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PubMed2005

Estimation of the dose to the nursing infant due to direct irradiation from activity present in maternal organs and tissues.

Radionuclides deposited internally in the mother will give rise to a radiation dose in the infant in two ways. The radionuclides may be transferred through milk and give rise to an internal dose in the infant, or the radionuclides may emit photons that are absorbed by the infant, giving rise to an external dose. In this paper, the external dose to the newborn infant caused by direct irradiation was estimated for monoenergetic photons. Voxel models (also called voxel phantoms) of the mother and infant were made in three geometries. These models, consisting of volume elements, or voxels, were designed so that the infant model was placed in the lap, at the breast and on the shoulder of the mother model. The Visual Monte Carlo (VMC) code was used to transport the photons through the voxel models. Source regions for the emitted photons, such as the whole body, the thyroid, the lung, the liver and the skeleton, were chosen. For the validation of the calculation procedure, VMC results were favourably compared with the results obtained by using other Monte Carlo programs and also with the previously published results for specific absorbed fractions. This paper provides estimates of the external dose per photon to the infant for photon energies between 0.05 and 2.5 MeV. The external dose per photon estimates were made for the three geometries and for the sources listed above. The results show that, for the geometry of the nursing infant model at the breast, the highest dose to the infant per photon comes from radionuclides deposited in the mother's liver. For the nursing infant model at the shoulder, the highest dose to the infant per photon comes from radionuclides deposited in the mother's thyroid, and for the nursing infant model in the lap, the highest dose to the infant per photon comes from radionuclides deposited uniformly in the whole body. The dose per photon results were then used to estimate the dose an infant might receive over the lactation period (6 months) due to the incorporation of 1 Bq of a radionuclide by the mother. This information may be used to provide external dose estimates to the infant in the case of a known or suspected radionuclide incorporation by the mother due to, for example, a nuclear medicine procedure.

Adult↗
PubMed1992

The potential for using non-physicians to compensate for the reduced availability of residents.

Both the number of residents and the amount of time existing residents have in which to carry out their activities may soon be decreasing. To consider the potential for alternative ways of staffing teaching hospitals, it is necessary to know how residents spend their time. The authors sought to learn this by conducting a time-motion study of eight internal medicine residents at two urban hospitals in New York City in 1988. The residents' activities were observed and coded by premedical students, and the authors independently classified the possible activities into (1) those that had to be done by a physician, (2) those that were educational only, and (3) those that could be done by a non-physician. A total of 1,726 activities of 67 kinds were coded, averaging 7.75 minutes each. The authors analyze and project their data using two models--the traditional model of care in which the physician is the primary medical manager of the patient, and an alternative model in which a midlevel practitioner, such as a nurse practitioner, would perform the day-to-day monitoring of patients. For example, the data indicate that in the traditional model, almost half of a resident's time is spent in activities that must be done by a physician, meaning that another kind of physician would be needed to do those activities if the resident were unavailable; but in the midlevel practitioner model, only around 20% of the activities would require a physician. The authors give detailed breakdowns of their data, estimate the kinds and numbers of non-physician health care professionals necessary to substitute for residents in appropriate activities, and review possible difficulties in implementing such substitutions.

Evaluation Studies as Topic↗
PubMed1998

Pain and powerlessness: the experience of living with peripheral vascular disease.

Peripheral vascular disease (PVD) is a widespread condition, the most common manifestation being a gradual occlusion of the arteries of the legs due to atheroma, which results in symptoms of ischaemia such as intermittent claudication or rest pain, ulceration and gangrene. Treatment of the condition is palliative and reconstructive, and aims to salvage the limb, restore mobility and function, and relieve pain. It usually involves attempts to revascularize the affected limb, either by surgical procedures such as bypass grafting, or by percutaneous transluminal angioplasty or thrombolysis. In some cases, it may be necessary to amputate the limb or part of it. Despite the chronicity of PVD, little is known about the ways in which individuals with vascular disease cope with their condition and about the effect it has on their life. In this context the aims of this study were to explore the lived experience of peripheral vascular disease, in order to identify key themes and categories, using a phenomenological grounded theory approach. A sample of nine individuals was drawn from patients who had had vascular bypass surgery within the past 18 months. Data were collected using audiotaped one-to-one interviews and the researcher's field notes, and were validated with a group of experienced vascular nurses. Transcripts were analysed using open and axial coding techniques, and major and minor categories were identified and related to other data collected. It appeared that vascular patients experienced powerlessness in relation to the direct effects of their condition and in relation to its treatment modalities. The findings suggested that the 'acute' style of management of PVD often led to unrealistic expectations on the patient's part, which gave rise to the experience of powerlessness. The implications of these findings for the management of patients with PVD are discussed.

Activities of Daily Living↗
PubMed1990

Language as research data: application of computer content analysis in nursing research.

Statements from clients are valuable research data in nursing. Traditional analysis of such data can be labor intensive and difficult to code reliably or to adapt to group comparisons. The Minnesota Contextual Content Analysis, a computer-assisted analysis program, offers a systematic approach to categorizing and reducing data and to interpreting manifest and latent meaning in linguistic communications. The text is used in entirety, and reliability of coding is ensured, even with great volumes of data and multiple variables. Social context of the communication and emphasized ideas are scored variables, allowing for statistical procedures to further refine the interpretation of meaning. This rigorous method can aid nurse researchers in using language as research data.

Communication↗
PubMedDate not supplied

Establishing inter-rater reliability scoring in a state trauma system.

Trauma systems rely on accurate Injury Severity Scoring (ISS) to describe trauma patient populations. Twenty-seven (27) Trauma Nurse Coordinators and Data Managers across the state of New South Wales, Australia trauma network were instructed in the uses and techniques of the Abbreviated Injury Scale (AIS) from the Association for the Advancement of Automotive Medicine. The aim is to provide accurate, reliable and valid data for the state trauma network. Four (4) months after the course a coding exercise was conducted to assess inter-rater reliability. The results show that inter-rater reliability is with accepted international standards.

Abbreviated Injury Scale↗
PubMed2005

A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method.

OBJECTIVES: To validate a chart-based method for identification of delirium and compare it with direct interviewer assessment using the Confusion Assessment Method (CAM). DESIGN: Prospective validation study. SETTING: Teaching hospital. PARTICIPANTS: Nine hundred nineteen older hospitalized patients. MEASUREMENTS: A chart-based instrument for identification of delirium was created and compared with the reference standard interviewer ratings, which used direct cognitive assessment to complete the CAM for delirium. Trained nurse chart abstractors were blinded to all interview data, including cognitive and CAM ratings. Factors influencing the correct identification of delirium in the chart were examined. RESULTS: Delirium was present in 115 (12.5%) patients according to the CAM. Sensitivity of the chart-based instrument was 74%, specificity was 83%, and likelihood ratio for a positive result was 4.4. Overall agreement between chart and interviewer ratings was 82%, kappa=0.41. By contrast, using International Classification of Diseases, Ninth Revision, Clinical Modification, administrative codes, the sensitivity for delirium was 3%, and specificity was 99%. Independent factors associated with incorrect chart identification of delirium were dementia, severe illness, and high baseline delirium risk. With all three factors present, the chart instrument was three times more likely to identify patients incorrectly than with none of the factors present. CONCLUSION: A chart-based instrument for delirium, which should be useful for patient safety and quality-improvement programs in older persons, was validated. Because of potential misclassification, the chart-based instrument is not recommended for individual patient care or diagnostic purposes.

Aged↗
PubMed1999

Tsessebe, Topi and Tiang: three distinct Tc1-like transposable elements in the malaria vector, Anopheles gambiae.

Three distinct types of Tc1-family transposable elements have been identified in the malaria vector, Anopheles gambiae. These three elements, named Tsessebe, Topi and Tiang, have the potential to encode transposases that retain most of the conserved amino acids that are characteristic of this transposon family. However, all three are diverged from each other by more than 50% at the nucleotide level. Full-length genomic clones of two types, Topi and Tsessebe, have been isolated and fully sequenced. The third, Tiang, is represented only by a 270 bp, PCR-amplified fragment of the transposase coding region. The Topi and Tsessebe elements are 1.4 kb and 2.0 kb in length, respectively, and differ in the length of their inverted terminal repeats (ITRs). The Topi elements have 26 bp ITRs, whereas the Tsessebe clones have long ITRs ranging in length from 105 to 209 bp, with the consensus being about 180 bp. This difference is due primarily to variation in the length of an internal stretch of GT repeats. The copy number and location of these elements in ovarian nurse cell polytene chromosomes varies greatly between element subtypes: Topi elements are found at between 17-31 sites, Tsessebe at 9-13 and Tiang at 20 euchromatic sites, in addition to several copies of these elements in heterochromatic DNA. The copy number and genomic insertion sites of these transposons varies between A. gambiae strains and between member species of the A. gambiae complex. This may be indicative of transpositionally active Tc1-like elements within the genome.

Amino Acid Sequence↗
PubMedDate not supplied

Conducting international research in midwifery: a workshop held at the ICM Congress, Vienna, April 2002.

A workshop on international research in midwifery was held at the International Confederation of Midwives (ICM) Triennial Congress in Vienna, April 2002. Thirty-five participants from 12 countries took part. The participants themselves defined the agenda, and subsequent discussion addressed the following issues: international research relationships and collaboration; ethical conduct in international research in midwifery; the role of the International Confederation of Midwives in international research; and identifying topics for an international midwifery research agenda. Recommendations arising from this workshop were as follows: develop guidelines and a code of ethics for the conduct of international research in midwifery; continue to actively support research and further develop that support; support education and capacity building for research at basic and continuing education levels; and update on a regular basis the priorities identified for collaborative international studies.

Austria↗
PubMed2006

Visit-level acuity and resource-based relative value unit utilization in a pediatric emergency department.

OBJECTIVE: There is currently limited data on the distribution of evaluation and management (E&M) codes and resource utilization in pediatric emergency departments. We sought to ascertain the following: (1) the distribution of visit-level acuity among patients who sought care in our pediatric emergency department (PED); (2) mean relative value units per physician hour (RVUs/h) as a measure of health care provider productivity; (3) the extent of correlation between the mean number of patients seen per hour and RVUs/h; and (4) the difference in RVU's generated using observation codes versus a higher level E&M code for diagnoses that require an extended level of service. DESIGN/METHODS: The study was conducted at an urban tertiary level, university-affiliated PED in a freestanding children's hospital. After obtaining data from patient encounters during the period from January through December 2004, we calculated total RVUs by using 2004 national Medicare data that pertained to facility coding, adjusted for data from Tennessee. We also reviewed the frequency of 3 diagnoses that usually require extended care to determine disposition (status asthmaticus [International Classification of Disease-9 Diagnosis Code 493.91], volume depletion [276.5], and sickle cell disease with crisis [282.62]). Utilizing a high-level E&M code (99285) and high-level, same day observation code (99236), we compared RVUs generated for each of the earlier said diagnoses. RESULTS: During the study period, 61,444 patient encounters occurred. Of the patients seen, 4678 (7.6%) were admitted. The most common E&M code used was 99283 (53.7%). The mean RVU's/h for pediatric emergency medicine physicians and for pediatricians (and nurse practitioners) were 4.36 and 3.08, respectively. There was high correlation between RVU's/h and the number of patients seen per hour (r = 0.85). The cumulative frequency of the 3 diagnoses that required extended care was 2602. Total RVUs generated when the high-level E&M code 99285 and the high-level observation code 99236 were used was 10,408 and 15,143, respectively. CONCLUSIONS: Our descriptive study provides PED benchmarking data on E&M code distribution and RVU utilization. RVU's/h may serve as a reliable measure of productivity. Although the use of observational codes in the PED requires additional documentation, their use for select diagnoses may appropriately reflect the level of service and have a favorable impact on the total number of RVU's generated.

Child↗
PubMed2006

Caring for adults with intellectual disabilities: perceived challenges for nurses in accident and emergency units.

AIM: This paper reports a study exploring the experiences of nurses in accident and emergency units caring for people with intellectual disabilities. BACKGROUND: People with intellectual disabilities are increasingly in contact with healthcare professionals in accident and emergency units. Often this contact occurs within the accident and emergency service, an area in which staff care for a diverse range of people. The experiences of people with intellectual disabilities within acute general hospitals in the United Kingdom and internationally has largely been reported as quite negative. Conversely, little is known about the experiences of nurses working in acute general hospitals, nor the exact nature of any challenges they encounter, in providing care to people with intellectual disabilities. This lack of understanding weakens opportunities for nurses to reduce barriers to providing an equitable service for people with intellectual disabilities. METHOD: Five focus groups were conducted with 27 accident and emergency nurses from five hospitals in Northern Ireland in the spring of 2004. The data were then coded and recurring themes identified. FINDINGS: This paper focuses on two themes: lack of knowledge of the nature of intellectual disability and dependence on carers. Whilst these themes have been acknowledged in the existing literature, they have received limited attention and exploration. The experience of fear and vulnerability was considered by participants to be a consequence of their lack of knowledge. The experience of these emotions is viewed as a key factor in nurses' over-dependence on patients' informal carers. CONCLUSION: Increased awareness is needed among professionals in accident and emergency units of the abilities and needs of people with intellectual disabilities.

Adaptation, Psychological↗
PubMed2001

Deaths attributed to pediatric complex chronic conditions: national trends and implications for supportive care services.

BACKGROUND: Children with complex chronic conditions (CCCs) might benefit from pediatric supportive care services, such as home nursing, palliative care, or hospice, especially those children whose conditions are severe enough to cause death. We do not know, however, the extent of this population or how it is changing over time. OBJECTIVES: To identify trends over the past 2 decades in the pattern of deaths attributable to pediatric CCCs, examining counts and rates of CCC-attributed deaths by cause and age (infancy: <1 year old, childhood: 1-9 years old, adolescence or young adulthood: 10-24 years old) at the time of death, and to determine the average number of children living within the last 6 months of their lives. DESIGN/METHODS: We conducted a retrospective cohort study using national death certificate data and census estimates from the National Center for Health Statistics. Participants included all people 0 to 24 years old in the United States from 1979 to 1997. CCCs comprised a broad array of International Classification of Diseases, Ninth Revision codes for cardiac, malignancy, neuromuscular, respiratory, renal, gastrointestinal, immunodeficiency, metabolic, genetic, and other congenital anomalies. Trends of counts and rates were tested using negative binomial regression. RESULTS: Of the 1.75 million deaths that occurred in 0- to 24-year-olds from 1979 to 1997, 5% were attributed to cancer CCCs, 16% to noncancer CCCs, 43% to injuries, and 37% to all other causes of death. Overall, both counts and rates of CCC-attributed deaths have trended downward, with declines more pronounced and statistically significant for noncancer CCCs among infants and children, and for cancer CCCs among children, adolescents, and young adults. In 1997, deaths attributed to all CCCs accounted for 7242 infant deaths, 2835 childhood deaths, and 5109 adolescent deaths. Again, in 1997, the average numbers of children alive who would die because of a CCC within the ensuing 6-month period were 1097 infants, 1414 children, and 2548 adolescents or young adults. CONCLUSIONS: Population-based planning of pediatric supportive care services should use measures that best inform our need to provide care for time-limited events (perideath or bereavement care) versus care for ongoing needs (home nursing or hospice). Pediatric supportive care services will need to serve patients with a broad range of CCCs from infancy into adulthood.

Adolescent↗
PubMed2001

Quality of care and outcomes of adults with asthma treated by specialists and generalists in managed care.

BACKGROUND: The growth of managed health care in the United States has been accompanied by controls on access to specialty physician services. We examined the relationship of physician specialty to treatment and outcomes of patients with asthma in managed care plans. METHODS: We conducted a mail survey of adult asthma patients who were enrolled in 12 managed care organizations and had at least 2 contacts for asthma (International Classification of Diseases, Ninth Revision, Clinical Modification code 493.x) during the previous 24 months; we also surveyed their treating physicians. This report concerns 1954 patients and their 1078 corresponding physicians. Treatment indicators included use of corticosteroid inhalers, use of peak flow meters, allergy evaluation, discussion of triggers, and patient self-management knowledge. Outcome measures included canceled activities, hospitalization or emergency department visits, asthma attacks, workdays lost, asthma symptoms, physical and mental health, overall satisfaction with asthma care, and satisfaction with communication with physicians and nurses. RESULTS: Significant differences were noted for patients of specialists and experienced generalists compared with those of generalist physicians. Peak flow meter possession was reported by 41.9% of patients of generalists, 51.7% of patients of experienced generalists, and 53.8% of patients of pulmonologists or allergists. Compared with patients of generalists, outcomes were significantly better for patients of allergists with regard to canceled activities, hospitalizations and emergency department visits for asthma, quality of care ratings, and physical functioning. Patients of pulmonologists were more likely to rate improvement in symptoms as very good or excellent. CONCLUSIONS: In a managed health care setting, physicians' specialty training and self-reported expertise in treating asthma were related to better patient-reported care and outcomes.

Adolescent↗
PubMed2006

Evaluation of the expressiveness of an ICNP-based nursing data dictionary in a computerized nursing record system.

This study evaluated the domain completeness and expressiveness issues of the International Classification for Nursing Practice-based (ICNP) nursing data dictionary (NDD) through its application in an enterprise electronic medical record (EMR) system as a standard vocabulary at a single tertiary hospital in Korea. Data from 2,262 inpatients obtained over a period of 9 weeks (May to July 2003) were extracted from the EMR system for analysis. Among the 530,218 data-input events, 401,190 (75.7%) were entered from the NDD, 20,550 (3.9%) used only free text, and 108,478 (20.4%) used a combination of coded data and free text. A content analysis of the free-text events showed that 80.3% of the expressions could be found in the NDD, whereas 10.9% were context-specific expressions such as direct quotations of patient complaints and responses, and references to the care plan or orders of physicians. A total of 7.8% of the expressions was used for a supplementary purpose such as adding a conjunction or end verb to make an expression appear as natural language. Only 1.0% of the expressions were identified as not being covered by the NDD. This evaluation study demonstrates that the ICNP-based NDD has sufficient power to cover most of the expressions used in a clinical nursing setting.

Dictionaries as Topic↗
PubMed2000

Results of provider self-adjudication using the prudent layperson standard compared with the managed care organization's emergency department claim review process.

STUDY OBJECTIVES: We compare the results of a provider "self-adjudicating" outpatient emergency department claims using a "presenting symptom-based" system with the managed care organization (MCO) adjudicating the claims using a "final diagnosis-based" system. METHODS: All outpatient visits from one MCO to an urban, university hospital between January 1, 1998, and February 28, 1999, were included. Each record was reviewed by 2 methods to determine whether the visit qualified for payment under the MCO's benefit structure. Under the provider adjudication, symptom-based system, all visits with nursing triage levels of immediate/emergency were approved automatically. Those with triage levels of delayed/nonurgent were reviewed by an emergency physician and approved if, in the physician's opinion, the presenting symptoms met the emergency criteria under the District of Columbia's Access to Emergency Services Act. A second claims review, blinded to the first, was performed with the diagnosis-based system used by the MCO before approval of the prudent layperson standard. This review divided the records into "approve," "deny," and "suspend" categories according to the discharge International Classification of Diseases, ninth revision code. The results of the 2 reviews were compared. RESULTS: We reviewed 1,830 records; 836 (46%) cases were triaged as immediate/emergency and 994 (54%) as delayed/nonurgent. Of the 994 delayed/nonurgent visits, physician review determined that 607 (61%) met the prudent layperson standard and 387 (39%) did not. Overall, the provider self-adjudication system determined that 1,443 (78.8%) of the 1,830 visits should be approved for insurance coverage. The MCO's system approved 966 (53%), denied 335 (18%), and suspended 529 (29%). Provider self-adjudication using a symptom-based system resulted in the immediate approval of 1,443 (77.8%) visits compared with 966 (52.7%) by a diagnosis-based system (P <.001). Excluding the 529 suspended claims, McNemar's statistical testing of 1,302 records failed to demonstrate the equivalence of the 2 systems (P <. 001). CONCLUSION: Compared with the standard ED claims review process used by the managed care industry, provider self-adjudication using a symptom-based system approves a greater proportion of visits, avoids rejection of many ED visits, and identifies many nonemergency visits that mistakenly appear to be emergencies. The possibility of providers and MCOs working together to adjudicate outpatient ED claims should be explored.

Ambulatory Care↗
PubMed2007

Contextual empowerment: the impact of Health Brigade involvement on the women of Miraflor, Nicaragua.

This qualitative, descriptive study investigated how working with Health Brigades influenced a sense of empowerment and a resultant shifting of gender-power relationships for women in a rural Nicaraguan community. A convenience sample of 10 women aged 18 to 65 years who had worked with the Brigades were interviewed. Open and axial coding were used to determine core categories and theoretical concepts. From this emerged a grounded theory of contextual empowerment. Key findings included that within this collectivist culture, the concept of contextual empowerment includes psychosocial and structural dimensions. Implications for nursing practice include the impact of unintentional role modeling.

Adult↗
PubMed1997

Department of Veterans Affairs, University of Utah consortium participation in the NLM/AHCPR Large Scale Vocabulary Test.

The Large Scale Vocabulary Test (LSVT) was designed to evaluate how well the Metathesaurus plus planned additions to Meta covered the documentation needs of clinicians. Our consortium collected 10,538 clinical narratives from patient problem lists recorded at 65 Veterans Hospitals, internal medicine ambulatory care practices, diagnostic history and physical examination data elements from Iliad, and nursing shift notes and emergency transport patient records. The results showed 94% of submitted terms resulted in acceptable matches. 49% of submitted terms were judged to be synonymous with the match terms, 35% were judged to be more specific (usually due to modifiers), 2%, were less specific, and 6% had an associative relationship. In 8% of cases either no match was found by the LSVT interface or all proposed matches were rejected by the raters. The LSVT content was quite suitable for coding our narratives. Necessary improvements for an electronic record would include the ability to compose modifiers together with root concepts.

Ambulatory Care↗
PubMed1998

An assessment of attitudes to, and extent of, the practice of denture marking in South Australia.

Denture marking or labelling is not a new concept in either prosthetic or forensic dentistry and its routine practice has been urged by forensic odontologists internationally for many years. In the general community it is often recommended for institutionalized persons to prevent confusion of ownership of dentures. In Australia, the Nursing Home Standards require that dentures of residents be 'discreetly labelled' and marking of all dentures is recommended by the Australian Dental Association. In some countries the marking of dentures is regulated by legislation, but elsewhere there seems to be a reluctance to effect this practice. Various methods which have been proposed include the insertion of an identifying label during the fabrication of the dentures with the utilization of a number of materials and coding systems. This study reports the results of a survey undertaken to determine the extent of the practice of denture marking in South Australia, the methods in use, and the attitudes of dentists, dental technicians and institutions to it. The results indicated that 24.5 per cent of all practitioners providing removable prostheses to their patients include an identifying label as part of the service on some occasions. This included 19.9 per cent of general dental practitioners, 25 per cent of specialist prosthodontists, 57.1 per cent of practitioners with training in forensic odontology, and 43.5 per cent of clinical dental technicians. No practitioner labelled dentures routinely. Reasons cited for not labelling dentures included cost, lack of awareness of standards and recommendations and a belief that it was of little importance.

Attitude of Health Personnel↗