss. Three patients had used antimicrobial drugs (two of them repeatedly), suggesting that in some cases this condition may be a manifestation of a hypersensitivity reaction to the antimicrobial agent.

Rod and cone activity in patients with dominantly inherited retinitis pigmentosa: comparisons between psychophysical and electroretinographic measurements.

Extended electroretinographic (ERG) testing has been carried out in a series of patients with retinitis pigmentosa, dominantly inherited. In 36 of 57 cases only cone b waves were evoked. In 20 of these, psychophysical tests showed only cones mediated vision (Massof class I), while in 16 statis scotopic perimetry demonstrated residual rod function (class II). In the remaining cases, where rod ERGs were seen, the light intensities required to evoke responses were not greatly elevated. A computer model was constructed to relate psychophysical threshold measurements to ERG data. This analysis of the results suggests that in one subgroup of patients the scotopic ERG is smaller than expected from the losses of visual field and that in another the psychophysical elevation of rod visual threshold is greater than expected from ERG measurements.

A modified ERG technique and the results obtained in X-linked retinitis pigmentosa.

An electroretinographic (ERG) technique is described in which the relationship between scotopic b wave amplitude and stimulus light intensity is determined. The relative amplitude of scotopic to photopic responses is assessed by means of red light and flicker. The method is applied to the detection of ERG abnormalities in heterozygotes for X-linked retinitis pigmentosa. These have been found in only a proportion of cases. The ERG results can be used to suggest the nature of the retinal abnormality.