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At least 289 records · Page 16Linked to original sources
PubMed2002

Evolutionary transitions in parental care and live bearing in vertebrates.

We provide the first review of phylogenetic transitions in parental care and live bearing for a wide variety of vertebrates. This includes new analyses of both numbers of transitions and transition probabilities. These reveal numerous transitions by shorebirds and anurans toward uniparental care by either sex. Whereas most or all of the shorebird transitions were from biparental care, nearly all of the anuran transitions have been from no care, reflecting the prevalence of each form of care in basal lineages in each group. Teleost (bony) fishes are similar to anurans in displaying numerous transitions toward uniparental contributions by each sex. Whereas cichlid fishes have often evolved from biparental care to female care, other teleosts have usually switched from no care to male care. Taxa that have evolved exclusive male care without courtship-role reversal are characterized by male territoriality and low costs of care per brood. Males may therefore benefit from care through female preference of parental ability in these species. Primates show a high frequency of transitions from female care to biparental care, reflecting the prevalence of female care in basal lineages. In the numerous taxa that display live bearing by females, including teleosts, elasmobranchs, squamate reptiles and invertebrates, we find that live bearing has always evolved from a lack of care. Although the transition counts and probabilities will undoubtedly be refined as phylogenetic information and methodologies improve, the overall biases in these taxa should help to place adaptive hypotheses for the evolution of care into a stronger setting for understanding directions of change.

Amphibians↗
PubMed2005

Transition of the adolescent patient with rheumatic disease: issues to consider.

This article discusses the definitions of transition and models for providing transition care to youth and young adults with rheumatic diseases in the context of differing cultural and health care systems. Issues and questions relating to pediatric rheumatology transition programming are outlined, and a model program of pediatric rheumatology transition is presented.

Adolescent↗
PubMedDate not supplied

State of the science: achievements and challenges across the spectrum of care for preterm infants.

The spectrum of care for preterm infants includes the perinatal and immediate neonatal periods, the initial hospitalization period including neonatal intensive care, transition to discharge, and from discharge through the first year of life. Care issues are sometimes lifelong. Advances and achievements of the past 20 years, particularly during the perinatal period and in neonatal intensive care, have resulted in significant increases in survivability of even the smallest and least mature infants. Challenges remain, particularly in establishing evidence-based standards of nursing practice in areas such as transition to oral feedings, breastfeeding in the intensive-care nursery, and developmentally based care, and in reducing short- and long-term morbidities in children born prematurely. This article illustrates achievements and challenges across the spectrum of care for preterm infants in the 1st year of life.

Female↗
PubMed1997

The patient care process: pathways in transition.

Developing patient care processes to include multiple activities of care, the continuum of care, primary diagnoses and co-morbid conditions, risk factors and outcomes of care improves patient care management in general. The Patient Care Process (PCP) is one initiative utilized to support standards of care and optimal resource utilization in our organization. This paper will focus on the issues and opportunities identified with the use of patient care plans, particularly the uniqueness of a new level of outcomes monitoring and evaluation.

Critical Pathways↗
PubMed2005

[The pediatric-to-adult transit clinic as a quality-securing measure in endocrinological diseases].

The establishment of structured transit clinics for pediatric patients with endocrinological diseases entering adulthood is a prerequisite for ensuring the quality of care for patients with chronic endocrine diseases. Since such patients have been receiving constant special pediatric care on a large scale only during the last 20 years, and only now is an improvement in life expectancy and quality of life becoming evident for the individual diseases, a comprehensive store of experience, or even of evaluated data, is lacking. In order to preserve the quality achieved in pediatric care, transitional structures must initially utilize the experience and results achieved in the pediatric setting, and adapt them to the requirements of adult patients. This is an ongoing process, and additional resources are required for the transition, e.g. for joint medical counseling and care, as also for the continuing utilization of non-medical pediatric services. The basis for the implementation of such models is, in principle, provided by the Gesundheitsmodernisierungsgesetz, GMG (health care modernization act), and, for reasons of quality control, the necessary structures should be put in place as quickly as possible.

Adolescent↗
PubMed2004

Short-form activity measure for post-acute care.

OBJECTIVE: To develop a comprehensive set of short forms using item response theory (IRT) and item pooling procedures for the purpose of monitoring postacute care functional recovery. DESIGN: Prospective study. SETTING: Six postacute health care networks in the greater Boston area, including inpatient acute rehabilitation, transitional care units, home care, and outpatient services. PARTICIPANTS: A convenience sample of 485 adult volunteers who were currently receiving skilled rehabilitation services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We developed a set of 6 short forms across 3 activity domains from new items and items from existing postacute care instruments. RESULTS: Inpatient- and community-based short forms were developed for each of 3 activity domains: physical & movement, applied cognition, and personal care & instrumental. Items were selected for inclusion on the short forms to maximize content coverage and information value of items across the range of content and to minimize ceiling and floor effects. We were able to match the distribution of sample scores with very good item precision for 1 of the constructs (physical & movement); the other 2 domains (personal care & instrumental, applied cognition) were more challenging because of the variability in patient recovery and ceiling effects. CONCLUSIONS: ITR methods and item pooling procedures were valuable in developing paired sets of short-form instruments for inpatient and community rehabilitation that provided estimates of functioning along a common metric for use across postacute care settings.

Activities of Daily Living↗
PubMed2004

Score comparability of short forms and computerized adaptive testing: Simulation study with the activity measure for post-acute care.

OBJECTIVE: To compare simulated short-form and computerized adaptive testing (CAT) scores to scores obtained from complete item sets for each of the 3 domains of the Activity Measure for Post-Acute Care (AM-PAC). DESIGN: Prospective study. SETTING: Six postacute health care networks in the greater Boston metropolitan area, including inpatient acute rehabilitation, transitional care units, home care, and outpatient services. PARTICIPANTS: A convenience sample of 485 adult volunteers who were receiving skilled rehabilitation services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Inpatient and community-based short forms and CAT applications were developed for each of 3 activity domains (physical & mobility, personal care & instrumental, applied cognition) using item pools constructed from new items and items from existing postacute care instruments. RESULTS: Simulated CAT scores correlated highly with score estimates from the total item pool in each domain (4- and 6-item CAT r range,.90-.95; 10-item CAT r range,.96-.98). Scores on the 10-item short forms constructed for inpatient and community settings also provided good estimates of the AM-PAC item pool scores for the physical & movement and personal care & instrumental domains, but were less consistent in the applied cognition domain. Confidence intervals around individual scores were greater in the short forms than for the CATs. CONCLUSIONS: Accurate scoring estimates for AM-PAC domains can be obtained with either the setting-specific short forms or the CATs. The strong relationship between CAT and item pool scores can be attributed to the CAT's ability to select specific items to match individual responses. The CAT may have additional advantages over short forms in practicality, efficiency, and the potential for providing more precise scoring estimates for individuals.

Boston↗
PubMedDate not supplied

A case study of nursing liability. Patient transfer from one facility to another.

Ongoing health care transitions include shorter hospital stays for elderly patients who need additional subacute care before they return to independent living. When continued care will be carried out in another facility, attentiveness to transfer details is essential to complete a safe and effective move.

Accidental Falls↗
PubMed1999

Indications for total parenteral nutrition in the hospitalized patient: a prospective review of evolving practice.

The indications for initiating total parenteral nutrition (TPN) were prospectively evaluated in 100 consecutive patients at a tertiary referral hospital with a long-standing Nutritional Support Service to illustrate the reasons why the parenteral route was chosen at this unique institution in terms of patient population. Sixty male and 40 female patients, average age 59 +/- 17 years (range 22-86 years), were classified a priori as to the underlying reasons for initiation of TPN. The study was conducted by a Nutrition Support Service at this hospital without pediatric, trauma, or burn services specializing in the care of patients with diabetes mellitus. Of the 100 patients, 63% were from the surgical service; 24% had diabetes mellitus. Their mean weight (118 +/- 29% of ideal), body mass index (25 +/- 6 kg/m(2)), and serum albumin (2.8 +/- 0.7 g/dL) indicated a reasonable body composition with a moderate systemic inflammatory response. Six patients received preoperative TPN for an average of 5 +/- 3 days with a variety of diagnoses including malignancy, Crohn's disease, bowel obstruction, and gastrointestinal bleeding. The underlying reasons for initiating nutritional support were related to three factors that largely determine the need for involuntary feeding: preexisting protein calorie malnutrition, actual or anticipated semistarvation for a prolonged period, and the presence of a systemic inflammatory response. The choice of TPN was based on anticipated or proven intolerance to full enteral feeding. The duration of time before initiation of TPN postoperatively was 6 +/- 5 days, which reflects our policy that initially well-nourished patients who are experiencing a systemic inflammatory response should not undergo more than 5 to 7 days of inadequate feeding. The duration of TPN overall was 11 +/- 10 days, which primarily illustrates the dramatic reduction in length of hospital stay that has occurred throughout the health care system and the willingness to provide TPN in alternative settings including transitional care units, rehabilitation hospitals, and for short-term care, the patient's home. The most common specific reasons identified for initiating TPN rather than enteral nutrition were ileus (25%), an underlying acid-base or electrolyte/mineral disorder (13%) requiring correction, and the convenience of TPN because a central venous catheter was in place (12%). The usual indication for nutritional support at this tertiary referral and specialty hospital was actual or impending protein calorie malnutrition. TPN was chosen for a variety of reasons related to actual or anticipated tolerance to enteral feeding. This audit demonstrates that our TPN practice has evolved in relation to time of initiation and duration of feeding, which reflect a clearer appreciation of the risks and benefits of TPN.

Journal Article↗
PubMed2006

Uncovering frustrations. A qualitative needs assessment of academic general internists as geriatric care providers and teachers.

BACKGROUND: General internists commonly provide medical care for older adults and geriatric education to trainees, but lack the necessary knowledge and skills to fulfill these tasks. OBJECTIVE: Assess the geriatric training needs of academic general internists in 3 hospital systems in Portland, OR. DESIGN: Ten focus groups and 1 semi-structured interview. Interview transcripts were analyzed using thematic analysis, a well-recognized qualitative technique. PARTICIPANTS: A convenience sample of 22 academic general internists and 8 geriatricians from 3 different teaching hospitals. MEASUREMENTS: We elicited stories of frustration and success in caring for elderly patients and in teaching about their care. We asked geriatricians to recount their experiences as consultants to general internists and to comment on the training of Internists in geriatrics. RESULTS: In addition to deficits in their medical knowledge and skills, our Internists reported frustration with the process of delivering care to older adults. In particular, they felt ill prepared to guide care transitions for patients, use multidisciplinary teams effectively, and were frustrated with health care system issues. Additionally, general internists' approach to medical care, which largely relies on the medical model, is different from that of geriatricians, which focuses more on social and functional issues. CONCLUSIONS: Although our findings may not be broadly representative, improving our general internists' abilities to care for the elderly and to teach learners how to do the same should address deficits in medical knowledge and skills, barriers to the processes of delivering care, and philosophical approaches to care. Prioritizing and quantifying these needs and measuring the effectiveness of curricula to address them are areas for future research.

Academic Medical Centers↗
PubMed2004

Observation of finite-size effects on a structural phase transition of 2D nanoislands.

We study a reversible, temperature-driven structural surface phase transition of Pb/Si(111) nanoislands with a variable-temperature scanning tunneling microscope. Our quantitative measurements indicate that the transition temperature decreases with decreasing island and domain size. The boundaries of the nanoislands also influence the transition. Careful examination of the change in the interior structure of nanoislands near the transition temperature allows us to image the effects of the thermal fluctuations.

Journal Article↗
PubMed1989

Who is holding the baby?

A survey of neonatal units has been undertaken to establish how many maternity units have to separate mothers from their well, low birthweight babies or low dependency special care babies. The study also looked at some differences in the hospitals practising transitional care, or shared care with mother, and a group of maternity wards looking after babies down to 1.8 kg on normal maternity wards.

Family↗