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Issue 21 - 4 July 2012

Articles on Glaucoma

1. Glaucoma
By Quigley, Harry A. The Lancet 377. 9774 (Apr 16-Apr 22, 2011): 1367-77
Most medical practitioners have regular contact with adults who have one of the two forms of glaucoma: open-angle glaucoma or angle-closure glaucoma. Data from population-based surveys indicate that one in 40 adults older than 40 years has glaucoma with loss of visual function, which equates to 60 million people worldwide being affected and 8.4 million being bilaterally blind. Even in developed countries, half of glaucoma cases are undiagnosed. Glaucoma is mostly asymptomatic until late in the disease when visual problems arise. Vision loss from glaucoma cannot be recovered, and improved case-detection methods for glaucoma are needed. Glaucoma is commonly treated with daily eye-drop drugs, but adherence to treatment is often unsatisfactory. As a usually asymptomatic and chronic disease, glaucoma has similar treatment challenges to chronic systemic diseases. Similarities to the pathogenesis of common CNS diseases mean that common neuroprotective strategies might exist. Successful gene therapy, which has been used for other eye diseases might be possible for the treatment of glaucoma in the future.

2. Glaucoma and Glaucoma Medications
By Turkoski, Beatrice B. Orthopaedic Nursing 31. 1 (Jan/Feb 2012): 42-3
Glaucoma is an insidious "thief of vision" that affects millions of Americans and is a leading cause of blindness worldwide. The signs of the most common form of glaucoma are incremental and are often not noticed until the vision loss is acute. Nurses, in any practice arena, who are aware and knowledgeable about glaucoma can play a vital role in identifying those at risk for glaucoma before irreversible damage is done. In addition, knowledgeable nurses will be able to educate those diagnosed with glaucoma about their disease and the proper use of their glaucoma medications. In the following discussion, a brief explanation of how glaucoma affects vision is presented and selected medications used to treat glaucoma are identified.

3. Primary open-angle glaucoma
By Weinreb, Robert N; Khaw, Peng Tee. The Lancet 363. 9422 (May 22, 2004): 1711-20
Primary open-angle glaucoma is a progressive optic neuropathy and, perhaps, the most common form of glaucoma. Because the disease is treatable, and because the visual impairment caused by glaucoma is irreversible, early detection is essential. Early diagnosis depends on examination of the optic disc, retinal nerve fibre layer, and visual field. New imaging and psychophysical tests can improve both detection and monitoring of the progression of the disease. Recently completed long-term clinical trials provide convincing evidence that lowering intraocular pressure prevents progression at both the early and late stages of the disease. The degree of protection is related to the degree to which intraocular pressure is lowered. Improvements in therapy consist of more effective and better-tolerated drugs to lower intraocular pressure, and more effective surgical procedures. New treatments to directly treat and protect the retinal ganglion cells that are damaged in glaucoma are also in development.

4. Deprivation and late presentation of glaucoma: Case-control study
By Fraser, Scott; Bunce, Catey; Wormald, Richard; Brunner, Eric. British Medical Journal 322. 7287 (Mar 17, 2001): 639-43
To identify socioeconomic risk factors for first presentation advanced glaucomatous visual field loss.
DESIGN: Hospital based case-control study with prospective identification of patients.
SETTING: Three hospital eye departments.
PARTICIPANTS: Consecutive patients newly diagnosed with glaucoma (n=220). Cases (late presenters) were those presenting with advanced glaucoma (n=110), controls were those with early glaucoma (n=110).
RESULTS: Median underprivileged area scores were higher among late presenters (29.5; interquartile range 9.0-42.2) than in the control group (21.3; 6.1-37.4) (P=0.035). Late presenters were more likely to be of lower occupational class (odds ratio adjusted for age and referral centre 20.1 (95% confidence interval 2.6 to 155) for group III compared with group I-II and 86.0 (11.0 to 673 for group IV-V compared with group I-II), to have no access to a car (2.2; 1.2 to 4.0), to have left full time education at age 14 or less (7.5; 2.3 to 24.7), and to be tenants rather than owner occupiers (local authority tenants 3.2; 1.7 to 5.8, private tenants 2.1; 0.7 to 5.8). Effects of deprivation were partly accounted for by family history of glaucoma, time since last visit to an optometrist, and lack of an initial diagnosis of glaucoma by an optometrist.
CONCLUSIONS: Area and individual level deprivation were both associated with late presentation of glaucoma. Existing evidence shows that late presentation is an important risk factor for subsequent blindness. Deprived groups thus seem to be at greater risk of going blind from glaucoma. Material deprivation may be associated with more aggressive disease as well as later presentation.

Articles - Ageing Health Journal

5. Difficulties sleeping: a natural part of growing older? 
By Grandner, Michael A; Patel, Nirav P; Gooneratne, Nalaka S. Aging Health 8. 3 (Jun 2012): 219-221
Interestingly, as subjects underwent levels of health screening, fewer and fewer sleep problems were reported as subjects were excluded for various medical reasons. [...]in these relatively healthy samples, rates of poor sleep were very low, and the poor sleep that was detected existed in the context of other medical issues. [...]although some aspects of sleep deteriorate with age, some aspects do not

6. Protecting the elderly against whooping cough: vaccinate now
By Talbot, H Keipp; Schaffner, William. Aging Health 8. 3 (Jun 2012): 223-224
Community-wide outbreaks have occurred in many states, now most notably in California and Washington. Because of this resurgence of disease there is a growing consensus that the acellular vaccine probably produces less durable immunity than the whole-cell vaccine did, resulting in waning protection over time, setting the stage for outbreaks among older age groups. Adults generally present themselves for medical care when they are already 2 or more weeks into their chronic cough illness. Because pertussis can superficially resemble other respiratory illnesses (e.g., chronic obstructive pulmonary disease, bronchitis, sinusitis, asthma and smoker's cough) and because internists and other caregivers of adults may not be familiar with the disease, whooping cough in adults often goes undiagnosed

7. Obesity in later life and dementia risk: a tale of many paradoxes
Power, Brian D; Almeida, Osvaldo P. Aging Health 8. 3 (Jun 2012): 225-227
In their meta-analysis, Anstey and colleagues reported no association between continuous BMI measurements in later life and dementia risk, but were reluctant to draw conclusions from the data because of the limited number of studies included, brief follow-up periods and lack of stratification by BMI category [8]. Since the publication of that meta-analysis, large studies stratified by BMI grouping and with longer follow-up periods have been completed. [...]mortality is highest for older people whose BMI decrease over time.

8. Cholinesterase inhibitors and memantine in more advanced Alzheimer's disease: the debate continues
By Dwolatzky, Tzvi; Clarfield, A Mark. Aging Health 8. 3 (Jun 2012): 233-237.
Evaluation of: Howard R, McShane R, Lindesay J et al. Donepezil and memantine for moderate-to-severe Alzheimer's disease. N. Engl. J. Med. 366 (10), 893-903 (2012). A large randomized controlled study was designed to evaluate whether community-living patients with moderate-to-severe Alzheimer's disease currently receiving donepezil would benefit from continuing this treatment, and whether initiating therapy with memantine at this point was beneficial. In the predominantly white female study population (mean age 77 years) comprising 295 community-dwelling patients, statistically significant cognitive and functional benefits of continuing treatment with donepezil for patients with moderate-to-severe Alzheimer's disease over a period of 52 weeks were found. Combination therapy with donepezil and memantine conferred no extra benefit to the cognitive and functional status of the subjects, although memantine therapy was associated with fewer behavioral and psychological symptoms. Further studies are required to clarify whether these agents are clinically beneficial in moderate-to-severe Alzheimer's disease.

9. High serum total cholesterol levels as a risk factor of ischemic stroke in Asian individuals
By Ong, Jonathan JY; Sharma, Vijay K. Aging Health 8. 3 (Jun 2012): 239-242
Evaluation of: Cui R, Iso H, Yamagishi K et al.; JPHC Study Group. High serum total cholesterol levels is a risk factor of ischemic stroke for general Japanese population: the JPHC study. Atherosclerosis 221(2), 565-569 (2012). An elevated cholesterol level is one of the established modifiable risk factors for secondary prevention of stroke. However, the stroke-cholesterol relationship remains a relatively weak relationship. Furthermore, the controversy regarding the optimal cholesterol level still persists. While elevated cholesterol levels are associated with higher risk for cerebral ischemic events, lower levels might increase the risk for hemorrhagic events. This study by Cui and colleagues presents robust large-scale epidemiological data regarding the association of elevated total cholesterol with the stroke risk among the Asian cohort. One of the important findings of this study is the relationship between elevated cholesterol and large artery atherosclerotic stroke. This is especially relevant in the Asian context, where large artery atherosclerosis constitutes more than half of all ischemic stroke subtypes. This paper reviews the study by Cui and colleagues regarding the role of high serum total cholesterol as a risk factor for ischemic stroke in Japanese men.

10. The use of exercise-based videogames for training and rehabilitation of physical function in older adults: current practice and guidelines for future research
By Smith, Stuart T; Schoene, Daniel. Aging Health 8. 3 (Jun 2012): 243-252
Declines in physical or cognitive function are associated with age-related impairments to overall health. Functional impairment resulting from injury or disease contribute to parallel declines in self-confidence, social interactions and community involvement. Fear of a major incident such as a stroke or a bone-breaking fall can lead to the decision to move into a supported environment, which can be viewed as a major step in the loss of independence and quality of life. Novel use of videogame console technologies are beginning to be explored as a commercially available means for delivering training and rehabilitation programs to older adults in their own homes. We provide an overview of the main videogame console systems (Nintendo Wii(TM), Sony Playstation® and Microsoft Xbox®) and discuss some scenarios where they have been used for rehabilitation, assessment and training of functional ability in older adults. In particular, we focus on two issues that significantly impact functional independence in older adults, injury and disability resulting from stroke and falls.

11. From International Journal of Nursing Practice, Volume 18, Issue 3, June 2012.
Identification of perceived barriers of pain management in Iranian children: A qualitative study (pages 221–225)
11B. Victorian rural emergency care—a case for advancing nursing practice (pages 226–232)
11C. Care plans using concept maps and their effects on the critical thinking dispositions of nursing students (pages 233–239)
11D. Dancing with data: An example of acquiring theoretical sensitivity in a grounded theory study (pages 240–245)
11E. Levels of empathy in undergraduate nursing students (pages 246–251)
11F. Exploring the meaning of hypoglycaemia to community-dwelling Singaporean Chinese adults living with type 2 diabetes mellitus (pages 252–259)
11G. Influence of Type D personality on health-related quality of life among Korean patients with end-stage renal disease (pages 260–267)
11H. Health-promoting lifestyle and depression in metabolic syndrome patients in Korea (pages 268–274)
11I. Assessing undergraduate nursing and midwifery students' compliance with hand hygiene by self-report (pages 275–280)
11J. The effect psychoeducation intervention has on the caregiving burden of caregivers for schizophrenic patients in Turkey (pages 281–288)
11K. A structured telephonic counselling to promote the exclusive breastfeeding of healthy babies aged zero to six months: A pilot study (pages 289–294)
11L. Non-infectious hyperthermia in acute brain injury patients: Relationships to mortality, blood pressure, intracranial pressure and cerebral perfusion pressure (pages 295–302)
11M. Australian registered and enrolled nurses: Is there a difference? (pages 303–307)
11N. Attitudes and practices of school-aged girls towards menstruation (pages 308–315)

On-line abstracts can be submitted until 14 September 2012.We are also planning a Telenursing Network meeting, an ICNP panel session, and the by-invitation ICNP Centres Consortium meeting.
More Information:

News - National

13.  Board appointed for new Health Promotion Agency
Jo Goodhew -22 June, 2012

Board members of the new Health Promotion Agency have been announced today by Associate Health Minister Jo Goodhew. “The new agency will be established on 1 July and it will lead and deliver innovative, high quality and cost effective health promotion programmes,” says Mrs Goodhew. The Health Promotion Agency brings the functions of ALAC, the Health Sponsorship Council and some health promotion work of the Ministry of Health into one agency.

14. Watchdog warns on dangerous doctors
NZ Herald - 2 Jun 2012

Incompetent doctors are putting patients in danger with only a slight chance of being found out, says a former medical watchdog. In a book to be launched on Wednesday, former Health and Disability Commissioner Ron Paterson - now a law professor at Auckland University - calls for radical changes to the Medical Council and its controls over doctors' competence. He suggests that as many as 200 doctors are incompetent to the point of being a danger to patients and that the council's methods of identifying them are weak. "It became clear to me that despite supposed safeguards, some incompetent practitioners were able to continue in practice and harm patients," Professor Paterson says in The Good Doctor.


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