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Biomedical subjects

S S Cook

Publications and source records attributed to S S Cook.

17 recordsLinked to original sources
PubMed1997

Configuring childbirth education to survive in managed care.

Managed care plans, especially in capitated systems, have not recognized the value of childbirth education for facilitating the transition to parenthood, especially for first-time parents. Advanced practice nurses, who are the logical facilitators and teachers of such programs, have not always made cogent arguments for inclusion of childbirth education. Physicians have been embroiled in their own issues regarding managed care. The interaction of these three forces creates serious but not insurmountable constraints for providing comprehensive, cost-effective quality care for childbearing families.

Female↗
PubMed1996

Educational innovation in a time of change.

At Columbia University School of Nursing, excellence in clinical practice has always been a major mission. The upheaval and rapid change in the current health care climate make meeting this goal difficult, especially in implementing educational innovations which might better prepare students for the practice world. This article explores the market forces, professional issues, and collaborative interactions that create both positive and negative influences on educational innovation.

Diffusion of Innovation↗
PubMed1994

Nurses and technology. Maintaining a balance between intervention and nurturing for childbearing women. A commentary on Dr. Inger Stauning.

Invasive and noninvasive medical technology are employed frequently in the health care of women, particularly childbearing women, often without any demonstrable benefit. Nurses are in a position to be advocates for their childbearing patients and to define and implement a realistic balance between supportive or facilitative caring and technical interventions.

Delivery of Health Care↗
PubMed1992

Unilateral facet dislocation of the lumbosacral junction.

Fracture-dislocation of the lumbosacral junction is an extremely rare injury. The authors are aware of only 24 reported cases. Only seven of these were unilateral facet dislocations. In this report, the authors review their experience with four cases of unilateral facet dislocations at the lumbosacral junction. In one of these cases, there was a pre-existing spondylolysis at L5, and the patient sustained a concomitant sacral fracture. From their review, the authors recommend the use of open reduction with internal fixation and lumbosacral fusion as the treatment of choice for this injury.

Adolescent↗
PubMed1991

Transfusion practice in central Virginia.

Increasing concern about the safety of transfusions and a desire to balance blood supply and blood needs stimulated a regional blood center to study the utilization of blood, rather than simply looking at distribution. A comprehensive survey of transfusion use, including packed red cells (RBCs), fresh-frozen plasma (FFP), and platelets (PLTs), was conducted in 12 Central Virginia hospitals. The medical records of 2579 transfused patients showed that the principal diagnoses in 23 percent of patients involved diseases of the circulatory system and those in 16 percent involved neoplasms, as classified under the diagnosis-related groups. Sixty-six percent (n = 1691) of patients had some type of surgery, with surgical patients overall using 1.9 times as many units of blood (RBCs, FFP, and PLTs) as nonsurgical patients. Mean patient age was 61 years, and the male:female ratio was 48:52 percent. This descriptive analysis of regional blood utilization has facilitated planning for local blood needs, provided indicators for areas of largest blood use, and given this region and others baseline data for future comparison.

Adolescent↗
PubMed1988

Protection against acute lethal viral infections with the native steroid dehydroepiandrosterone (DHEA).

A significant protective effect of a native adrenal steroid, dehydroepiandrosterone (DHEA), was demonstrated in studies of two lethal viral infection models in mice: systemic coxsackievirus B4 and herpes simplex type 2 encephalitis. The steroid was active either by long-term feeding or by a single subcutaneous injection. A closely related steroid, etiocholanolone, was not protective in these models. Histopathological analysis, leukocyte counts, and numbers of spleen antibody forming cells in the coxsackievirus B4 model suggests that DHEA functions by maintaining or potentiating the immune competence of mice otherwise depressed by viral infection. DHEA was not effective in genetically immunodeficient HRS/J hr/hr mice and did not demonstrate antiviral activity in vitro. While the molecular basis for DHEA's effect on the immune system is not known, studies by others suggest that it may counteract the stress related immunosuppressive effects of glucocorticoids stimulated by viral infection. Because DHEA is a native steroid that has been used clinically with minimal side effects, the utility of DHEA in the therapeutic modulation of acute and chronic viral infections including the acquired immune deficiency syndrome deserves intensive study.

Animals↗
PubMedDate not supplied

Assuring quality and access in advanced practice nursing: a challenge to nurse educators.

In an environment characterized by a projected over-supply of primary care providers and a public seeking higher quality, cost-effective care, advanced practice nurses will be measured not only by their comparative value in delivering conventional primary care, but also by the uniqueness of their contributions to health outcomes. These value-added skills, distinctive to nursing practice at all levels, include health education, disease prevention, health promotion, community resource access, and partnerships with patients. Government, private payors, and national and state regulators all authorize increasingly independent practice by advanced practice nurses. When advanced practice nurses assume such fully accountable primary care roles, their title and certification should be distinctive to that level of practice. A Doctor of Nursing Practice (DNP) degree would signal to the public that nurses--at their highest practice competency--are at the same level as other health professionals holding doctorates (such as MD, DDS, or PharmD).

Clinical Competence↗
PubMedDate not supplied

Variation in the use of breast-conserving therapy for Medicare beneficiaries in Virginia: clinical, geographic, and hospital characteristics.

BACKGROUND: Treatment for early-stage breast cancer has evolved significantly in recent years. Breast-conserving therapy (BCT) has been shown to offer equivalent survival compared to traditional mastectomy. However, there is marked variation in the performance of BCT which may not reflect clinical appropriateness or patient preference. Little is known about the factors related to variation in BCT performance in older women with early-stage breast cancer. METHODS: Retrospective claims analysis of 1,512 Medicare patients using part-A data for the years 1992 to 1993, with additional explicit chart review. A clinical algorithm was developed to categorize patients according to their candidacy for BCT and compare this to their treatment. Demographic, clinical, and geographic variables were included in the model. RESULTS: The overall BCT rate in Virginia was 20%, with marked variation among providers of all types. BCT rates ranged from 0% to 44% among hospitals caring for more than 12 cases per year. Twenty-six percent of patients considered good candidates for BCT by current guidelines received this option. Large urban hospitals had significantly higher rates of BCT than smaller hospitals, regardless of the presence of radiation oncology capability. Distance from radiation oncology facilities was a factor in low BCT rates of rural populations, but low BCT rates also were present even in facilities with access to radiation oncology services. CONCLUSIONS: These data present a detailed analysis of the patterns of BCT for Virginia Medicare beneficiaries with early-stage breast cancer. Clinical contraindications to BCT for confirmed early-stage disease were uncommon. Despite similar patient profiles and hospital-reported range of cancer services, marked variation in BCT rates exists. A large number of patients chose traditional mastectomy over BCT due to fears of radiation, but few received radiation oncology consultation. BCT rates were highest in hospitals with radiation oncology facilities on grounds; hospitals with facilities nearby had rates similar to those without access to radiation facilities. Patient preferences are documented poorly. This study provides further evidence that many women are receiving BCT in patterns that may not reflect clinical appropriateness for BCT nor access to necessary facilities.

Algorithms↗
PubMedDate not supplied

Red blood cell transfusions for elective hip and knee arthroplasty: opportunity to improve quality of care and documentation.

OBJECTIVES: To assess current practice for red blood cell transfusion relative to the American College of Physicians guideline for red blood cell transfusion; to determine comparative rates and relative appropriateness of autologous versus allogeneic blood use; and, to assess cost implications of current transfusion practices. DESIGN: Computerized quality-of-care algorithm applied retrospectively to medical-record and blood-bank data. SETTING: Twenty-six hospitals in Colorado, Connecticut, Georgia, Oklahoma, and Virginia. PATIENTS: Medicare beneficiaries (2,137) who were hospitalized in 1993 for two elective surgical procedures: total hip arthroplasty and total knee arthroplasty. Of the 1,195 patients who received a preoperative or postoperative transfusion, 728 were excluded from the analysis because the hospital medical record did not contain the clinical documentation necessary to apply the American College of Physicians guideline to each unit transfused. The remaining 467 patients comprised the sample. RESULTS: For 467 patients who underwent these two procedures and received a total of 651 units of preoperative or postoperative blood, there were 256 excess units transfused. Two hundred four of these units were autologous, and 52 were allogeneic. These excess units accounted for $48,200 of the total $121,000 direct cost of transfused units. CONCLUSIONS: These findings demonstrate that current medical records lack the documentation necessary to evaluate transfusion practice for the majority of Medicare beneficiaries undergoing elective hip and knee arthroplasty. The direct costs of preoperative and postoperative blood transfusion for these two procedures could be reduced by nearly 40% through adherence to the American College of Physicians guideline. The majority of this cost saving would be realized through reduction in unnecessary collection and use of autologous blood.

Algorithms↗
PubMedDate not supplied

Adenocarcinoma of the breast with osseous metaplasia. Report of a case with needle aspiration cytology.

A 68-year-old black female developed a painless left breast mass that increased in size over a nine-month period before the patient sought medical attention; fine needle aspiration biopsy was performed as part of the initial workup. Only occasional malignant cells were present on the slides despite the use of a good aspiration technique on this large mass. The additional finding of rare osteoblasts and multinucleated cells, interpreted as osteoclasts, suggested osseous metaplasia within the lesion. The diagnosis of osseous metaplasia in an infiltrating ductal carcinoma of the breast was therefore suggested by careful cytologic screening of the material from a firm lesion that yielded smears with otherwise inexplicably low cellularity.

Adenocarcinoma↗