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At least 19 recordsLinked to original sources
PubMed2001

Clinical nurse specialist as facilitator of interdisciplinary collaborative program for adult sickle cell population.

This article describes the evolution, implementation, and outcomes of a collaborative interdisciplinary inpatient program designed to improve the quality of healthcare provided to adult patients with sickle cell disease. Efforts by the clinical nurse specialist were directly responsible for improved patient education, more efficacious treatment of painful crises, and increased specialty consultation. Staff and patient satisfaction with the program have been very encouraging, and a city-wide initiative that embraces a comprehensive approach to the global care of this special needs population has been designed and is currently being implemented.

Adult↗
PubMed1994

[Trends in the field of tuberculous diseases in the Eastern Europe and former U.S.S.R].

According to WHO questionnaire data, reports of national ministries of health, medical associations and other medical institutions, tuberculosis morbidity in the majority of the East European countries and CIS surpasses that for the West Europe. In 1990-1992 it varied from 18 to 80 cases per 100,000 people. The lowest morbidity was recorded in the Czech Republic, the highest in Roumania and Kazakhstan. In Estonia, Latvia, Lithuania, Russia and Ukraine tuberculosis morbidity tends to a slow reduction, while in Armenia, Kyrgyzstan, Latvia, Lithuania, Moldova, Roumania, Turkmenistan mortality rates constantly grow. Antituberculous therapeutic and prophylactic policy in the East Europe and CIS should be aimed at finding the resources for adequate supply of the population with antituberculous medications, introduction of WHO-recommended short course of chemotherapy. On demand, health care system should be restructured and new educational programs for specialists and the population introduced.

Adolescent↗
PubMedDate not supplied

Using a primary nurse manager to implement DCCT recommendations in a large pediatric program.

PURPOSE: This study was conducted to determine whether recommendations from the Diabetes Control and Complications Trial (DCCT) could be implemented in a large pediatric population using a diabetes clinical nurse specialist program coordinator dedicated to intensive management. METHODS: Patients' charts were reviewed to examine HbA1c levels from before the results of the DCCT were published and again 1 year after the recommendations were implemented. Patients who met the following criteria (N = 124) were enrolled: type 1 diabetes, less than 18 years old, followed at Yale for 1 year prior to the results of the DCCT and 1 year after, and HbA1c level recorded in the medical chart. RESULTS: HbA1c levels were significantly lower 1 year after implementing the DCCT protocol; 3 years later these same patients improved even further as evidenced by another decrease in HbA1c levels. The patients were taking more insulin (more Ultralente and regular insulin and less NPH) and had an increased number of injections at both the 1-year and 3-year follow-up points. CONCLUSIONS: The DCCT protocol can be implemented in a large population of pediatric patients with the help of a nurse who is dedicated and available to the patients for ongoing adjustments and provides creative ways to overcome the barriers to achieving normoglycemia.

Adolescent↗
PubMed1989

Evolution of a cardiac transplantation program: role of the clinical nurse specialist.

The evolution of our cardiac transplantation program necessitated learning new information and adding new personnel to keep pace with the needs of our patient population. As the program developed, the role of the clinical nurse specialist also changed. The clinical component remains important, but is now shared with additional nursing personnel. Therefore, the CNS is able to devote more time to new program development, which includes devising policies and procedures, nurse orientation, and research. The CNS assigns a high priority to these duties, which are vital in planning for excellence in patient care and contributing to the growing scientific knowledge about heart transplantation.

Heart Transplantation↗
PubMed2002

Impact of an asthma program on the quality of life of children in an urban setting.

A comprehensive asthma program involving a pharmacist and physician evaluated quality of life (QOL) for children with asthma and the relationship between changes in QOL and traditional outcomes. The program consisted of aggressive medical management and a comprehensive education program. Children were from an inner-city population who had been referred to a specialist. Twenty of the 29 children enrolled in the program were available for 1-year follow-up. Significant improvements were seen in overall QOL scores and in each domain in the instrument, which exceeded the minimal important difference. A strong relationship was not found between changes in QOL total score and changes in asthma questionnaire score, frequency of nocturnal asthma, symptomatic days, and exercise tolerance. Further research is necessary to support these findings.

Adolescent↗
PubMed2001

[Estimating the supply of medical specialists in Colombia by using the capture-recapture method].

OBJECTIVE: Given that it is not known how many medical doctors there are in Colombia and that, without that datum, studies of demand are simply theoretical exercises, we proposed to estimate the supply of 12 medical specialties in Colombia, using the capture-recapture technique, which was developed by zoologists to estimate wild-animal populations. METHODS: Three lists, or "captures," were used: 1) university degrees obtained abroad and graduates of postgraduate programs in Colombia, 2) members of medical societies, and 3) specialists in the principal health care enterprises. To estimate the total population we used the CAPTURE software program. RESULTS: A total of 24,910 records were obtained: 8,397 from the university records, 6,561 from the scientific societies, and 9,952 from the health care businesses. More than half of the physicians have entered the labor market during the last decade. The estimated number of physicians (with the 95% confidence interval) for each specialty was: anesthesiology, 1,753 (1,727 to 1,789); cardiology, 607 (598 to 624); dermatology, 517 (514 to 525); obstetrics and gynecology, 2,338 (2,290 to 2,400); pulmonary disease, 304 (297 to 320); neurosurgery, 324 (319 to 334); neurology, 321 (296 to 369); ophthalmology, 1,049 (1,042 to 1,061); orthopedics, 1,217 (1,212 to 1,227); otolaryngology, 634 (628 to 645); psychiatry, 855 (838 to 879); and urology, 452 (452 to 458). CONCLUSIONS: The capture-recapture technique is useful in the study of human resources. In Colombia the number of specialists doubled in less than a decade. There are specialties that are already oversupplied, such as neurosurgery. All the other specialties show growth rates that indicate a future over-supply for the health care system.

Colombia↗
PubMed2005

Routine ultrasound screening and detection of congenital anomalies outside a university setting.

BACKGROUND: To assess the sensitivity for detecting fetal congenital anomalies by a routine ultrasound examination program at midtrimester performed in an unselected population by midwives and specialists in obstetrics and gynecology. METHODS: Six hundred seventy-six of the pregnancies had the midtrimester ultrasound examinations performed outside the county. Three hundred seventeen of the women had midtrimester ultrasound examinations performed in the county, but delivered outside the county. A total of 18 181 pregnancies were eligible for the study. RESULTS: Altogether there were 267 fetuses and newborns with anomalies, which gives a prevalence of 1.5%. One hundred three of the 267 anomalies were detected at the midtrimester ultrasound examination, yielding a sensitivity of 39.0%. There were 11 false positives and 163 remained undiagnosed (false negatives), which gives a specificity of 99.9% and a positive predictive value of 90.4%. The sensitivity for detecting anomalies ranged from 74.4 to 8.3% according to the organ system of the fetus. CONCLUSIONS: Our study shows that midtrimester routine ultrasound examination in district hospitals can achieve a detection rate of congenital anomalies comparable with tertiary centers. One-stage ultrasound examination at midtrimester gives acceptable results concerning congenital anomalies with few false-positive results.

Chromosome Aberrations↗
PubMed1995

A survey in Puglia: the attitudes and opinions of specialists, general physicians and patients on follow-up practice. G.S.Bio.Ca.M.

BACKGROUND: The follow-up for breast cancer patients is a well established routine practice requiring the organization and coordination of many professional figures and a large expenditure of national health funds. To study the problems in practical clinical management of such a complicated health program in a typical population, a questionnaire survey of the opinions and attitudes of specialists, general practitioners and patients directly involved in clinical follow-up was performed in the Puglia region of Southern Italy. MATERIALS AND METHODS: A representative sample of specialists (n = 285), general practitioners (n = 263) and patients (n = 284) involved in the management of follow-up practice for breast cancer in Puglia received different questionnaires to ascertain their behaviour, attitudes, opinions, perception of the disease and the organizational requirements for treatment. A total of 57.4% of questionnaires were returned. RESULTS AND DISCUSSION: The most important results were: (a) about one-third of cases complained of difficulties in follow-up management due to the lack of cooperation and integration of follow-up procedures among specialists; (b) the general practitioners preferred to have a more active role in follow-up; (c) the patients reported that being managed by more than one physician or living far from follow-up facilities resulted in an inferior quality of life.

Adult↗
PubMed1998

Tobacco, drug, and HIV preventive media interventions.

Media-based health promotion interventions can reach large segments of the population and lower barriers to participation in programs. By collaborating with media specialists, we can develop interventions that might be broader, more publicized, and ultimately more likely to change behaviors and attitudes within the community. The present paper describes a series of media interventions involving smoking cessation, drug abuse prevention, stress reduction, weight control, and HIV/AIDS prevention. The process by which I became involved in these interventions is discussed, and the implications of developing these types of large-scale behavioral interventions are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1979

Development of a research program in a community teaching hospital.

Affiliation between community hospitals and university centers has become a prominent trend. St Mary's Hospital, a 298-bed community hospital, affiliated with the University of Rochester, School of Medicine and Dentistry, and in five years developed an academic program. The strategies we utilized included the following: (1) definition of the number of specialists needed for the hospital's patient population; (2) development of specific subspecialty units with more than one member with the primary intent of fostering an investigative program; (3) analysis of total projected faculty salary and laboratory renovation and equipment costs to allow staged development of the program; (4) design of a flexible research areas; and (5) joint use of equipment and space with the Clinical Laboratory Service. The program was financed through third-party reimbursement, faculty-generated Department of Medicine funds, gifts by private patrons, and extramural grants. At a time of diminishing investigative support, a medium-sized community hospital can develop a research program.

Academic Medical Centers↗
PubMed1978

Education and integration of midlevel health-care practitioners in obstetrics and gynecology: experience of a training program in Washington state.

The impetus for the development of the Gynecorps Training Program was the identification of medically underserved populations of women in Washington State and their need for preventive health care, the maldistribution of physicians, and the success of a pilot program for training midlevel personnel conducted in 1972 by the Department of Obstetrics and Gynecology, University of Washington School of Medicine. The program trains community-based and -sponsored Registered Nurses and Physician's Assistants as women's health-care specialists, with the goal of delivering preventive care in obstetrics and gynecology to populations of high-risk, low-income, and/or underserved women. A summary of the training program, its curriculum, and the integration of its graduates into community health teams is presented and discussed.

Certification↗