Patient and practitioner compliance with silicone hydrogel and daily disposable lens replacement in the United States

Objective: The objectives of this study were to assess current recommendations for replacement frequency (RF) of silicone hydrogel (SH) and daily disposable (DD) lenses, to determine compliance with these recommendations, and to investigate the reasons given for noncompliance.

Methods: A package containing 20 patient surveys was sent to 309 eye care practitioners (ECPs) in the United States who had agreed to participate in the study. One thousand eight hundred fifty-nine completed surveys were received from 158 ECPs and 1,654 surveys were eligible for analysis. Questions related to patient demographics, lens type, lens wearing patterns, the ECP instructions for RF, and the actual patient reported RF. ECPs were asked to provide lens information and their recommendation for RF after the surveys had been completed and sealed in envelopes. All responses were anonymous.

Results: Sixty-six percent of patients were women and their mean age was 34 ± 12 years. Eighty-eight percent of lenses were worn for daily wear, 12.8 ± 3.2 hours a day, 6.2 ± 1.5 days a week. Lens type distribution was 16% DD, 45% 2 week (2W) SH, and 39% 1 month (1M) SH. ECP recommendations for RF varied according to the lens type; 1% of 1M (95% CI 0.2-1.7), 4% of DD (95% CI 2.1-7.2), and 18% of 2W (95% CI 15.1-20.7) patients were given instructions that did not conform to the manufacturers' recommended RF (MRRF). When considering only those patients who were given the correct instructions for RF, 38% were not compliant with the MRRF; noncompliance rates varied according to the lens type and were 12% for DD (95% CI 8.6-17.2), 28% for 1M (95% CI 24.9-32.1), and 52% for 2W (95% CI 47.8-55.8). The most frequent reasons for over wearing lenses were forgetting which day to replace lenses (51%) and to save money (26%). Fifty-three percent believed that a reminder system would aid compliance; the most popular methods being a cell phone reminder or text message (29%) and a nominated day each week or month (26%). Discussions between the ECPs and the patients were more extensive for patients who were compliant with the MRRF.

Conclusions: ECPs recommended RFs more frequently with DD and 1M SH lenses than with 2W SH lenses, consistent with manufacturers' recommendations. Patients were less compliant with RF than ECPs for all lens types investigated. Patients were most compliant with RF when wearing DD lenses and least compliant when wearing 2W SH lenses. Better communication facilitated greater compliance with RF. More than half of those not replacing lenses, when recommended, reported that this was because they forgot which day to replace their lenses.

Patient and practitioner compliance with silicone hydrogel and daily disposable lens replacement in Canada

Purpose: To assess current recommendations by optometrists for replacement frequency (RF) of silicone hydrogels (SH) and daily disposable (DD) contact lenses in Canada, determine rates of non-compliance with recommendations by both the optometrist and patient, and investigate reasons for non-compliance.

Methods: Survey packages were sent to optometrists in Canada who had agreed to participate. Patients completed survey questions regarding demographics and contact lens wearing patterns, including recommended and actual contact lens RF. Optometrists were asked to provide lens information and their recommendation for RF. Fifty-eight optometrists returned 654 surveys, of which 578 were eligible for analysis.

Results: Seventy percent of patients were female with a median age of 32 years. Lens type distribution was 18% DD, 35% two-week SH, and 47% one-month SH. Six percent were worn for extended wear. Daily wear median wearing time was 12 hours/day, a median of five days/week for DD, seven days/week for SH (two-week and one-month). Optometrists’ recommendations were non-compliant with the manufacturers’ recommended RF for 6% of DD, 35% of two week, and 2% of one-month patients. Patients were non-compliant with recommendations from both the manufacturer and optometrist for 12% of DD, 43% of two-week, and 31% of one-month lens wearers. The most common reason for non-compliance was forgetting which day to replace lenses. Fifty-six percent thought a reminder system would help with compliance. A higher proportion of compliant patients followed the RF because of confidence in their optometrist.

Conclusions: Optometrists generally recommended RFs consistent with manufacturers’ recommendations for DD and one-month SH lenses but often recommended longer intervals for two-week SH lenses. Patients were most compliant when wearing DD lenses and least compliant when wearing two-week SH lenses. Communication between the patient and optometrists concerning the risks of non-compliance, or initiating a reminder system might improve compliance.

A fish out of water? Legal practitioner - practitioner teacher? Bourdieu, the legal field and the scholarship of teaching in practical legal training

It is surprising to discover during early doctoral research that there is a paucity of Australian scholarship using Bourdieu’s theoretical tools in the field of law, and in the sub-field of post-graduate pre-admission practical legal training. This article introduces Bourdieu’s conceptions of habitus, field, categories of capital, symbolic violence, and misrecognition. It describes how Bourdieu applied these tools to identify structural hostility between legal academics and practitioners, and the struggles for control in the field of law. Review of three North American studies that used Bourdieu’s theories follows, involving law students’ habitus in transition, class stratification in legal education, and gender stratification in law firm partnerships. Drawing on three internally connected ‘moments’ necessary to use Bourdieu’s tools, together with four critical questions concerning teachers’ engagement with the scholarship of teaching, this article identifies new questions for investigation. These questions will frame further research to discover whether the objective structures of the practical legal training field and the habitus of legal practitioners constrains them to act as ‘fish out of water’ in the context of a scholarship of teaching.

Mercy health mental health nurse practitioner project report

The Nurse Practitioner – Mental Health model investigates the options for providing a service to a group of clients who present at Werribee and Western Emergency Departments (ED) and currently receive either limited mental health service or have an undiagnosed mental illness. This group comprises at risk young adults who do not meet the criteria for ongoing treatment in public mental health services at present. At risk young adults are those who fit known demographic variables for risk and have a risk catalyst (eg relationship break up) and a situational response to this (self harm). Mercy Mental Health Program service survey indicates gaps in services to this group using current referral pathway with potentially 40-70% lost to follow-up and a significant increase in risk for suicide.

Screening and intervention for mental health problems in alcohol and other drug settings: Can training change practitioner behaviour?

Aims: The comorbidity of substance use and mental health problems poses a significant challenge for alcohol and other drug (AOD) treatment services. In many cases, AOD practitioners do not have experience or training in identifying or managing mental health conditions. Methods: This project examined the implementation of screening and intervention practices for mental health disorders among AOD clients. Training and supervision was provided to 20 AOD practitioners across five sites in four agencies with a focus on enhancing skills in detection of, and intervention for, mental health conditions among their clients. A package developed for this purpose, known as PsyCheck, was used. A random file audit was undertaken to examine changes in detection of mental health conditions. Findings: There were significant improvements in detection after training and supervision, with detection rates almost doubling in this time. Conclusions: Training and supervision using the PsyCheck package appears to have the potential to improve mental health detection and intervention in AOD services. This study shows promise for the implementation of mental health intervention in AOD services.

National nursing registration in Australia : a way forward for nurse practitioner endorsement

Purpose : The move to national registration of health professionals and the creation of the Nursing and Midwifery Board of Australia (NMBA) provides both challenges and opportunities for the regulation of nurse practitioners (NPs) in Australia.

Data sources : National and state health policy documents, accessible on the Internet, concerning the regulation and endorsement processes for NPs in Australia were examined.

Conclusions : The similarities between two of the previous jurisdictional NP endorsement processes in New South Wales and Victoria provide a common ground on which to build a robust national system. However, there are also key differences between these two states. These differences were mainly in the evidence required to assess competency of NP applicants and the authority to prescribe medications. All Victorian NP applicants were required to complete an approved medication subject at a master's level.

Implications for practice : A consistent endorsement process that delivers NPs of the highest standard and allows for efficient use of their skills and expertise is vital. This needs to be performed with the aim of providing high-quality care in a regulatory environment that protects the public and clearly articulates the level of competence expected of all NPs.

Identity on the edge: The impact of risk, compliance and performativity on VET practitioner identity.

 German Sociologist, Ulrich Beck’s seminal political analysis of risk, Risk Society: Towards a New Modernity, in 1992 posited the concept of ‘risk’ that has become privatised, objectified and a matter for individual concern. This study examines how the management of ‘risk’ is achieved through individual scrutiny, audit and review and the impact these practices have on changing VET practitioner identity. Preliminary PhD interviews with VET practitioners, using grounded theory methodology, identified the symbiotic nature of risk management and generation within the current diverse and challenging VET environment. Resistance or acquiescence to compliance practices and the performative VET environment have significant implications for VET practitioners’ identity construction.

The discursive practices of nurse practitioner legislation in Australia

Aim.  The aim of this paper was to examine the nurse practitioner legislative framework in Australia from a critical social theory perspective. Background.  National regulation for nurses and midwives has superseded all previous state legislation with effect from July 2010. The aim of this change was to streamline regulation processes across all health professionals requiring regulation, in order to eliminate diverse state-based regulatory policies that were identified as hindering transferability of the workforce across Australia. This paper explores the changes with reference to nurse practitioners. Since their introduction to Australia different legislative practices between states have presented difficult endorsement procedures which have affected employment. Data sources.  Information for the paper is drawn from a doctoral study which examined the politics of advancing nursing in Australia, with particular reference to the discourses of nurse practitioners. This is augmented by more recent legislative documents and policies, as well as media reports, to examine the process of change in legislation and the unfolding discourses on employment and practice. Implications to nursing.  Nurse practitioner endorsement may be more complicated, defeating the original premise of transferability of a skilled workforce across state jurisdictions. Conclusion.  This paper exposes the influence that powerful discourses can have on a major change to professional practice.

Obesity prevention programs and policies: practitioner and policy-maker perceptions of feasibility and effectiveness

Objectives: