The influence of advanced general dentistry training on practice patterns of Iowa dental graduates.
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Biomedical subjects
Publications and source records attributed to J J Warren.
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In order to effectively organize the use of nursing time during clinic check-in, we designed a forward chaining rule based program for nursing history taking, problem tracking, and documentation. The program consists of a medical logic module trigger engine which identifies relevant rules for nursing history, an interactive question manager for nursing history taking, and a rule generation shell implemented within a specially designed Medical Query Language (MQL) shcema. At clinic check-in, the engine refreshes the rule set for the patient from interaction with the computerized medical record. The interaction driver assists the nurse with tracking of elapsed time, and allows him/her to pursue questions, record data, and create or complete nursing interventions. Nursing question sets and interventions are maintained longitudinally to assure continuity of care. Nursing problems are created on the problem list within the computerized record as the rule system identifies their existence.
The ambulatory office setting is increasingly becoming a central focus of patient care. The nursing staff are integral to patient care management in this environment. They are frequently the heaviest users of medical records and are generally early advocates of well designed computer records systems. As our implementation of a Computer Stored Ambulatory Record (COSTAR V) has grown in complexity and utility, reorganization of the record and development of new features to support nursing has become critical. This demonstration will show how nursing information management has changed using a variety of computer record tools, including features of exam room data entry, specialized nursing displays and problem based patient summaries. Specific items for demonstration will include: nursing check-in module, rule driven nursing history program, prescription refill functions, documentation and billing for nursing procedures, nursing telephone management functions, a module for management of anticoagulation and document retrieval and display utilities.
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In this study, the professional and bureaucratic role conceptions and role deprivation of students participating in a preceptorship program were compared to those in a traditional faculty-supervised clinical group. The role conceptions and role deprivation of nursing faculty and preceptors were also examined. One hundred eighteen students in a two-year upper division baccalaureate program participated in this study. The Corwin Nursing Role Conception tool was administered. Results indicated no differences in role conceptions or role deprivation in students participating in the preceptorship program and those who did not. There were no differences in the developmental pattern of role conception and role deprivation during two years of nursing education. Also, nursing faculty had a significantly higher professional role conception and a significantly lower bureaucratic role conception than preceptors but there were no differences in role deprivation between the two groups.
A taxonomy of nursing diagnoses improves communication within the domain of nursing practice. The author contends that use of this tool throughout the health care delivery system could lead to improved management of nursing care. Improvements could be made in identification of staffing requirements, justification of third party payments, development of quality assurance programs, establishment of standard terminology between nurses, and generation of an extensive and valid research data base. Nursing administrators should consider using accepted nursing diagnoses as one of the tools available to improve nursing care and to document nursing accountability.
Antibody-capture enzyme immunoassay (EIA) for the detection of Toxoplasma-specific IgM has been shown to provide significantly higher specificity than the indirect IgM EIA. A new commercially available antibody-capture EIA (PLATELIA Toxo IgM EIA) converted 99 out of 100 false-positive Toxo-plasma IgM determinations to true negative. Experiments using Toxoplasma IgM calibrators demonstrated the antibody-capture EIA is approximately eightfold more sensitive than a new automated microparticle EIA for Toxoplasma IgM antibodies (IMX Toxo IgM EIA), and approximately equal in sensitivity to the indirect immunofluorescence assay. Precision studies of the antibody capture EIA using low, medium, and high calibrators gave coefficients of variation ranging from 3.0%-4.5% for within-run and 5.2%-11.4% for run-to-run variation experiments. Interference from high levels of bilirubin, albumin, hemoglobin, and lipid was not detected. Sera from patients with inflammatory or infectious disorders were tested for interference in the antibody-capture EIA. False-positive Toxoplasma IgM results were not observed, but low-level negative interference was detectable when patient sera was mixed with Toxoplasma-positive sera. Preparations of purified human IgM also produced negative interference in the antibody-capture EIA for Toxoplasma IgM.
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In the early 1970s the need for a precise and computerizable language of nursing phenomena was identified. This need stimulated the formation of the National Conference Group for the Classification of Nursing Diagnoses. The group began the work of identifying nursing diagnoses and developing a taxonomic structure for their classification. Based on the initial success with the development of nursing diagnoses, the conference group became the North American Nursing Diagnosis Association (NANDA). There are two benefits of taxonomic development within nursing: one is scientific in nature, while the other is applied or practical. The development of this taxonomy has occurred over a span of 17 years including nine national conferences. Details of this development have been abstracted from the proceedings of the nine conferences and the minutes of the Taxonomy Committee in order to explicate the taxonomic structure. The rules for the classification, developed by the committee, are presented. Future directions for taxonomic development and collaboration with other health care professions are proposed.
In the process of placing diagnoses into Taxonomy I, certain inconsistencies became apparent. Inadequate definition of both diagnoses and human response patterns, lack of defining characteristics, and inconsistency in the levels of abstraction within the taxonomic hierarchy made the task of assigning a diagnosis to a taxonomic pattern difficult. Ambiguity in the definitions of the nine patterns resulted in ambiguity in the basic foundation, which affected the entire structure. The Taxonomy Committee, before evaluating the current structure, had to make the following decisions regarding the current human response patterns: (1) Should the nine human response patterns be retained for further taxonomic work? and (2) If they are retained, what should be the first step in examining Taxonomy I-Revised? This second article in a series of four will familiarize the readers with the process and decisions by which Taxonomy II of the North American Nursing Diagnosis Association (NANDA) is evolving through the work of the Taxonomy Committee. This article also will identify the specific problems encountered in the development of Taxonomy I and Taxonomy I-Revised, and describe the steps establishing the validity of the process of formation of the nine human response patterns.
A number of persistent issues in the nursing diagnosis community have challenged the ability of one nursing diagnosis taxonomy to account for nursing's practice. The North American Nursing Diagnosis Association (NANDA) Taxonomy Committee, charged with the preparation of one taxonomy for all, has struggled with some of these issues and has initiated development of axes. The issues, figuratively speaking, become the axes. The axes are intended to describe the dimensions of the human condition. This article, third in a series of four, describes the process and development of the proposed axes.
The decision to utilize dental treatment often rests with a nursing home resident's family member or guardian, and factors associated with family member/guardian acceptance of dental services for residents have not been identified. This paper reports the results of a study which found that nearly 66% of nursing home residents' next of kin identified themselves as being primarily responsible for making health care decisions for the residents. Among these 109 resident/next of kin pairs, utilization of dental services by the residents was associated with younger next of kin, next of kin with higher levels of education, and next of kin who perceived dental need for the resident. In addition, residents who were female, physically mobile, not mentally alert, dentate, and had fewer years of education had dental services accepted for them at a higher rate than did residents who were male, physically immobile, alert, edentulous, or had more years of education. Findings suggest that more effort should be directed at educating the next of kin of nursing home residents in the value of dental care among the elderly.
This article is a discussion of the research trends concerning noncompliance, ethical concerns about noncompliance with prescribed treatment of chronic disease, requirements for ethical practice concerning noncompliance and chronic illness, and needed research about the relationship between noncompliance and coping with chronic disease. Questions are proposed to guide specific research concerning the ethics and therapeutic regimen compliance of patients with chronic cardiac disease.
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