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Biomedical subjects

R M Kleinpell

Publications and source records attributed to R M Kleinpell.

At least 19 recordsLinked to original sources
PubMed2000

Colesevelam hydrochloride: a non-absorbed, polymeric cholesterol-lowering agent.

Colesevelam hydrochloride (formerly known as Cholestagel((R)) and re-named WelCholtrade mark, GelTex Pharmaceuticals, Inc. and Sankyo Parke-Davis) is a new, polymeric, high potency, water-absorbing hydrogel. It has been shown to be a safe and effective cholesterol-lowering agent with a non-systemic mechanism of action, good tolerability and minimal side effects. To date, the lipid-lowering activity of colesevelam has been evaluated in approximately 1400 subjects. Colesevelam reduces low density lipoprotein (LDL)-cholesterol levels, in a dose-dependent manner, by as much as 20% (median) in patients with hypercholesterolaemia. Dosing regimen evaluations indicate that colesevelam is effective at both once per day and twice daily dosing and that concurrent administration of colesevelam with hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins), specifically lovastatin, does not alter the absorption of the statin. Combination therapy with HMG-CoA reductase inhibitors, including lovastatin, simvastatin and atorvastatin, produces an additional reduction (8 - 16%) in LDL-cholesterol levels above that seen with the statin alone. The overall incidence of adverse effects with colesevelam alone and in combination with statins is comparable with that seen with placebo. Colesevelam lacks the constipating effect seen with typical bile acid sequestrants, a trait that would be expected to improve compliance with lipid-lowering therapy. Colesevelam, recently approved by the US FDA, represents a valuable non-absorbed alternative in the armamentarium against hypercholesterolaemia, both for monotherapy and combination therapy, as an adjunct to diet and exercise.

Allylamine↗
PubMed1999

Evolving role descriptions of the acute care nurse practitioner.

Currently, more than 1,200 advanced practice nurses have sought certification as acute care nurse practitioners (ACNPs). Surveys of practicing ACNPs have shown that the role is expanding in terms of practice settings and role components. This article reports on the results of ongoing survey with ACNPs that portray the role of the ACNP as an evolving career opportunity for advanced practice nurses.

Acute Disease↗
PubMed1999

Continuing education for advanced practice nurses.

Continuing education (CE) enables the advanced practice nurse (APN) to be apprised of practice issues and meet recertification requirements. Opportunities for obtaining CE program credits for APNs have expanded, yet uncertainty exists regarding specific program requirements for obtaining state and national certification. To obtain accurate information related to state requirements for CE for APNs, all 50 state boards of nursing were contacted by telephone in July 1998. Responses were received from all 50 states by telephone or facsimile transmission. This article outlines information related to CE for APNs including state renewal and national recertification requirements. Factors to consider when deciding on CE offerings in advanced practice nursing are also discussed.

Certification↗
PubMed1998

Reports of role descriptions of acute care nurse practitioners.

Expanded roles and practice settings are evolving for the Acute Care Nurse Practitioner (ACNP). In this study, the ACNP's role is described by 384 people seeking certification. Although ACNPs continue to work predominantly in tertiary care centers, ACNP roles in secondary and other facilities have emerged. Acute care nurse practitioners report that managing patient care; providing care consistency; interacting with family members; planning for patient discharge; and teaching the patient, family, and other members of the health care team are major focuses of the role. Changes in health care will continue to give rise to new and innovative settings for ACNP practice. Communication about the ACNP remains essential to gaining acceptance of the role and enabling its expansion.

Acute Disease↗
PubMed1997

Improving telephone follow-up after ambulatory surgery.

The number of ambulatory surgery procedures performed annually is steadily increasing. Telephone follow-up of patients after ambulatory surgery remains an important component of care for ambulatory surgery patients. The purpose of this prospective quality improvement project was to obtain a more comprehensive telephone follow-up of ambulatory surgery patients in a large metropolitan medical center. During a 3 month evaluation period, 485 patients (61% of a convenience sample of 798 who had undergone an ambulatory surgical procedure) were interviewed to determine the incidence of side effects and elicit patient satisfaction. Postoperative side effects reported most frequently included pain, bleeding, nausea, dizziness, and fever. A majority of patients reported receiving adequate discharge instructions and excellent nursing care. This quality improvement project initiated by staff nurses resulted in changes in the procedure for documenting postoperative phone assessments from narrative notes to the use of a semistructured form for telephone follow-up after ambulatory surgery.

Adolescent↗
PubMed1997

What influences patients' reports of three aspects of hospital services?

OBJECTIVES: Market forces make it essential to know what policies and actions influence patients' reports of hospital services. No studies have examined the role of patient characteristics, labor quality and staff characteristics, nonlabor resources, managerial practices, and employee attitudes within a single investigation. METHODS: The authors collected, simultaneously, data about labor, management and service processes, nonlabor resources, and employee attitudes on 117 nonintensive medical-surgical inpatient units in 17 hospitals selected from a pool of 69 institutions within a metropolitan area by a stratified random sample. Of the 2,595 patients who agreed to participate, 2,051 (79%) completed telephone interviews regarding their experiences with physical care, education, and pain management services within 26 days of hospital discharge. RESULTS: A significant amount of variation in patients' service reports was explained (adjusted R2 = 0.41 physical care, 0.35 pain management, 0.44 education). Although the predictors varied for each service report, patient characteristics, especially those related to personal resources, had a large explanatory role. A labor assignment pattern that could explain why earlier studies found labor quality and staff characteristics to have only a weak role in the prediction of patients' service reports was noted. CONCLUSIONS: The results related to patient characteristics may indicate opportunities to improve care by confronting service design strategies that erroneously rely on a homogeneous patient population. Measurement challenges identified by this study must be addressed to determine the role of labor quantity and staff characteristics.

Health Care Surveys↗
PubMed1997

Acute-care nurse practitioners: roles and practice profiles.

The purpose of this study was to explore aspects of the acute-care nurse practitioner (ACNP) role. The first certification examination for ACNPs was administered in December 1995. In January 1996, all applicants were mailed a study questionnaire about their practice. Responses were received from 125 of the 136 applicants (93% response rate). Work settings included hospital-based specialty and unit-based areas, urgent-care centers, and multipractice clinics. Predominant role components were conducting histories and physical examinations, prescribing treatments, and performing therapeutic procedures. Although long hours, resistance and uncertainty about the role, and perceived low salary exist, advantages identified reflect the role's autonomy, broad scope of practice, and contributions to collaborative care. Further exploration of roles, practice issues and outcomes of care will provide additional information about this new practitioner in advanced practice nursing.

Adult↗
PubMed1997

Whose outcomes. Patients, providers, or payers?

While it is clear that measuring outcomes is important, choosing which outcomes to measure remains unclear. Controversy exists in outcomes measurement as to which specific outcome measures should be selected. Additionally, should one set of outcome measures be used for one purpose, such as comparing overall medical outcomes and another set used for another purpose, such as comparing individual patient outcomes? While it becomes obvious that comparisons would be easier if the same outcomes were used, knowing which outcomes to choose to best measure an effect is not always an easy task. The challenge in outcomes measurement comes in selecting outcomes that are comprehensive, comparable, meaningful, and accurate in their reflection of the effects of care.

Attitude of Health Personnel↗
PubMed1994

The effect of two nursing interventions on families of ICU patients.

Although much research has addressed family needs of ICU patients, only a few studies have examined interventions aimed at meeting these family needs. Therefore, the purpose of this study was to examine the effects of two interventions, a family information pamphlet and a family group session, on 60 family members of ICU patients. Results revealed no statistically significant differences between the family member groups on Critical Care Family Needs Inventory scores (p = .45), which assessed important needs, or State Trait Anxiety scores (p = .61). Consistent with previous research on families' needs, the majority of the needs identified as most important by all family members related to receiving information. Small sample sizes may have contributed to nonsignificant differences between family member groups, and study replication with larger sample sizes is recommended.

Clinical Nursing Research↗
PubMed1992

Needs of family members of intensive care unit patients.

To identify important needs of families of critically ill patients, and the degree to which these needs were being met, 64 family members and 58 nurses were asked to complete a modified version of the Critical Care Family Needs Inventory (Molter & Leske, 1983). Family members and nurses identified many similar important needs, such as the need to have questions answered honestly, the need to be called at home about changes in the patient's condition, and the need to know why things were done for the patient. However, family members indicated that some needs were both more important and less satisfactorily met than the nurses perceived: the need to know the occupational identity of staff members, directions as to what to do at the patient's bedside, and having friends for support.

Adaptation, Psychological↗