Pharmaceutical care applied to the hospice setting: a cancer pain model

Following orthodontic treatment, the mechanical debonding of brackets often results in damage to the enamel surface of teeth. Loss of natural luster, a roughened surface, and scarring may occur. When scarring occurs, a method for re-establishing the enamel luster and surface characteristics can be instituted by either the restorative dentist or the orthodontist. One method of restoring enamel luster and natural surface characteristics following removal of orthodontic fixtures is through a sequence of enamel polishing. This article discusses logical steps for the restoration of enamel through the utilization of polishing burs and progressive pastes (Proxyt), Ivoclar Vivadent, Amherst, NY) for the final aesthetic orthodontic result.     

A model of health care delivery in a child day-care setting

Many children in our country spend all or part of their days in group day care while their parents work or go to school. These children are not only at risk for day-care-related illnesses, but also may lack preventive health care because their parents have time constraints or financial barriers. A group of nursing faculty members found that by collaborating with early childhood educators, accessible and cost-effective health care could be provided to children at a campus day-care site. This collaboration allowed for the early detection of problems, thereby reducing barriers to learning. Furthermore, by entering a day-care system, nurses found opportunities to conduct health education and promotion that had a positive impact on children, parents, and day-care staff. This model, or components of it, could be replicated in similar settings.     

Development and validation of a multidimensional multivariate model for accounting for infractions in a correctional setting.

A Person by Situation by Response Mode by Reinforcer (sanction) model for accounting for infractions of rules by male inmates incarcerated in a federal correctional facility was developed and evaluated. In a series of 4 preliminary studies, a 720 (number of inmates) by 16 (number of institutional subsettings in which infractions occurred) by 63 (number of types of infractions defined by institutional authorities) by 30 (number of existing sanctions contingent on institutional infractions) model was empirically refined into a 3 by 2 by 4 by 2 model. The utility of the model was assessed using questionnaire and ex post facto methodology. Second- and 3rd-order interactions were inconsequential in accounting for behavioral variance. Findings that were replicated across studies (response mode main effect, Person by Sanction interaction) indicate that management policies should be designed such that incarceration in institutions is less conducive to verbal aggression and evasion and that institutional disciplinary procedures should be matched to inmate types. (55 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advance directives in a correctional setting.

Using advance directives to preconsent to mental health treatment is a promising approach to contending with the quandary posed by patients suffering from severe mental health illness, particularly those in a prison setting. The implementation of advance directives represents unfamiliar territory because it focuses on the patient's ability to preconsent to treatment rather than the commonly interpreted prerefusal of treatment. The challenge of consenting in the prison system generates a set of unique problems. The environment in which the instrument is signed can impose significant pressures and therefore result in a viable legal challenge. The prison setting is the most coercive environment in which a patient can be treated, particularly when the patient is mentally ill. Mentally ill prisoners signing preconsent for treatment advance directives have an opportunity for unprecedented relief yet may also experience pressure to select treatments desirable to the prison staff. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

State-coordinated services for traumatic brain injury survivors: toward a model delivery system

Since 1985, the state of Minnesota, through a variety of advocacy, legislative, and interagency efforts, has made incremental gains in public policy and service development for persons with traumatic brain injury (TBI). This article reviews the roles and functions of select state programs and departments in coordinating TBI services. Key initiatives, as well as the current model of public policy and services, are outlined. Current and future service development and initiatives are discussed. Finally, specific implementation recommendations are proposed.     

The Sacred Circle: a conceptual framework for spiritual care in hospice

Hospice care has consistently recognized the need to integrate spiritual care into holistic plans of care for dying patients and their families. Designing and implementing spiritual care interventions can be potentially difficult for hospice practitioners who have not had specific training in theology or pastoral care. Matthew Fox, a theologian, has developed a model of spiritual development that utilizes an ecumenical, ethical framework that can be directly applied to the care of hospice patients and families. This model employs a Sacred Circle approach that begins with an emphasis upon the sense of awe and wonder (the Via Positiva), moves into the next cycle by recognizing problems and negative emotions (the Via Negativa), that then flows into the creative solutions to problems (the Via Creativa), which finally transforms the problem into a new level of understanding (the Via Transformativa).     

Moving toward a broader model of health care.

This article looks at how we can move toward a broader model of health care. It discusses advances in U.S. health care, the issue of health care coverage for all Americans, the need for a biopsychosocial model of health care, and the impact that psychologists can make in improving health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Elders' end-of-life decisions: implications for hospice care

Elders' views on various end-of-life decision options were studied to determine each option's acceptability if they were faced with the need for such decisions. 388 black and white elders aged 60 to 100 responded to 17 decision scenarios depicting situations with a low quality of life, rating acceptability of each of 7 options for each scenario. Based on factor analysis of responses over scenarios, three scores were computed: maintaining life, ending life, and letting others decide. Profile types were identified and related to demographic background and personality variables. Implications for hospice care are drawn.     

Nurse-physician communication in home care and hospice: a physician's point of view

As economic pressure continues to mount within the medical system, more and more patient contact is shifting away from expensive inpatient care. Initially, the shift in patient visits was away from the hospital and into clinics and the physicians offices. With the growth of capitated medical groups and prepaid care, not just inpatient days are declining. With efforts to control costs, the numbers of physician office and clinic visits are declining also.     

Out-patient hospice services--their importance for palliative care in Germany

Morphologic and morphometric sperm characteristics of mouse epididymal extracts from animals exposed to static magnetic fields were evaluated. For this purpose, animals were exposed for 35 days to a field of 0.7 T generated by a commercial permanent magnet for either 1 or 24 h per day. The values of morphometric parameters were obtained using the morphometric module of the Sperm Class Analyzer computerized image analysis system, and percentages of abnormalities were calculated. The size of sperm heads was unaffected by exposure to static magnetic fields. Lack of hook was a sperm head abnormality found significantly more frequently in animals exposed continually than in nonexposed animals, showing a possible alteration to the spermatogenic process after exposure to static magnetic fields. The percentage of sperm with coiled tails or of sperm with abnormal midpiece or tail was not altered by exposure.     

Euthanasia from the perspective of hospice care

The hospice believes in the concept of a gentle and harmonious death. In most hospice settings there is also a rejection of active euthanasia. This set of two apparently conflicting principles can be defended on the basis of two arguments. The first is that doctors should not foster the intent to kill as part of their moral and clinical character. This allows proper sensitivity to the complex and difficult situation that arises in many of the most difficult terminal care situations. The second argument turns on the seduction of technological solutions to human problems and the slippery slope that may arise in the presence of a quick and convenient way of dealing with problems of death and dying.     

Issues in patient-focused care for the respiratory care practitioner

Patient-focused care is the redesign of patient care so that personnel and resources are organized around the patient instead of departments. The reasons are many but usually involve cost reductions and improvement in the customer's perception of quality. Goals for this process include grouping patients by diagnosis, decentralizing services, and cross-training staff. The respiratory care practitioner is well prepared to fit into the patient-focused care model. Recent surveys show the impact of hospital restructuring on respiratory care to be rather positive.     

Depressive symptom reversal for women in a primary care setting: a pilot study

Our goal is to assess the viability of an in vitro preparation of bovine ciliary body/epithelium (CBE) in a small volume Ussing-type chamber. A new small volume Ussing-type chamber with continuous perfusion was developed for bovine CBE. The trans-CBE electrical parameters were monitored and the electrical responses of the CBE to ouabain (1 and 0.01 mM) were recorded. The trans-CBE fluxes of [14C]-L-ascorbate and [3H]-L-glucose were also studied. The bovine CBE preparation was stable inside the chamber in terms of its potential difference (PD), short circuit current (SCC) and trans-CBE resistance. They were -0.51+/-0.05 mV (aqueous side negative), -5.43+/-0.04 microAcm-2 and 94+/-2 Q.cm2 (mean s.e.m., n=35), respectively. The preparation hyperpolarised when 0.01 mM ouabain was administered to the aqueous side, depolarised when ouabain was applied to the stromal side. [3H]-L-glucose diffusion was about 74 nEq h(-1)cm(-2) in either direction (n=12). Taking the area magnification factor of the CBE into consideration, the diffusional L-glucose flux across the bovine CBE was comparable to other tight epithelia. A significant net ascorbate flux (0.26+/-0.05 nEq h(-1)cm(-2), n=4, p<0.01) was found in the stroma to aqueous direction. We have developed a viable in vitro bovine CBE preparation which was (1) electrically stable, (2) responsive to ouabain, (3) tight to L-glucose diffusion, and (4) capable of actively secreting ascorbate. A net trans-CBE chloride transport (0.81+/-0.30 microEq h(-1)cm(-2), n=12, p=0.01) from stromal to aqueous side was found in the present in vitro model under short-circuited conditions.     

Coordinated systems of community-based health care delivery: a vehicle for health care reform

The need for health care reform in this country continues to be high on the public agenda. Deficits in the access of United States citizens to needed health care services continues, despite recent efforts at health care reform. In addition, the health status of children in this country is of paramount concern. Significant threats to the health of this nation's children have spurred several proposals for reducing the cost of health care while improving the quality of outcomes. A sample of these proposals is analyzed. An example of a health care program which exemplifies one such proposal for health care reform is then discussed. Findings of a recent research project that is relative to the benefits of such a program are provided.     

The case management model of patient care delivery

Case management is a model of care delivery that integrates patient and provider satisfaction and consideration of cost factors and provides a method of managing individuals' holistic health concerns. Using the case management approach, nurses can optimize client self-care, decrease fragmentation of care, provide quality care across a continuum, enhance clients' quality of life, decrease length of hospitalization, increase client and staff satisfaction, and promote cost-effective use of scarce resources. Case management offers nurses an opportunity to demonstrate their roles in multidisciplinary health care teams. Case management is relevant in ambulatory surgery settings and in the perioperative care of complex surgical patients.     

New approaches to syphilis control. Finding opportunities for syphilis treatment and congenital syphilis prevention in a women's correctional setting

BACKGROUND: With prostitution and drugs the most common reasons for arrest among New York City (NYC) women, female arrestees are at high risk for acquiring syphilis and delivering congenitally infected babies. Despite routine syphilis screening of all NYC inmates, many are released before the need for treatment is recognized, and once released, few could be found for treatment. GOALS: To improve syphilis treatment rates among female correctional inmates in NYC. STUDY DESIGN: At a women's correctional health clinic, on-site, rapid, qualitative nontreponemal syphilis testing (STAT rapid plasma reagin [RPR]) and on-line access to the local syphilis case registry were introduced to supplement the usual admission medical evaluation. Treatment decisions made using the authors' jail protocol were compared with treatment criteria used in NYC's sexually transmitted disease (STD) clinics. Patients consisted of a consecutive sample of 685 remandees admitted one or more times during the day shift, March 24, 1993, to July 31, 1993, who had a full complement of mandatory admission medical tests. Using the study protocol, syphilis treatment decisions were made and needed treatment was furnished at the end of the admission medical evaluation. The main outcome measures were correct identification and treatment of syphilis in this population, compared with standard NYC Department of Health (DOH) STD clinic practice, as well as the effect of the jail protocol on pregnancy outcomes and need to treat offspring for congenital syphilis. RESULTS: Compared with NYC DOH STD clinic practice, the study protocol was 95% sensitive and 88% specific in arriving at appropriate treatment for syphilis. Treatment at the end of the admission medical evaluation increased syphilis treatment rates from 7% to 84% of women with indications for treatment and to 88% of pregnant women with indications for treatment. Prospective follow-up for birth outcomes revealed no spontaneous abortions and eight live births. Seven of the eight did not need congenital syphilis treatment because their mothers were adequately treated while incarcerated. CONCLUSIONS: Qualitative (or STAT) RPR testing and access to DOH syphilis case registry data provide prompt and accurate diagnostic information that can lead to an overall increase in the number of inmates appropriately treated (with a minimum amoung of overtreatment) in a women's correctional facility. This protocol may be applicable in other high-risk, transient populations.     

Halo skeletal traction pin site care: toward developing a standard of care

Halo skeletal traction may be used to immobilize a patient's head and neck following a cervical fracture. Prevention of infectious reactions around the pin sites of halo traction is a priority in rehabilitation nursing practice. Although prophylactic treatment of skeletal pin sites is a generally accepted practice, there is great diversity of opinion and very limited systematic investigation as to how the sites should be treated. In this article, the author reviews the literature on pin site care and suggests a protocol based on the current literature.