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PubMed2006

Stages of change and transitioning for adolescent patients with obesity and hypertension.

When exploring an adolescent patient's readiness to transition his/her health care to adult practice, it is important to understand the processes that allow for change and which promote self-efficacy and self-care. The large numbers of adolescents with hypertension and obesity, possible antecedents to adult kidney disease, require attention be paid to promoting lifestyle changes and adherence to treatment regimens as these patients enter adulthood. Transitioning to adult care is in many cases an externally imposed change, but a young patient's readiness for this change may be amenable to intervention based on the Stages of Change Model. This article reviews the impact of adolescent obesity and hypertension on future health, the application of the Stages of Change Model in health care and specifically with adolescents, and the concept of transitioning for young patients with special health care needs. The authors suggest that the application of the Stages of Change Model, including the use of motivation interviewing and cognitive-behavioral techniques, may encourage lifestyle change and treatment adherence and assist in preparing patients for transition to the adult health care setting.

Adolescent↗
PubMedDate not supplied

Improving the continuity of care between general practitioners and public hospitals.

OBJECTIVE: To improve the quality of clinical care through better continuity of services between the public hospital and general practitioners (GPs), focusing on expediting discharge of patients from hospital through improved use of resources provided by GPs. DESIGN: Stage 1: Participant observation during ward rounds and unstructured interviews to gain an understanding of the perceptions of hospital staff and GPs of the GP's role in the discharge process. Stage 2: Semi-structured interviews with registrars and GPs of 30 patients (who were admitted to a medical ward and discharged to the care of their GP) to get the participants' views of each other's roles in providing continuity of care. RESULTS: There was a general lack of trust on both sides, and poor communication owing to several structural and perceptual problems. Registrars focused on specialist care and outpatient follow-up, being almost oblivious to GP functions, apart from monitoring the management plan developed in the hospital; they made no use of GPs' knowledge of the case or their experience in treating patients within their families and social milieu, and frequently wished to do everything within the hospital. GPs, on the other hand, often felt alienated from the hospital system, although they had much to offer by being able to contribute details of the patient's background and by using their special skills, which went well beyond passively monitoring progress. RECOMMENDATIONS: 1. Information about the patient's GP should be made available to hospital staff. 2. Interns should make telephone calls to GPs after admission and when the discharge date is known. 3. Early-discharge summaries should be forwarded and include: (i) reasons for giving or altering medications; (ii) specific plans after discharge; (iii) information conveyed to the patient and family about the illness; and (iv) a summary of the case by the consultant. 4. Registrars and interns should be educated about the appropriate involvement of GPs in the discharge process and throughout the patient's stay in hospital. 5. Direct involvement of the GP with the patient during hospital stay should be encouraged. 6. A pilot study should be set up to investigate the role of a liaison person in overcoming problems of the transition of care of hospitalised patients to the community.

Australia↗
PubMed1987

Forecasting client transitions in British Columbia's Long-Term Care Program.

This article presents a model for the annual transitions of clients through various home and facility placements in a long-term care program. The model, an application of Markov chain analysis, is developed, tested, and applied to over 9,000 clients (N = 9,483) in British Columbia's Long Term Care Program (LTC) over the period 1978-1983. Results show that the model gives accurate forecasts of the progress of groups of clients from state to state in the long-term care system from time of admission until eventual death. Statistical methods are used to test the modeling hypothesis that clients' year-over-year transitions occur in constant proportions from state to state within the long-term care system. Tests are carried out by examining actual year-over-year transitions of each year's new admission cohort (1978-1983). Various subsets of the available data are analyzed and, after accounting for clear differences among annual cohorts, the most acceptable model of the actual client transition data occurred when clients were separated into male and female groups, i.e., the transition behavior of each group is describable by a different Markov model. To validate the model, we develop model estimates for the numbers of existing clients in each state of the long-term care system for the period (1981-1983) for which actual data are available. When these estimates are compared with the actual data, total weighted absolute deviations do not exceed 10 percent of actuals. Finally, we use the properties of the Markov chain probability transition matrix and simulation methods to develop three-year forecasts with prediction intervals for the distribution of the existing total clients into each state of the system. The tests, forecasts, and Markov model supplemental information are contained in a mechanized procedure suitable for a microcomputer. The procedure provides a powerful, efficient tool for decision makers planning facilities and services in response to the needs of long-term care clients.

Aged↗
PubMed1996

Results of treatment one year later: child and adolescent partial hospitalization.

OBJECTIVE: One criticism of academicians is that they evaluate and disseminate outcome studies based more on the value and merit of the research design than on the utility of the findings for improving clinical practice. Increasing pressure on programs to evaluate the effectiveness of behavioral health care is transitioning outcome measurement from the exclusive domain of the researcher toward the clinical/organizational domain. To explore the multiple applications of such clinical outcome data, this article presents the results from a study of 114 patients completing treatment in two child and adolescent partial hospital programs. METHOD: Four areas define the scope of clinical outcome measurement pertinent to partial hospitalization: changes in the patient's clinical status, changes in the patient's level of daily functioning, impact on the utilization of behavioral health services after discharge, and patient/family satisfaction with treatment. Using these four domains, this study compares data assessed at admission and at 1 year postdischarge. RESULTS: Analyses used paired t tests primarily to measure change between admission and 1 year after discharge. Overall, the data show improvement in general functioning that remains evident up to 1 year postdischarge. CONCLUSIONS: Finding positive results in specific areas emphasized therapeutically--such as family functioning and use of community-based mental health resources after discharge, and the parent's attribution of improvement to experiences in treatment--provides justification for relating improvement to the treatment episode.

Activities of Daily Living↗
PubMed2006

Impact of medication therapy discontinuation on mortality after myocardial infarction.

BACKGROUND: Nonadherence to medications is common, but the determinants and consequences are poorly defined. The objectives of this study were to identify patient and myocardial infarction (MI) treatment factors associated with medication therapy discontinuation and to assess the impact of medication discontinuation 1 month after MI on 12-month mortality. METHODS: This was a multicenter prospective cohort of patients with MI enrolled in the Prospective Registry Evaluating Myocardial Infarction: Event and Recovery study. The outcomes were use of aspirin, beta-blockers, and statins at 1 month after MI hospitalization among patients discharged with all 3 medications as well as 12-month mortality. RESULTS: Of 1521 patients discharged with all 3 medications, 184 discontinued use of all 3 medications, 56 discontinued use of 2 medications, 272 discontinued use of 1 medication, and 1009 continued taking all 3 medications at 1 month. In multivariable analyses, patients not graduating from high school (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.20-2.60) were more likely to discontinue use of all medications. The effect of increasing age on medication therapy discontinuation was greater for females (OR, 1.77; 95% CI, 1.34-2.34) than males (OR, 1.23; 95% CI, 1.02-1.47). Patients who discontinued use of all medications at 1 month had lower 1-year survival (88.5% vs 97.7%; log-rank P<.001) compared with patients who continued to take 1 or more medication(s). In multivariable survival analysis, medication therapy discontinuation was independently associated with higher mortality (hazards ratio, 3.81; 95% CI, 1.88-7.72). Results were consistent when evaluating discontinuation of use of aspirin, beta-blockers, and statins separately. CONCLUSIONS: Medication therapy discontinuation after MI is common and occurs early after discharge. Patients who discontinue taking evidence-based medications are at increased mortality risk. These findings suggest the need to improve the transition of care from the hospital to outpatient setting to ensure that patients continue to take medications that have mortality benefit.

Adrenergic beta-Antagonists↗
PubMed2005

Comparison of perfusion MRI by flow-sensitive alternating inversion recovery and dynamic susceptibility contrast in rats with permanent middle cerebral artery occlusion.

We compared cerebral blood flow (CBF) parameters obtained by dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) with those obtained by flow-sensitive alternating inversion recovery (FAIR) in brain regions with different perfusion levels in rats with permanent middle cerebral artery (MCA) occlusion. MCA occlusion was performed in 19 rats. T2-weighted MRI, FAIR and DSC-MRI were performed within 48 h after occlusion. CBF parameters were analyzed in regions of interest with either prolonged or less prolonged mean transit time (MTT). Ratios of ipsi- vs contralateral CBF values were calculated and tested for correlation and differences between FAIR and DSC-MRI. FAIR-aCBF ratios correlated significantly with DSC-rCBF ratios. The mean FAIR-aCBF ratio was significantly lower than mean DSC-rCBF ratio in the area with prolonged MTT. In the area with less prolonged MTT, the mean FAIR-aCBF ratio and mean DSC-rCBF values did not differ significantly. We conclude that FAIR correlates with DSC-MRI if perfusion is preserved. FAIR provides lower CBF values than DSC-MRI if perfusion is reduced and MTT is prolonged. This probable underestimation of perfusion may be caused by transit delays. Care should be taken when quantifying CBF with FAIR and when comparing the results of FAIR- and DSC-MRI in areas with hypoperfusion.

Animals↗
PubMed2006

Health-related quality of life in children and emotional reactions of parents following completion of cancer treatment.

BACKGROUND: Completing therapy is one of the major transitions in care in the practice of pediatric oncology and, therefore, deserves special consideration. The purpose of the study was to investigate health-related quality of life (HRQOL) of pediatric patients, and emotional reactions of their parents, shortly after the end of successful treatment. METHODS: HRQOL of 126 patients, aged 1-15 years, on average 2 months after the end of successful treatment, was assessed with the TNO-AZL Pre-school Quality of life Questionnaire and the TNO-AZL Children's Quality of life Questionnaire. Emotional adjustment of 124 mothers and 111 fathers was assessed with the General Health Questionnaire and the Situation Specific Emotional Reaction Questionnaire. The outcomes of the patients and parents were compared with norm data by means of one sample t-tests, one sample sign-tests or binomial tests. RESULTS: All age groups, except patients aged 8-11 years, experienced worse HRQOL than the norm with respect to motor functioning. In addition, pre-school patients were rated worse on sleeping, appetite, stomach, skin, problem behavior, anxiety, and liveliness, and patients aged 6-7 years on autonomy and cognitive functioning. Parents reported more psychological distress than the norm. Compared to parents whose children were 1-5 years after cancer treatment, they suffered more from feelings of loneliness, helplessness, and uncertainty. CONCLUSIONS: A few months after the end of successful cancer treatment, both patients and parents appeared to experience worse well-being than the norm to a clinically relevant extent. Supporting patients and parents should not stop when treatment ends.

Adolescent↗
PubMed2005

Long-term follow-up of survivors of childhood cancer.

OBJECTIVE: This study was designed to improve the long-term follow-up of childhood cancer survivors by developing standard monitoring for adverse effects; Providing concise treatment summaries for each patient and identifying already existing adverse effects; Determining patient risks for long-term adverse effects; and providing individualized 10-year of plans for follow-up. METHODS: A retrospective chart review of long-term childhood cancer survivors followed by the institution's pediatric oncologists was performed. Criteria for review included being at least 5 years from diagnosis and 2 years off chemotherapy. Patients are followed annually by the pediatric oncologists. RESULTS: At the time of review, there were 26 long-term survivors of childhood cancers enrolled at the clinic. Their charts have been reviewed and treatment summaries formulated. Fifty-four adverse effects have been detected. 74% of the patients have long-term adverse effects from receiving cancer therapy. The most common were growth hormone deficiency, hypothyroidism, seizures, and hearing loss. Ten year follow-up plans have been devised for each patient. CONCLUSION: The presence of long-term adverse effects is common in childhood cancer survivors. The pediatrician is pivotal in helping assure their patients are receiving adequate follow-up to detect these complications as well as assisting in the transition to care as an adult.

Adolescent↗
PubMed2003

Transition from pediatric to adult care of children with chronic endocrine diseases: a survey on the current modalities in Italy.

We report on a survey carried out in 65 pediatric and adult endocrinological centers concerning: 1) the modalities of the transfer of children with chronic endocrine diseases from pediatricians to adult endocrinologists, 2) opinions and suggestions from physicians of the Centers, and 3) specific details regarding GH deficiency. The main results are: 1) The mean age of transfer is around 18 yr of age. 2) The reasons for the transfer are personal convincement of pediatricians in 47%, administrative reasons in 37% and patient's desire in 16% of cases 3) In the majority of cases a discharge summary is sent by the pediatrician to the endocrinologist often followed by a phone call, whereas 30% of endocrinologists do not send a report back to pediatricians. 4) Less than half of the Centers are satisfied with the modalities of the transfer and the remainder complain about the lack of communication, no common guidelines, and differences in the management of patients. However, all are willing to try to improve this important time for adolescents with chronic diseases. 5) As far as GH deficiency is concerned, the main differences between pediatric and adult endocrinological centers are the different tests used to re-evaluate the diagnosis and the higher doses of GH used by pediatricians to treat young adults. In conclusion, considering the interest and desire of physicians, a structural intervention of the scientific societies to help to overcome problems is highly desirable.

Adolescent↗
PubMed1993

Geography of health: some trends and perspectives.

The present evolution of geography of health is highlighted through a selection of recent publications. Some current research trends are listed, such as disease ecology in a changing environment, geography of AIDS, urbanization, epidemiological transition, health care delivery. The most salient future perspectives are pointed out.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Transition through the continuum of care in a continuing care retirement community: can a functional rating scale be a decision-making tool?

This retrospective descriptive study was done to determine if the Geriatric Functional Rating Scale (GFRS) can be used as an objective measure of a resident's need for a higher level of care in a continuing care retirement community (CCRC). A total of 290 of the 300 available independent living residents in a CCRC underwent assessment with the GFRS. At the end of the study period (February 2000 through December 2003), 84% of those who initially had a score of > or =40 were still living independently (alone or with a spouse), of those scoring 20 to <40, 11% were living independently, 40% required some assistance, and 20% entered a Long-Term Care Facility (LTC). Of those scoring <20 initially, none were living independently at the end of the study period. GFRS scores of > or =40 seemed to correlate with continued independence and <40 with an increasing need for assistance. The GFRS provides a functional database on each resident and may be a good objective predictor of future level of care. The sensitivity and specificity of GFRS scores <40 were 42% and 96%, respectively, for either admission to a facility or death. The positive predictive value was 87% and the negative predictive value was 72%.

Activities of Daily Living↗
PubMed2001

Characteristics of staff victims of patient assault: ten year analysis of the Assaulted Staff Action Program (ASAP).

Patient assaults on staff have been a continuing risk for inpatient and community-based psychiatric healthcare providers. This study presents a ten-year analysis of the characteristics of staff victims of patient assaults in one public mental health system of care, a period which included the transition to managed care initiatives within this system. Assault data was gathered within the context of the Assaulted Staff Action Program (ASAP), a voluntary, system-wide, peer-help, crisis intervention program that is designed to assist employees with the psychological sequelae of these patient events. In general, the findings were consistent with previously reported inpatient and community studies. Less experienced, less formally trained employees remain at high risk. The impact of managed care initiatives was found in community residences where younger female staff were most at risk. The implications of the findings and possible risk management strategies are discussed.

Adult↗
PubMed1998

Triangulation in nursing research: issues of conceptual clarity and purpose.

The controversy concerning the value of qualitative, quantitative and triangulation approaches to nursing research for understanding human behaviour and increasing nursing knowledge has been an increasing source of debate among nurse scholars. However, the differences and similarities of these three perspectives have not been fully compared as either philosophies or methodologies. The purposes of this paper are to provide an understanding of the origin and development of the triangulation research method, clarify major sources of confusion in the presentation of a triangulation study, and discuss the problems and possible solutions of a triangulation study. Finally, an example of multiple triangulation in a nursing research within a Taiwanese cultural context -- turning points of recovery from cardiac surgery during the intensive care unit transition -- is presented. In the course of the paper, suggestions are also given to help nurse researchers recognize when it is most appropriate to use a certain research method, whether that be qualitative, quantitative or triangulation.

Cardiovascular Surgical Procedures↗
PubMed1996

Process for preventing or identifying and resolving problems in drug therapy.

A consistent process for preventing or identifying and resolving problems related to drug therapy is described. The process was originally developed to help pharmacy students focus on drug therapy issues during their clinical clerkship rotations. The first version of this approach to quality improvement consisted of lists of questions designed to prompt the student to prevent or identify and correct drug therapy problems. Because the learning style of some students is more visual, the questions were incorporated into flow charts. Students at a community hospital used the flow charts during their rotations through the critical care, medical-surgical, and psychiatric units, and the process appeared to result in improvements in the quality of care and in savings in the cost of care. As a result, a staff development and training project was begun to determine if staff pharmacists who use this process to evaluate drug therapy will begin to provide pharmaceutical care. This sort of transitional model of pharmaceutical care may expedite global implementation of the new practice philosophy. Flow charts encouraging a uniform approach to the prevention or identification and correction of drug therapy problems were developed for use by pharmacy students and generalist pharmacists.

Clinical Clerkship↗
PubMed1999

Transitions, part 1: beyond pharmaceutical care.

A systems view of the amalgamation of existing pharmacy practice models is proposed. Pharmacy's evolution is traceable as a series of stages. The stages in pharmacy's evolution have been manufacturing pharmacy, compounding, distribution, clinical pharmacy, and pharmaceutical care. Good pharmacy practice (GPP) represents an international attempt to unite various conceptualizations of practice, including pharmaceutical care. GPP in turn provides a foundation for a model to explain current and changing practice, the total pharmacy care (TPC) model. TPC combines five existing practice models: drug information, self-care, clinical pharmacy, pharmaceutical care, and distribution. TPC, as the sum of these models, asserts that there will be an ongoing need for all five existing models of practice, that the proportion of pharmacists employing each model will reflect the needs of a given health care environment at a given time, and that if changes in health care provide more opportunities for pharmaceutical care, pharmacists will shift increasingly toward that type of practice. Total pharmacy care is the delivery of a comprehensive range of services that result in the maximum possible contribution to the health of a nation's population within the limits of the health care delivery structure.

Forecasting↗
PubMed1996

Long-term pediatric care in the managed care environment.

Pediatric subacute care is a transitional phase along the continuum of care. Consumers, providers and payors must address the system-wide changes needed to integrate this population within the subacute care environment.

Ethics, Nursing↗