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BACKGROUND: Assessing the pupillary light reflex is a core component of neurological assessments. Pupil size and reactivity can provide early warning about early neurological decline. Automated infrared pupillometry is noninvasive and easy to use and has greater reliability compared with manual assessments to obtain objective and consistent measurements of pupillary size and reactivity to light. METHODS: This is a case series of 3 patients who had poor baseline clinical neurological examinations. Because it would be more difficult to detect acute neurological deterioration, automated infrared pupillometry and the Neurological Pupil index (NPi) were used in addition to the clinical neurological examination. NPi values < 3.0 prompted further imaging. RESULTS: In each case, abnormal NPi values prompted emergent imaging that confirmed acute cerebral edema and resulted in a change in management and treatment plan. CONCLUSION: The automated infrared pupillometry is a noninvasive monitor that can provide additional objective data in patients with a poor baseline neurological examination in whom it may otherwise be difficult to detect neurological deterioration.

Background: Pupillary light reflex (PLR) is informative about patients with neurological injury. Automated pupillometry provides discrete variables such as dilation velocity (DV). The objective of ...

Background A study aimed at reducing the time spent on the phone obtaining insurance preauthorisation in a neurosurgical clinic was successfully completed. However, the researchers were unable to reject the null hypothesis because of a combination of chronological bias and the Hawthorne effect. Aim To increase nurse researchers' awareness of the potential to introduce a chronological bias as a confounder in clinical research and suggest potential alternative approaches to study design. Discussion The researcher shared the study's purpose, design and outcome measure with the participants before collecting the baseline data. This enabled the participants to alter their practice before the intervention was implemented (a chronological bias) and change their behaviour surrounding the outcome (the Hawthorne effect). Conclusion The use of the Delphi method became a catalyst for change before the collection of baseline data, the combination of chronological bias and the Hawthorne effect affecting the study's results. Implications for practice Nurse researchers seeking to improve practice should collect baseline data before informing participants and consider the risks and benefits of blinding (concealment) surrounding the outcome.