Pharmacist as a provider of oncology ambulatory care services

The services provided by a pharmacist to ambulatory oncology patients is described. The pharmacist takes drug histories, monitors drug therapy, gives patient discharge consultations and acts in cooperation with local physicians and the medical staff in providing chemotherapy to cancer patients for home administration. The pharmacist also provides inservice education and acts as a consultant to the medical, nursing and pharmacy staffs.     

Administrative issues in ambulatory oncology care

The major priority of the ambulatory care nurse administrator is to negotiate the role changes that have occurred in ambulatory care and allow nurses to practice developed skills and collaborate with other health care professionals. Defining the scope of practice, developing standards of care, staffing requirements, budgeting, and developing a quality assurance program are major responsibilities of the ambulatory nurse administrator.     

Nursing care delivery models in ambulatory oncology

The action of sodium orthovanadate (Na3VO4) on spontaneous mechanical activity of the longitudinal muscle was investigated in isolated segments of rabbit distal ileum. Vanadate (0.3-1000 microM) concentration-dependently enhanced the amplitude of phasic contractions (pendular movements) and caused the muscle tone to slightly increase at the highest concentrations. Both these effects were mimicked by the Ca2+ channel activator BAY K 8644 (10-1000 nM). Vanadate- and BAY K 8644-induced potentiation of mechanical activity was antagonized by the Ca2+ entry blocker nifedipine (3 nM). In Ca(2+)-free, K(+)-depolarized preparations, vanadate (100 microM) failed to contract the musculature, but potentiated the contractile response to applied calcium (CaCl2: 30-300 microM). The action of vanadate was similar to that of BAY K 8644 (3 nM) and was antagonized by nifedipine (0.1 nM). These results suggest that extracellular calcium is required for vanadate-induced smooth muscle excitation which, at least in part, appears to arise from facilitation of calcium influx through voltage-dependent Ca2+ channels.     

Care tracker: a new approach to nursing care in ambulatory settings

It is becoming increasingly clear that mitochondrial Ca2+ uptake from and release into the cytosol has important consequences for neuronal and glial activity. Ca2+ regulates mitochondrial metabolism, and mitochondrial Ca2+ uptake and release modulate physiological and pathophysiological cytosolic responses. In glial cells, inositol 1,4,5-trisphosphate-dependent Ca2+ responses are faithfully translated into elevations in mitochondrial Ca2+ levels, which modifies cytosolic Ca2+ wave propagation and may activate mitochondrial enzymes. The location of mitochondria within neurones may partially determine their role in Ca2+ signalling. Neuronal death due to NMDA-evoked Ca2+ entry can be delayed by an inhibitor of the mitochondrial permeability transition pore, and mitochondrial dysfunction is being increasingly implicated in a number of neurodegenerative conditions. These findings are illustrative of an emerging realization by neuroscientists of the importance of mitochondrial Ca2+ regulation as a modulator of cellular energetics, endoplasmic reticulum Ca2+ release and neurotoxicity.     

Continuity of services: the managers'' challenge

A 1.5% glycine solution has recently been introduced as a bladder irrigation fluid. In this study, glycine solution was compared with two other recognised bladder irrigants (chlorhexidine and noxythiolin) for its inhibitory activity against common urinary tract pathogens. Glycine solution supported the growth of nearly 50% of the bacterial strains tested whereas chlorhexidine and noxythiolin were completely inhibitory. In quantitative studies with selected strains it was found that growth could be initiated from as few as 200 organisms/ml. It was concluded that glycine solution was capable of supporting bacterial growth and thus, from a microbiological viewpoint, was unsuitable as a bladder irrigant.     

Empowerment of diabetics: a challenge for community nursing

Empowerment of diabetic patients can be promoted by the use of blood glucose self-monitoring. Community nurses play an important role in teaching effective and accurate techniques.     

Continuity of care and delivery of ambulatory services to children in community health clinics

This study assesses how continuity of care influences receipt of preventive care and overall levels of ambulatory care among children and adolescents in community health clinics (CHCs). It is a secondary data analysis of the 1988 Child Health Supplement to the National Health Interview Survey. Of 17,110 children in the sample population, the 1465 who identified CHCs as their routine source of care formed the study population. Continuity of site was defined as identification of a CHC as a source of both routine and sick care, and continuity with a clinician was defined as identification of a specific clinician for sick visits. In bivariate analyses both continuity with the CHC and with a specific clinician were associated with increased levels of preventive care and overall ambulatory care. In logistic regression models, continuity of care was associated with nearly a two-fold increase in the odds of receiving age-appropriate preventive care. Alternatively, insurance status was a better predictor of receipt of overall levels of ambulatory care. We conclude that expanding financial access alone is unlikely to sufficiently improve low-income children's access to Community Health Clinics. Additional emphasis on localizing the delivery of both routine and sick care services in a single site or with a specific clinician may be needed to achieve higher levels of both preventive care and overall ambulatory care.     

Access to ambulatory care for adolescents: the role of a usual source of care

Using data from the 1987 National Medical Expenditure Survey, characteristics of ambulatory service utilization for adolescents aged 11 through 17 were examined. Access to health care was further explored by identifying adolescents at risk of not receiving an ambulatory service in the event of symptomatology. Approximately two-thirds of an estimated 25 million adolescents experienced an outpatient visit. African American race, Hispanic ethnicity, middle income, and lack of insurance and a usual source of care placed adolescents at risk for not receiving an ambulatory service. Sixteen million adolescents experienced symptomatology, but only one-third saw a physician. Those lacking a usual source of care were at greater odds of not receiving care. For symptom-based care, inequities were related more to lack of usual source of care rather than socioeconomic characteristics. Health care reform efforts may benefit from ensuring that adolescents have an identified usual source of care to ensure equity of access to care.     

Young people's health needs in Botswana: a challenge for nursing

The health needs and problems of young people in Botswana are embedded in the sociocultural, economic and political settings in which they grow up. Recognition of young people as a unique group can help minimize the problems and meet their total needs. In Botswana they are subjected to many problems that impact negatively on their development and welfare. These problems pose a daunting challenge to such service providers as nurses, community leaders, parents and young people themselves.     

Merger management: a challenge to nursing leadership

Intravascular ultrasound (IVUS) represents a new method to assess vessel lumen and wall morphology. To prospectively evaluate the usefulness of IVUS for further therapeutic decisions in left main stem (LM) lesions with unclear angiographic definition, this study was launched. We studied 56 patients with significant stenosis of the LAD and/or LCX arteries and questionable LM morphology. 30-MHz IVUS catheters with 2.9 or 3.2 F outer diameters were used. A significant luminal reduction of the left main stem was defined as an area stenosis greater than 50% or a minimal luminal diameter smaller than 3 mm as determined by IVUS. 36 of 56 patients (61%) fulfilled these criteria. Additionally, 12 patients showed a ruptured plaque within the LM. 30 of these 36 patients were originally thought to be candidates for angioplasty. After positive IVUS 34 of these 36 patients were sent to surgery. No perioperative ischemic complications occurred. In angiographically unclear left main stem findings. IVUS establishes a definitive diagnosis. After IVUS confirmation of significant left main stem pathology operative management should be the preferred approach as compared to transluminal coronary interventions. However, prospective randomized studies are needed to define the most efficient approach.     

Latex sensitivity: a public health care challenge

Latex sensitivity is becoming epidemic in the health care arena. Providers of health care need to be aware of the signs and symptoms, the treatments, and the consequences of latex sensitive reactions. In this article, I will provide information about latex sensitivities that will enable health care workers and their patients to have a better understanding of the phenomena. Resource information is provided for the latest information pertaining to latex sensitivities to aid in the education of health care providers and their patients.