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At least 991 records · Page 55Linked to original sources
PubMed1997

[Transition in nutritional management and the home care service system in our hospital].

During the past two years, Kaname-cho Hospital has been diligent in meeting the health care needs of its patients through its home care service. In nutritional management, considering the activity of daily living (ADL) and the burden of the family, gastrostomy and intravenous hyperalimentation (IVH) have been increased. Although we started with services provided by physicians, nurses, and medical social workers (MSW), recently clinical pharmacists and dieticians have entered our home care services. Due to the strong support of our staff, it is now possible for Kaname-cho Hospital to provide a very fine, efficient home care service.

Community Health Nursing↗
PubMed2007

Medical and non-medical barriers to outpatient treatment of fever and neutropenia in children with cancer.

BACKGROUND: A number of clinical trials have employed clinical criteria that can identify pediatric patients at low-risk for complicated episodes of fever and neutropenia (F&N) and have successfully treated low-risk patients in the outpatient setting. Despite this, inpatient management remains the standard of care. This trial tested the hypothesis that a strategy of initial hospitalization followed by continuation of therapy in the outpatient setting could be practically implemented in the majority of episodes. PROCEDURE: Patients presenting with F&N were initially evaluated to determine if they had high-risk clinical criteria that would exclude them from this approach. Eligible patients were then hospitalized and treated with iv antibiotics. On subsequent days the attending physician determined whether the patient had exhibited improvement and could continue therapy in the outpatient setting with oral antibiotics. Outpatients were seen three times weekly and continued antibiotics until recovery from F&N. RESULTS: Outpatient oral antibiotic therapy was practically implemented in less than one-quarter of episodes of pediatric F&N. Forty-nine percent of episodes were excluded from study by medical and social protocol exclusion criteria. One hundred five episodes were enrolled and among these 59 episodes included outpatient management. Common barriers to outpatient care included serious medical comorbidities, non-medical barriers including language and distance of residence from the medical center, and lack of interest. The average duration of outpatient care was 3.6 days following an average of 3.5 days of hospitalization. Ninety percent did not require rehospitalization. They experienced no complications. CONCLUSIONS: In only a minority of episodes can outpatient antibiotic management be implemented. Medical comorbidities and social barriers can make the transition to outpatient care difficult. However, initial hospitalization followed by oral antibiotic outpatient management appears safe and effective for low-risk patients who exhibit good responses to initial antibiotic therapy in hospital.

Administration, Oral↗
PubMed1997

Appropriate and necessary healthcare: new language for a new era.

Conceptual and language changes are necessary to accompany the paradigm shift from fee-for-service medicine to managed care. Medical necessity is an inadequate and ambiguous term defined differently by providers, payers, patients, and legislators. The attempt by legislators in Minnesota to develop a universal standard benefits set for healthcare services strikingly underscores the need to define relevant terminology to accompany the transition to managed care. We suggest the term appropriate and necessary healthcare as a state-of-the-art term for the new era of managed care.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

Quality criteria for medical staff admission: a beginning.

Pressures influencing the size and composition of medical staffs are increasing as hospitals and physicians respond to competition, market priorities, increasing numbers of physicians, and quality-of-care concerns. This article examines whether the quality of care provided by an applicant may be the primary criterion for admission to a hospital's medical staff. Methodological, legal, and organizational concerns that arise from this approach are reviewed. A quality criteria approach can assist in responding to increasing numbers of physicians, the transition to management care, and the marketing interests of a hospital.

Clinical Competence↗
PubMed1998

Demography and epidemiology of dying in the U.S. with emphasis on deaths of older persons.

As chronic disease continues to be the major cause of death and as the elderly population grows, it is important to evaluate the adequacy and completeness of health care strategies for the elderly. Two studies, the National Mortality Followback Survey and the National Institute on Aging Survey of the Last Days of Life, were designed to examine the circumstances of death for representative samples of decedents. Four areas of focus are location of death, transitions among health care settings, circumstances at the time of death, and changes in physical and cognitive function in the last year of life. Although the data are helpful for family planning, they are limited by a lack of data on costs.

Activities of Daily Living↗
PubMed1996

Factors affecting medical students' selection of Canadian psychiatric residency programs: Part II-Some contemporary issues.

OBJECTIVE: The presence of a national cohort of trainees entering psychiatric residency allowed an assessment of contemporary factors influencing their particular program choices. Factors of specific interest included the effect on program choice of relationships with significant others and government attitudes to fiscal restraint, mental health care reform, and licensure. METHOD: A self-administered questionnaire was sent to 110 trainees identified in the 16 Canadian university departments of psychiatry who began training in July 1994. RESULTS: While a committed relationship was a primary determinant of program choice, government policies attempting to influence patterns of care had little effect. CONCLUSION: A strong commitment to undergraduate teaching will improve the attractiveness of psychiatry as a career. This must include exposure of students to teachers who mentor practice patterns attuned to provincial mental health reforms, since government initiatives alone, developed to promote desired transitions in psychiatric care, will not influence training program choice.

Adult↗
PubMed1995

Intravesical bacillus Calmette-Guerin for the treatment of superficial transitional cell carcinoma of the prostatic urethra in association with carcinoma of the bladder.

Between 1981 and 1989, 83 male patients with stages Ta, Tis and T1 transitional cell carcinoma were treated with bacillus Calmette-Guerin (BCG). Of 17 patients with carcinoma in situ of the prostatic urothelium 13 had identifiable prostatic ducts and periurethral ductal transitional cell carcinoma was identified in 7. At a median followup of 64 months (range 29 to 90) 12 of 17 patients (70%) had a complete response in the prostatic urethra. Among the 10 patients with mucosal carcinoma without ductal involvement 8 responded as did 4 of the 7 with mucosal and ductal involvement. A total of 9 patients had persistent tumor or recurrence in the bladder or prostate. Two men had recurrence in the prostatic urethra and, due to age and co-morbidity, both were treated by transurethral resection and fulguration. Cystectomy was performed in the remaining 7 patients. Three of 31 patients (10%) whose prostate urethral biopsies were negative before BCG therapy had a positive biopsy afterwards. After treatment with BCG, the actuarial curves for cancer specific, progression-free and overall survivals showed no statistical difference between male patients with an initially positive or initially negative prostatic urethral biopsy. BCG is a reliable agent for initial therapy of superficial prostatic transitional cell carcinoma. Careful followup can identify persistent tumor, recurrences or progression that identifies patients for whom cystectomy is appropriate.

Administration, Intravesical↗
PubMed1998

Telecommunication technologies in high-tech homecare.

The future of critical care nursing will be dependent upon the subspecialty's ability to prepare the high-tech homecare nurse for practice in the next millennium. Client self-management of highly complex interventional therapies will be enabled by the high-tech homecare nurse, who will facilitate the transitioning of critical care nursing to the home setting. Rapidly evolving technologic capabilities will be managed by the high-tech homecare nurse, who will assist in the development of a seamless health care delivery system, where quality of care is maintained in settings beyond the traditional boundaries of the intensive care unit.

Aged↗
PubMedDate not supplied

Portfolio 2000: managing clinical systems.

Powerful forces are changing the provision of health care. Management is transitioning into new responsibility for a leaner, more flexible, customer-focused operation to support the goals of integrated systems of the 21st century--to minimize disease and to promote health. In response to this evolution, the clinical systems management concept describes multidimensional competencies, which are transportable throughout the continuum of care (1). These new knowledge competencies and core competencies applied in a different context are characterized in this paper.

Communication↗
PubMed1997

Code Stroke: rapid transport, triage and treatment using rt-PA therapy. The NINDS rt-PA Stroke Study Group.

With the approval of rt-PA therapy for ischemic stroke, stroke care has acutely transitioned from focusing on rehabilitative services to emergency services. This treatment, which must be initiated within the first three hours after the onset of stroke symptoms, requires reorganization of current management approaches. Developing a Code Stroke Team facilitates this process and helps to identify potential thrombolysis candidates. A pathway to deliver rapid care begins with 911 notification and transport, emergency department triage and procedures, and moves through the initiation of thrombolytic therapy. We call this pathway "Code Stroke".

Cerebrovascular Disorders↗
PubMed2005

Staggered transition to epoprostenol from treprostinil in pulmonary arterial hypertension.

OBJECTIVE: To describe a successful transition process from subcutaneous treprostinil to intravenous epoprostenol after the failure of treprostinil in a patient with idiopathic pulmonary arterial hypertension and present an algorithm to achieve the conversion without significant adverse reactions. CASE SUMMARY: A 25-year-old white female receiving subcutaneous treprostinil 97 ng/kg/min was admitted to the intensive care unit for transition from subcutaneous treprostinil to a target intravenous epoprostenol dose of 72 ng/kg/min via a staggered interval dose adjustment approach. The patient experienced facial flushing, hot flashes, and headache when dose adjustments of the drugs were made simultaneously; however, when dose adjustments were staggered, the adverse reactions did not occur and larger adjustments could be achieved. DISCUSSION: This case demonstrates a suboptimal therapeutic response to treprostinil for the treatment of idiopathic pulmonary arterial hypertension. The transition of treprostinil to epoprostenol is rare; however, in the event therapy change is needed, dosing information is minimal. A staggered transition dosing regimen that accounts for the pharmacokinetic differences between epoprostenol and treprostinil was successfully used in this case. CONCLUSIONS: The approach in this case demonstrates the success of staggered-interval dose adjustments to minimize supratherapeutic symptoms and coincides with the pharmacokinetic profile of the 2 medications.

Adult↗
PubMedDate not supplied

Social security reform in Central and Eastern Europe: variations on a Latin American theme.

After Chile reformed its social security system in 1981, several other Latin American countries and certain Central and Eastern European (CEE) countries implemented the Chilean model, with some variations: either a single- or multitier system, or with a period of transition to take care of those in the labor force at the time of the change. The single-tier version consists of individual accounts in pension fund management companies. Multi-tier systems retain some form of public program and add mandatory individual accounts. Most of the CEE countries did not want to incur the high transition costs associated with the Chilean model. The switch to a market economy had already strained their economies. Also, the countries' desire to adopt the European Union's Euro as their currency--a move that required a specific debt ceiling--limited the amount of additional debt they could incur. This article describes the CEE reforms and makes some comparisons with the Latin American experience. Most of the CEE countries have chosen a mixed system and have restructured the pay-as-you-go (PAYGO) tier, while the Latin American countries have both single- and multi-tier systems. Some CEE countries have set up notional defined contribution (NDC) schemes for the PAYGO tier in which each insured person has a hypothetical account made up of all contributions during his or her working life. Survivors and disability programs in CEE have remained in the public tier, but in most of the Latin American programs the insured must purchase a separate insurance policy. Issues common to both regions include: Administrative costs are high and competition is keen, which has led to consolidation and mergers among the companies and a large market share controlled by a few companies. Benefits are proportionately lower for women than for men. A large, informal sector is not covered by social security. This sector is apparently much larger in Latin America than in the CEE countries. Issues that are unique to some of the CEE countries include: Individual accounts in Hungary and Poland have proved more attractive than originally anticipated. As a result, contributions to the public PAYGO system in Hungary and Poland fell short of expectations. In several countries, laws setting up the programs were enacted without all the details of providing benefits. For example, in some countries laws must now be drawn up for establishment of annuities because they do not yet exist. Setting up a coherent pension policy has been difficult in some countries because of frequent and significant changes in government. This situation has affected the progress of reform in various stages of development. In general, a definitive assessment of individual accounts in these countries will not be possible until a cohort of retirees has spent most of its career under the new system.

Aged↗
PubMed1993

A severity index designed as an indicator of acuity in palliative care.

Patients who are facing terminal illness frequently experience changes in health care settings which are necessitated by acute events during palliative care. This pilot study evaluates the reliability, criterion validity, and appropriateness of the San Diego Severity Index (SDSI) in a population of advanced cancer patients in different care settings. The SDSI includes diagnostic, acuity, and psychosocial assessments. Cancer patients were evaluated in an outpatient oncology clinic (SCRF), a hospice home care (HC) program, and an acute care hospital/hospice centre (ACC). Scores were lowest for SCRF (9.51 +/- 3.7), HC was intermediate (24.04 +/- 8.8), while patients at the ACC scored the highest (29.33 +/- 7.0). Patients admitted to the ACC were significantly more acute, as assessed by the SDSI, than those utilizing outpatient services. This instrument may be useful as an indicator of appropriate transitions between health care settings.

Acute Disease↗