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At least 739 records · Page 41Linked to original sources
PubMed1997

Ethical considerations in the treatment of cystic fibrosis.

Over the last several decades, rapid medical advancement in the treatment of persons with cystic fibrosis (CF) has brought with it a number of ethical concerns. The increasing life expectancy of persons with CF has made transitions in care increasingly common. This change in life expectancy along with advances in assisted reproductive technologies has focused attention on reproductive decision making in CF. Living lobar lung transplantation, although technically developed, remains ethically problematic. The understanding of ethical issues arising in the treatment of CF is crucial to providing optimal care.

Cystic Fibrosis↗
PubMed2003

Pressure ulcers and the transition to long-term care.

OBJECTIVE: To estimate the prevalence of pressure ulcers among newly admitted residents of long-term-care facilities and to determine whether patients admitted from hospitals had a higher prevalence than those admitted from home or other settings. DESIGN: Prospective cohort study conducted between 1992 and 1995. SETTING: 59 long-term-care facilities in Maryland. PARTICIPANTS: 2015 residents aged 65 years and older newly admitted to participating long-term-care facilities. MAIN OUTCOME MEASURE: Stage II, III, or IV pressure ulcer, first mentioned in the long-term-care facility's chart within 2 days of admission. MAIN RESULTS: Of the 2015 residents studied, 208 (10.3%) had 1 or more pressure ulcers on admission to a long-term-care facility. The proportion of patients with 1 or more pressure ulcers was 11.9% among those admitted from a hospital and 4.7% among those not admitted from a hospital (P<.001). In multivariable analysis, admission from a hospital was significantly associated with pressure ulcer prevalence on admission (odds ratio, 2.2; 95% confidence interval, 1.3-3.7). A lower prevalence of pressure ulcers on admission was significantly associated with being white; a higher prevalence was associated with being chairbound or bedridden, being underweight, and having fecal incontinence. CONCLUSION: Admission to a long-term-care facility from a hospital is an important marker for higher pressure ulcer risk. The identification of pressure ulcer risk factors is essential to the implementation of prevention activities, ensuring that appropriate interventions are targeted to the residents who are most likely to benefit.

Activities of Daily Living↗
PubMed2004

Numerical study of the stability of double fingers with the phase-field model.

Doublon is one of the typical patterns found in crystal growth. It is a bound state of two fingerlike patterns. In this paper, we obtain a phase diagram for doublons with numerical simulations of the phase-field model. Numerical simulations are performed in a channel. Two small seeds of crystal with different sizes are set on the left side of the channel as an initial condition, in order to find whether the two fingers grow into a doublon or one finger overcomes the other owing to mutual competition. It is confirmed that a stable doublon is formed when the undercooling is large and the anisotropy is weak. Furthermore, we find a doublon with oscillating groove in a certain parameter range. We investigate more carefully the transition between the doublon and the dendrite by changing the anisotropy parameters stepwise, and show that the difference of the tip velocities of the doublon and the dendrite increases continuously from zero at a critical value of anisotropy.

Journal Article↗
PubMed2001

Tetragonal crystalline carbon nitrides: theoretical predictions.

New tetragonal phases of crystalline carbon nitride (CN) and their atomic structures have been identified using a self-consistent-charge density-functional tight-binding method. A tetragonal rocksalt structure provides theoretical support to recent experimental evidence for a stoichiometric CN phase with tetragonal symmetry. A body-centered tetragonal CN phase with 1:1 stoichiometry is predicted to be highly stable and of interesting atomic structure with complicated C-C and N-N dimerizations along the c axis. The cubic-to-tetragonal transitions are carefully examined to understand the underlying mechanism.

Journal Article↗
PubMed2002

High-temperature superfluidity of fermionic atoms in optical lattices.

Fermionic atoms confined in a potential created by standing wave light can undergo a phase transition to a superfluid state at a dramatically increased transition temperature. Depending upon carefully controlled parameters, a transition to a superfluid state of Cooper pairs, antiferromagnetic states or d-wave pairing states can be induced and probed under realistic experimental conditions. We describe an atomic physics experiment that can provide critical insight into the origin of high-temperature superconductivity in cuprates.

Journal Article↗
PubMed2006

"They were talking about me"--elderly women's experiences of taking part in a discharge planning conference.

INTRODUCTION: Discharge planning procedures needs improving to make transition to care settings in the community smooth, safe and secure. Research about discharge planning that involves a patient perspective is limited. The intention of this study was to focus on the patients' (elderly women) experiences of taking part in discharge planning conferences (DPCs) to deepen our understanding of the meaning of facing "the world of the institution" from a life-world perspective. AIM: This study aims at describing elderly women's experience of taking part in a DPC as they are about to be discharged from hospital. METHODOLOGICAL DESIGN: To illuminate the phenomenon from a life-world perspective, an interview study was chosen. Eight follow-up interviews with seven elderly women were carried out. The interviews were analysed using a qualitative content analysis methodology. FINDINGS: The interpretation of data was that the women's future was as in suspense as they got ill or were hit by accidents. The analysis revealed four themes that reflected the women's experiences of taking part in the DPCs: Being affiliated; Being in focus, Standing outside; and finally Being unprepared. STUDY LIMITATIONS AND CONCLUSION: The limitations of the study are related to: selection of participants; participation in the interview was connected to a video recording study; gap in time between participation in the DPC and the interview. The findings are still seen as trustworthy as the experiences expressed by the participating women in data are to be seen as a contribution to an emerging understanding of the meaning of the phenomenon from a life world perspective. The findings make clear that the institutional world easily and without much resistance from the patients transgresses the border of their life worlds. This awakes a need to reconsider how a caring perspective can be established in practice.

Adaptation, Psychological↗
PubMed1977

Brief hospitalization: a two-year follow-up.

The author present two-year follow-up data of a controlled study of 175 newly admitted inpatients who lived with families, comparing the relative efficacy of brief hospitalization (with and without transitional day care) and standard hospitalization (with all patients offered outpatient aftercare). The long-term results confirm the preliminary finding that brief hospitalization is preferable to longer term hospitalization for most patients. Briefly hospitalized patients spent significantly less time as inpatients and showed less psychopathology and impairment in role functioning. In contrast to preliminary findings, the long-term results indicate that use of day care reduced the number of inpatient days.

Adult↗
PubMed1987

Beyond model programs: evaluation of a countywide system of residential treatment programs.

Assessing deinstitutionalization as a social policy requires examining a system of programs rather than single, "model" services. The authors report an evaluation of 19 residential treatment programs in Hennepin County, Minnesota, that provide three different levels of care (intensive, transitional, and supportive) for mentally ill clients. Data on client characteristics, program outcomes, and hospitalization costs were collected in two study periods between 1980 and 1985. The results showed that the programs served three distinct client subpopulations that differed in recidivism, vocational status, discharge setting, and costs according to the type of program. Clients in all programs made substantial gains in community integration, and as a group the programs were cost-effective.

Chronic Disease↗
PubMed1996

Outcomes of residential treatment of substance abuse in hospital- and community-based programs.

OBJECTIVE: The study sought to determine whether inpatient readmission rates differed for patients with substance use disorders who were treated in either hospital-based or community-based transitional residential care. Length of residential care and intensity of outpatient mental health aftercare were examined as predictors of readmission. METHODS: Department of Veterans Affairs nationwide databases were used to document readmissions at one- and two-year intervals for male inpatients treated for substance use disorders who were discharged either to hospital-based (N = 2,190) or community-based (N = 4,490) residential care. Patients with and without concomitant psychiatric diagnoses were identified. RESULTS: Patients treated in community-based residential programs had lower one- and two-year readmission rates than patients who received hospital-based residential care. Longer episodes of residential care and more outpatient mental health care were also associated with lower readmission rates. Among patients with concomitant psychiatric disorders, those in hospital-based care benefited more from longer episodes of residential care and more intensive outpatient mental health aftercare. Residential care, longer episodes of care, and more outpatient mental health care were independent predictors of lower one- and two-year readmission rates after patient-based risk factors were controlled. CONCLUSIONS: The findings highlight the value of providing adequate amounts of residential and outpatient care for patients in substance abuse treatment, especially patients with concomitant psychiatric disorders.

Adult↗
PubMed2005

Effect of newer anaesthetics on duration of stay in postanaesthesia care unit in patients undergoing major abdominal surgery.

Newer anaesthetic agents, such as remifentanil and sevoflurane, are more expensive than conventional anaesthetics, such as isoflurane and fentanyl. However, newer anaesthetics might outweigh their higher acquisition costs by reducing length of stay in the postanaesthesia care unit and thereby reducing personnel costs. We retrospectively investigated the influence of newer anaesthetics on time to eligibility for discharge from the postanaesthesia care unit in consecutive patients undergoing major abdominal surgery. Using a chart review, patients undergoing major abdominal surgery with three different anaesthetic regimens (isoflurane/fentanyl (n = 80), sevofluranelfentanyl (n = 40), and sevoflurane/remifentanil (n = 42)) were compared regarding duration of anaesthesia, surgery, time till extubation, and time to eligibility for discharge from the postanaesthesia care unit. Extubation times were shorter in patients in the sevoflurane/fentanyl and the sevoflurane/remifentanil groups compared to patients in the isoflurane/fentanyl group. Time to eligibility to discharge from the postanaesthesia care unit was similar in isoflurane/fentanyl and sevoflurane/fentanyl group. In the sevoflurane/fentanyl group, time to eligibility for discharge from the unit showed a tendency to be increased (P = 0.08), however these patients were significantly older compared to the other groups. Sevoflurane and remifentanil did not appear to reduce time to eligibility to discharge from the postanaesthesia care unit in our patients undergoing major abdominal surgery compared to isoflurane and fentanyl. This study highlighted the necessity for carefully planned transition from remifentanil to other longer-acting analgesia in our patients.

Abdomen↗
PubMedDate not supplied

Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network.

Confusion about patients' medication regimens during the hospital admission and discharge process accounts for many preventable and serious medication errors. Many organizations have begun to redesign their clinical processes to address this patient safety concern. Partners HealthCare, an integrated delivery network in Boston, Massachusetts, has answered this interdisciplinary challenge by leveraging its multiple outpatient electronic medical records (EMR) and inpatient computerized provider order entry (CPOE) systems to facilitate the process of medication reconciliation. This manuscript describes the design of a novel application and the associated services that aggregate medication data from EMR and CPOE systems so that clinicians can efficiently generate an accurate pre-admission medication list. Information collected with the use of this application subsequently supports the writing of admission and discharge orders by physicians, performance of admission assessment by nurses, and reconciliation of inpatient orders by pharmacists. Results from early pilot testing suggest that this new medication reconciliation process is well accepted by clinicians and has significant potential to prevent medication errors during transitions of care.

Clinical Pharmacy Information Systems↗
PubMed2006

Neurologists for patient safety: where we stand, time to deliver.

Neurologists have a professional opportunity, an ethical responsibility, and sound clinical and economic reasons for engaging in efforts to improve patient safety. Better communication with patients and other providers, closer follow-up of consultation cases, and more focused supervision of trainees will help to reduce current patterns of error and misunderstanding. Patient education with attention to health literacy should improve adherence to management plans and help to bridge transitions of care across providers and sites. Through teaching and by example, neurologists can profoundly influence successive generations of clinicians to adopt safer practices, a culture of openness, and enhanced professionalism. The federal Safety and Quality Improvement Act of 2005, once implemented, should increase the evidence basis for safer care through voluntary, legally protected reporting of errors and adverse events within the framework of patient safety organizations.

Medical Errors↗