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PubMed2002

The transition of adolescents with diabetes from the children's health care service into the adult health care service: a review of the literature.

Adolescents with diabetes have unique health needs, which impact upon their transition from children's health care services into adult health care services. These health needs result from the precarious period in their lives, when they have to cope with the stresses of being a maturing person. This coincides with their move from the children's into the adult health care service. Whilst coping with these pressures they must also keep their diabetes under control. The impact of emotional and physical demands upon the adolescent means that they are more susceptible to non-adherence, which may result in reduced diabetic control. This literature review identifies some of the many barriers erected to the transition into the adult health care system; these barriers may be constructed by any one of the parties involved: the children's health care team, adult health care team, the adolescent or their family. Principles of a successful transition are explored, along with the prerequisite qualities required of health care providers and the health care service.

Adaptation, Psychological↗
PubMed2003

Oral health care and preventive strategies in Albania--a country in transition.

Reforms and big changes have occurred in oral health care in Albania, as in all the other East European countries after 1990. Reforms were characterised by privatisation, decentralisation, and new forms of financing, planning and managing of dental services. Following that, two forms of oral health care provision currently exist: a public service and a private service. Changes have also occurred in dental education. Studies on oral health status of the population recently showed a higher prevalence of oral diseases when compared to that before 1990. A new oral health strategy, based on a preventive approach has been started, focused on wide and regular use of fluoridated toothpaste, dental health education and promotion, sealant application and annual oral examinations.

Albania↗
PubMed2006

Effects of outcome on in-hospital transition from intravenous insulin infusion to subcutaneous therapy.

It is widely accepted by medical practitioners that diabetes is a major independent risk factor for the development of cardiovascular disease. However, less attention has been directed toward elevated blood glucose as a predictor of poor outcomes in hospitalized patients in cardiac critical care. This has occurred despite documentation of hyperglycemia in a significant proportion of patients admitted for cardiac care and considerable data supporting the use of intravenous (IV) insulin to achieve glycemic control. The increased risk for mortality due to hyperglycemia provides a strong rationale for an intensive approach using insulin to control blood glucose levels in cardiac patients being treated in acute care and surgical settings. IV insulin infusion is the therapy of choice for patients in cardiac critical care units, with transition to a subcutaneous insulin therapy regimen when appropriate. The timing of this transition can be critical. Strong evidence from studies on patients who have undergone cardiac surgery suggests that glycemic control by insulin infusion should be maintained for > or =3 postoperative days. Nonetheless, transition from IV to subcutaneous therapy must occur at some point during the hospital stay. In conclusion, the implementation of measures to achieve glycemic control in acute cardiac care hospital settings can significantly reduce morbidity and mortality and can substantially decrease the costs associated with prolonged hospital stays. This report reviews recent clinical data on the benefits of IV insulin infusion in cardiac patients in critical care and provides recommendations on transitioning patients from IV insulin infusion to subcutaneous therapy.

Blood Glucose↗
PubMedDate not supplied

When insurance status is not static: insurance transitions of low-income children and implications for health and health care.

OBJECTIVES: Among low-income children, to characterize the frequency of transitions in health insurance coverage and examine associations of transitions with health status and health care access. METHODS: Data from the 1999 National Survey of America's Families were used in weighted analyses to identify sociodemographic characteristics associated with health insurance transitions for children living in households with income <200% of the federal poverty level over the preceding 12 months. In logistic regression models, we examined associations of insurance transitions with children's health status (fair/poor health), postponement of children's medical care or prescription medications, and lack of physician visits. RESULTS: Among 27.93 million low-income children in 1999, 5.7 million (20.4%) had experienced an insurance transition in the preceding year. Non-Hispanic black children (24.5%) and children whose parents did not have a partner or spouse (23.5%) were significantly more likely than other children to have experienced transitions. Hispanic children (16%) were least likely to have experienced transitions. Compared with children with continuous private coverage, children who had transitioned from public to private coverage were more likely to report fair or poor health, children who experienced transitions that included a period of no coverage were more likely to report postponed medical care and prescription drugs, and children who experienced a no-coverage-to-private-coverage transition were more likely to have foregone physician visits. CONCLUSION: Transitions in insurance coverage affect many low-income children and may represent barriers to their health care. Considering insurance transitions may provide a more complete picture of children's health and health care utilization.

Child↗
PubMed2000

Friend or foe? How primary care physicians perceive hospitalists.

BACKGROUND: Increased use of hospitalists is redefining the role of primary care physicians. Whether primary care physicians welcome this transition is unknown. We examined primary care physicians' perceptions of how hospitalists affect their practices, their patient relationships, and overall patient care. METHODS: A mailed survey of randomly selected general internists, general pediatricians, and family practitioners with experience with hospitalists practicing in California. MAIN OUTCOME MEASURES: Physicians' self-reports of hospitalists' effects on quality of patient care and on their own practices. RESULTS: Seven hundred eight physicians were eligible for this study, and there was a 74% response rate. Of the 524 physicians who responded, 34% were internists, 38% were family practitioners, and 29% were pediatricians. Of the 524 respondents, 335 (64%) had hospitalists available to them and 120 (23%) were required to use hospitalists for all admissions. Physicians perceived hospitalists as increasing (41%) or not changing (44%) the overall quality of care and perceived their practice style differences as neutral or beneficial. Twenty-eight percent of primary care physicians believed that the quality of the physician-patient relationship decreased; 69% reported that hospitalists did not affect their income; 53% believed that hospitalists decreased their workload; and 50% believed that hospitalists increased practice satisfaction. In a multivariate model predicting physician perceptions, internists, physicians who attributed loss of income to hospitalists, and physicians in mandatory hospitalist systems viewed hospitalists less favorably. CONCLUSIONS: Practicing primary care physicians have generally favorable perceptions of hospitalists' effect on patients and on their own practice satisfaction, especially in voluntary hospitalist systems that decrease the workload of primary care physicians and do not threaten their income. Primary care physicians, particularly internists, are less accepting of mandatory hospitalist systems. Arch Intern Med. 2000;160:2902-2908

Attitude of Health Personnel↗
PubMedDate not supplied

Enabling the transition to hospice through effective palliative care.

The end of life has changed dramatically in recent years as life expectancies have increased, chronic disease rates have risen, and families, health care systems, and society have changed. As technology has advanced, death too often has become viewed by society as "failure" and even "optional." Too often, referral to hospice has come too late to be sufficiently effective. While expertise in palliation of pain and symptoms at the end of life has been developed, palliative care has not been well integrated with management of chronic diseases or incorporated into the continuum of medical management from health and wellness to the end of life. We can, and must, do better.

Attitude to Death↗
PubMed2004

Acute Transition Alliance: rehabilitation at the acute/aged care interface.

The acute/aged care interface has presented many challenges to funders, providers and planners in the health and aged care sectors. Concerns have long been expressed in the aged care sector about the changing needs of clients admitted permanently into residential aged care from hospitals where the decision for placement would often have been made in a crisis situation, without the opportunity to explore appropriate options. This article describes the process and outcomes to date of a collaborative effort between the acute care and aged care sectors in South Australia to develop a more integrated approach to discharge opportunities for older people. The program involves both residential and community care elements and seeks to provide rehabilitation, to restore function and to avoid inappropriate permanent residential care for older Australians following acute admissions to a public hospital. Interim outcomes are promising and show only 17% of those admitted to the program are discharged to long-term residential care.

Acute Disease↗
PubMed2003

Antimicrobial egg cleaning by the fringed darter (Perciformes: Percidae: Etheostoma crossopterum): implications of a novel component of parental care in fishes.

Broad-spectrum antimicrobial compounds have recently been identified in the epidermal mucus of fishes and probably serve as a first line of defence against microbial pathogens. Because of the ubiquitous nature of fungi and bacteria in aquatic systems, defence against these pathogens should be required throughout the lifespan of fishes, including the egg stage. We conducted experiments on Etheostoma crossopterum (Percidae: Catonotus), the fringed darter, to determine if the presence of a guarding male inhibits microbial colonization of eggs. Based on results from a combination of in-stream experiments, in vitro microbial assays, and morphological characteristics and behaviour of breeding males, we propose that antimicrobial egg cleaning by the guarding male is an effective component of parental care in these fish. Although innate antimicrobial compounds have been identified in a variety of organisms ranging from insects to vertebrates, integration of these compounds into a species's reproductive life history has been identified only in a small number of insect species. The results from this study not only indicate that E. crossopterum males provide a novel form of vertebrate parental care, but also have implications regarding the evolution of parental care in fishes and transitional evolutionary stages from no parental care to male parental care.

Animals↗
PubMed1992

Discharge planning predicting patients' needs.

The elderly are at higher risk for longer and more frequent lengths of hospital stay than other adults. Comprehensive discharge planning programs, including early identification of those at risk, can alter these statistics. Screening inventories to identify patients at risk have been available for many years, but they are not specific to the needs of the elderly. The Blaylock Risk Assessment Screen (BRASS) is administered on admission and identifies patients at risk for prolonged hospital stay and in need of discharge planning resources. The nurse can use the data BRASS provides to improve care outcomes while the patient is in the hospital and in the transition to home care. It shows promise for use as the first phase of a discharge planning program.

Activities of Daily Living↗
PubMed1994

Training for the transition to case management in home care.

Hospital nurses who wish to enter home care offer a gold mine of clinical skills. The only thing missing is case management experience. How can agencies help nurses acquire this last commodity and take the final step to home care? Training programs may be the answer.

California↗
PubMedDate not supplied

The quality and cost of medical care. The potential for information technology to meet the challenge.

The rising cost of health care has precipitated a variety of cost containment initiatives. With the accelerated transition to managed care, the question of quality has emerged. The feeling of many is that cost reduction alone can have only one effect, a reduction in quality. In response, many have focused on the need to reassess and reengineer the processes involved in the delivery of care and to integrate these processes to ensure better management of the patient through the monitoring of the continuum of care. In this paper, we describe the potential for the application of an information technology, known as workflow management technology, in the design and control of health care delivery processes.

Communication↗