PubMed Health⌕ Search

Biomedical subjects

S Diwan

Publications and source records attributed to S Diwan.

17 recordsLinked to original sources
PubMed2001

Agitation and dementia-related problem behaviors and case management in long-term care.

Existing data on case management (CM) time were analyzed to investigate the impact of agitation and dementia-related behavior problems on the use of CM time by older clients (N = 242) in a Medicaid waiver-funded home and community-based services program. Among clients with dementia (n = 73), regression analysis revealed that having problem behaviors resulted in increased use of CM time. Among clients with behavior problems, those with greater functional ability consumed greater CM time. Content analysis revealed that most CM activity focused on service coordination rather than on direct attempts to manage problem behaviors. Implications for CM programs include the need to consider case mix when allocating caseload size and provision of specific training on interventions to address behavior problems.

Adult↗
PubMed2001

Assessing need for intensive case management in long-term care.

This article presents a brief screening tool to help case managers identify clients in a home- and community-based services (HCBS) program who need more intensive social work case management (CM). Using existing data from a case management time study (N = 242) and a content analysis of 70 cases in a Medicaid waiver-funded HCBS program, this study highlights a number of issues, such as dementia-related behavior problems, noncompliance with treatment, poor informal caregiver health and mental health, and a conflicted or problematic relationship between client and caregiver, which are useful in predicting need for intensive case management. Kappas for interrater reliability and t tests for discriminant validity show these items to be reliable and valid. This tool will allow for better allocation of CM resources in terms of case manager time and type of expertise needed to address these issues.

Aged↗
PubMed1999

Allocation of case management resources in long-term care: predicting high use of case management time.

The expansion of publicly funded home care services and case management (CM) programs has fueled concerns about containing the costs of these programs. For CM practice, the issue is one of tailoring CM to those who really need it and are most likely to benefit from it. This concern calls for a better understanding of factors that increase the need for CM resources, defined as the use of CM time. This study of 242 clients in a Medicaid-waiver-funded home care program found clients' problem behaviors, higher functional ability, informal support problems, and problems with service provider agencies to be predictive of greater use of CM time. These findings suggest the need to develop appropriate assessment of problem areas, implement effective protocols to manage specific problems, and address such issues as appropriate levels of staffing and provider accountability.

Adult↗
PubMed1997

Composition of the home care service package: predictors of type, volume, and mix of services provided to poor and frail older people.

This study of 270 poor and frail elders in a Medicaid waiver program examined the service package, that is, the type of service (health or social), volume, and the mix or combinations of services provided. Predictors of use and volume of service differed depending on type of service. The most frequently prescribed service combinations were: (a) nursing, home health, and homemaker; (b) homemaker only; (c) nursing and home health; (d) nursing and homemaker; and (e) nurse only. Across the service combinations, living alone increased the odds of receiving social services such as a homemaker, whereas declining primary ADL function increased the odds of receiving health services such as a home health aide.

Aged↗
PubMed1997

Inherited factor X deficiency in two brothers.

Two brothers born to same parents were diagnosed with inherited factor X deficiency of severe type. Clinical presentation in both the cases were haemarthrosis. The elder brother was diagnosed in the year 1991 when he was four and half years old. Recently the youngest child in the family also presented with haemarthrosis at age of one and half years. Diagnosis was made by abnormal results of Coagulation factors screening mainly Prothrombin time, Activated partial thromboplastin time, Russell's viper venom test, mixing tests factor X assay. Both the brothers had Factor X activity less than one percent.

Child, Preschool↗
PubMed1996

Negotiating advance directives for persons with AIDS.

A focus group was conducted to determine the views of persons with AIDS about how to best conduct the process of establishing advance directives. (Advance directives are instructions regarding future medical care to be implemented should a patient be unable to communicate his/her treatment preferences.) Several hypotheses emerged from this focus group that were then formally tested with a questionnaire. The results of the questionnaire identified (a) predictors of attitudes toward advance directives and (b) predictors of the act of having established a directive. Based upon the findings from the focus group and the questionnaire, recommendations for social workers raising the issue of advance directives can be made. First, time for the client to adjust to seropositive notification should be allowed prior to raising the advance directive issue. Second, the advance directive issue should be raised in the context of empowerment rather than being embedded in other paper work. Third, people who are most likely to be disturbed by the process of establishing advance directives are those who have low health locus of control, low trait optimism, low reliance on active involvement as a coping mechanism, and low reliance on distraction as a coping mechanism. More time should be allotted for people with those characteristics.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Supervision and quality assurance in long-term-care case management.

The role of supervision in assuring the quality of long-term-care case management has often been overlooked. This article describes a collaborative project undertaken by an Area Agency on Aging, a department of social work in an urban university, and 10 county-based senior services agencies to develop the supervisory component of quality assurance. The project included an educational workshop for supervisors, the development and implementation of a learning needs assessment, and the development of supervision plans for case management in the senior services agencies as part of an ongoing quality assurance system.

Aged↗
PubMed1994

Differences in the scalability of formal and informal in-home care of urban elderly.

Differences in the scalability of formal and informal in-home care to elderly are examined. A Guttman scale showed that exclusive use of informal in-home care was hierarchically scalable, but not when services were provided by any formal sources. There was some clustering of formal services, for example, a large number of those who received meals also used homemaker services. However, a large number of those who received nursing did not receive personal care. There was no overall pattern to the use of formal services. Implications of these findings as related to service planning and delivery are discussed.

Aged↗
PubMed1992

Percutaneous laser disc decompression: an update--Spring 1992.

Percutaneous laser disc decompression (PLDD) is being performed in multiple centers in the United States, Germany, Austria, France, and Switzerland with the Nd:YAG having the longest follow up at more than 75 months. The experience with this procedure, in both humans and animals, carried out over the past decade is presented along with a detailed discussion of the surgical procedure. Conditions that favor such surgery and contraindications to the procedure are also presented. There are a number of important advantages to PLDD that make it a procedure that merits continued investigation. Because PLDD is relatively noninvasive, it can be repeated. Because there is no cutting, there is no perispinal scar formation, with possible future pain secondary to entrapment of nerves by scar. Because of its effectiveness for treatment, the laser, in this application, should prove to be an important addition to the spinal surgeon's armamentarium.

Adolescent↗
PubMed1992

Percutaneous laser disc decompression. A new therapeutic modality.

The authors present a new advance in the treatment of herniated disc disease using percutaneous Nd:YAG laser to vaporize a small portion of nucleus pulposus, thereby decompressing the disc. In vitro and in vivo animal data are presented. Three hundred seventy-seven magnetic resonance imaging or computed tomography scan-documented, herniated, nonsequestered lumbar intervertebral discs with corresponding clinical findings in 333 patients were so treated in an outpatient setting. The longest follow-up was 62 months, with a mean of 26 months. According to the Macnab criteria, there was a good to fair response in 261 patients (78.4%), and a poor response in 72 (21.6%); 166 patients experienced relief of pain during the procedure. One-third of repeat magnetic resonance imaging scans at 4-6 months postlaser treatment showed modest to moderate decrease of disc herniation.

Adult↗
PubMedDate not supplied

ATSDR evaluation of health effects of chemicals. V. Xylenes: health effects, toxicokinetics, human exposure, and environmental fate.

Xylenes, or dimethylbenzenes, are among the highest-volume chemicals in production. Common uses are for gasoline blending, as a solvent or component in a wide variety of products from paints to printing ink, and in the production of phthalates and polyester. They are often encountered as a mixture of the three dimethyl isomers, together with ethylbenzene. As part of its mandate, the Agency for Toxic Substances and Disease Registry (ATSDR) prepares toxicological profiles on hazardous chemicals found at Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) National Priorities List (NPL) sites that are of greatest concern for public health purposes. These profiles comprehensively summarize toxicological and environmental information. This article constitutes the release of the bulk of this profile (ATSDR, 1995) into the mainstream scientific literature. An extensive listing of known human and animal health effects, organized by route, duration, and end point, is presented. Toxicological information on toxicokinetics, biomarkers, interactions, sensitive subpopulations, reducing toxicity after exposure, and relevance to public health is also included. Environmental information encompasses physical properties, production and use, environmental fate, levels seen in the environment, analytical methods, and a listing of regulations. ATSDR, as mandated by CERCLA (or Superfund), prepares these profiles to inform and assist the public.

Animals↗
PubMedDate not supplied

U.S. Food Guide Pyramid food group intake by Asian Indian immigrants in the U.S.

This study examined the food group intake and the dietary quality of middle-aged and older Gujarati Asian Indian immigrants (45 years or older) living in two urban metropolitan areas in the U.S. Participants (90 men, 99 females) completed a 24-hour dietary recall, which was used to determine if they met the daily food group intake guidelines of the U.S. Food Guide Pyramid. The overall quality of their reported dietary intake was determined using the Healthy Eating Index based on their nutrient and food group intake. Both men and women met the daily number of servings recommendations for the grains (men: 9.3 servings/day; women: 6.9 servings/day) and vegetables (men: 4.5 servings/day; women: 3.6 servings/day) groups, but did not meet the recommendations for fruits, dairy and meats groups. The total score on the Healthy Eating Index of the diets of these participants was 73, indicative of a dietary intake that does not meet the established U.S. dietary guidelines. These immigrants should be educated about appropriate food choices (ethnic and non-ethnic) within each of the U.S. Food Guide Pyramid food groups to improve the overall quality of their dietary intakes.

Dairy Products↗