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PubMed1981

Evaluation of the Limulus test for endotoxemia in neonates with suspected sepsis.

A simplified test for endotoxemia was evaluated in parallel with 198 blood cultures from 115 neonates requiring transitional or intensive care. The Limulus assay disclosed endotoxemia in seven of eight patients with gram-negative bacteremia tested on one or two occasions. It was not specific for bacteremia, especially during the first week of life, when 37 of 112 tests from nonbacteremic infants (33%) were positive. In older infants, positive tests were obtained in only ten of 55 without bacteremia (18%) (P less than 0.07), six of whom had necrotizing enterocolitis as the likely source of endotoxemia. Gram-negative bacteremia existed in 5% of infants (two of 39) less than or equal to 7 days with positive tests and in 37% of older infants (six of 16) (P less than 0.01). Endotoxemia appears to be frequent among infants appearing to have sepsis and may contribute to neonatal morbidity. The Limulus assay may be a useful diagnostic test for coliform bacteremia and necrotizing enterocolitis beyond the first week of life.

Endotoxins↗

PubMed1991

Results of contemporary radical cystectomy for invasive bladder cancer: a clinicopathological study with an emphasis on the inadequacy of the tumor, nodes and metastases classification.

We reviewed 261 patients who underwent a radical operation at a single institution as definitive treatment of invasive bladder cancer to evaluate the survival and accuracy of the tumor, nodes and metastasis system in characterizing the prognosis. Between January 1979 and June 1987 the 261 evaluable patients underwent 1-stage radical cystectomy with pelvic node dissection and urinary diversion. No chemotherapy and/or radiation therapy was given before or after the operation. The postoperative mortality rate was 1.8%. The over-all staging error between clinical and pathological stages was as high as 44%. The over-all actuarial 5-year survival rate was 54.5%. The 5-year survival rates were 75% for stage pT1, 63% for stage pT2, 31% for stage pT3 and 21% for stage pT4 disease. A significant difference in the survival (p less than 0.002) was observed in stage pT3 by dividing tumors confined within the bladder wall (pT3a, 50%) from those extending throughout the bladder wall (pT3b, 15%). A careful evaluation of transitional cell involvement of the prostate in stage pT4a cancer led to the identification of 2 different patterns: 1) contiguous when a bladder tumor extended directly into the prostate through the bladder wall and 2) noncontiguous when a bladder tumor and a transitional cell carcinoma of the prostate were found simultaneously. These patterns had completely different (p less than 0.05) survival rates (6 versus 37%). The patients with high grade tumors had a worse prognosis in comparison with those with grades 1 and 2 tumors (41 versus 56%, p less than 0.005). The over-all 5-year survival of patients with positive nodes was 4% in comparison with 60% of those without nodal involvement (p less than 0.001). Despite current optimal surgical treatment, nearly 50% of all patients with invasive bladder cancer continue to die. The need for a modification of the current tumor, nodes and metastasis tumor classification to provide the clinician a more reliable staging system for planning treatment modalities is indeed mandatory.

Actuarial Analysis↗

PubMed1999

Stressors and concerns in teen asthma.

Adolescents are uniquely susceptible to poor outcome with asthma because of their desire for autonomy, denial of disease, preference for immediate gain rather than prophylaxis, restricted ability to control their psychosocial and physical environment, and difficult transition to health care. Tobacco smoking as well as related drug abuse and passive exposure to tobacco is a major obstacle to managing adolescent asthma, together with atopy and psychosocial problems. Recent investigations indicate that adolescents are uniquely susceptible to tobacco industry promotions and logos because of these developmental characteristics. By understanding adolescent development, behavior and peer group impact, with its spectrum from early to late adolescence, clinicians can target their educational interventions more successfully in asthma. Health care provision for the adolescent with asthma requires a multidisciplinary team spearheaded by a primary care provider with the expert guidance of an allergist, outreach nurse, mental health worker, and social service representative. This care must be negotiated with an appropriate educational plan on the basis of NHLBI guidelines to be successful. Medications should be prescribed no more than twice a day, whenever possible, in conjunction with an action plan on the basis of peak flow readings to warn the adolescent when to use more medication and when to call the clinician. The plan should empower adolescents by recognizing their need for autonomy with self-management, enabling them to have a safe and comfortable lifestyle, and being physically and mentally at ease with their peers, family, school, and work environments.

Adolescent↗

PubMed2003

Inflammatory bowel disease in early childhood and adolescence: special considerations.

Several aspects of IBD overlap between pediatric and adult population. Those include nutritional issues, bone density, and medical and surgical therapies. Some aspects like natural course of the disease, and epidemiology and genetics are more easily examined and researched in the pediatric population. Others like pubertal and growth delay, and transition of health care are unique to pediatric patients. This article examines some of the similarities, as well as differences of IBD in these two populations.

Adaptation, Psychological↗

PubMed2000

Nurses' job satisfaction and organizational climate in a dynamic work environment.

The infrastructure and organization of hospitals are changing rapidly as a result of major transitions in health care. Downsizing in hospitals has caused employees to have to take on new tasks and, often, multiple tasks with a decrease in available resources and an increase in job complexity. Naturally, such organizational changes have a profound effect on the nature and duration of patient hospitalization and on the job responsibilities and roles of inpatient staff. In many hospitals, there is a perception of chaos, sometimes resulting in frustration among the nursing personnel. The purpose of this study was to describe the relationship between nurses' job satisfaction and organizational climate.

Adult↗

PubMedDate not supplied

Air medical referring customer satisfaction: a valuable insight.

INTRODUCTION: To remain competitive and survive, air medical programs must have a mechanism for obtaining customer feedback, especially when alternate transport options are available. The goal of this survey was to examine the air medical service's performance as perceived by customers requesting the transport. METHODS: Surveys were mailed to 400 referring customers who had contact with the flight crew during the transition of patient care. The survey consisted of 16 statements evaluating the service by using a 4-point Likert scale, three demographic questions, one statement evaluating overall satisfaction, and two open-ended questions for comments or suggestions. RESULTS: Two hundred forty-four surveys were returned for a 61% responses rate. Results indicated referring customers are satisfied with the service provided Written comments and suggestions were divided into two categories, positive comments and suggestions for improvement. Three common themes were identified within the suggestions for improvement: crew rapport, communications, and operations. Suggested improvements were evaluated, and selected strategies were incorporated into program operation. CONCLUSION: Customer feedback furnishes valuable insight into their needs and perception of a service. Comments and suggestions for improvement can promote critical inquiry into service operation and provide a catalyst for improvement.

Air Ambulances↗

PubMed2006

Reconciliation failures lead to medication errors.

Poor communication of medical information at transition points of care--at admission, transfer, and discharge--often results in medication errors, but various strategies can reduce the likelihood of error.

Documentation↗

PubMed1998

Perceived social support and community adaptation in schizophrenia.

Prompted by the continuing transition to community care, mental health nurses are considering the role of social support in community adaptation. This article demonstrates the importance of distinguishing between kinds of social support and presents findings from the first round data of a longitudinal study of community adaptation in 156 people with schizophrenia conducted in Brisbane, Australia. All clients were interviewed using the relevant subscales of the Diagnostic Interview Schedule to confirm a primary diagnosis of schizophrenia. The study set out to investigate the relationship between community adaptation and social support. Community adaptation was measured with the Brief Psychiatric Rating Scale (BPRS), the Life Skills Profile (LSP) and measures of dissatisfaction with life and problems in daily living developed by the authors. Social support was measured with the Arizona Social Support Interview Schedule (ASSIS). The BPRS and ASSIS were incorporated into a client interview conducted by trained interviewers. The LSP was completed on each client by an informal carer (parent, relative or friend) or a professional carer (case manager or other health professional) nominated by the client. Hierarchical regression analysis was used to examine the relationship between community adaptation and four sets of social support variables. Given the order in which variables were entered in regression equations, a set of perceived social support variables was found to account for the largest unique variance of four measures of community adaptation in 96 people with schizophrenia for whom complete data are available from the first round of the three-wave longitudinal study. A set of the subjective experiences of the clients accounted for the largest unique variance in measures of symptomatology, life skills, dissatisfaction with life, and problems in daily living. Sets of community support, household support and functional variables accounted for less variance. Implications for mental health nursing practice are considered.

Adaptation, Psychological↗

PubMed2002

Low-molecular-weight heparin therapy for non-ST-elevation acute coronary syndromes and during percutaneous coronary intervention: an expert consensus.

BACKGROUND: Therapy with either low-molecular-weight heparin (LMWH) or glycoprotein (GP) IIb/IIIa receptor antagonists is of benefit to patients with acute coronary syndromes (ACSs). However, algorithms that define how LMWH may be used in patients, proceeding from medical management to intervention and in conjunction with GP IIb/IIIa inhibitors, are lacking. The objectives of this task force were to formulate recommendations based on all available data for the use of LMWH, both with and without GP IIb/IIIa receptor antagonists, and to provide seamless integration of care during the transition from medical to interventional management. METHODS AND RESULTS: An international task force of 14 cardiologists with extensive experience in clinical trials was convened in New York in February 2001 to address issues related to the use of LMWH in patients with non-ST-elevation ACS. Evidence from randomized trials, observational studies, and other reports was discussed, and consensus recommendations were formulated. CONCLUSIONS: Substantial evidence exists that patients receiving LMWH for an ACS can safely undergo cardiac catheterization and percutaneous coronary intervention. Concerns regarding the transition of these patients from the medical service to the cardiac catheterization laboratory should therefore not impede the upstream use of LMWH. Furthermore, LMWH and GP IIb/IIIa receptor antagonists can be used safely in combination, with no apparent increase in the risk of major bleeding. Consensus algorithms for therapy are presented.

Acute Disease↗

PubMed2003

Enhancing communication for end-of-life care: an electronic advance directive process.

An advance directive, a description of one's future preferences for medical treatment, must be easily available to care providers to ensure that one's treatment preferences are honored. The transition of our health care system to an electronic medical record complicated the availability of a patient's written advance directive. This paper describes the development of an electronic advance directive to facilitate access to a patient's treatment wishes at any site in our health care system. The successes and challenges encountered in the development process are discussed.

Advance Directives↗

PubMed2003

Probation foster care as an outcome for children exiting child welfare foster care.

Little research has been done to help us understand what happens to children who exit child welfare foster care for reasons other than emancipation. Almost no research exists to help us understand out-of-home placement supervised by other providers of children's social services such as juvenile probation or mental health. This study examined school-age children who entered out-of-home placement supervised by probation departments after they left child welfare foster or group care. Instability in child welfare placements significantly increased the risk of a transition to probation foster care. Among the children exiting child welfare placements, those who had entered their first spell in care at ages 12 through 14 or were first removed because of sexual abuse or neglect were at greater risk of probation out-of-home placement. Implications for social work policy and services are discussed.

Adolescent↗

PubMed1994

Bringing quality to the customer: a new paradigm for quality managers.

The transition of health care organizations to total quality improvement (TQI) models has significant consequences for quality manager roles and quality systems. Changing paradigms regarding one's quality role and programs requires critical self-awareness, new knowledge, and a fresh approach to employee-customer relations. The quality manager's challenges are to discover one's own learning needs, integrate new philosophies into one's behavior, and successfully model and mentor TQI to fellow health care providers. Quality managers have an opportunity to develop a vital and powerful leadership role vis-à-vis TQI and the point of contact between health care provider and patient.

Humans↗

PubMed1989

Cardiac disease and the family: impact, assessment, and implications.

Cardiac disease is a major threat to the quality of life of both patients and families. Using King's definition of a social system, this article provides a general overview of the impact of cardiac disease on the family social system. Acute and chronic illness require emotional, cognitive, and materials support to prevent maladaptive coping by patients and family members. Techniques for family assessment are detailed. Specific interventions appropriate for acute, transitional, and rehabilitative care are provided. Implications for nursing practice and research that includes family members are given.

Acute Disease↗

PubMed1998

New chemotherapy regimens for metastatic bladder cancer.

M-VAC remains the standard of care for metastatic transitional cell carcinoma (TCC), but its limitations include significant toxicity and infrequent durable disease-free survival. Recent investigation has focused on the identification of novel chemotherapeutics with single-agent activity in metastatic TCC and on their incorporation into more active combination regimens. Paclitaxel, gemcitabine and ifosfamide are among the most active new agents. Numerous phase II trials of novel combinations have yielded promising preliminary results. Longer follow-up and results from randomized trials will be necessary to determine the impact of newer chemotherapy regimens on survival.

Journal Article↗

PubMed1990

From ICU to rehabilitation: a checklist to ease the transition for the spinal cord injured.

Spinal cord injuries are devastating. The injured person faces many unknowns including surgical procedures, hospitalization and rehabilitation. Frequently, the transition from acute care to rehabilitation is frightening. In the intensive care unit (ICU), the patient receives one-to-one nursing care and develops trust, but then may feel abandoned when faced with rehabilitation. In order to facilitate readiness for rehabilitation, coordinators of the Southeastern Michigan Spinal Cord Injury System proposed a checklist of activities designed to meet individual patient and family needs. Coordinators assess the patient within 24 hours of admission to the spinal ICU. The physiatrist is notified of the admission and recommends initial therapies as appropriate. The patient is followed through the acute phase and preparations are made for rehabilitation. A checklist format has been developed to coordinate the transfer. This article describes the checklist and its use at our institution.

Adaptation, Psychological↗

PubMed2005

Task-specific expression of the foraging gene in harvester ants.

In social insects, groups of workers perform various tasks such as brood care and foraging. Transitions in workers from one task to another are important in the organization and ecological success of colonies. Regulation of genetic pathways can lead to plasticity in social insect task behaviour. The colony organization of advanced eusocial insects evolved independently in ants, bees, and wasps and it is not known whether the genetic mechanisms that influence behavioural plasticity are conserved across species. Here we show that a gene associated with foraging behaviour is conserved across social insect species, but the expression patterns of this gene are not. We cloned the red harvester ant (Pogonomyrmex barbatus) ortholog (Pbfor) to foraging, one of few genes implicated in social organization, and found that foraging behaviour in harvester ants is associated with the expression of this gene; young (callow) worker brains have significantly higher levels of Pbfor mRNA than foragers. Levels of Pbfor mRNA in other worker task groups vary among harvester ant colonies. However, foragers always have the lowest expression levels compared to other task groups. The association between foraging behaviour and the foraging gene is conserved across social insects but ants and bees have an inverse relationship between foraging expression and behaviour.

Animals↗

PubMed2003

Adults with cystic fibrosis: meeting the challenge!

The number of adults with cystic fibrosis (CF) is increasing. They are striving for independence and a fulfilling life with focus on career, relationships, education and finances at a time when lung function is likely to be declining and complications of this multi-system disease are increasing. Maintaining the quality and improving the duration of life are continuing challenges for the -clinician and the patient. Increased hope and greater expectations have been provided by a number of recent clinical advances and active research into novel treatments, including gene therapy. There has been increased recognition of the necessity for early diagnosis, adequate monitoring and effective intervention for complications such as diabetes and osteoporosis. Research into multi-resistant bacteria and clonal strains of Pseudomonas aeruginosa is ongoing and attention has focused on infection control policies. Although more high-level evidence is required on many issues confronting people with CF, a considerable effort has been made over the last decade to provide a more evidence-based approach to therapy with a number of large controlled clinical trials. For the adult with CF, there are also more decisions to be made. There is focus on reproductive health, with most couples enjoying the real possibility of having children. For those with advanced disease, the option for lung transplantation is well established. Maintenance of quality care will require adequate planning, effective transition programmes from paediatric to adult care, specialized training for doctors, nurses and allied health professionals and the allocation of sufficient resources to accommodate the inevitable increase in patient numbers.

Adult↗

PubMed1993

Coming of age with diabetes: patients' views of a clinic for under-25 year olds.

This study is both an evaluation of patients' perceptions of a diabetes clinic for under-25 year olds, and an assessment of experiences in transferring from a paediatric clinic. Sixty-nine patients with Type 1 diabetes (74% of the total clinic), including 41 females, completed evaluations of the clinic and recall of experiences in transfer. Mean age on transferring clinic was 15.9 (range 12-20) years. Paediatricians were perceived to emphasise family and social life, school or work progress; adult physicians tended to stress the risk of long-term complications, importance of exercise and need to maintain strict levels of glycaemic control. Our data suggest that transition to adult care can generally be achieved non-traumatically, but patients may perceive some difficulty because of different emphases and treatment advice favoured by paediatricians and adult physicians.

Adolescent↗