Integration of education and services as a base for the formation of human resources in health care]

It will be necessary to coordinate the University role with health institutional policies concerning the definition of health goals, and personnel functions as the latter should be trained if and when they are offered the opportunities of grasping both theory and practice in an environment closely related to everyday problems and realities. Accordingly, health care changes must precede health educational changes. There are two factors that interfere with a proper integration between the education care system: 1) an excess number of medical (or health students that overcome teaching facilities and 2) the correct trend in health care, based on specialists, attached to large hospital centers in urban environments. No attention is paid in this way to the importance of the health team, to health promotion, health education, preventive measures, etc. In several Mexican schools new curricula have been developed in which students face actual health problems from the beginning of the studies and they are trained as another resource of the health system being involved in all type of health activities in health centers, schools, nurseries, out-patient community clinics, etc.     

Overview and implications of Medicaid managed care for people with developmental disabilities

The inclusion of people with developmental disabilities in managed care as part of general efforts by states to enroll and Medicaid recipients in such plans was reviewed. Managed care was defined and the processes by which managed care organizations deliver services were explained. Escalating costs and utilization were discussed as the primary reason for the shift to managed care. The use of Medicaid Section 1115 waivers by states to include Medicaid recipients was explored. The relation between acute health care and long-term care, and the utilization patterns in each, were briefly described. Finally, elements of managed care that are particularly important to people with developmental disabilities, such as care coordination, maintenance of quality, and individual and family support, were discussed.     

Hydrocephalus secondary to intracranial hemorrhage in premature infants

Premature (low birth weight) infants are particularly susceptible to intracranial hemorrhage. This frequently arises from the subependymal area and may dissect into the brain or into the ventricles. If the infant survives, hydrocephalus is a frequent sequela. Because of major improvements in the care of premature infants in recent years and the proliferation of intensive care nurseries, increasing numbers of low birth weight infants are surviving and developing hydrocephalus. Seven cases are described of infants who developed hydrocephalus following intracranial bleeding. Initially, ventricular and lumbar punctures were done to attempt to control head growth but this was unsuccessful. Two were treated with temporary external ventriculostomy which did not permanently control the hydrocephalus. Definitive treatment included ventriculo-atrial shunts using an expandable 'telescopic' cardiac catheter in two and ventriculoperitoneal shunts in five. The pathogenesis and management of the condition are discussed.     

Filial maturity. A view of developmental psychology on the relations between adult children and their weak aged parents

With this article we would like to contribute to the elaboration and clarification of the concept of filial maturity. We first roughly outline how the concept has been used during the past 30 years to describe the nature and quality of the adult child-parent relationship. The concept is analysed in more detail. We argue that filial maturity can be placed in a developmental psychological perspective. This means that it has to be conceived as a specific maturity in the filial role and that some arguments can be given to explain the developmental psychological character of the concept. In view of the theoretical and clinical applicability of the construct we prefer to consider filial maturity as a non-age-graded developmental task within the context of filial care of adult children for their aged parents. Within this context of parent care we propose a (new) definition of the concept and differentiate it from other related constructs. Our definition highlights three important dimensions which refer to the way the adult children engage in the relationship with their parents: (a) they behave in an empathetic and responsive way in the intergenerational relationship, without role-reversal, (b) they take care of their aged parents without loosing their own autonomy, and (c) they respect their parents in their autonomy and enduring parental role.     

Assessment of the patient with cleft lip and palate. A developmental approach

Children with cleft lip and palate require interdisciplinary team care from infancy through adolescence. An understanding of developmental stages allows the cleft palate team to adapt and integrate its services into the rapidly changing life of the child. This article discusses the maturational, developmental stages of childhood and the services the child with cleft lip and palate and the child's family deserve through each stage. Health care providers in all settings may continue to provide appropriate care for all patients with cleft lip and palate, despite the challenges of a changing health care environment, by emphasizing the needs of the child in all developmental stages.     

More on nonmaternal child care.

Cautions that C. Etaugh's (see record 1980-11778-001) conclusion that high-quality nonmaternal care does not appear to have adverse effects on a child's development could be interpreted as meaning that nonmaternal care is never harmful to children. More consideration to the developmental status of each family member and to each member's feelings about the childcare arrangement is needed in further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress-point intervention for parents of repeatedly hospitalized children with chronic conditions

Little is known about how to assist children with chronic conditions and their families cope with repeated hospitalizations. A two-group, pretest-posttest study was done to determine whether a community-based, stress-point nursing intervention for parents could decrease distress and improve child and family functioning. Fifty participants were randomly assigned to intervention or usual care control groups. The intervention focused on specific, parent-verified child and family issues. Three months after hospitalization, intervention parents had better coping and family functioning than those in the usual care group. Intervention parents' anxiety was initially higher and then lower. There were no child behavior differences between the groups after hospitalization. Intervention children had no developmental regression at 2 weeks and better developmental gains 3 months after discharge than the usual care children. Stress-point intervention for families and their children with chronic conditions improved family coping and functioning, and eliminated hospitalization-induced developmental regression.     

Starting young: improving the health and developmental outcomes of infants and toddlers in the child welfare system

The number of infants and toddlers entering out-of-home care has increased dramatically in the past few years, yet few published reports examine their needs. This article describes a collaborative, multidisciplinary developmental follow-up program for infants and toddlers that builds on the community-based family support model described in the Family to Family Foster Care Reform Initiative. The children's health and developmental status, as well as the program's effectiveness, are highlighted.     

The growth and development of an Intravenous Nurses Society chapter PICC council

Growing interest in peripherally inserted intravenous catheters led to the development of the PICC Council. This council was established to provide a resource of information for the area nurses involved in peripherally inserted intravenous catheters use and care. The group went through various developmental stages as they sought to establish cohesiveness and professional collaboration across a variety of practice settings. The outcome was the development of recommendations for vocabulary, communication, and care/maintenance activities, that could be used by intravenous nurses to enhance patient care coordination.     

Delivering health and mental health care services to children in family foster care after welfare and health care reform

As the 20th century draws to a close, fundamental changes in the organization, financing, and delivery of health care and welfare services, principally directed at poor families, are likely to result in an increased number of children entering out-of-home care. These children typically have significant physical, mental health, and developmental problems. Whether the quality of health care services they receive will improve as a result of health care reform efforts and new approaches to service delivery remains to be seen. This article addresses some of the major changes wrought by welfare and health care reform and describes the essential features of a health care system that can meet the special needs of children in care.     

Postdischarge utilization of medical services by high-risk infants: experience in a large managed care organization

BACKGROUND: Infants discharged from intensive care nurseries are a high-risk infant (HRI) population known to have increased utilization of medical services. Most studies tracking HRIs have been based on data obtained from individual chart review or direct patient contact. Given the high cost of such studies, it is desirable to develop less costly methods to track such infants. OBJECTIVES: Our goals were: (1) to identify an HRI cohort at two neonatal intensive care units; (2) to identify a control group of infants not meeting HRI criteria; and (3) to measure outpatient and inpatient utilization in both controls using computerized files in a managed care organization. METHODS: Using California Children's Services criteria as our starting point, we established an HRI definition. From a 1-year birth cohort of 7579 infants at two facilities, we identified 250 infants meeting the HRI definition at two neonatal intensive care units during 1990. We then matched the HRIs with a cohort of 896 randomly selected control newborns (those not meeting the HRI definition). Using organizational computer files and state of California death certificate tapes, we followed these infants until February 28, 1992. We measured the number of hospitalizations, total number of hospital days, and total number of outpatient visits and expressed these outcomes as rates per person-year. We also measured postdischarge mortality. RESULTS: The rate of hospitalization in the HRI group was 6.07 times (95% confidence interval [CI], 4.74-7.77) that in the control group. The utilization of hospital days by the HRI population (hospital days per 1000 person-months) was 13.24 times higher (95% CI, 11.00-16.04). The outpatient visit rate was 1.40 times higher (95% CI, 1.36-1.45) in the HRI population. CONCLUSION: Our findings in a large managed care organization corroborate previous studies showing that hospitalization rates are significantly higher among HRIs. In our study population, outpatient utilization was significantly higher as well. Our study also demonstrates the feasibility of using computerized files to study outcomes in selected pediatric populations. These methods can be used for epidemiologic studies, interventional trials, and planning for resource allocation.     

Pediatric residency as preparation for primary care practice

OBJECTIVES: To assess the effectiveness of pediatric residency training as preparation for primary care and make recommendations for improving residency training. METHOD: Two surveys were sent to graduate of the pediatric residency at the University of Colorado from 1984 to 1991. The first survey requested information about practice patterns and ratings of preparedness in 45 areas important for primary care. The second survey requested ratings of importance for increasing training time in 25 areas judged as inadequate in the first survey. RESULTS: Of 147 surveys mailed, 103 graduates responded and rated themselves as less than adequately trained in 25 of 45 areas selected for relevance to primary care. Graduates of the primary care track rated themselves as significantly better trained than graduates of nonprimary care tracks in 10 of 45 areas; nonprimary care graduates had higher ratings in 2 of 45 areas. The second survey (completed by 70 of the 103 initial responders) indicated that the top 5 areas needing increased time in residency training were, in descending order, orthopedics, developmental and behavioral problems, learning disability, attention-deficit hyperactivity disorder, and school difficulty. Graduates of the primary care track rated themselves as adequately trained in developmental and behavioral problems and attention-deficit hyperactivity disorder, but they and nonprimary care graduates felt inadequately prepared in the other 3 areas. CONCLUSION: Implications of these results change with different content areas, suggesting the need to improve training for all residents in some areas and extending to all residents some of the curriculum already implemented in the primary care track.     

The child with HIV in day care and school

HIV-infected children attend day care programs and schools in communities throughout the United States. This article examines the care of these children in the school and child care environment. Legal issues of school access, confidentiality, and school policies are discussed. Specific health, developmental, psychosocial, and educational needs of infected children are presented along with the roles that the nurse can play, as advocate and care provider for the child and family, and as school/community resource and educator.     

Developmental versus conventional care: a comparison of clinical outcomes for very low birth weight infants

The purpose of this research was to describe the clinical profile of very low birth weight (VLBW) infants receiving conventional versus developmental care during their hospitalization and to determine the appropriateness of developmental-care interventions. A phase-lag study with 124 preterm infants indicated that although there were no significant differences in individual clinical outcomes, developmental care had a significant effect on the physiologic stability of the infant over time. Developmental interventions were used for all infants receiving the developmental-care intervention, with varying frequency.     

Child care research: A case for Canadian national standards.

Research on child care is reviewed with respect to the effects of (1) licensing/regulation and (2) teacher education on the provision of high quality care for young children and developmental outcomes. A model is proposed indicating direct and indirect links between licensing and regulation, teacher education, the quality of child care, and child development outcomes. Discussion focuses on critical differences in American and Canadian demographics and attitudes toward social assistance and how this influences interpretation of research findings. Using the Canadian context as a framework, recommendations are made for national standards regarding (1) licensing and regulation of child care and (2) teacher education. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Risk Adjustment for the Medicare program: lessons learned from research and demonstrations

The Balanced Budget Act (BBA) of 1997 requires numerous changes in Medicare. Medicare's managed care program has been reinvented as "Medicare + Choice," offering an expanded range of delivery system options for beneficiaries and a schedule of payment changes that will dramatically affect managed care plans. Preceding some of these BBA-legislated changes to Medicare were years of research and demonstrations. Risk-adjusted payment in the Medicare + Choice program, which is mandated for implementation in 2000, is one example of a longstanding developmental initiative. This paper provides a brief overview of risk adjustment-related research and demonstration activities carried out by the Health Care Financing Administration (HCFA) since the 1980s, and describes a possible technical approach for the implementation of risk-adjusted Medicare managed care payments in 2000.     

A national survey of percutaneous central venous catheter practices in neonates

PURPOSE: This study was conducted to describe current practices for maintenance of percutaneous central venous catheters (PCVCs). DESIGN: A survey technique was used. SAMPLE: A national mailing to 511 nurseries resulted in a response from 309. Of those who responded, 206 reported using PCVCs. MAIN OUTCOME VARIABLE: Maintenance practices for PCVCs. RESULTS: The most common catheter site preparation technique was the use of Betadine, or Betadine and alcohol. Transparent dressings were the most commonly used site cover, and were changed when loose or soiled. Contamination precautions varied; most nurseries used Y-administration sets and extension tubing for medication administration into the PCVC system.     

Comparison between the dynamics of lipid/gramicidin A systems in the lamellar and hexagonal phases: a solid-state 13C NMR study

Adolescence is a developmental period marked by multiple challenges and demands which create a heightened vulnerability to the development of emotional disorders. Primary care physicians are in an ideal position to intervene in the early stages and prevent the tragic consequences which can occur with an untreated mental health disorder. This article reviews the assessment and treatment of adolescent mental health in the primary care medical setting. Knowledge of these disorders and their manifestations in the primary care environment will enable clinicians to provide higher quality medical care and will reduce the potential for continual life disruptions into the adult years.     

Training Primary Care Psychologists: A Model for Predoctoral Programs.

This article focuses on blueprints for developing primary care psychology training in graduate psychology programs. The rationale and the foundations for establishing primary care psychology as a generalist model in clinical programs are identified. An outline of a core curriculum for multiprofessional training and an introductory knowledge base for primary care psychology is presented. Finally, a developmental model for primary care practicum training and supervision is described and exemplified. Funding issues, faculty development, and student evaluations of this training are discussed. This article represents the ever-evolving model and lessons learned through 10 years of experience in collaborative programs among Wright State University's School of Professional Psychology, the School of Medicine, the College of Nursing and Health, and a set of urban community health centers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)