Biomedical subjects
Publications and source records attributed to C Curran.
The issue of violence and potential violence against Approved Social Workers (ASWs) cannot be discussed in isolation from its occurrence in mainstream social work. The contents of this article highlight some key issues, raise areas of concern and offer some constructive ideas regarding the planning of a strategy and policy for Approved Social Workers.
A group of 175 traumatic brain injury (TBI) patients who had undergone intensive rehabilitation at Bethesda Hospital attended a follow-up interview 2 years after injury. The majority of patients had suffered severe TBI. Outcome was documented in ten areas: medical/physical, mobility, activities of daily living (ADLs) accommodation, marital status, leisure and recreation, employment/study, communication, cognition and behaviour. Whilst most patients were physically independent and competent in personal and domestic activities of daily living, a third of the group were still reliant on assistance with community skills and transport, and more than half of those who previously had a job, were not working at 2 years post-injury. Around two-thirds of the sample reported cognitive, behavioural and emotional changes. There is clearly a need for ongoing community-based support and assistance in dealing with practical difficulties and psychological problems as they are experienced after return to the community.
The present study used a multivariate approach to investigate which of a range of variables relating to demographic factors, injury severity and degree of disability on admission to rehabilitation were the best predictors of employment status 2 years after traumatic brain injury (TBI). Subjects were 74 TBI patients who had been working prior to injury, had undergone rehabilitation at Bethesda Hospital and attended a review clinic 2 years after injury. A cross-validation sample consisted of a further 50 such subjects. Following preliminary analysis four input variables were selected: age under or over 40 at time of injury, Glasgow Coma Scale score on acute hospital admission, duration of post-traumatic amnesia and total score on the Disability Rating Scale (DRS) on admission to rehabilitation. Stepwise discriminant function analysis resulted in a discriminant function consisting of three variables--total score on the Disability Rating Scale, Glasgow Coma Scale Score and age--which correctly classified 74% of grouped cases. A second analysis using the original discriminant function correctly classified 68% of the cross-validation sample. Chi-square analysis showed no significant difference between these results, thus confirming these variables, in combination, as predictors of employment status 2 years after TBI.
As the United States struggles to redefine the cost and delivery of health services, health care executives struggle to identify the most appropriate strategic agenda. With the model for the market evolution of health care becoming an accepted industry paradigm, it serves as an excellent medium for discussing the potential challenges an institution may face as its market progresses toward managed competition. Four cities, each at a different stage of evolution, are discussed in an effort to help health care executives in craft strategies for sustaining their institution's viability.
The debate over how changes expected in health care reform will affect the role of nursing in providing patient care is the hottest topic in nursing circles this year. Clearly, patient care will not be delivered in the same manner 5 years from now as it is today. In this interview, Connie Curran, EdD, RN, FAAN, editor of Nursing Economic$ and a highly regarded nursing consultant, discusses many aspects of the health care reform debate, including the future of academic health centers, nursing's and medicine's role in shaping the language of health care reform, the battle for fewer jobs, paths of professional development, and effects of reform on nursing research. Dr. Curran, who will serve as keynote speaker for ANNA's 25th Anniversary National Symposium in Dallas, TX this June, was interviewed by ANNA President Terran Warren Sims at the Nursing Economic$ office in Washington, DC. The former executive director of the American Organization of Nurse Executives (AONE), Dr. Curran has lectured on the effects of health care reform to audiences around the country. She is currently serving a 1-year appointment as a senior scholar in residence at the Institute of Medicine, which is studying various aspects of health care reform.
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Ventilatory dysfunction has become the main focus of current research in sudden infant death syndrome (SIDS). This has been correlated with structural abnormalities in the carotid body and respiratory nuclei of the brainstem. In recent studies, the denervating effect of asphyxial brainstem dysfunction on the pulmonary neuroendocrine cells, which probably function as chemoreceptors, was demonstrated and prompted the following study. The pulmonary neuroendocrine system was evaluated in 25 victims of SIDS and 20 control infants, ranging in age from 3 weeks to 7 months and 1 to 12 months, respectively. The pulmonary neuroendocrine cells were stained by the Churukian-Schenk method and the neuroendocrine cell-positive airway values expressed as a percentage of the total number of airways. The range of positive airway values for victims of SIDS was 2% to 97% with a median of 73%. In contrast, the range for the control infants was 1% to 44% with a median of 25.5%. The SIDS victims' percentage was significantly greater than the control infants' percentage (P less than .0001). The number of pulmonary neuroendocrine cells in positive airway was also increased among SIDS victims compared with control infants. The altered pulmonary neuroendocrine cell pattern could be attributable to either brainstem dysfunction or chronic hypoxia. These explanations are not, however, mutually exclusive of one another; in fact, it is possible that both mechanisms may be operative.
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Identification and control of hypertension are important public health concerns. Lack of regular health care makes diagnosis and control difficult in some populations. Community health nursing services in settings where clients regularly congregate promote identification and control of hypertension. This study focused on the effects of community health nursing screening and monitoring services for hypertension provided to participants in a breadline, a senior nutrition program, an English as Second Language (ESL) class, and employees providing these services. Community health nurses (CHNs) provided 2,407 blood pressure-related service encounters. Blood pressures were elevated in 19% of encounters, and 10% of clients had elevations that warranted referral for medical assistance. At the end of the 18-month study period, 67% of all clients with elevations and 71% of those referred for medical assistance had achieved normal blood pressures. One-way analysis of variance indicated a significant relationship between the number of encounters with the nurses and a positive outcome for all clients with elevations. This relationship was not supported for those clients referred to medical assistance. The effectiveness of intervention appeared to vary somewhat among subgroups with some groups more likely than others to achieve a positive outcome. Group differences in outcome were not statistically significant.
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