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PubMedDate not supplied

A discharge planning tool for use with families of high-risk infants.

The transition from hospital care to home care for high risk infants can be facilitated by the process of discharge planning. A tool designed specifically to coordinate discharge counseling and instruction for parents of high-risk infants has been developed and implemented in a perinatal center. Preliminary results indicate that the tool enables the health team to make an objective, rather than subjective, decision in respect to discharge of infants. Use of the tool also standardizes and documents the nurse's role in discharge planning.

Chicago↗
PubMed1997

Management of insulin-dependent diabetes mellitus in adolescents.

There are many reasons for a specific management plan for adolescents with insulin-dependent diabetes mellitus (IDDM). Although most new patients can be managed initially on an outpatient basis, as they reach their teenage years, blood glucose control deteriorates and insulin requirements increase. Eating disorders, missing insulin injections, excess of alcohol all contribute to poor glycaemic control. Teenagers who have had diabetes for a number of years may have developed microvascular complications and disturbances of growth can occur, more often in girls than in boys. The transition to adult care continues to be a significant problem both for paediatricians and patients. Diabetes management during adolescence requires a team effort involving nurse educator, dietitian, paediatric diabetologist and, possibly, a social worker, with referral to specialists if necessary. Organizing this type of care requires a Regional Paediatric Diabetes Centre.

Adolescent↗
PubMed1978

Psychiatric training for the primary care obstetrician-gynecologist resident.

The author describes a model for the psychiatric training of obstetrics-gynecology house staff members who serve as primary care physicians for women. By integrating psychiatric skills with specialty training, the psychiatrist can enhance continuity of patient care for the resident during his transition to the role of primary care obstetrician-gynecologist.

California↗
PubMed2005

Bone marrow failure: a child is not just a small adult (but an adult can have a childhood disease).

Aplastic anemia may be inherited or acquired. The distinction between these lies not in the age of the patient, but in the clinical and laboratory diagnoses. Adult hematologists must consider adult presentations of the inherited disorders, in order to avoid incorrect management of their patients. Physicians for adult patients must also realize that children with inherited disorders now survive to transition into their care. The major inherited bone marrow failure syndromes associated with development of pancytopenia include Fanconi anemia, dyskeratosis congenita, Shwachman-Diamond syndrome, and amegakaryocytic thrombocytopenia. The ages at presentation are highly variable, but often include individuals of adult age who have previously undiagnosed Fanconi anemia or dyskeratosis congenita. Many of the genes responsible for these disorders have been identified (12 Fanconi anemia genes, 3 dyskeratosis congenita genes, and 1 each for Shwachman-Diamond syndrome and amegakaryocytic thrombocytopenia). A high index of suspicion and specific testing of children or adults with what appears to be acquired aplastic anemia may identify inherited disorders. Correct classification of patients with aplastic anemia of any age is mandatory for their appropriate management.

Adult↗
PubMed2005

Clinical assessment and treatment of attention deficit hyperactivity disorder in adults.

Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder that frequently persists into adulthood, with significant levels of inattentive, hyperactive and impulsive behavior. Impairments associated with adult ADHD include distress from the symptoms, impaired ability to function in work and academic settings, and problems sustaining stable relationships. The disorder is commonly associated with volatile moods, antisocial behavior, and drug and alcohol misuse. There is an increased risk of developing comorbid anxiety, depression, personality disorders, and drug and alcohol dependence. Despite the proven effectiveness of drugs such as methylphenidate, dexamphetamine and atomoxetine, few cases of ADHD are recognized and treated in the UK. The reasons for this are unclear, since most psychiatrists working with children and adolescents are aware that ADHD commonly persists into adult life and they also see the disorder affecting parents of children with ADHD. Issues of transition from the care of child to adult psychiatry and the need to refer adult relatives of children with ADHD to suitable psychiatric services are a major concern. Furthermore, many cases of adult ADHD go unrecognized or are seen by mental health teams that are not familiar with the subtleties of the adult presentation. As a result, misdiagnosis and treatment for conditions such as atypical depression, mixed affective disorder, cyclothymia, and borderline and unstable emotional personality disorders is not uncommon. There is therefore a requirement for further training in this area. This review will describe the common clinical presentation and provide guidelines for the diagnosis and treatment of ADHD in adults. Any psychiatrically trained physician using standard psychiatric assessment procedures can perform clinical evaluations for adult ADHD. As with other psychiatric disorders in adulthood, ADHD has its own characteristic onset, course and psychopathology. Symptoms of ADHD are trait-like, being stable characteristics from early childhood, and commonly co-occur with affective instability. Stimulants are the mainstay of treatment and are effective in around 70% of cases. Psychotherapeutic interventions also have an important role. These guidelines will assist psychiatrists and other adult mental health workers in identifying and treating individuals with adult ADHD.

Adult↗
PubMed1993

Progression of essential thrombocythemia to blastic crisis via idiopathic myelofibrosis.

We report a 61-year-old man with essential thrombocythemia (ET) whose clinical course was followed for 12 years. The ET evolved into true idiopathic myelofibrosis (IM) 6 years after the initial diagnosis and progressed to myeloid blastic transformation 6 years later. The cytogenetic analysis showed a normal karyotype during the ET phase but subsequent analysis revealed an abnormal karyotype during the IM phase which evolved clonally at blastic crisis with constant involvement of chromosome 13q and chromosome 7. The close monitoring of essential events, using clinical, morphologic, immunologic and cytogenetic parameters, allowed us to carefully identify the transition from one chronic myeloproliferative disease (MPD) to another. This is only the second case reported showing a clinical evolution of this nature. The clinical and biological aspects of the disease are briefly discussed.

Blast Crisis↗
PubMed2006

[Cystic fibrosis: facing patient transition from the pediatrician to the internist].

The increased survival of patients with cystic fibrosis (CF) resulted in the appearance of new pulmonary and non-pulmonary complications. Even though subjects with CF present with inflammatory pulmonary changes at birth, several pathogens such as Staphyloccocus aureus, Haemophilus influenzae and Pseudomona aeruginosa contribute to the progression of pulmonary injury. Clinical presentations vary according to patient age; even though mild forms exist, patients with severe forms, develop respiratory insufficiency and end-stage disease at an early stage. Today, new diagnostic and therapeutic tools, increase the possibility of an early diagnosis and of greater survival. Successful management will depend on the timely selection of adequate antimicrobials, the use of pancreatic enzyme supplementation and early institution to respiratory physiotherapy. The transition from pediatric care to adult care must occur according to development of each patient. This timing must be flexible and there should be a constant communication and coordination within the different specialists in internal medicine. Thus, it is crucial to recognize the disease progression as a continuous process, giving the appropriate physiologic support and evaluating the needs of the patient and close relatives.

Adolescent↗
PubMed1995

Residency training--the profession's forge for leadership development.

The concept of leadership may be the most widely studied and least understood topic in the domain of social services. Leadership has been described as a major force in the profession's transition to pharmaceutical care and effective program development. Pharmacy practice residency programs are a major means of developing and sustaining leadership for the growth of the profession. Three concepts that are explored include: (1) some insight into noncognitive elements of residency training that are critical to the development of professional practice, (2) analysis of leadership perceived to be critical for pharmacists, and (3) a definition of how residency training can develop professional leaders to meet the challenges for pharmacy.

Competency-Based Education↗
PubMedDate not supplied

Social planning in Canada for families with HIV infection.

Parents living with HIV and their children face complex medical and social problems. Whether the children are infected or not, they are all affected by the presence of HIV in a parent. The purpose of this article is to describe the problems of families with HIV and to propose social planning measures to respond to their psychosocial needs. It is based on a multicentre study that included in-depth interviews with 110 parents representing 91 Canadian families living with HIV. The study's findings and recommendations were reviewed by parents with HIV, social workers specializing in helping affected families, and a multidisciplinary consensus conference. This process identified six areas needing attention: stigma and disclosure; promoting and supporting family health; planning and transitions for the care of children; economic issues; cultural and immigrant issues; and education, advocacy, policy development, and research. Recommendations for action were made in each area.

Canada↗
PubMed2002

A prospective population based study on outcome of juvenile chronic arthritis in Costa Rica.

OBJECTIVE: To study the disease process and outcome in an unselected group of patients with juvenile chronic arthritis (JCA). METHODS: From a population based study in San José, Costa Rica, 47 patients with JCA with disease onset from 1993 through 1995 were investigated after median duration of 4.1 yrs (range 2.9-4.9) (incidence group). Another 49 children with disease onset prior to 1993 and younger than 16 years of age on December 31, 1995 (cross sectional group) were also followed. RESULTS: In the incidence group, 4/47 children changed subtype during the course of the disease. All did so within 2 years from disease onset, and the same observation was made in the cross sectional group. Uveitis was described at onset in a single case, and no child developed uveitis later. In patients from the incidence group in the process of being transferred to adult rheumatology clinics, 48% were still taking medication. Patients who had involvement of proximal interphalangeal (PIP) joints at onset had an increased risk of being active or stable at followup (RR 12.3, 95% CI 1.4-108.3). A higher chance of no continuing disease activity at followup was observed in children with oligoarticular disease than in the other subtypes (RR 2.8, 95% CI 1.2-6.9). CONCLUSION: Uveitis associated with antinuclear antibody positive JCA and psoriatic arthritis in Costa Rican children is uncommon, and the risk of developing uveitis remains low during the course of the disease. Involvement of PIP joints predicts an increased risk of continuing disease. The course of JCA in Costa Rican children is not milder than in Caucasian populations, since 48% of the patients showed persistent disease activity at the transition to adult care.

Adolescent↗
PubMed2002

[A brief history of evidence-based medicine].

Evidence - based medicine, a fairly new subject, focusing on the perfect combination of individual clinical experience, existing best evidence available and patient value, has created a new approach and thought for clinicians and researchers. Evidence - based medicine has promoted the transition of health care. The definition and development of evidence - based medicine in China and the world as a whole are reviewed in this article.

China↗
PubMed2004

Stop shuffling paper. Case study: document management offers efficiency, access.

Document image management (DIM) technology for patient charts can organize tasks, automate redundant chores, improve access to data and decrease error. DIM allows multiple users to share patient information and has audit and security features. The technology offers a strategic benefit for practices preparing for health care's ongoing transition from paper-based systems to electronic ones.

Documentation↗
PubMed2004

Frequent attenders in family practice in Croatia: retrospective study.

AIM: To determine the number of "frequent attenders" in family practice offices in Croatia according to the number and proportion of frequent attender visits in the total number of visits, and to follow up the frequent attenders and the number of visits they made over a period of three years. METHODS: The retrospective study involved 8 family practice offices in Northern Croatia. The number of visits to family practice was determined for 4,312 patients aged over 18 years. There were 1,826 men (42.3%) and 2,486 (57.7%) women. The follow up period lasted from January 1, 1997 to December 31, 1999. The borderline value that divided the frequent from non-frequent attenders was the value at the third quartile of the number of visits in a single age-sex group of patients. RESULTS: We recorded a total of 58,088 visits of patients older than 18 years to 8 family practice offices in the three-year period. In 1997, out of 4,312 patients who made a total of 17,938 visits, 944 (22%) frequent attenders made 11,257 (63%) visits. In 1998, there were a total of 20,350 visits made, with 966 (22%) frequent attenders making 12,145 (60%) visits. In 1999, a total of 20,725 visits were made, with 988 (23%) frequent attenders making 12,259 (59%) visits. The differences in the distribution of frequent vs non-frequent attenders according to age and sex were not statistically significant in any of the three study years (chi-square, p=0.727). Older men and older women were not more often frequent attenders than younger men and younger women, respectively. Out of 4,312 patients, 1,714 (40%) were frequent attenders in one of the three study years. Of these, 884 (21%) were frequent attenders in one year, 476 (11%) in two years, and 354 (8%) in all three subsequent study years. Out of 4,312 patients, 1,762 (41%) patients in 1997, 1,139 (26%) in 1998, and 1,116 (26%) patients in 1999 did not make a single visit to a family physician. CONCLUSION: Frequent attender visits make a great proportion of the total number of visits to family practice offices in Croatia, a country with a health care system in transition. Eight percent of patients remained being frequent attenders during all three study years.

Croatia↗
PubMed2003

[Possible courses of caregiver's support in Alzheimer's disease].

The Legos (a laboratory specialized on health economics at Dauphine University, Paris) conducted a detailed survey at three daycare centres for persons suffering from Alzheimer's disease in France, Germany and Spain, to examine in depth their objectives, organization, practices and relations to patients' families. Though it proved difficult to establish a true typology, the analysis showed that the support provided to caregivers by the daycare centres were responding to three main approaches: one aimed at stimulating or keeping the cognitive abilities of the patients; a second one based on the remaining autonomy of the patients and striving to improve the provided home cares and services, in order to avoid or postpone a departure to a nursing home; the last one dealing with the socialization of the patients through an action on the strong relationship with their family. The survey, as well as the study of the available literature published in English and French on the day care centres, also stressed that some delicate questions were not getting the thorough attention they deserve; e.g. the interaction between what is going on in the day care centre and the life outside the centre, the management of the transition between the day care centre and home when the patient returns, the information and professional training of the carers (formal and informal), the various financial aspects of caregivers' support and of attendance at a daycare centre and, last but not least, the different ways of taking into consideration the opinion and the quality of life of the patients.

Aged↗
PubMed2005

Five steps to electronic health record success.

There's no denying that the electronic health record is on its way. By taking the following five well-planned steps, healthcare CFOs and CIOs can help make electronic record implementation in their hospitals as smooth as possible: Define "electronic health record" across the entire organization, Set appropriate expectations, Choose the technology carefully, Accept and promote process changes, Carefully plan the transition from paper-based to electronic records.

Guidelines as Topic↗
PubMed2004

White coat principles.

The White Coat Ceremony, which many dental schools use to mark the transition to patient care, is an opportunity to reflect on the values of dental practice. Eight principles are offered for consideration: 1 ) patient care is the point of practice; 2) the doctor-patient relationship is essential; 3) discuss options and possibilities; 4) mistakes will be made; 5) tell the truth; be assertive; 7 ) consult; and 8) manage your stress and your life.

Anniversaries and Special Events↗
PubMedDate not supplied

[Diabetes mellitus in childhood and adolescence: 2. Specific aspects in adolescents].

The management of adolescents with diabetes mellitus involves specific aspects at diagnosis and during follow-up. A type 2 diabetes should be excluded at diagnosis since this condition is increasingly observed in closed relationhip with the progression of obesity in young people. During initial education process, the parents should be involved while a specific space and time for interaction with the adolescents is required. During follow-up, all aspects of the adolescent process should be taken into account together with diabetes. This includes risk-taking or exploratory behaviours, feeling of being different, angryness and difficulties for the adolescents to consider the long-term complication risk. Special attention should be devoted to the transition towards adult care.

Adolescent↗