Project caring for life--long-term care funding alternative

The synopsis of The Hawaii Long-Term Care Task Force describes the product of project: "Caring ... For Life" as "the framework for implementation of a long-term care system. Framework will encompass promotion, programs, education, legislation and other initiatives necessary for an effective system. The product will be a combined effort of the private sector and government to bring about changes which will provide a continuum of services to all residents in need of long-term care in the least intensive, most appropriate and affordable setting." The purpose of this concept paper has been to paint the big picture of LTC as it now is and provide, in concept, an alternative picture of what it could be. It is by no means complete but hopefully will serve as an initial effort to be addressed and, if appropriate, be expanded upon or modified. It could also serve as a basis of comparison for other alternatives as they are considered. Long-term care is a complex problem, there are no quick fixes. The solution will require great imagination and the ultimate of our creativity. The product should be flexible and above all, should be able to stand the test of time.     

The funding of psychological health care services.

Examines issues related to the funding of psychological services identified by a joint task force of the Canadian Psychological Association and the Council of Provincial Associations of Psychologists. Discussion focuses on the identification and assessment of systems, sources, and methods of payment. The review of delivery and payment systems suggests that the majority of psychologists use a few payment sources and methods and that education about payment alternatives is needed. Implementation of training in psychology practice innovations and implications of the task force findings for professional standards are discussed. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linking critical care nursing and genetics with research funding opportunities

OBJECTIVE: To assess the long-term (3-9 years) results of augmentation ileocystoplasty for non-neurogenic female urge incontinence in terms of continence, the need for intermittent self-catheterization and the need for additional or auxiliary treatment, to define the long-term complications and to assess the patients' satisfaction with the outcome. PATIENTS AND METHODS: The study comprised 51 women who underwent augmentation ileocystoplasty for non-neurogenic urge incontinence between November 1987 and December 1993; 27 patients had associated interstitial cystitis. All patients had exhausted conservative methods, with an unsatisfactory outcome. All patients were interviewed about the results of the procedure, and their charts reviewed and updated with relevant information. RESULTS: Within a mean (range) follow-up of 75.4 (36-109) months, 27 patients (53%) were completely continent, 13 (25%) had occasional leaks and nine (18%) continued to have disabling urge incontinence frequently requiring pads. Regular self-catheterization was needed by 20 (39%) patients while the rest emptied adequately with no or minimal residual volumes. Additional pharmacotherapy had to be used by 12 (24%) patients. Three patients later developed stress urinary incontinence and were managed with fascial sling procedures. The patch was revised in two patients and excised from four others because they had high residual volumes and uncontrollable infections. Two patients had an ileal conduit diversion for persistent incontinence. The most common complication was recurrent urinary tract infections, seen in 22 patients using intermittent self-catheterization. Mucus retention occurred regularly in 10 patients, six had chronic diarrhoea, four had latent bowel obstruction, one developed a bladder stone, one an incisional hernia and one developed patch necrosis and perforation. Twenty-seven patients (53%) were happy with the outcome of the procedure while 20 (39%) were not; four patients were unsure whether a change had occurred. CONCLUSION: Augmentation ileocystoplasty is a valuable alternative for women with intractable urge incontinence. However, these patients and their physicians should be aware of its limitations, specifically the possibility that incontinence may persist and the high probability of the need for self-catheterization, with potential subsequent urinary tract infection.     

Health care policy and long-term care.

Discusses changes in the age structure of the nation, the locus of care, the nature of disease, and the cost of care as factors that have led to recent proposed revisions in health-care policy. The need for increased future involvement of a rehabilitation philosophy as a response to the current crisis in policy is examined. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care enigmas

A study of the exacrinous function of the pancreas made in 205 healthy persons aged from 18 to 90 has evidenced that in ageing there takes place in the duodenal mixture of juices a statistically significant decline in the activity of trypsin and of its inhibitor, lipase, amylase, in the level of bicarbonates and in the volume of the juice along with an increase in the content of chlorides. In ageing more marked changes become apparent following application of the agents stimulating the pancreatic secretion of the secretin and pancreozymin mechanism of action, and then the greatest changes are seen to occur on the level of lipase and trypsin and the least -- on the level of the amylase activity and the bicarbonate alkalinity content. Note has also been taken of an age-specific statistically significant decline in the activity of the studied pancreatic enzymes in the blood (trypsin, its inhibitor, lipase, amylase) and in the urine (lipase, amylase).     

Health care policy, psychotherapy research, and the future of psychotherapy.

In a quest for accountability in the delivery of health services, health care policymakers in both government and private sectors are creating clinical practice guidelines, many of which heavily emphasize medical and pharmacological approaches. Yet, there are now sufficient data to support the efficacy of psychotherapeutic procedures for a wide variety of specific disorders, and it seems now is the appropriate time to communicate these findings to health care policymakers and the public at large. At the same time, data must be developed on the delivery of these interventions by frontline clinicians in the settings where they practice. The emergence of practice research networks may accomplish this latter goal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care of adolescents

Partial trisomy 6p with duplications ranging from 6p21 to 6p25 is emerging as an established syndrome. A case of duplication of segment p22-p25 of the short arm of chromosome 6 as the result of a maternal t (1;6)(q44;p22.2) translocation in a mentally retarded girl with congenital anomalies is reported here. The associated phenotypic anomalies are compared with other reported cases of duplication 6p involving adjacent regions.     

Health care administration and the law

Eighty-six feral cats from a sheep grazing area in the Tasmanian Midlands and 21 from King Island were examined for internal parasites. Major food items in order of decreasing prevalence in stomach contents were insects, lizards, birds, rodents and frogs in the Midlands, and rodents, birds, insects, and lizards on King Island. Feral cats from the Midlands had 4 cestode, 7 nematode, 2 trematode and 3 protozoan parasites as follows: Spirometra erinacei (66.3%), Taenia taeniaeformis (2.3%), Dipylidium caninum (1.2%), Toxocara cati (86.0%), spiruroid nodules containing Cylicospirura felineus and Cyathospirura dasyuridis (57.0%), Ollulanus tricuspis (11.4%), Uncinaria stenocephala (2.3%), Aelurostrongylus abstrusus (39.2%), Capillaris aerophila (30.0%), Echinoparyphium sp (27.1%), Fibricola minor (6.8%), Isospora felis (12.7%), I. rivolta (5.4%), and Sarcocystis sp (1.8%). Antibodies to Toxoplasma gondii were found in 51 of 53 serums. Three cestode and 5 nematode parasites were found in cats from King Island: T. taeniaeformis (49.2%), D. caninum (23.8%), S. erinacei (19.0%), T. cati (90.5%), C. felineus (42.9%), C dasyuridis (9.5%), O. tricuspis (4.8%) and C. aerophila (9.5%). This is the first record of Cylicospirura felineus, Fibricola minor and Echinoparyphium sp in cats in Australia.     

Health care report cards

PURPOSE: A decreased concentration of magnesium in the urine is a risk factor for renal calcium stone disease that may be caused by decreased enteral absorption of magnesium. We analyze the possible reciprocal influences of enteral absorption of calcium and magnesium in patients with renal stone disease. MATERIALS AND METHODS: We measured the fractional enteral absorption of 47calcium and 28magnesium in 11 patients with renal calcium stone disease, including 8 with and 3 without hypercalciuria. Two tests were performed using calcium and magnesium, respectively, followed by another test in which the enteral absorption of calcium and magnesium was measured after both cations were administered together. RESULTS: We noted no clear influence of either cation on the absorption of the other in the 3 patients without hypercalciuria. However, in the 8 hypercalciuric patients enteral calcium absorption decreased after the concurrent administration of magnesium and enteral magnesium absorption increased after the concurrent administration of calcium. Each effect was proportional to the other. CONCLUSIONS: The results of this study indicate that the oral supplementation of magnesium in patients with hyperabsorptive hypercalciuria and renal calcium stone disease is favorable because it decreases calcium absorption and increases magnesium absorption. Both factors may reduce risk factors for renal calcium stone formation.