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PubMed2004

Epidemiology and short-term outcomes of injured medicare patients.

OBJECTIVES: To describe characteristics and short-term outcomes of Medicare patients hospitalized after injuries in 1999. DESIGN: Analysis of national population-based case series. SETTING: Hospitalized Medicare patients. PARTICIPANTS: All fee-for-service Medicare patients aged 65 and older admitted for the first time in 1999 with principal injury diagnoses (International Classification of Diseases, Ninth Revision, codes 800-904, 910-929, 940-957, 959). MEASUREMENTS: Incidence rates, stratified by anatomic location (hip, other extremity, spine, head, chest, other), sex, and age group (65-74, 75-84, >or=85). For each category, Charlson comorbidity scores, Abbreviated Injury Scores, hospital length of stay, discharge disposition, hospital mortality, 30-day mortality, and readmissions within 30 days of discharge. RESULTS: A total of 439,605 persons were admitted at least once (crude rate 1,654/100,000). Rates of hospitalization increased with age and were generally higher in women (except head injuries). Comorbidities were more common in men. Hip fractures constituted 46.6% of cases and other extremity injuries another 30.7%. Hospital mortality (3.7% overall) increased with age, was greater in men, and was highest in patients with head injuries. The proportion discharged to skilled nursing facilities (43.8% overall, range 10.0-61.9% by age/sex/anatomic category) also increased with age, was higher in women, and was highest in patients with hip fractures. Slightly more than one-tenth (12.3%) of patients were readmitted within 30 days. Thirty-day mortality was 2.0 times hospital mortality (range 1.2-3.4 by category). CONCLUSION: Most injuries resulting in hospitalization for the Medicare population involve the extremities, but other injuries have higher mortality. Many injured patients are not discharged home but receive additional institutional care. Thirty-day survival is much lower than observed hospital survival. Further studies of injuries using Medicare data are warranted.

Aged↗

PubMed2003

Tobacco counseling at well-child and tobacco-influenced illness visits: opportunities for improvement.

OBJECTIVE: To assess the frequency of clinician-reported delivery of counseling for avoidance of child environmental tobacco smoke (ETS) exposure and tobacco use at periodic well-child visits and at illness visits for asthma and otitis media (OM). METHODS: Combined data from the National Ambulatory Medical Care Survey and the outpatient portion of the National Hospital Ambulatory Medical Care Survey from 1997 to 1999 were analyzed. The frequency of pediatric visits (<or=18 years) that included clinician-reported counseling for tobacco use/exposure prevention was assessed. Diagnosis-specific visits were determined by using International Classification of Diseases, Ninth Revision codes for asthma (493-), OM (381-, 382-), and well-child visits. Bivariate and regression analyses were performed. RESULTS: Of 33 823 ambulatory care visits by children, 1.5% were reported to include delivery of tobacco counseling. Only 4.1% of well-child visits, 4.4% of illness visits for asthma, and 0.3% of illness visits for OM included tobacco counseling. With the use of logistic regression models, adolescent patient visits (13-18 years) were more likely to include delivery of tobacco counseling than younger child visits [OR = 15.8, 95% CI (7.5-33.5)]. Visits by children with Medicaid and those seen by a nurse practitioner or a physician's assistant were also more likely to include tobacco counseling (odds ratio: 1.6; 95% confidence interval: 1.002-2.50; and odds ratio: 3.0; 95% confidence interval: 1.5-6.0, respectively). There were no significant differences in counseling delivery by race, ethnicity, or clinician specialty. CONCLUSIONS: Rates of tobacco counseling at well-child visits and at illness visits for diagnoses directly affected by tobacco use and ETS are extremely low. Significant opportunities exist to improve counseling rates for child ETS exposure and adolescent tobacco use in primary care.

Adolescent↗

PubMed1999

Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data

OBJECTIVES: The purpose of this study was to develop a convenient and inexpensive method for identifying and individual's risk for hospital readmission for congestive heart failure (CHF) using information derived exclusively from administrative data sources and available at the time of an index hospital discharge. BACKGROUND: Rates of readmission are higher after hospitalization for CHF. The significant determinants of rehospitalization are debated. METHODS: Administrative information on all 1995 hospital discharges in New York State which were assigned International Classification of Diseases--9--Clinical Modification codes indicative of CHF in the principal diagnosis position were obtained. The following were compared among hospital survivors who did and did not experience readmission: demographics, comorbid illness, hospital type and location, processes of care, length of stay and hospital charges. RESULTS: A total of 42,731 black or white patients were identified. The subgroup of 9,112 (21.3%) who were readmitted were distinguished by a greater proportion of blacks, a higher prevalence of Medicare and Medicaid insurance, more comorbid illnesses and the use of telemetry monitoring during their index hospitalization. Patients treated at rural hospitals, those discharged to skilled nursing facilities and those having echocardiograms or cardiac catheterization were less likely to be readmitted. Using multiple regression methods, a simple methodology was devised that segregated patients into low, intermediate and high risk for readmission. CONCLUSIONS: Patient characteristics, hospital features, processes of care and clinical outcomes may be used to estimate the risk of hospital readmission for CHF. However, some of the variation in rehospitalization risk remains unexplained and may be the result of discretionary behavior by physicians and patients.

Journal Article↗

PubMed1999

Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data.

OBJECTIVES: The purpose of this study was to develop a convenient and inexpensive method for identifying an individual's risk for hospital readmission for congestive heart failure (CHF) using information derived exclusively from administrative data sources and available at the time of an index hospital discharge. BACKGROUND: Rates of readmission are high after hospitalization for CHF. The significant determinants of rehospitalization are debated. METHODS: Administrative information on all 1995 hospital discharges in New York State which were assigned International Classification of Diseases-9-Clinical Modification codes indicative of CHF in the principal diagnosis position were obtained. The following were compared among hospital survivors who did and did not experience readmission: demographics, comorbid illness, hospital type and location, processes of care, length of stay and hospital charges. RESULTS: A total of 42,731 black or white patients were identified. The subgroup of 9,112 patients (21.3%) who were readmitted were distinguished by a greater proportion of blacks, a higher prevalence of Medicare and Medicaid insurance, more comorbid illnesses and the use of telemetry monitoring during their index hospitalization. Patients treated at rural hospitals, those discharged to skilled nursing facilities and those having echocardiograms or cardiac catheterization were less likely to be readmitted. Using multiple regression methods, a simple methodology was devised that segregated patients into low, intermediate and high risk for readmission. CONCLUSIONS: Patient characteristics, hospital features, processes of care and clinical outcomes may be used to estimate the risk of hospital readmission for CHF. However, some of the variation in rehospitalization risk remains unexplained and may be the result of discretionary behavior by physicians and patients.

Black or African American↗

PubMed2003

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 triennial International Confederation of Midwives (ICM) 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 ICM in international research; and identifying topics for an international midwifery research agenda. Recommendations arising from this workshop were: that guidelines and a code of ethics for the conduct of international research in midwifery be developed; that the ICM and national midwifery organisations continue to actively support research, and further develop that support; that the ICM support education and capacity building for research at basic and continuing education levels; and that the priorities identified for collaborative international studies be updated on a regular basis.

Education↗

PubMed1994

The experiences of lesbians in Alcoholics Anonymous.

A feminist ethnographic study of lesbians' experiences in recovery from alcohol problems was done to understand from their perspectives how they identified alcohol use as problematic, sought help, experienced health care interactions and participation in Alcoholics Anonymous (AA), and maintained recovery. Through community-based purposive sampling in San Francisco, 35 lesbians recovering from alcohol problems participated in semistructured ethnographic interviews of 2 hours duration, which were subsequently interpreted using ethnographic coding, narrative analysis, and matrix analysis. A major finding was that participation in AA was fraught with tension in three areas. Each tension was defined by two poles of experience that appear to be in conflict. They were assimilation versus differentiation, authority versus autonomy, and false consciousness versus politicization. These tensions are elaborated and supported by examples from the women's interviews. Nursing implications regarding the role of AA in recovery for marginalized women are discussed.

Adult↗

PubMed1996

Parity and coronary heart disease among women in the American Cancer Society CPS II population.

Four of five cohort studies have shown an increase in cardio-vascular disease with increased parity, after control for a number of cardiovascular risk factors. The effect has been observed primarily in categories of four or more livebirths. To analyze this issue further, we conducted an analysis of 585,445 women from the American Cancer Society Cancer Prevention Survey II (CPS II). There were 4,787 deaths from coronary heart disease (International Classification of Diseases Codes 410-414) among these women during the follow-up period from 1981 to 1989. After controlling for a number of cardiovascular risk factors, we found no increased trend in heart disease with increased parity. Rare ratios for women with no live births or 1, 2, 3, 4, 5, and 6 or more livebirths were 1.00, 0.95, 0.89, 0.82, 0.94, 0.98, 0.94, respectively. Without control over confounders, however, we observed an increased risk for the highest party category (rate ratio = 1.18; 95% confidence interval = 1.04-1.34). Positive findings for parity to date have been found primarily in cohort studies representative of the general population, whereas our own data and another earlier negative study among nurses came from more select populations likely to be relatively homogeneous for socioeconomic variables. Positive findings in the literature may be due, at least in part, to confounding by unmeasured variables related to socioeconomic status.

Adult↗

PubMedDate not supplied

The net cost of Alzheimer disease and related dementia: a population-based study of Georgia Medicaid recipients.

The objective of this study was to estimate the direct medical cost of Alzheimer disease (AD) and related dementia to the Georgia Medicaid program. A retrospective, cross-sectional, matched control group design was used. AD cases 50 years of age and older were identified by using International Classification of Diseases (9th edition, Clinical Modification) diagnosis codes from 1994 Georgia Medicaid administrative claims files. For every case, three age- and gender-matched non-AD controls were selected. Differences in average recipient Medicaid expenditures between cases and controls were estimated using weighted least squares regression analysis, adjusting for age, gender, race, Charlson comorbidity index, Medicare eligibility, and months of Medicaid eligibility. A total of 8,671 AD cases were identified (prevalence, 4.4%). The average adjusted annual Medicaid expenditure per AD recipient was $14,492 (U.S.). The net (i.e., excess) average annual Medicaid cost per AD recipient (i.e., the difference in adjusted mean expenditures between cases and controls) was estimated to be approximately $8,200. Excessive nursing home expenditures accounted for most of the additional cost of treating dementia (> 85%), although inpatient hospital, physician, outpatient, and prescription drug expenditures also were higher among patients with AD. Based on these estimates, Georgia Medicaid is projected to spend almost $70 million annually for AD and related dementia. The excessive cost attributable to AD poses a significant burden to the Georgia Medicaid program.

Aged↗

PubMed1995

Breast cancer patients' experiences of nursing care with the focus on emotional support: the implementation of a nursing intervention.

Nursing care with the focus on emotional support, aimed at improving breast cancer patients' adjustment to everyday life, was implemented. The women were offered the opportunity to talk about illness-related thoughts and reactions, as well as to express feelings of anxiety, fear and anguish with a nurse who listened, consoled and answered questions. The organizational changes included extensive co-operation between the surgical ward and primary health care, shorter waiting times, and changed routines around information about the diagnosis. A total of 26 Swedish women, aged 35-69, with newly diagnosed breast cancer, described their experiences of the disease and nursing care in a semi-structured interview 6 months after the primary treatment. Data were coded by open coding; themes and categories were formulated. Findings showed that emotional support, as well as organizational changes of care, led to feelings of safety and security. Most of the women could plan for the future despite a demanding situation. The study indicates that the nursing intervention may improve women's sense of control, and also that further changes in care are needed to meet their psychosocial needs, such as adequate information about medical treatment and more 'confirming' relationships.

Adult↗

PubMedDate not supplied

Commentary on "Waiting in Araf". Informed consent: issues and regulations.

Children have the right to safety and appropriate consideration of their physical, emotional, and psychological needs in regards to treatment or research decisions. Parents have an equal right to be honored in their parenthood and respected for what they would want as the best thing for their child as a member of the family. When children are mature enough, they should be offered the opportunity of assenting or dissenting to research participation. Until such time, parents may make what they feel to be the best decisions. If a nurse feels that these principles are being violated, he or she should attempt to seek further clarification. In order to obtain information about an ongoing research project, it would be appropriate to contact the IRB or a member of the hospital ethics committee. In most cases, a satisfactory explanation will be found. In the rare case that patient's rights are truly being violated, the American Nurses Association Code of Ethics requires that nurses report incompetent, unethical, or illegal practices (ANA, 1994). Nurses who "whistle-blow" may or may not be protected against retaliation. Some states in the U.S. have developed laws that prohibit the discharge of an employee who reports unethical practices. One might expect that in some countries a nurse might not only endanger her position for such reporting but endanger his or her life as well. Ulusoy reports on research done on children without knowledge or consent of parents. Although this case took place long ago, it is certain that there are still countries in which informed consent is undeveloped and such practices continue. Nurses in developed countries with established consent policies can be hopeful that such activity is no longer seen here. As international collaboration in nursing research grows, nurses in developed nations can work to provide educational opportunities regarding the consent process for colleagues across the globe.

Adult↗

PubMed2000

Professional nurses' perception of nursing mentally ill people in a general hospital setting.

The aim of this study was to explore professional nurses' perception of nursing mentally ill patients in a tertiary hospital in Durban. An explorative, qualitative, descriptive and contextual design was followed as the basis for conducting the study. The above-mentioned research design was achieved through field work conducted in an urban-based general hospital. A sample of 12 professional nurses was selected from a population of 800 professional nurses employed in this setting using a purposive sampling technique. This sample size was determined by saturation of data as reflected in repeating themes. Both individual phenomenological semistructured interviews and field notes in the form of observations were used as methods of data collection. The field work was conducted without any preset theoretical framework of reference by using bracketing and intuiting. During interviews, participants were asked only one research question, namely: 'How do you perceive nursing mentally ill patients in your unit or ward?' Communication skills were employed to encourage participants to verbalize their perception of nursing mentally ill patients in a general hospital setting. A tape recorder was used to collect data and the data was transcribed verbatim. Data collected was analysed following the descriptive method of Giorgi (1986). Coding was carried out by the researcher and an independent expert who is a psychiatric nursing specialist and a qualitative research expert. After data analysis, the results were reflected within universal categories of the Nursing for the Whole Person Theory in order to give them structure. The four themes that emerged from the findings are: perception of self, perception of a patient, perception of feelings that hinder nursing the mentally ill, and perception of the environment. The measures for ensuring trustworthiness proposed by Guba (Lincoln Y.S. & Guba E.G. (1985) Naturalistic Inquiry. Sage, Beverly Hills) were used as the basis for ensuring reliable and valid findings. The perception of nursing mentally ill people within a general hospital setting was negative and affected the intellectual and the affective component of the nurses' psychological functioning within their internal environment. It was recommended that nurses' knowledge and skills should be increased and that they should be given emotional support in terms of counselling.

Adult↗

PubMedDate not supplied

The changing epidemiology of mechanical ventilation: a population-based study.

The number of critical care beds in the United States has been increasing considerably, but it is unclear how these additional beds have been used. Mechanical ventilation for acute respiratory failure almost always demands ICU care and is likely to be a reliable indicator of critical care resource requirements on a population level. The objective of this study was to measure changes in the yearly incidence of mechanical ventilation in a statewide population. The North Carolina Hospital Discharge Database contains data on all discharges from nonfederal, nonpsychiatric hospitals in North Carolina. Authors extracted data on adult patients with International Classification of Diseases, 9th Revision, Clinical Modification procedure codes for mechanical ventilation from 1996 to 2002. The incidence of mechanical ventilation for adults grew from 284/100,000 population in 1996 to 314/100,000 in 2002, an increase of 11% (P < .05). While patients aged >64 had the highest age-specific incidence of mechanical ventilation each year, the greatest increase in incidence occurred in younger age groups (19% increase for age 18-64 vs 4% increase for age >64). The mean Charlson score increased from 1.76 +/- 1.73 to 1.89 +/- 1.86 (P < .001). Renal disease became more prevalent among patients requiring mechanical ventilation (17% of patients in 1996 vs 24% in 2002). Hospital charges adjusted for the medical consumer price index increased by 12%. The proportion of patients discharged to home declined from 45.4% to 34.4%, and discharges to nursing homes grew from 7.3% to 10.7%. The incidence of mechanical ventilation is increasing, and the increase is associated with a higher burden of comorbidities and fewer discharges to home.

Acute Disease↗

PubMed1999

Increasing incidence of medically recognized migraine headache in a United States population.

OBJECTIVE: To investigate trends in the incidence of medically recognized migraine in Olmsted County, Minnesota over approximately a decade. METHODS: The authors used the records-linkage system of the Rochester Epidemiology Project to identify individuals whose records included any diagnostic rubric related to headache for the 3-year period 1979 through 1981 and the 2-year period 1989 through 1990. A nurse abstracter and a neurologist (J.W.S.) reviewed the complete history of each potential case and assigned a diagnosis using the International Headache Society classification (IHS, modified). Only patients who consulted a doctor for their headache and had their initial visit for migraine within the study years were considered as incident cases. RESULTS: The incidence of medically recognized migraine increased in female subjects between the 1979-through-1981 period and the 1989-through-1990 period for all ages, but particularly among those who were aged 10 to 49 years. The peak incidence rate at age 20 to 29 years increased from 634.5 new cases per 100,000 person-years in 1979 through 1981 to 986.4 in the 1989-through-1990 period (absolute increase 351.9; relative increase 56%). The rise in incidence in female subjects was most sizable for migrainous disorder (IHS code 1.7); smaller increases were noted for migraine without aura and with typical aura. Only a slight absolute increase in migraine incidence rates was observed in male subjects, restricted to those 10 to 19 years of age (absolute increase 174.7; relative increase 89%). CONCLUSIONS: Although the incidence rates reported here are restricted to patients who consulted a doctor for their headache, the authors suggest that the incidence of migraine has increased over time in female subjects, especially those of reproductive age. The increase was most pronounced for migrainous disorder. Incidence rates were more stable in male subjects over time.

Adolescent↗

PubMed2001

The public awareness of aphasia: an international survey.

We surveyed 929 shoppers in Exeter (England), Louisiana (USA) and Sydney (Australia) to determine what they knew of aphasia. Between 10% and 18% said they had heard of aphasia but only between 1.5% and 7.6% had even some basic knowledge of aphasia. We found that more females knew something about aphasia than males and that older people were more likely to have heard of it, although those with some knowledge were significantly younger. Informants had heard of aphasia mainly through their work or the media and were mainly professionals like teachers, nurses, therapists, managers and administrators, followed by a retired/student group. We found some differences in awareness levels in the different locations we sampled. Results have implications for targeting awareness raising and campaigning.

Adolescent↗

PubMed2006

A theory for the nursing care of patients at risk of suicide.

AIM: This paper presents a nursing care theory developed to guide the care given to people with suicidal ideas and those with a previous suicide attempt. BACKGROUND: Suicide is a major public health problem. According to the World Health Organization, international suicide rates range from highs of more than 20 per 100,000 people in Hungary (1997 figures), to fewer than 10 per 100,000 in the United Kingdom (2002 figures). In 2002, the number of completed suicides in Taiwan increased by nearly 10% over the previous year, and the Taiwanese Government has set targets to reduce this rate. Psychiatric nurses play a vital role in helping reduce the suicide rate through prevention, education and by providing care that promotes the healing of patients who attempt suicide. METHODS: A grounded theory approach was used. Fifteen patients who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses working on acute wards were interviewed and observed using an observer-as-participant strategy. Data were collected through field notes and by tape-recorded interviews during 2003, and analysed using open, axial and selective coding and the qualitative software program QRS NUD*IST. FINDINGS: The core category that emerged from the data collected was the provision of 'safe and compassionate care via the channel of the therapeutic relationship'. Other key categories linked to and embraced within this core category were: providing holistic assessments; providing protection; providing basic care; and promoting healing through advanced care. CONCLUSION: The theory generated from the findings could be used by nurses as a guide as they initiate and maintain therapeutic relationships with patients who are at risk of suicide. The theory could advance the quality of care provided by nurses. In addition, it holds potential for instilling hope in patients who have lost their ability to cope with life events and perhaps life itself.

Hospitals, Psychiatric↗

PubMed2004

Electronic reporting to improve patient safety.

BACKGROUND: Limited data are available on the experiences of voluntary event reporting systems to improve patient safety. OBJECTIVE: Development and implementation of educational initiatives to facilitate the use of an electronic reporting system (ERS) in an academic medical center to measure the impact on knowledge of the ERS on reporting behavior and safety attitudes and to evaluate the accuracy of the information being reported. METHODS: A voluntary internal confidential electronic system for reporting safety events was implemented which involved patients and visitors. A multifaceted educational program was developed to promote safety awareness and use of the ERS system. The safety event detail reported for the calendar year 2002 was tracked and trended and central event analyses were performed for five high event clinical areas. A survey was administered to assess safety knowledge and attitudes of patient care personnel. RESULTS: 2843 safety events were entered into the ERS during 2002 with an increase during the course of the year (p = 0.055, linear trend) for all events. Nurses entered 73% of the events and physicians only 2%. 453 events (16%) were unsafe conditions or near misses and 623 (22%) were associated with patient harm. System factors were considered by the reporter as contributing to the event in only a few cases (5%). Central event analysis revealed that 39% of events had coding errors either in event classification, level of impact, or location; significant underreporting was also present. Although survey response rates were low (10.3%), responders showed a high degree of knowledge on general questions of patient safety and an increase in knowledge on use of the ERS (p = 0.0015, linear trend). CONCLUSIONS: Knowledge on the use of the reporting system and the frequency of reported events increased over the first year of the study. More work is needed to involve physicians in reporting, to improve the accuracy of submitted information, and to better prioritize, organize, and streamline event analysis.

Computer Literacy↗

PubMed2005

Influenza vaccination coverage among hospital personnel over three consecutive vaccination campaigns (2001-2002 to 2003-2004).

This study was carried out to assess influenza vaccination coverage among hospital personnel and the impact of health promotion campaigns, within the hospital, designed to increase vaccination coverage over three consecutive vaccination campaigns (2001-2002 to 2003-2004). The health promotion tool used in the 2001-2002 and 2002-2003 were informative posters distributed throughout the hospital. In the 2003-2004 season, the recommendation was also published in the internal bulletin and Web site of the hospital. In addition, a physician and a nurse from the Department of Preventive Medicine visited all departments offering vaccination in the work place. The overall vaccination coverage in the 2001-2002 campaign was 16% with coverage of 11.5% in nurses and 15% in physicians. In the 2002-2003 and 2003-2004 campaigns the overall vaccination coverage was 21% and 40%, respectively (p<0.01). Staff physicians and resident physicians reached 60 and 42% coverage rates in the 2003-2004 campaign, but coverage in nurses and nursing assistant remained around 30% (p<0.01). In summary, influenza vaccination coverage among hospital based healthcare personnel increased significantly during the last three seasons, however, it still remains low despite active attempts at promoting influenza vaccination.

Adult↗

PubMed1990

Quality of reporting in diabetes patient education research: 1954-1986.

The quality of reported research representing a number of disciplines involved in diabetes patient education was investigated in this study. A rigorous literature search identified 47 studies reported between 1954 and 1986 that met inclusion criteria; 29 were published studies, 18 were unpublished. Quality of the research was measured by Duffy's Research Appraisal Checklist (RAC) and also by coding each study as to the number of threats to internal and external validity present. Overall quality as measured by the RAC ranged from 34 to 95 on a 100-point scale. A statistically significant relationship was found between publication date of the research report and quality, indicating improvement in quality during recent years. Quality of published versus unpublished research reports was not found to differ significantly. Recommendations for improving methodological rigor of future studies include: (a) the use of more rigorous designs, particularly those involving control groups such as randomized clinical trials; (b) reporting of more complete data in research reports; and (c) monitoring of the quality of future studies.

Clinical Nursing Research↗