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Biomedical subjects

N Schwab

Publications and source records attributed to N Schwab.

10 recordsLinked to original sources
PubMed2003

[Extended outcome assessment in endonasal sinus surgery].

BACKGROUND: Endonasal optically guided surgery has gained wide acceptance for treatment of chronic sinusitis. However, irrespective to the advent of minimally-invasive techniques, standard outcome assessment has not always reflected the increased technical and conceptual efforts. "Psychometric" instruments offer additional information on patients' perceptions of health. We analyzed the practical value of an extended outcome assessment. METHODS: Standardized interviews were carried out with 103 patients pre- and postoperatively applying several psychometrical instruments ("SF-36" and other valid general health-status instruments besides disease-specific questionnaires, providing 124 items/questions altogether). RESULTS: The diverse changes of subtle health status subscores as a rule paralleled each other and were concordant with traditional self-estimated global ratings of the surgical success by the patient. Significant postoperative changes of the "SF-36" questionnaire were especially seen in the subscale "bodily pain" and "level of energy". With few exceptions only, items reflecting any indirect burden of chronic sinusitis revealed less pronounced improvements postoperatively. CONCLUSION: It appears legitimate to question the special benefits of extended psychometric outcome research in comparison to traditional global ratings for daily surgical practice.

Adult↗
PubMed2001

Consent and release.

Because school nursing practice by definition involves delivering services to minors, school nurses often find themselves with questions about consent. Because school districts, much like other health care providers, occasionally face liability for the undesired health care outcomes of their clients (i.e., students), another question that surfaces frequently deals with release from liability. Each question must be answered based on analysis of the specific facts and applicable laws. This article provides an overview of the principles that provide school nurses with general guidance on consent issues and release of liability and, by way of example, applies them in the answers to four specific questions forwarded by practicing school nurses.

Adolescent↗
PubMed2001

[Public, decentralized and community health networks in Bolivia].

Health sector reform in Bolivia is based primarily on the principles of decentralization and equity, and with the objectives of improving quality and of expanding health services coverage in rural and low-income areas of the country. As an experiment in reform, the Bolivian Ministry of Health and Social Welfare, the department of La Paz, and the municipality of El Alto signed an agreement with a nongovernmental organization (NGO), transferring to the NGO the overall management of one of the health services networks in El Alto. The transfer was based on a management contract that had process and outcome indicators for the network. A year after implementation began, the preliminary results suggest that through the agreement the quality of management and services has improved, health services coverage has expanded, and the network's primary care services have been strengthened. Bed occupancy rates are generally very low in secondary hospitals in Bolivia, with that figure being just 43% in the department of La Paz in 1999. However, in the second 6 months of operation of the El Alto network the occupancy rate for the network's hospital reached 84%. Between the first 6 months of 1999 and the same period in 2000, outpatient consultations increased by 55% in the network (83% in the hospital and 18% in the network's primary care centers). Over that same period, institutional deliveries increased by 41% and the percentage of deliveries in the primary care centers grew from 5% of the total to 9%. A recent user survey found that 87% of the people receiving care in the network felt highly satisfied with the service they had received, and 75% of the persons surveyed said they would recommend the service to others. These are not typical data for health services in Bolivia. This pilot effort suggests that a change in the organization and management of a health services network, with a separation of the roles of purchaser and provider, combined with management based on results and with community participation in the process, can improve the quality and efficiency of those health services, stimulate demand for them, and increase user satisfaction.

Adolescent↗
PubMed2000

School health services after Cedar Rapids Independent School District v. Garret F.

In 1999, the U.S. Supreme Court ruled that "school health services" include nursing services that are required for students needing one-on-one ("private-duty") nursing care to attend school. This ruling settled opposing federal court interpretations of the Individuals with Disabilities Education Act, clarifying the rights of students with complex medical needs and the responsibility of school districts to provide them with an appropriate educational program. In responding to the challenges and opportunities raised by this decision, school nurses must understand the implications for school nursing practice and for school districts, educate their school leaders and communities, and provide leadership for creative and collaborative problem solving.

Child↗
PubMed1995

Delegation and supervision in school settings. Standards, issues and guidelines for practice (Part 1)

Part one of this article reviews nursing standards and practice issues related to the delegation of nursing activities to, and the supervision of, unlicensed assistive personnel. Part two, which will be published in a future issue, provides specific strategies, practices and resources to assist school nurses to apply these standards and concepts in their everyday school nursing practice.

Humans↗
PubMed1993

Effects of somatostatin and captopril on glomerular prostaglandin E2 production in normal and diabetic rats.

Somatostatin (SRIH) has recently been shown to be effective in reversing many of the early changes of diabetic nephropathy. It is unknown whether SRIH exerts its protective effects via its ability to suppress growth hormone (GH) or via other direct renal effects. Since changes in glomerular prostaglandin (PG) E2 production are thought to be an important part of the underlying pathophysiology of diabetic nephropathy, we sought to determine if SRIH altered glomerular PG E2 production in the rat. Whole glomeruli isolated from streptozotocin-diabetic rats and from controls were incubated with either saline, captopril, or varying concentrations of SRIH, and PG E2 production was determined by direct radioimmunoassay of media. Incubation with captopril (10(-4) M) resulted in equivalent increases in PG E2 production in glomeruli from both control and diabetic rats (140.8 +/- 12.8% and 150.2 +/- 18.9% respectively). Incubation with high concentrations of SRIH (10(-6) M) also resulted in significant increases in glomerular PG E2 production in both diabetic and control rats. However, at low SRIH concentrations (10(-10) M), glomerular PG E2 production was increased only in the diabetic rats (167.0 +/- 11.4% vs 95.3 +/- 9.2% in normals). We conclude that SRIH increases glomerular PG E2 production, and that glomeruli from diabetic rats appear to be more sensitive to lower concentrations of SRIH when compared to normal rats. It is possible that this effect on PG E2 production may underlie the favorable effects of SRIH on the glomerulus in diabetes.

Animals↗
PubMed1991

School health records: nursing practice and the law.

School nurses are increasingly faced with professional-legal dilemmas related to student health records and documentation. This article provides guidance in an often extremely confusing area, as well as recommendations for policy and practice changes that might help simplify the search for resolutions.

Child↗