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PubMed2006

Adoption and sustainability of decision support for patients facing health decisions: an implementation case study in nursing.

BACKGROUND: Effective interventions prepare patients for making values-sensitive health decisions by helping them become informed and clarifying their values for each of the options. However, patient decision support interventions have not been widely implemented and little is known about effective models for delivering them to patients. The purpose of this study was to describe call centre nurses' adoption of a decision support protocol into practice following exposure to an implementation intervention and to identify factors influencing sustainable nursing practice changes. METHODS: Exploratory case study at a Canadian province-wide call centre guided by the Ottawa Model of Research Use. Data sources included a survey of nurses who participated in an implementation intervention (n = 31), 2 focus groups with nurses, interviews with 4 administrators, and a document review. RESULTS: Twenty-five of 31 nurses responded to the survey measuring adoption of decision support in practice. Of the 25 nurses, 11 had used the decision support protocol in their practice within one month of the intervention. Twenty-two of the 25 intended to use it within the next three months. Although some nurses found it challenging to begin using the protocol, most nurses reported that it: a) helped them recognize callers needing decision support; b) changed their approach to handling these calls; and c) was a positive enhancement to their practice. Strategies identified to promote sustainability of practice changes included integration of the decision support protocol in the call centre database, streamlining the patient decision aids for easier use via telephone, clarifying the administrative direction for the call centre's program, creating a call length guideline specific for these calls, incorporating decision support training in the staff development plan, and informing the public of this enhanced service. CONCLUSION: Although most nurses adopted the decision support protocol for coaching callers facing values-sensitive decisions, to sustain practice changes, interventions are required to manage barriers in the practice environment and integrate decision support into the organization's policies, resources, and routine activities.

Journal Article↗

PubMed2000

Inhalation sedation with nitrous oxide: a review.

The General Dental Council guidelines regarding the use of general anaesthesia in general practice have changed; inhalation sedation with nitrous oxide has been shown as a safe alternative to general anaesthesia for many patients and is a technique particularly suited to the practice environment.

Anesthesia, Dental↗

PubMed1989

Report from the American Nurses' Association council on psychiatric and mental health nursing.

Society has demonstrated a major need for expanded gerontological and geropsychiatric nursing services. Current needs have not yet been met and the call for service will increase throughout the balance of this century and beyond. Social responsiveness demands that nurses: (1) formally establish their clinical authority in care of the aged; (2) lobby for public policy which enables the provider professional to control the practice environment, rather than be controlled by it; (3) improve the educational preparation of nurses to care for the aged; and (4) expand the professions' scientific and research base in this area. The national professional organization of registered nurses, the American Nurses' Association, provides leadership to influence the course of nursing as it continues to provide vital services in a dramatically changing environment.

Aged↗

PubMed1999

Physician substance use by medical specialty.

Self-reported past year use of alcohol, tobacco, marijuana, cocaine, and two controlled prescription substances (opiates, benzodiazepines); and self-reported lifetime substance abuse or dependence was estimated and compared for 12 specialties among 5,426 physicians participating in an anonymous mailed survey. Logistic regression models controlled for demographic and other characteristics that might explain observed specialty differences. Emergency medicine physicians used more illicit drugs. Psychiatrists used more benzodiazepines. Comparatively, pediatricians had overall low rates of use, as did surgeons, except for tobacco smoking. Anesthesiologists had higher use only for major opiates. Self-reported substance abuse and dependence were at highest levels among psychiatrists and emergency physicians, and lowest among surgeons. With evidence from studies such as this one, a specialty can organize prevention programs to address patterns of substance use specific to that specialty, the specialty characteristics of its members, and their unique practice environments that may contribute risk of substance abuse and dependence.

Adult↗

PubMedDate not supplied

Job turnover intentions among Certified Pharmacy Technicians.

OBJECTIVE: To describe the job withdrawal intentions of a nationwide sample of Certified Pharmacy Technicians (CPhTs). DESIGN: Cross-sectional descriptive design. SETTING: A random sample of 3,200 CPhTs whose names and contact information were acquired from the Pharmacy Technician Certification Board. INTERVENTIONS: Mailed survey. MAIN OUTCOME MEASURES: Responses to questions eliciting job withdrawal intentions, reasons for remaining/staying with the employer, and various quality of worklife attitudes. Employment intentions were regressed over quality of worklife and practice environment variables in a forward-conditional logistic regression procedure. RESULTS: Nearly 4 in 5 respondents indicated intentions to remain with the current employer during the next 12 months. Relationships with coworkers, good benefits, and work schedule were frequently cited as reasons to stay. Poor salary, lack of advancement opportunity, and insufficient staffing were cited frequently as factors among those indicating intentions to leave. Mean hourly wages differed among respondents with intention to leave due to salary, those not citing salary as a reason to remain or leave, and those citing salary as a reason for staying. Intention to remain was associated with higher pay, perceived employer support, number of years with the current employer, and lower career turnover intentions, with organizational commitment acting as a powerful mediator for all of the variables. CONCLUSION: Differences in CPhTs' future employment intentions were described more comprehensively by perceptions of the employing organization than by perceptions of managers/supervisors and coworkers or personal/work environment variables. Implications for pharmacy organizations are discussed.

Certification↗

PubMed2004

Access to dental care: solving the problem for underserved populations.

BACKGROUND: Americans are enjoying an increasing level of oral health. However, oral health improvements are not being experienced evenly across the population. The poor, some minorities, institutionalized elderly people and other groups do not have adequate access to dental care. OVERVIEW: The author discusses the need to understand clearly the barriers to care affecting underserved populations and presents a framework for designing access-to-care programs. CONCLUSIONS: The author concludes that access-to-care problems are complex and will not be solved easily or quickly. A complete understanding of the barriers to care being experienced by any group under consideration must be achieved, and an improvement plan must be designed to address those specific barriers considering the demand for care, the dental work force and the economic environment. PRACTICE IMPLICATIONS: Failure to understand the barriers to care and address them adequately will result in limited success in enhancing access to dental care for underserved populations.

Adolescent↗

PubMed2006

Role of the pharmacist.

The prevalence of cardiovascular risk factors continues to rise, with considerable emphasis on the upward trends in obesity and diabetes mellitus, which have increased by 46% and 60%, respectively, in the past 10 years. The alarming increase in the prevalence of diabetes and obesity has resulted in the development of new and innovative drug therapies to assist in managing cardiometabolic risk factors. This advent creates many opportunities for pharmacists to evaluate patients' drug regimens and influence lifestyle modification. Drug therapy management programs allow pharmacists to take active roles in assessing drug regimens and to intervene as appropriate. No matter what their practice environment, pharmacists have numerous opportunities to recognize and recommend treatment for cardiometabolic risk factors and to increase patient compliance by educating patients and health care practitioners.

Cardiovascular Diseases↗

PubMed2002

Transition to the neonatal nurse practitioner role: making the change from the side to the head of the bed.

Role transition is never easy, but is complicated by the experienced neonatal nurse's frustration with reverting to a student role and becoming a novice practitioner, sometimes after years of developing a reputation as an expert nurse. This article discusses this transition, focusing on the skills needed to move successfully from nurse to nurse practitioner. Common to all advanced practice transitions are stages similar to those Benner identifies in her novice-to-expert theory of nursing practice. Feelings of frustration and inadequacy are common during the first year as an NNP. Studies focusing on role transition and role development suggest that a strong nursing identity is important for success in the NNP practice environment. Strategies to enhance the transition are discussed.

Career Mobility↗

PubMed2000

Interleukin-1 genetic association with periodontitis in clinical practice.

BACKGROUND: Periodontitis is a bacterial disease modified by multiple risk factors. The pro-inflammatory cytokine interleukin- (IL-1) is a key regulator of the host responses to microbial infection and a major modulator of extracellular matrix catabolism and bone resorption. It has been reported that variations in the IL-1 gene cluster on chromosome 2 are associated with increased susceptibility to severe adult periodontitis. METHODS: The present study evaluated the association between a composite IL-1 genotype, including allele 2 at each of two loci (IL-1A +4845 plus IL- B +3954), and a broad spectrum of periodontally healthy to diseased patients in a population that is typically encountered in a dental practice setting. Ninety patients, non-smokers or former smokers with less than 10 pack-year (pk/yr) history, were recruited from a private dental practice. The major outcome variable was bone loss determined by computerized linear measurements of radiographs. Genotypes were analyzed from finger-stick blood samples using previously reported methods. RESULTS: Multivariate logistic regression models demonstrated that patient age, former smoking history, and the IL-1 genotype were significantly associated with severity of adult periodontitis. For non-smokers or former light smokers (<5 pk/yr), IL-1 genotype positives were at increased odds ratio of having moderate to severe periodontal disease of 3.75 (95% CI: 1.04-13.50) to 5.27 (95% CI: 1.23-22.70), depending on ethnicity, compared to IL-1 genotype negatives. Former moderate smokers (>5 pk/yr and <10 pk/yr) who were IL-1 genotype negative were at increased odds ratio of having moderate to severe periodontal disease of 7.43 (95% CI: 1.20-46.20) compared to non-smokers or former light smokers who were IL-1 genotype negative. In addition, past smoking history was also a significant effect modifier as demonstrated by the statistically significant interaction between past smoking history status and IL-1 genotype status. CONCLUSIONS: This study demonstrates that the composite IL-1 genotype is significantly associated with the severity of adult periodontitis. It also confirmed that both IL-1 genotyping and smoking history provide objective risk factors for periodontal disease in a private practice environment.

Adult↗

PubMed1995

State legislative strategies to improve the supply and distribution of generalist physicians, 1985 to 1992.

State laws enacted between 1985 and 1992 were reviewed to examine state involvement in influencing the supply and distribution of generalist physicians. Forty-seven states enacted 238 relevant laws during this period. In 1991 and 1992, 36 states enacted 98 laws, as compared with 1985 and 1986, when 8 states enacted 12 laws. Legislation addressed planning and oversight; financial incentives to institutions, students, and residents; and strategies to enhance the practice environment. A new strategy is to link funding to measureable outcomes, such as the career choices of a state medical school's graduates. Few states devoted resources to evaluate their efforts.

Education, Medical↗

PubMed1990

Amoxicillin/clavulanic acid. An update of its antibacterial activity, pharmacokinetic properties and therapeutic use.

Clavulanic acid enhances the antibacterial spectrum of amoxicillin by rendering most beta-lactamase-producing isolates susceptible to the drug. In clinical trials amoxicillin/clavulanic acid is clinically and bacteriologically superior to amoxicillin alone and at least as effective as numerous other comparative agents, such as orally administered cephalosporins, cotrimoxazole, doxycycline and bacampicillin, in the treatment of adults and children with the most common forms of infection encountered in general practice, i.e. urinary tract infections, upper and lower respiratory tract infections, otorhinolaryngological infections, and skin and soft tissue infections. It may also provide effective treatment for uncomplicated gonorrhoea, chancroid and gynaecological infections as well as acting as a prophylactic agent against surgical infection. Thus, in general practice environments where beta-lactamase production has restricted the effectiveness of amoxicillin, the combination of clavulanic acid with amoxicillin has clearly extended the usefulness of a tried and proven first-line antibacterial agent.

Amoxicillin↗

PubMed2001

Networked ICD-9 coding system for a radiology department.

OBJECTIVE. We describe a networked database system to implement a departmental list of International Classification of Diseases, 9th edition (ICD-9) codes for use by reporting radiologists. CONCLUSION. Our system is reliable, easy to use, and has increased coding accuracy and speed. In-house development allowed designing a system to specifically address the needs of the radiology group. The resulting list of codes accurately reflects the current practice environment and grows dynamically to suit changing needs.

Computer Communication Networks↗

PubMed2002

Holocaust survivors in a primary care setting: fifty years later.

Past studies have not assessed the prevalence of emotional disturbances in Holocaust survivors seeking medical treatment in a family practice environment. The present study examined the prevalence of lifetime (the presence of symptomatology at any time) and current posttraumatic stress disorder (PTSD) symptoms, general anxiety, and depression in Holocaust survivors seeking medical treatment in a primary care setting. 20 of the 27 Holocaust survivors in our sample received a current diagnosis of PTSD and reported significant symptoms of depression and general anxiety. Although 74% of the survivors were currently diagnosed with PTSD, participants in this study had reported an overall decline in reexperiencing, hyperarousal, and overall PTSD symptoms but exhibited increased avoidance and numbing symptoms throughout the lifespan. These preliminary results suggest that removing avoidance as a defense mechanism during the course of psychotherapy may leave these survivors without an adequate way for coping with their trauma, subsequently increasing their vulnerability to psychopathology. Implications for psychological interventions are provided.

Aged↗

PubMedDate not supplied

Frostbite: review and current concepts.

BACKGROUND: A literature review was conducted to analyze developments in the epidemiology, pathogenesis, treatment, and prevention of frostbite injury. Increased participation in outdoor activities, as well as the epidemic of homelessness, makes knowledge of the treatment of frostbite crucial for physicians in both rural and urban areas. METHODS: A literature search, using the key words "frostbite" and "cold," was done using MEDLINE and Index Medicus. This search focused on the epidemiology, pathogenesis, treatment, and prevention of frostbite. RESULTS: Research done during the past 15 years has clarified the pathogenesis of frostbite injury and led to a better understanding of how to limit tissue loss. The etiology of frostbite is commonly related to alcohol use, psychiatric illness, or motor vehicle problems. The pathogenesis is linked to tissue freezing, hypoxia, and the release of inflammatory mediators. The initial clinical manifestations of frostbite injury are similar for superficial and deep tissue damage, so early treatment is identical for all injuries. Optimum therapy is based on the rapid reversal of tissue freezing by rewarming in 104-108 degrees F water and the institution of oral and topical antiprostaglandin therapy to limit the release of inflammatory mediators. CONCLUSION: Rapid triage and treatment of frostbite can lead to dramatic improvements in outcome and prognosis. Increased awareness of antiprostaglandin therapy and preventive measures is crucial for physicians in diverse practice environments.

Cold Temperature↗

PubMedDate not supplied

A systematic review of studies comparing myocardial infarction mortality for generalists and specialists: lessons for research and health policy.

BACKGROUND: Much of the research comparing specialists and generalists is from studies of patients who had a myocardial infarction. The present study systematically examined this research. METHODS: Medline was used to search for all articles published from 1990 to 2003 that compared cardiologists and generalists for adjusted mortality rates of patients with myocardial infarction. From each article identified, information was abstracted on factors that could have influenced the comparisons. RESULTS: The studies consistently found that patients of generalists were at greater risk of mortality from both cardiac and noncardiac risk factors and had higher unadjusted mortality rates. Adjusting for risk factors decreased the differences between cardiologists and generalists. Studies that seemed to do the best job taking into account patient differences had similar adjusted-mortality rates for the cardiologists and generalists. No studies adequately took into account reasons the patient did not have care by a cardiologist, eg, patient preferences, severity of comorbid disease, general health status, or resource availability. CONCLUSIONS: Generalists and cardiologists differ substantially with respect to their patients and practice environments. Results comparing patient outcomes by specialty are often influenced by important patient or resource characteristics that were not taken into account.

Cardiology↗

PubMed1998

Long-term positive and negative identity priming: evidence for episodic retrieval.

An episodic retrieval account of negative priming (Neill, 1997; Neill & Valdes, 1992) was evaluated in three experiments. During practice, regular word pairs were presented to subjects differing numbers of times. The subjects named specific target words while they ignored specific distractor words. Following a 5-min retention interval, memory for practice was revealed: Test responses for target words exhibited positive priming that increased with increases in the number of times that the words had been attended. Test responses for distractor words exhibited either positive priming (Experiment 1) or negative priming (Experiments 2-3) that also increased with increases in the number of times that the words had been ignored. The type of priming that distractors exhibited was determined by several contextual similarities between the practice environment, in which distractors were ignored initially, and the test environments, in which they were processed subsequently. Negative priming that spanned a 5-min interval, increased with increases in the number of times that a distractor was ignored, and was sensitive to contextual changes indicated that the direction of the effect was temporally backward because the test probe cued memory for earlier processing of the priming stimulus when the distractor had been ignored.

Adult↗

PubMedDate not supplied

A comparative evaluation of two educational strategies to promote publication by nurses.

BACKGROUND: Two group educational strategies to promote publication by nurses at The Johns Hopkins Hospital were evaluated and found to result in similar success rates. METHOD: Eighteen nurses, divided into two groups, attended three monthly sessions for instruction, guidance, and encouragement on writing and publishing. One group received additional guidance and encouragement during quarterly meetings for 1 year. Data were collected on participants' characteristics and publication success rates. RESULTS: Both groups achieved similar publication success rates. CONCLUSION: A group education program to promote publication by novice nurse authors achieved positive outcomes and used resources more cost-effectively than the traditional method of individual instruction and guidance. Two factors having positive effects on publication success were: a) having a clear topic for publication at the outset of the educational program, and b) holding a positive perception of the value placed on publication within one's practice environment. The authors suggest alternative educational and other strategies to encourage nurses to share their clinical knowledge through publication.

Curriculum↗

PubMed1994

Curriculum issues related to nurse turnover.

The problem of turnover rates among registered nurses has implications for nursing curriculum and for continuing education programs. After a brief presentation of turnover issues, curriculum implications will be discussed under three broad areas: (a) content about turnover included in nursing management textbooks; (b) nursing curriculum issues that influence the survivability of graduates of schools of nursing and thereby affect turnover rates; and (c) continuing education needs of registered nurses. This paper is not a summary of solutions for turnover. The problem of turnover is complex and poorly understood. The curricular issues provide challenges to traditional nursing education that would increase the likelihood of the development of "hardy" nurse graduates who have survival skills for the practice environment.

Curriculum↗