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Biomedical subjects

R M Grimes

Publications and source records attributed to R M Grimes.

At least 19 recordsLinked to original sources
PubMed2000

Training of obstetric nurses and HIV testing in pregnancy at a managed care organization.

The purpose of this study was to evaluate the effectiveness of an HIV Training Programme for obstetric nurses at a managed care organization. Nurses were trained to counsel pregnant women about the HIV antibody test according to the latest recommendations made by the US Public Health Service and the Texas legislature. Training improved the nurses' overall knowledge about the content of the programme and nurses were more likely to offer the HIV test to all pregnant women. Still, contrary to what was predicted, the nurses did not give more information to increase the knowledge pregnant women had about HIV infection, transmission and available treatments. However, pregnant women who received prenatal care after the nurses attended the programme were more likely to be tested than women who received prenatal care before the nurses were trained (96% versus 48%); in turn, the likelihood that high-risk women would be tested for HIV also increased (94% versus 60%). There was no evidence that mandatory testing with right of refusal would deter pregnant women from being tested for HIV. The increased rate of HIV testing was attributable to the providers asking their patients to be tested rather than on their patients' knowledge of its benefits.

Adult↗
PubMed1999

Legal considerations in screening pregnant women for human immunodeficiency virus.

This article examines the legal implications of studies showing that the probability of maternal-to-infant human immunodeficiency virus transmission can be reduced by physician interventions. These interventions require knowledge of a pregnant woman's human immunodeficiency status. Hence the offering of human immunodeficiency virus testing has become a standard of care in pregnancy. This standard of care is examined with respect to the following: (1) the physician's legal duty to the infant, (2) negligence for failing to test, (3) liability when testing only reduces the probability of transmission, (4) damages, (5) informing women about the results of their testing, (6) protecting against liability, and (7) dealing with human immunodeficiency virus-infected pregnant women. It is concluded that the physicians are likely to have legal difficulties if a human immunodeficiency virus-infected baby is born to a woman who was not offered testing or if testing is done without documenting consent. Suggestions are made for reducing liability when testing is done, when patients refuse testing, and when one is caring for human immunodeficiency virus-infected women.

Female↗
PubMed1999

A preliminary study of African-American physician involvement in the care of HIV-infected patients.

In 1995, questionnaires were sent to the mailing list of the National Medical Association (NMA). The mail responses were supplemented by questionnaires distributed at the NMA annual meeting. Of the 709 respondents, approximately 63% were primary care providers, pediatricians, or obstetrician-gynecologists; 72% were treating from zero to 10 human immunodeficiency virus (HIV) patients while 9% were treating > 90 HIV patients; and 12% had been treating HIV patients > 10 years. The majority of these patients were African American; male-to-male sex and injecting drugs were the two major risk factors. Complexity of HIV care and lack of reimbursement were the principal barriers to providing HIV care. The burden of providing HIV care is borne by a relatively small number of physicians, and African-American physicians are actively involved in this care. Programs are needed to increase the number of African-American providers treating HIV patients and to provide appropriate reimbursement for providing this care.

Black or African American↗
PubMed1998

HIV/AIDS practice patterns, knowledge, and educational needs among Hispanic clinicians in Texas, USA, and Nuevo Leon, Mexico.

Hispanic clinicians in Texas, United States of America, and in the neighboring state of Nuevo Leon, Mexico, were surveyed to determine their educational needs in the area of HIV/AIDS. Two-thirds of the 74 Texan and 22% of the 104 Mexican physicians queried had seen at least one HIV/AIDS patient in the previous year. The majority of the respondents were primary care physicians who: 1) were in private practice; 2) saw more than 1,000 patients per year; 3) had been out of training for more than 10 years; 4) provided some HIV prevention education to patients based on their perceived risk of infection; 5) rated their own knowledge of HIV/AIDS as average but rated their knowledge of treatments for the disease below average; 6) received most of their information about HIV/AIDS from journals rather than formal continuing education programs; 7) thought Hispanic patients had special needs with regard to HIV/AIDS care; and 8) were willing to attend education programs to improve their HIV/AIDS management skills. The greatest barriers to caring for HIV patients were lack of clinical knowledge and fear of infection. These results point to a need for a large-scale training program to improve the HIV/AIDS management skills of Hispanic clinicians in Texas and Nuevo Leon.

Acquired Immunodeficiency Syndrome↗
PubMed1998

HIV/AIDS education survey for mental health professionals.

A total of 6804 mental health professionals, e.g., licensed and certified psychologists, licensed professional counselors, in Arkansas, Louisiana, New Mexico, Oklahoma, and Texas were mailed a questionnaire regarding HIV/AIDS topics professionals might recommend for educational programs. Participants were asked to rate how strongly they would recommend each topic. The return rate was 31% (2121). The percentage of participants who did not recommend the topics was low (0.7%-10.9%). Most topics were either recommended (6.5%-50.2%) or strongly recommended (29.0%-92.8%). Topics with ratings of 80% of participants endorsing the strongly recommended rating included psychological crises associated with learning one is HIV positive, psychosocial issues, and counseling dying clients regarding grief, loss, and legal issues. The results are discussed in terms of continuing to develop educational programs targeting mental health professionals.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Oropharyngeal lesions in AIDS.

Any physician who is treating HIV-infected patients can expect to deal with individuals who are or will be experiencing the physical manifestations of the disease. Fortunately, most of these conditions can be successfully treated; other cases have palliative treatments that can improve quality of life and assist in pain reduction and suffering. All patients with HIV need to be managed jointly throughout their illnesses so that these patients do not receive conflicting advice, prescriptions, and so forth. Also, patients benefit from receiving care from the specialist that is most appropriate for their condition. The physician or dentist working alone can often help the patient; when they work together, however, optimum care is likely the result.

AIDS-Related Opportunistic Infections↗
PubMed1997

Minimizing the risk.

Explore the source record for details and available documents.

Centers for Disease Control and Prevention, U.S.↗
PubMed1997

The advanced practice nurse in primary care: responsibility for reporting infectious diseases.

Advanced practice nurses are increasingly practicing in primary care settings where they are diagnosing and treating infectious diseases. Care is not complete until these conditions are reported to the local health department. Reporting is not optional--it is the law in every state. This article critiques case studies where disease reporting did not occur, reviews the evidence on noncompliance with reporting laws, discusses reasons for reporting, describes how state laws vary with respect to reporting, and presents steps to assist the advanced practice nurse in reporting infectious diseases.

Disease Notification↗
PubMed1996

Oral manifestations of HIV infection.

OBJECTIVE: To provide a comprehensive, literature-based guide to the diagnosis of and the management and referral of patients with oral diseases associated with human immunodeficiency virus (HIV) infection. DATA SOURCES: The literature was reviewed to identify common oral manifestations of HIV infection, the physical and laboratory findings associated with them, and the therapies used to treat them. The National Library of Medicine's AIDSLINE database was searched using the term "mouth diseases." Additional references were identified from the bibliographies of these articles and related textbooks. STUDY SELECTION: English-language abstracts were reviewed to determine each paper's clinical relevance. To be considered clinically relevant, a paper had to describe the physical appearance of oral manifestations, methods used to diagnose oral manifestations, or treatment and referral guidelines. More than 600 abstracts were identified. DATA EXTRACTION: After the abstracts were reviewed, articles were selected and were reviewed for possible inclusion. If both of two reviewers agreed that an article was clinically relevant and dealt with conditions that occurred in more than 1% of HIV-infected patients, the article was included. DATA SYNTHESIS: 16 conditions that occur in more than 1% of HIV-infected patients were identified. Information on these conditions was collected and sorted into three categories: clinical appearance, diagnostic methods, and treatment. CONCLUSIONS: Almost all patients with HIV infection will contract oral diseases. Guidelines for recognizing, diagnosing, and managing these conditions are presented. Most conditions can be treated or alleviated through the combined efforts of the physician and the dentist.

HIV Infections↗
PubMed1996

Tuberculosis control in health care workers: an algorithmic approach.

Health care workers have always been at risk for contracting tuberculosis (TB) from patients with active disease. In addition, health care workers who have active TB pose a risk for transmitting TB to patients. As a result, institutions that employ health care professionals must adopt programs to reduce the probability of transmission of TB to their employees or their patients. This article discusses the new guidelines for preventing TB issued by the Centers for Disease Control and Prevention and suggests approaches for adapting the guidelines to the needs of individual institutions. It emphasizes the importance of skin testing for early detection, correct interpretation of the tests, the approaches to determining who should be tested, and the relative frequency with which employees should be tested. It presents algorithms to assist employee health and infection control personnel in screening current and prospective employees, and in responding to positive and negative test results, and the booster effect.

Algorithms↗
PubMed1996

The epidemiology of AIDS/HIV infection: a review for the dentist.

This article reviews 14 recently published articles on the epidemiology of human immunodeficiency virus (HIV) infection. Each article is summarized and evaluated for its usefulness in helping the practicing dentist to perform the various roles of diagnosing and treating disease, managing auxiliary staff, providing community leadership, and educating fellow professionals and patients. Each article was selected based on timeliness, accuracy, and accessibility by a panel of two dental school faculty members, a physician and HIV information specialist, and a school of public health faculty member with extensive experience in HIV and acquired immune deficiency syndrome (AIDS).

Acquired Immunodeficiency Syndrome↗
PubMed1994

Evidence of intraprison spread of HIV infection.

BACKGROUND: Individuals entering prison are known to have high rates of human immunodeficiency virus (HIV) infection, and inmates are known to engage in high-risk behavior. This suggests the potential for intraprison spread of HIV infection, but this has not been documented. METHODS: All prisoners (N = 556) in the Florida Department of Corrections who had been continuously incarcerated since 1977 were identified. The medical records of these prisoners were reviewed to determine whether they had been tested for HIV infection and, if tested, whether the results were positive. Results were considered positive if there were reactions to two enzyme-linked immunosorbent assays confirmed by Western blot assay. If an individual tested positive, the medical record was reviewed to determine whether the patient had been treated for conditions consistent with HIV infection. RESULTS: Eighty-seven of the 556 prisoners had undergone testing for HIV infection. Of the tested inmates, 18 (21%) were found to be positive for HIV infection. Eight of these individuals had no HIV-related conditions, and 10 had HIV-related symptoms. CONCLUSIONS: The results present strong evidence for intraprison transmission of HIV infection. Given that most inmates serve relatively short sentences, there is a strong possibility that prison-acquired HIV infection will be carried into the "free world." Preventive programs in prisons may be very important in controlling HIV infection in our society.

Adult↗
PubMed1993

Potential bias in teacher referrals to the school nurse.

Education literature suggests gender, race, and socioeconomic status of students influence the quality and quantity of interactions with their teachers. Studies show that teachers favor White, male, and upper-income children. This preliminary study was conducted to determine if bias was evident in teacher referrals to the school nurse. Referrals from seven elementary schools were studied. The 117 children referred for nonroutine nursing intervention during the nine-week period were compared with 3,787 children not referred. Results showed no differences by gender, but significant differences occurred by socioeconomic status and race (p < .001). When controlling for gender and race, no differences existed between White males and African American males. However, significantly (p < .001) more African American females were referred than White females.

Adolescent↗
PubMed1993

HIV infection and AIDS in Texas. A Special Report.

Human Immunodeficiency Virus (HIV) infection and the Acquired Immune Deficiency Syndrome (AIDS) are significant public health problems in Texas. This paper summarizes the most recent information on HIV infection and AIDS from global, national, and state perspectives. Current information on the manifestations of HIV infection and AIDS which are important to dentistry, ramifications for dental health care workers, and initiatives for HIV/AIDS education for dental health care workers in Texas are presented.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Management of HIV infection: a summary of summaries (I).

Often the hardest task in managing HIV-infected patients is keeping up-to-date on the latest in HIV care. Presented here is a summary of 32 current, accessible articles for the primary care physician.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Case-mix groups for VA hospital-based home care.

The purpose of this study is to group hospital-based home care (HBHC) patients homogeneously by their characteristics with respect to cost of care to develop alternative case mix methods for management and reimbursement (allocation) purposes. Six Veterans Affairs (VA) HBHC programs in Fiscal Year (FY) 1986 that maximized patient, program, and regional variation were selected, all of which agreed to participate. All HBHC patients active in each program on October 1, 1987, in addition to all new admissions through September 30, 1988 (FY88), comprised the sample of 874 unique patients. Statistical methods include the use of classification and regression trees (CART software: Statistical Software; Lafayette, CA), analysis of variance, and multiple linear regression techniques. The resulting algorithm is a three-factor model that explains 20% of the cost variance (R2 = 20%, with a cross validation R2 of 12%). Similar classifications such as the RUG-II, which is utilized for VA nursing home and intermediate care, the VA outpatient resource allocation model, and the RUG-HHC, utilized in some states for reimbursing home health care in the private sector, explained less of the cost variance and, therefore, are less adequate for VA home care resource allocation.

Aftercare↗