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Results for “Transitional Care”

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At least 1,099 records · Page 61Linked to original sources

PubMed1992

An exploration of the variables involved when instituting a do-not-resuscitate order for patients undergoing bone marrow transplantation.

Written do-not-resuscitate (DNR) orders can facilitate the transition from aggressive care to supportive care in patients undergoing bone marrow transplantation who are critically ill. The DNR decision often is complicated by clinical and ethical problems. To assist nurses in analyzing these complex situations, a retrospective review was conducted on medical records of 40 patients who died on an eight-bed bone marrow transplant unit in which a formal DNR policy was in place. A review of specific variables for patients designated DNR and non-DNR showed that the groups did not vary in age, diagnosis, disease, or type of transplant. The non-DNR group developed life-threatening complications earlier in their transplant course, whereas multisystem failure was the common factor among the patients with DNR designation. The few ethical problems documented in the medical records did not appear to reflect the complexity of the DNR decision.

Adolescent↗

PubMed2006

[Adult congenital heart diseases: physicians facing new difficulties].

Nowadays, 70 to 80% of the patients with congenital heart disease reach adulthood. Transition from pediatric cares to adult medicine is sometimes difficult resulting in loss of follow up, which can be deleterious in young adult with serious disease. Specialized units have been created all around the world and now in Europe. The needs for this population are specific (employment, contraception, pregnancy). Complex operated defects will need specialized assessment and follow up (tetralogy of Fallot, atrial switch for transposition of the great arteries). Arrhythmias are an important cause of admission. Native defect are sometimes revealed in adulthood (simple: asd, arterial duct, complex double discordance, Ebstein disease), or are not operable (mainly cyanotic disease).

Adult↗

PubMed2006

Isolation to interface to integration - is it feasible to seek a holistic profession?

OBJECTIVES: Over thirty years both divergence and synergy have been seen in the health informatics (HI) domain; to the point where aspiration is towards a collective environment recognising HI as a mature discipline internationally. The author considers catalysts and inhibitors to this goal over 30 years, and asks the question - is one professional identity achievable and desirable? This review of development of HI aims to promote reflection of the status, value and attributable influence with a view to recognising an internationally entity. Aspects of professionalism, practice, regulation and registration can then be refined to produce a universally understood inclusive community without loss of distinction to sub-specialties within it. METHODS: The author utilised literature searches, research studies, domain knowledge and cooperative inquiries as context. Evaluation of issues is grounded in learned society investigations of professionalism and commitment to development of professional registration of those in informatics for the care domain. RESULTS: Transition from isolated applications through interfaced 'best of breed' solutions working together to integrated closely coupled single-vendor solutions is mirrored by professional groups, established through special interests, working together on big initiatives and then formally benefiting from a cohesive group. Phasing of such staged development is different by country or by focus/topic. CONCLUSIONS: The global HI situation will never again be as diverse as historically it was. Recognition of the lifecycle of the interacting factors explored in this paper will help HI to assume a world-wide brand identity whilst sustaining the subsidiarity of specialist cohorts within it.

Diffusion of Innovation↗

PubMedDate not supplied

Improving clinical communication through structured conversation.

Communication failure plays an important role in causing medical errors. Clinical communication is highly complex and prone to error especially during transitions of patient care and emergent situations. Standardized approaches and tools may provide potential solutions to improve the quality of communication and prevent subsequent patient harm. The National Patient Safety Foundation, through its Stand Up for Patient Safety Program, is committed to assisting organizations improve clinical communication.

Clinical Competence↗

PubMed1989

[Long-term clinical follow-up (2 years) of 78 patients hospitalized in a crisis situation].

This is a preliminary study focusing on a 2 years follow-up of 78 patients addressed to psychiatric hospitalization and psychodynamically oriented crisis intervention. Relationship between psychopathological, clinical and interactional profile at first medical interview and clinical/social assessment at 1 and 2 years follow-up were studied, indicating different predictors for long-term treatment (DSM III R diagnosis and psychotic symptoms scores) and global improvement (age and sex) as well as poorer outcome for social functioning than for symptomatic measures. Comment is also provided on the observed high concordance between clinical predictions at crisis treatment completion and research staff assessments at 1 and 2 years follow-up. The evaluated crisis intervention model was found to provide a valuable setting to structure acute psychiatric episode treatment and long-term care, even though transition from clinical recovery to effective social-interpersonal reinvestments was observed to raise problems in the addressed psychiatric population.

Bipolar Disorder↗

PubMed1989

[Stress and strain analysis in monitoring functions in a fully automated production plant].

The introduction of new technologies in the automobile industry produces a substantial structural change. This change may lead to a decrease in physical work with a contrary increase in mental and emotional stress at monitoring and controlling tasks. A summarizing analysis of the stress was made by means of the "Arbeitswissenschaftliches Erhebungsverfahren zur Tätigkeitsanalyse (AET)" and for characteristic working conditions the energy expenditure during work was measured. As indicators of strain, the heart rate was registered continuously with portable magnetic tape recorders and additionally the urinary excretion of adrenaline and noradrenaline was analyzed. During and after the implementation of new technologies a shift from physical to mental and/or emotional stress could be observed, but the remaining components of physical load are not to be disregarded and the changing strain patterns have to be analyzed carefully during the transitional stages of the implementation process.

Automation↗

PubMed1987

[Ambulatory surgery in orthopedics].

Growing importance is being assumed by orthopaedic outpatient surgery. An account is given in this paper of advantages, obstacles, prerequisites, surgical indications, preparations for surgical intervention, and anaesthesia. Close cooperation between the clinical and outpatient departments has proved to ensure smooth transition in patient care from one sector to another in the case of complications.

Ambulatory Surgical Procedures↗

PubMed1980

Organization and operation of a home parenteral nutrition program with emphasis on the pharmacist's role.

A home parenteral nutrition program was organized at Mayo Clinic-Rochester Methodist Hospital in 1975. To date, 26 patients with chronic malnutrition usually due to either severe short bowel syndrome or extensive Crohn's disease have been trained in home parenteral nutrition for a total treatment period of 430 patient-months. Home parenteral nutrition is an attractive alternative for these patients in that it dramatically improves nutrition, promotes rehabilitation at home, and probably decreases long-term expenses. The numerous medical, psychosocial, and financial problems confronting patients on home parenteral nutrition are managed through a multispecialty team consisting of physicians, pharmacists, nurse, social worker, dietitian, physiatrist, psychiatrist, and business manager. The pharmacist is the person with whom the patient has the most contact during a 2-week training period. In addition to patient education, the pharmacist coordinates the transition to home care, offers in-service education on home parenteral nutrition to nurses and house officers, tests and evaluates the equipment, coauthors a training manual, and edits a quarterly newsletter to patients who are on home parenteral nutrition.

Crohn Disease↗

PubMed1977

Dietary fibre, transit-time, faecal bacteria, steroids, and colon cancer in two Scandinavian populations. Report from the International Agency for Research on Cancer Intestinal Microecology Group.

A comparison of dietary intake and faecal characteristics in population samples from two areas of Denmark and Finland with 4-fold variation in colon-cancer incidence suggests that the aetiology of colon cancer may be multifactorial and is not associated in a simple manner with dietary fat, neutral steroids, acid steroids, or their bacterial metabolites. However, meat consumption was greater in the high-incidence areas. Higher intakes of dietary fibre and milk in the low-incidence area suggest a possible protective effect, unrelated to mouth-anus transit-time. Further careful dietary and metabolic studies are needed to clarify the relationships between possible carcinogenic and protective effects of diet.

Cellulose↗

PubMed1996

Knowledge skills of the home healthcare nurse.

As nurses make the transition from acute care settings to home care, it is important to understand their learning needs so that effective orientation and staff-development programs can be planned. This study identifies the knowledge and skills most needed by home care nurses by surveying nurses who currently practice in the field.

Adult↗

PubMedDate not supplied

Federal block grants and public health: a call for physician partnership and leadership. AMA Council on Scientific Affairs.

Current transitions in health care financing and delivery systems have significant implications for public hospitals, community clinics, and health agencies, which provide important outreach and preventive services and rely heavily on federal and state funds. Strong concerns are being raised about the consequences of abrupt and drastic changes in funding of community health institutions and the continuing deterioration of rural and urban public health infrastructures. The viability of public hospitals, clinics, and local health agencies is threatened as government officials consider proposals for defunding, restructuring, or eliminating these entities. In 1996, Congress, the Clinton administration, and state and local government officials considered federal grant proposals and reforms that had potentially far-reaching implications for medical and public health professionals, expressing strong interest in consolidating various specific and narrowly defined categorical grant programs into broader block grant programs. Although no legislation was enacted, deliberations about federal block grant proposals provided important opportunities for physicians and medical societies to support public health activities and guard against further funding reductions that could weaken community health programs and diminish existing levels of quality and access. Ultimately, such deliberations provided a stimulus for medical associations and physicians to strengthen or renew partnerships with public health agencies and officials and provide necessary leadership to ensure that public health and preventive medicine become more integral components of the nation's health system.

American Medical Association↗

PubMedDate not supplied

Transitioning to independence: challenges for young people with disabilities and their caregivers.

For all teens, the process of moving from childhood to adulthood is challenging. For young people with disabilities, transitioning to independence presents even more challenges. Barriers to successful transition for young people with disabilities include low expectations by parents and other significant people in the community, lack of knowledge of existing career and vocational education services, and lack of self-advocacy skills. This article provides an overview of issues related to transitioning to adult independence and offers suggestions for assessment, planning, and intervention that can help nurses be effective partners with families and other caregivers in transition efforts. Nurses caring for children with disabilities can help families see strengths in their children and develop realistic, developmentally-appropriate expectations for skill development, attitudes, and behaviors that will promote self-sufficiency in adulthood. Nurses can help families think about possibilities for independence and refer families to community resources that can help young people with disabilities pursue postsecondary education, obtain and maintain jobs, and live independently.

Activities of Daily Living↗

PubMed2005

The longitudinal relationship between the use of long-term care and depressive symptoms in older adults.

PURPOSE: The aim of this study was to estimate the longitudinal relationship between transitions in the use of long-term care and older adults' depressive symptoms and to investigate whether this relationship could be explained by markers of older adults' underlying health, or other variables including demographics, personality, and partner status. DESIGN AND METHODS: Data were from the Longitudinal Aging Study Amsterdam, which consists of a random, community-based sample of 3,107 older Dutch people (55-85 years of age) stratified by age and gender. The use of informal care, professional home care, and institutional care was recorded, and respondents were screened on depressive symptoms. Follow-up measurements took place at 3 and 6 years. RESULTS: Longitudinal analyses showed significant associations between the enduring use of professional long-term care and an increase in depressive symptoms. Transitions to professional home care or institutional care were also associated with considerably more depressive symptoms after 3 years, whereas transitions from professional home care or institutional care to no care or informal care only were not associated with a change in depressive symptoms. Most of the associations remained significant after indicators of underlying health and other covariates were adjusted for, and also after the data were reanalyzed for respondents with and without functional limitations. IMPLICATIONS: This study does not involve a controlled experiment of professional long-term care among older adults. However, the findings suggest the possibility that receiving professional long-term care could introduce new stressors and increase the risk of depressive symptoms. Our analyses illuminate the concerns of elders regarding their use of professional long-term care and may help in planning for more effective delivery of this type of care.

Aged↗

PubMedDate not supplied

Relinquishing in-home dementia care: difficulties and perceived helpfulness during the nursing home transition.

Institutionalization of an elderly relative suffering from dementia is a key transition in the caregiving career. This study determines factors that predict the problems and help dementia caregivers perceive while institutionalizing an elderly relative. By using a sample of 185 dementia caregivers interviewed before and after institutionalization, the authors conducted a multivariate regression to identify relevant predictors of search difficulties, professional help, and family help during the nursing home transition. The personal and social resources of caregivers prior to placement (e.g., mastery, family conflict, socioemotional support, duration of care, education, and physical health) were reliable predictors of search difficulties and perceived helpfulness. Such findings will prove useful to long-term care practitioners who wish to facilitate the institutionalization process for caregiving families.

Adaptation, Psychological↗

PubMed1998

Becoming a primary care nurse practitioner: challenges of the initial year of practice.

The transition from student to primary care practitioner is exciting and challenging and offers seemingly limitless opportunities. This article presents results of a model generated from a longitudinal study of 35 newly graduated primary care nurse practitioners during their first year of practice. Stages of development include laying the foundation (recuperating from school, negotiating the bureaucracy, looking for a Job, and worrying); launching (feeling real, getting through the day, battling time, and confronting anxiety); meeting the challenge (increasing competence, gaining confidence, and acknowledging system problems); and broadening the perspective (developing system savvy, affirming oneself, and upping the ante). Anticipatory guidance is offered for new graduates and their mentors and colleagues. Mentors can provide crucial information about appropriate expectations and create key structures to facilitate new practitioners' needs for consultation and advice.

Education, Nursing, Graduate↗

PubMed1980

Factors contributing to loss of anaerobic bacteria in transit from the patient to the laboratory.

Care and attention to detail in the sampling, transit and submission of a specimen for anaerobic bacteriological investigation are of paramount importance. The swab is a relatively inefficient sampling device and is often abused. A transport system may help, but a full evaluation of our sampling and transport methodology is needed and this will be influenced by local circumstances.

Anaerobiosis↗

PubMed2001

Transition of adult patients with cystic fibrosis from paediatric to adult care--the patients' perspective before and after start-up of an adult clinic.

UNLABELLED: Although most patients with cystic fibrosis (CF) survive into adulthood, many CF centres are still run by paediatricians. A transition programme from the paediatric CF unit to a newly established CF clinic at the Department of Internal Medicine was carried out for the whole group of patients > or =18 years. We aimed to evaluate our patients' opinion of the transition by analysing the results of two surveys performed before and after the transition. Nine months before the transition, we mailed an anonymous questionnaire. Statements regarding the forthcoming transition were to be answered on scales from 1 to 4, and the patients had to check a list of adjectives describing the current treatment in the paediatric CF centre as well as the presumed care in the adult unit. Fifteen months after the transition, a second survey with similar questions was carried out. RESULTS: 44 of 68 patients (65%) aged 18 to 33 years replied to the first and 56% of patients to the second questionnaire. Mean duration of treatment at the paediatric CF centre was 7.5 years (range: 1 to 22 years). Twelve patients each were classified as supporters or opponents of the transition, the remaining patients as intermediates. Older patients and those who had not required hospitalisation during the preceding year had a more positive attitude to the transition (p <0.05). There was a linear relationship between the transition attitude score and the presumed quality of care in the Internal Medicine Department (r = 0.62, p <0.001), but no relation to the quality of present paediatric care (r = -0.09, p = 0.59). In the second survey, patients rated the quality of care in the adult CF unit better than prior to the transition. CONCLUSIONS: The transition from paediatric to a newly established adult CF centre was accepted by most adult CF patients. Thorough training of all staff of the new adult unit and a close co-operation between both departments are pre-requisites to guarantee a smooth transition of all patients.

Adolescent↗

PubMed1998

Public health, communicable diseases, and managed care: Will managed care improve or weaken communicable disease control?

BACKGROUND: Several changes can be anticipated in the practice of communicable disease control as a result of the health care delivery system's transition from a predominantly fee-for-service system to a predominantly managed care system. These changes will clearly involve clinical services provided by public health agencies, such as immunizations and diagnosis and treatment of tuberculosis and sexually transmitted diseases, as well as those that do not involve direct patient care, such as public health surveillance, disease investigation, outbreak control, contact tracing, public health laboratory services, and health education. METHODS: In this paper I review the potential impact of managed care on each of these areas of communicable disease control and suggest strategies for minimizing adverse effects and maximizing potential areas of cooperation. RESULTS: Examples of successful strategies include California's Medi-Cal managed care expansion, which allows local public health agencies to bill managed care organizations for the sexually transmitted disease, immunization, and confidential HIV services they provide to managed care beneficiaries. A different strategy is illustrated by the Pacific Business Group on Health, an employer-based purchasing group, that uses purchasing power to standardize the clinical preventive services benefit across all plans with which it contracts and to promote immunization goals. CONCLUSION: This analysis and these examples suggest that the emergence of managed care as the predominant form of health care financing and delivery in the United States offers an important opportunity for public health.

California↗