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Biomedical subjects

M G Titler

Publications and source records attributed to M G Titler.

At least 19 recordsLinked to original sources
PubMed1998

Cost-identification analysis in oral cavity cancer management.

The objectives of this study were to investigate potential relationships between pretreatment patient-mix characteristics, treatment modalities, and costs generated during the pretreatment work-up, treatment, and 1-year follow-up periods for patients with oral cavity cancer (OCC). Another objective was to identify potential areas for cost reduction and improved resource allocation in the management of OCC patients. Using a retrospective cohort of 73 patients with OCC, pretreatment patient-mix characteristics and treatment modalities were evaluated in relation to university-based charges incurred during the pretreatment evaluation, treatment, and 1-year follow-up periods. Simple regression and stepwise multiple regression analyses were used to develop predictive models for cost based on independent variables, including age, AJCC TNM clinical stage, smoking history, American Society of Anesthesiologists (ASA) class, comorbidity as defined by the Kaplan-Feinstein grade and treatment modality. The dependent measurements included all physician, office, and hospital charges incurred at the University of Iowa Hospitals and Clinics during the pretreatment evaluation, treatment, and follow-up periods, as well as the total pretreatment through 1-year follow-up management costs. Independent variables that were identified as being significantly associated with treatment costs included T classification, N classification, TNM stage, unimodality versus multimodality treatment, and the Kaplan-Feinstein comorbidity grade. Age, smoking status, and ASA class were not significantly associated with costs. The majority of the OCC management costs were incurred during the treatment period. The most substantial decreases in management costs for OCC will be realized through measures that allow identification and treatment of disease at an early stage, in which single-modality treatment may effectively be used. Resource allocation for OCC should support the investigation of measures through which the diagnosis and treatment of OCC at the earliest possible stage is facilitated. The presence of comorbid illness is a significant component in the determination of management costs for OCC and should be included in analyses of resource allocation for OCC. The singular diagnosis of OCC encompasses a wide range of patient illness severity, and diagnosis-related reimbursement schemes for OCC treatment should optimally differentiate between early and advanced stage disease.

Aged↗
PubMed1996

Issues in the development and implementation of clinical pathways.

Issues related to the development and implementation of clinical pathways require thoughtful planning, collaborative teamwork, and an understanding of the evolutionary nature of this work. Creating an understanding of the purpose behind the development of these guidelines often is only the first issue to be considered. Other common issues include physician involvement, documentation, pathway development, variance data analysis and feedback, and integration with outcomes management activities. Successfully addressing these issues is an ongoing component of a clinical pathway program.

Critical Pathways↗
PubMed1996

Use of the nursing interventions classification by critical care nurses.

A survey of 111 critical care nurses was carried out to determine the frequency with which they perform each of the 336 interventions in the NIC. Forty-nine interventions were used at least daily, indicating a set of core interventions unique to critical care practice. These findings have implications for critical care practice, education, and research.

Adult↗
PubMed1995

Discharge readiness assessment.

Discharge planning has a long and varied history in health care delivery. As length of stay declines, the health care provider has less time to educate patients and families about home care and less time to coordinate services from home health and community agencies. As a result, many patients and families are discharged with unmet home care needs and thus are at an increased risk for complications and hospital readmissions. Readiness for discharge is one part of discharge planning and is a multifaceted, multistage concept that provides an estimate of patients' and their family members' ability to leave an acute care facility. Discharge readiness assessment is the evaluation of strengths and needs in five areas: physiologic stability, competency (cognitive and psychomotor) of the patient and family to carry out self-care management regimens, perceived self-efficacy to carry out self-care management regimens, availability of social support, and access to the health care system and community resources. Each of these areas is presented as a component of discharge readiness assessment.

Chronic Disease↗
PubMed1995

Developing family-focused care.

Critical care nurses have a responsibility to provide care from a family-systems perspective in which illness is not an isolated, time-limited event, but instead a highly stressful situation that evolves from the family's history and contributes dynamically toward its future. This article discusses nurse-family relationships, strategies to promote family-focused care, and mechanisms to make family-focused care a reality.

Critical Care↗
PubMed1994

Research utilization in critical care: an exemplar.

The authors describe the process and outcome of implementing a research-based pain management protocol in four adult critical care units at a large, Midwestern tertiary care center. The project was initiated and directed by members of the divisional research committee. Strategies used to change practice included determining if pain management was a problem via quality assessment monitors, surveying nurses regarding their knowledge and attitude toward pain management, educating staff members about the research base for the practice change, using change champions in each unit, and developing a core group of nurses in each unit to facilitate the change. Outcomes of this research utilization project include a 41% decline in the number of patients in pain, a 44% decline in pain intensity, and improvement in nurses knowledge about pain.

Clinical Nursing Research↗
PubMed1994

Pain management in the critically ill: what do we know and how can we improve?

Pain management in the critically ill is a challenge and a problem of great concern for critical care nurses. The authors review research on pain in the areas of pain assessment, nurses' knowledge and attitudes, pharmacologic interventions, and nonpharmacologic interventions for the management of pain. Although the research base is not completely developed in the critically ill population, implications for practice are provided, based upon the findings in populations akin to the critically ill. Strategies are outlined for achieving improved pain control in critical care units through education, adoption of standards on pain management, and quality improvement activities.

Clinical Nursing Research↗
PubMed1994

Outcomes measurement in clinical practice.

Although nurses contribute significantly to patient outcomes, there are few data documenting the nature or magnitude of that impact and how it may vary in different practice settings or geographic regions (Lang & Marek, 1992). Only when we move beyond the theoretical into the practical application of outcome evaluation and management will we be able to have a data-driven system to articulate nursing's contribution to patient outcomes. Making this application a reality requires the vision and talents of nurses in all roles from staff nurses to administrators.

Clinical Nursing Research↗
PubMed1994

Drawing coagulation studies from arterial lines: an integrative literature review.

How much blood must be discarded from a heparinized arterial line to obtain accurate coagulation studies, specifically activated partial thromboplastin time? The published literature provides insight into the question and guidelines for practice in adult critical care. This article reviews and integrates findings from 14 research studies published from 1971 to 1993 on discarding blood from arterial lines for coagulation studies. Investigators compared activated partial thromboplastin time values from arterial and venous blood samples using various discard volumes, sites and sizes of catheters, and heparin flush concentrations. Similarities and differences in arterial and venous activated partial thromboplastin time were reported. Studies have demonstrated that adequate discard volume for activated partial thromboplastin time is 6 times the catheter dead space. These results should not be generalized to systemically heparinized patients, pediatric patients, or other types of heparinized lines such as pulmonary artery, central venous, or Hickman catheters.

Blood Specimen Collection↗
PubMed1993

Group functioning of a collaborative family research team.

Collaborative research teams are an attractive means of conducting nursing research in the clinical setting because of the many opportunities that collaboration can supply. These opportunities include a chance to: (1) network with other nurses who have similar interests, (2) share knowledge and expertise for designing clinical studies that directly affect daily practice, (3) develop instruments, (4) write grant proposals, (5) collect and analyze data, and (6) prepare manuscripts for publication. The effectiveness of research teams, however, is strongly influenced by group functioning. This article describes the functioning of a collaborative family interventions research team of nursing faculty members and CNSs at a large Midwestern university setting. The formation of the group and membership characteristics are described, along with strategies used to identify the research focus and individual and group goals. Aspects related to the influence of the group on members and the internal operations of the group are also addressed. Future strategies to be explored will focus on the size of the group and joint authorship issues. The authors also set forth a number of recommendations for development of collaborative research groups.

Clinical Nursing Research↗
PubMed1993

Behavioral responses of family members during critical illness.

This articles describes the behavioral responses of adult family members to critical illness and how these responses change over the course of the hospitalization. A convenience sample of 52 family members of patients in intensive units completed the Iowa ICU Family Scale, a self-report tool measuring sleep, eating, activity, family role, and support behaviors. Scales were completed by family members each day during the first week and then weekly throughout the patient's ICU stay. Family members reported sleeping less with a poorer quality of sleep, less nutritional intake, an increased use of cigarettes, alcohol, and over-the-counter and prescription medications, and spending more time talking, visiting the patient, and waiting. Stress was highest at the time of the ICU admission, began to plateau at Day 6, and then dropped considerably by Day 28. These findings suggest that crisis intervention is important during the early phase of caring for critically ill patients and their family members.

Adaptation, Psychological↗