Caregivers and HIV infection. Services and issues

Because of the complexity of their illness, patients infected with HIV may require many services to facilitate the management of the disease. The primary care provider must understand and facilitate the services that are needed and needs to be familiar with the individuals responsible for the care of each patient. There are many stresses that have been identified in HIV caregiving, for informal caregivers and health care workers. These stresses are described, and suggestions for appropriate interventions are outlined.     

Formulating treatment partnerships with patients and their families. A case study

1. A care environment, per se, can foster patient recovery and confidence that things will work out as well as can be expected when staff practices and explicit processes are patient-centered and adapted to developmental and individual needs. 2. Separating more cognitively impaired from higher functioning patients and developing more specialized nursing teams affords a healing and restorative care environment, individualized care routines and specialty groups along with finely-tuned patient/family education. 3. Organized staff education and mentoring programs combined with master scheduling enhances the continuity of patient-centered practices and risk management protocols.     

Quality and outcomes management in gastroenterology

The delivery of medical care is undeniably changing. Resources are becoming increasingly scarce, and the progressive rise of health care expenditures needs to be restrained. Although the field of outcomes assessment is not well understood, it is increasingly being applied to the practice of medicine. The underlying goal of outcomes management should be to improve quality by identifying the most efficient use of finite resources and integrating these into practice guidelines. Although reduction of health care costs is important, it should be a secondary goal. Providers of health care must take an active role in outcomes research and management both in understanding and in implementing these techniques in medical practice. In doing so, it is essential that physicians maintain the proper emphasis on quality patient care.     

The need for continuing education in ethics as reported by rural and urban mental health care providers.

Continuing professional education (CPE) sponsors planning events for mental health care licensees can assure better attendance if they can successfully address the needs of their target audience. Offering topics of interest is particularly crucial when CPE events need to draw large numbers of attendees to be financially viable. A survey of nearly 400 health licensees regarding CPE needs, especially as related to ethics, revealed that the greatest interest in such CPE was reported by master's-level mental health care providers. Topic areas with the greatest draw were the management of clients who present with special issues (e.g., substance abuse, medical illness, or cultural diversity) and competent management of colleague misconduct and impairment, rather than more traditional ethics issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

锌电解峰、谷、平的合理利用

叙述了某厂利用峰、谷、平电价的差异,合理安排生产和取得的经济效益的实例,提出了按峰、谷、平操作应该具备的条件和采取的措施.     

Health maintenance organizations and children with special health needs. A suitable match?

OBJECTIVE: To address how well health maintenance organizations (HMOs) meet the needs of almost 700,000 children with disabilities due to chronic conditions enrolled in these plans. DESIGN: A cross-sectional survey. MEASUREMENTS/MAIN RESULTS: Health maintenance organizations offered better protection than conventional plans against out-of-pocket expenses and were much more likely than fee-for-service plans to cover ancillary therapies, home care, outpatient mental health care, and medical case management. In addition, few HMOs maintained exclusions for preexisting conditions. Other aspects of HMO policies, however, were found to operate against the interest of families with chronically ill children. In particular, HMOs commonly made specialty services available only when significant improvement was expected within a short period. Also, HMOs typically placed limits on the amount and duration of mental health, ancillary services, and certain other services frequently needed by chronically ill children. Probably the most serious problems for chronically ill children enrolled in HMOs were the lack of choice among and access to appropriate specialty providers. PARTICIPANTS: Individual HMO plans. SELECTION PROCEDURE: A sample of 95 geographically representative HMOs were selected; 59 (62%) responded. INTERVENTIONS: None. CONCLUSIONS: Health maintenance organizations offer several advantages over traditional fee-for-service plans for families whose children have special health needs. However, the results also indicate that HMOs do not always operate effectively as service provision systems for these children. To a large extent, the availability and quality of services available to a child with special needs is likely to depend on the parents' ability to maneuver within the system.     

Conceptual framework for clinical and general management

The UK has more than five years experience of the introduction of patient based management information systems into acute hospitals. These systems support the measurement of activity, process of care and cost of care allowing linkage of management processes of the hospital to direct treatment and care of individual patients. An implicit 'product' model for acute hospital care underlies these systems. When considering the management information needs of community health providers, the limitations of this model became apparent and highlighted the need for a more general model. The paper suggests such a model, not only appropriate for community care but also a better model for hospital services.     

Application of the competency model to clinical health psychology.

In response to the growing emphasis on defining professional competence within applied psychology (e.g., clinical, neuropsychology, counseling, school), in 2007 American Psychological Association Division 38 (Health Psychology) sponsored a summit meeting with a specific focus on revisiting the standards of graduate curricula and training in clinical health psychology. Using the cube model of core competency domains of professional psychology as a framework, summit participants were charged with identifying the foundational and functional competencies expected of a well-trained, entry-level clinical health psychologist. As a product of these discussions, the present article is presented as an initial effort to identify the competencies and begin the discussion in clinical health psychology. As such it is likely to be of interest to a wide audience, including clinical training programs with an existing or planned emphasis in clinical health psychology, practitioners interested in acquiring the competencies required to practice as a clinical health psychologist, and students evaluating potential graduate and postgraduate training options in clinical health psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building Systems of Care for Children With Chronic Health Conditions.

Objective: To describe the leadership role that rehabilitation psychologists can play in improving the health care delivery system for children with special health care needs (CSHCN). Setting: Midwest academic health center and surrounding communities. Participants: Children with chronic health conditions and disabilities and their families. Intervention: A model research demonstration project designed to promote family-centered, comprehensive, coordinated, and community-based care for CSHCN. The project aims to enhance environmental supports for CSHCN and their families in 2 ways: (a) by improving the ability of primary care providers to deliver effective chronic care management and (b) by integrating this improved clinical practice into an enhanced Medicaid managed care service delivery system for persons with chronic illness and disabilities. Conclusions: Psychologists have the potential to improve the quality of life of CSHCN and their families by intervening not only through direct services but also by promoting positive changes in the larger health care environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological factors in diabetes and its treatment.

Reviews the psychological factors of diabetes with respect to etiology, psychological impact and adjustment to the disease, family dynamics, and psychological programs to aid diabetes management. Stress appears to influence metabolism both directly and indirectly. Little evidence exists for a consistent pattern of traits that typifies diabetes or poor management of the disease. Several studies have shown diverse psychological problems related to diabetes, especially in the area of social problems and peer relationships among juveniles. A variety of psychological interventions may be helpful in the care of diabetes; however, none of these are conclusively useful. Research should clarify the role of stress and stress management and focus on psychological factors related to metabolic control. Treatment research needs careful specification of interventions and measurement of both behavioral and metabolic outcomes so that connections among them may be assessed. (97 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The "Heart Area" of Juan Canalejo Hospital Complex. A new approach to clinical management

The present work describes the process by which the pilot project of clinical management of the Hospital Complex Juan Canalejo, designated as "Heart Area", was implemented. In the first section, the needs and reasons that led to the undertaking of this project are explained. The project's objectives and operative strategies are listed. In the Material and Methods section, three basic aspects of the "Heart Area" are described: selection criteria of the "Area", its structure and function, and its foundation and development. In the Results section, we compare the activity undertaken in the "Area" to the situation present prior to its implementation, in relation to quality and costs. Finally, in the Conclusions, we comment on the important implications that our project can have within the Hospital Complex Juan Canalejo as well as in the health care field in general.     

General practitioners' opinions of continence care training

AIMS: To examine general practitioners' confidence in the diagnosis and management of urinary incontinence, to define their unmet continence training and educational needs, and to evaluate the current provision of continence care in general practice, including the role of practice nurses. METHODS: A pre-tested postal questionnaire was sent to 600 general practitioners throughout New Zealand to obtain information about their demography and training in incontinence management, their confidence in diagnosis and treatment, and their perceptions of met and unmet educational needs in continence care. They were also asked about current provision of continence promotion in their practice and their views on the role of practice nurses in caring for incontinent patients. Confidence data were recorded on five point scales and analysed using chi square tests. Cluster analysis was used to describe groups with different opinions on practice nurses' roles. RESULTS: The response rate from eligible contacts was 81.3%. Although most respondents provide continence care, only 2.6% offered special clinics for continence promotion. Fewer than half felt confident to diagnose the causes of incontinence. Confidence in managing incontinence in children was consistently lower than for other incontinence presentations. There was no difference by sex in confidence in caring for incontinent patients although female respondents were more likely to consider management of continence care part of a practice nurse's role (chi 2 = 47.5, p < 0.01) and to routinely ask well women about incontinence (chi 2 = 243.6, p < 0.01). Most respondents (71.9%) could not remember having had any formal training in the management of incontinence at either undergraduate or postgraduate level. Recall of postgraduate education was associated with greater levels of confidence in management of continence problems. There was general agreement that it was appropriate to include training in continence management in vocational and continuing medical education. CONCLUSION: A substantial proportion of general practitioners perceive a lack of adequate medical training in incontinence care at both undergraduate and postgraduate levels. There is a need for improved education for both general practitioners and practice nurses.     

Case management: integrating roles in the subacute setting

Nurses have great potential to advance the professional practice of nurse case management in the subacute care industry. This health care setting has created a new arena in which nursing may adapt and redefine the role of the case manager to meet the needs of an integrated system of outcomes based health care. Through cooperation and collaboration with a multidisciplinary team, the nurse case manager increases the cost effectiveness of care and enhances patient outcomes.     

Painless dentistry. Fact or fiction?

The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning. The purpose of this study was to investigate the effectiveness of a discharge planning protocol in identifying elderly patients' home care needs. The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older. The control group received the usual hospital discharge planning protocol. In the experimental group, nurse/social worker teams coordinated the discharge planning process, using an adapted form of the Discharge Planning Questionnaire (DPQ) to identify the home care needs of elderly patients. Thirty days after hospital discharge, both patient groups participated in a telephone survey to obtain information about health care problems they experienced during home recovery and their use of health care resources. The findings indicated that the majority of the elderly patients had functional dependencies, which required the help of another person to carry out daily household duties and provide assistance with basic needs, especially ambulation. These functionally dependent patients only received home care referrals about 50% of the time. These findings raise questions about current reimbursable services. Logistic regression analysis indicated that patients with increased functional dependency and patient problems during home recovery had a greater likelihood of rehospitalization and emergency department usage. This information about the home care of elderly patients after hospitalization supports the need for comprehensive functional assessment as part of discharge planning. This study also suggests that the nurse/social worker team can provide effective screening and discharge planning coordination of home care. Physician involvement and effective communication networks must be in place.     

Attitude, knowledge, and skill competencies for practice in professional geropsychology: Implications for training and building a geropsychology workforce.

Professional geropsychology is a growing area of practice and training. To meet the mental health needs of an aging population, increasing numbers of psychologists need to develop competence to work with older adults, their families, and related care systems. The Pikes Peak model for geropsychology training (Knight, Karel, Hinrichsen, Qualls, & Duffy, 2009) delineates attitude, knowledge, and skill competencies for professional geropsychology practice and makes recommendations for training. In this paper, we define and illustrate the Pikes Peak geropsychology practice competencies through a case example. In the case, an older man with complex needs seeks care through a generalist psychologist in an outpatient setting. The attitudes, knowledge, and skills that the psychologist needs to consider, and implications for training, are reviewed. Training recommendations and resources are provided, with a focus on the training needs of psychologists who wish to expand their practices to include older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of international emergency medicine: a role for U.S. emergency physicians and organizations. SAEM International Interest Group

There is a rapidly growing interest in emergency medicine (EM) and emergency out-of-hospital care throughout the world. In most countries, the specialty of EM is either nonexistent or in an early stage of development. Many countries have recognized the need for, and value of, establishing a quality emergency health care system and are striving to create the specialty. These systems do not have to be high tech and expense but can focus on providing appropriate emergency training to physicians and other health care workers. Rather than repeatedly "reinventing the wheel" with the start of each new emergency care system, the preexisting knowledge base of EM can be shared with these countries. Since the United States has an advanced emergency health care system and the longest history of recognizing EM as a distinct medical specialty, lessons learned in the United States may benefit other countries. In order to provide appropriate advice to countries in the early phase of emergency health care development, careful assessment of national resources, governmental structure, population demographics, culture, and health care needs is necessary. This paper lists specific recommendations for EM organizations and physicians seeking to assist the development of the specialty of EM internationally.