Introducing ICD-10 into psychiatric coding practice: a WA experience.
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Abstracting and Indexing↗
Biomedical subjects
K Ahern
Publications and source records attributed to K Ahern.
National correct coding initiative affects CPT reporting.
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Abstracting and Indexing↗
Total iron-binding capacity-estimated transferrin correlates with the nutritional subjective global assessment in hemodialysis patients.
We examined the value of transferrin concentrations in estimating nutritional status as determined by the subjective global assessment (SGA) score. Fifty-nine hemodialysis patients (37 men and 22 women, aged 59+/-16 years, dialyzed for 3.6+/-3.9 years) were selected by predetermined criteria. All received erythropoietin (EPO) and oral iron therapy. SGA evaluation was conducted twice by both a dietitian and a physician. Serum iron, total iron-binding capacity (TIBC; which is linearly correlated with transferrin), transferrin saturation ratio, ferritin, albumin, total protein, and cholesterol were measured. Twenty-seven (46%) patients were well nourished (group A), 20 (34%) were moderately nourished (group B), and 12 (20%) were poorly nourished (group C) according to the SGA. TIBC values were 276+/-47 mg/dL, 217+/-54 mg/dL, and 176+/-41 mg/dL, respectively (P < 0.00001), and thus directly correlated with the state of nutrition. The relationship between TIBC and nutritional status was independent of age and number of years on hemodialysis. Serum ferritin values were 104+/-93 ng/mL, 161+/-154 ng/mL, and 363+/-305 ng/mL, respectively (P < 0.0003), and thus inversely correlated with the state of nutrition. Transferrin saturation ratios were slightly higher in the severely malnourished patients. The number of years on dialysis were a determinant of nutritional status. These values were 2.4+/-2.4 years for group A, 3.9+/-4.0 years for group B, and 5.7+/-3.9 years for group C (P < 0.05). The average age of the poorly nourished patients was 10 years older than the well-nourished patients. Serum iron values were lower but transferrin saturation ratios were higher in the severely malnourished patients. The required EPO doses were higher in the poorly nourished patients. We suggest that transferrin values are superior to other laboratory tests in assessing nutrition and will supplement SGA criteria. Serum ferritin may be useful as a predictor of illness. Older patients who have been on dialysis longer warrant special concern. Malnutrition may be an indicator of EPO resistance in dialysis patients. Finally, since a decreased TIBC level in poorly nourished patients may erroneously increase the transferrin saturation ratio, our findings may have implications in making the diagnosis and treatment of anemia and iron deficiency in malnourished dialysis patients.
Adult↗
The professional consequences of whistleblowing by nurses.
When nurses encounter misconduct in the workplace, their ethical codes of conduct bind them to the role of patient advocacy and compel them to safeguard the patient from harm. However, reporting misconduct can be personally and professionally risky. The aim of the research was to examine the professional consequences of whistleblowing and nonwhistleblowing in nursing. A descriptive survey design was used to examine the professional effect of reporting misconduct (whistleblowing) and not reporting misconduct (nonwhistleblowing). Ninety-five respondents were included in the study; 70 were self-identified as whistleblowers and 25 were self-identified as nonwhistleblowers. Results indicated that there were severe professional reprisals if the nurse reported misconduct, but there were few professional consequences if the nurse remained silent. Official reprisals included demotion (4%), reprimand (11%), and referral to a psychiatrist (9%). Whistleblowers also reported that they received professional reprisals in the form of threats (16%), rejection by peers (14%), pressure to resign (7%), and being treated as a traitor (14%). Ten per cent reported that they felt their career had been halted. These findings suggest that when nurses identify and report misconduct in the workplace, they may experience serious professional consequences.
Adolescent↗
Whistle-blowing: effective and ineffective coping responses.
How do nurses respond when they identify misconduct in patient care settings? The authors used a descriptive survey (N = 95) to identify effective coping strategies of whistle-blowers (n = 70) and non-whistle-blowers (n = 25). Results identified four effective coping strategies used by whistle-blowers. The authors offer recommendations to nurses who encounter misconduct in their workplace.
Adaptation, Psychological↗