Radiation safety in the endoscopy setting.
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Because of low rates of colorectal cancer screening among African Americans, it may be beneficial to begin educating persons about this disease before age 50. Using the Patient/Provider/System Theoretical Model for cancer screening, this study compared knowledge of colorectal cancer, sources of information, and awareness of programs among participants of age 20-29, 30-49, and 50-75 years. The majority (n = 354) were women and African American (mean age = 37 years, mean education = 12th grade). Younger participants tended to know less about the disease, but there were few differences in knowledge between the two older groups. Persons in the 40-49-year age group were more likely to be familiar with the role diet plays in the risk of colorectal cancer. Participants associated the need for screening with the presence of symptoms. Television and radio were listed as the most frequent source of information about cancer. The Internet was the least used. The majority were not familiar with selected national programs and services focused on increasing awareness of cancer. Findings suggest that colorectal cancer-related information should be targeted toward this population before age 50, using multiple sources such as TV/radio, providers, magazines, and cancer-related organizations. An estimated 104,950 colon and 40,340 rectal cancer cases will be diagnosed in 2005 with an estimated 56,290 deaths from the disease (American Cancer Society [ACS], 2005). Despite a stabilization of colorectal cancer (CRC) incidence rates since the 1980s, African American males and females have higher incidence and mortality rates associated with this disease compared to Whites. The 5-year survival rate for CRC among African Americans improved to 54% during the years 1995-2000, but lagged well behind the 64% survival rate for Whites during the same time period. Screening and early detection of CRC followed by effective treatment is crucial to reducing these mortality rates.
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Are deaths that occur in critical care expected or unexpected? The objective was to illustrate the incidence of deaths in adult critical care units. We also wanted to discover if our patient population fit the norm of those who die in these units in the United States. Are the patients with many comorbid conditions? Could they benefit from advance care planning? A prospective chart review was completed on all deaths that occurred in our 5 critical care units. Most deaths (76.6%) were expected. Patients had an average of 3.3 comorbidities. Greater public knowledge about advance care planning is needed and must include education about the full range of options in end-of-life care.
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Congestive heart failure (CHF) is the leading cause of rehospitalization and loss of revenue for home care agencies and hospitals. This article outlines how an agency used telehealth to provide CHF patients quality care and improved outcomes while decreasing the number of skilled home nursing visits and reducing rehospitalization rates to 1.2%.
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Disease management programs are beginning to encompass providers across the healthcare continuum, including home healthcare. The premise behind disease management is that coordinated, evidence-based interventions can be applied to the care of patients with specific high-cost, high-volume chronic conditions, resulting in improved clinical outcomes and lower overall costs. Outcomes data (actual results) are central in this approach to patient care.
PURPOSE: To provide physicians and nurses with an overview of strategies for descriptive documentation of skin and wound assessments and interventions. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in learning about strategies for documenting skin and wound assessments and interventions. OBJECTIVES: After reading the article and taking the test, the participant will be able to: 1. Describe documentation related to the use of risk assessment and manual assessment tools. 2. Describe documentation related to the use of skin and wound assessment tools.
There is a critical link between patient outcomes achieved and the implementation of best practice that is often misunderstood and frequently overlooked. As OBQI ushers in a new outcomes-driven environment of measuring care quality, it is important to understand this link and implement clinical interventions accordingly.
Home care has the opportunity to positively affect the quality of care and outcomes of patients with diabetes by implementing evidence-based practice. However, many clinicians are unsure how to locate and use this guidance. This article describes how the staff nurse can use evidence-based practice interventions and outcomes from the American Diabetes Association's standards to provide optimal care for patients with diabetes.
In 2006, the latest revision of the Infusion Nursing Standards of Practice was published by the Infusion Nurses Society. The Standards define the scope of practice and educational requirements for nurses who practice in infusion therapy in all healthcare settings. This article provides a description of the Standards, including a discussion of 12 Standards to illustrate their application in home care.
The day-to-day responsibilities of managing seizures and epilepsy fall most heavily on patients and their families. Unfortunately, health care services in the United States are not organized to identify, diagnose, and treat people with seizures effectively nor are they delivered in such a way that patients and their families can engage in a positive, collaborative relationship with health care providers. This article describes a model of chronic illness care as applied to seizures and epilepsy, that is, how care should be structured to help people with seizures live as well as possible.
Congestive heart failure (CHF) is the most common reason for a hospital admission in the Medicare age group and is nearly double the rate of pneumonia, the next highest volume diagnosis. The economic burden of this debilitating, chronic disease demands a mechanism to improve quality of care while preventing unnecessary hospitalizations. Beginning in 1995, Evanston Northwestern Healthcare (ENH) created a disease management program involving a multidisciplinary team designed to decrease length of stay (national average = 6.2 days; ENH = 4 days), reduce costs, prevent readmissions (national 30-day readmission rate = 23%; ENH CHF Program = 2.3%), and improve compliance with the treatment regimen. Compliance monitoring through an automated telemanagement program reinforces education, identifies early warning signs and reduces the likelihood of hospitalization. After 18 months, telemanagement participants' compliance rate averages 89.5%. CHF hospitalization rates are 0.6/patient/year compared with the national benchmark of 1.7/patient/year. A disease management program consists of inpatient consultation, education, outpatient CHF clinic, cardiac home care, and compliance monitoring. Throughout this continuum, education must be communicated consistently by all team members. A CHF Assessment Guide assists the multidisciplinary team to thoroughly complete all education and address unique solutions to patients' needs.
As managed care and capitation methods of payment become more common to hospitals, a strategy to improve quality and reduce costs is introduced in response to these new pressures. Nursing leaders must take the initiative and respond to these changes by reducing the variations in patient care. The author describes seven initiatives undertaken by the nursing leaders of The St. Joseph Healthcare System in Albuquerque. New Mexico during a 3-year period. The success of these initiatives and their universal application is discussed.
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