The Milieu Enhancement Model: a nursing practice model, Part I

The Milieu Enhancement Nursing Practice Model (MEM) served as the conceptual framework for implementing a 3-year project funded by the Department of Health and Human Services through the Division of Nursing as a demonstration grant (No. 1 D10 NU 600013) from October 1987 through September 1990. The MEM is described and examples of its use in developing health care forms, conducting research, guiding practice, and categorizing enhancements are presented.     

A transformational model for the practice of professional nursing. Part 1, The model

Our healthcare system is undergoing major transformation. Most nurse executives know that change is necessary and inevitable, but are less certain how to position their departments for these changes. The Transformational Model for the Practice of Professional Nursing was developed as a "road map" for that purpose. Part 1 of the model discusses the paradigm shifts that need to occur in professional practice for future success. The various components of the model are presented, and applications are identified. Part 2 will appear in the May 1994 issue of JONA, and will discuss the implementation of this model into a practice setting.     

Measuring individual differences in implicit cognition: the implicit association test

An implicit association test (IAT) measures differential association of 2 target concepts with an attribute. The 2 concepts appear in a 2-choice task (2-choice task (e.g., flower vs. insect names), and the attribute in a 2nd task (e.g., pleasant vs. unpleasant words for an evaluation attribute). When instructions oblige highly associated categories (e.g., flower + pleasant) to share a response key, performance is faster than when less associated categories (e.g., insect & pleasant) share a key. This performance difference implicitly measures differential association of the 2 concepts with the attribute. In 3 experiments, the IAT was sensitive to (a) near-universal evaluative differences (e.g., flower vs. insect), (b) expected individual differences in evaluative associations (Japanese + pleasant vs. Korean + pleasant for Japanese vs. Korean subjects), and (c) consciously disavowed evaluative differences (Black + pleasant vs. White + pleasant for self-described unprejudiced White subjects).     

The value of maintaining outcomes in an individual practice for 25 years

Decision making in orthopaedic surgery is facilitated by outcome data, not only from the literature, but also from one's own practice. Between 1971 and 1996, 2602 primary and 587 revision total hip replacements were performed. All had prospective collection of data, which altered surgical practice. A posterior approach in 147 primary total hip replacements resulted in 10 dislocations (6.8%) leading to the use of the anterolateral approach in 1788 subsequent hips with only eight dislocations (0.45%). The initial 298 hips were done in a standard operating room with restricted access and were covered with perioperative antibiotics. No infections occurred permitting ongoing use of inexpensive infection prevention. From 1971 to 1975, 168 classic polished Charnley stems were implanted with only seven stems requiring revision to date. In contrast, use of the matte finished Müller prosthesis in the early 1970s in 58 hips has resulted in nine revised stems. From 1980 to 1990, 789 second generation design matte finished Iowa stems were implanted. Prospective data collected disclosed that a small number (1.5%) of early loosenings occurred and all were associated with extensive bone lysis which made revision difficult. Only polished stems are now cemented by the author. The author firmly believes that his practice patterns have been promptly and appropriately altered by the availability of a prospectively collected hip data file.     

Caring for the older patient, Part I: The relationship of theory to practice

This is the first article of a four-part series on gerontology and its applications to the care of elderly patients in nuclear medicine. The series includes discussions about the theories of aging, approaches to meeting the special needs of the elderly and ethical dilemmas in caring for the elderly. It also reviews anatomical and physiological changes associated with aging and the role of nuclear medicine studies in caring for the elderly. Upon completion of this article, the reader should be able to: (a) describe the aging U.S. population by citing demographic data; (b) identify the theories of aging and distinguish their major characteristics; (c) differentiate a gerontologic approach from a geriatric approach in caring for the elderly; and (d) recognize factors important to the delivery of effective care for the elderly.     

Determining laboratory value: Part 1

This article will describe how to determine a fair market value for a dental laboratory. Part one addresses how to define fair market value, how value is perceived and how to prepare for laboratory evaluation. Part two, to be printed in April, will address how to apply an appropriate valuation methodology to determine worth.     

Independent practice association physician groups in California

Hemispatial neglect is a neurological disorder which entails a spatial bias that penalizes events occurring in the hemispace contralateral to a brain lesion. Mechanisms operating upon various stages ranging from perception to action have been invoked to explain neglect. The present study explores the contribution of a defective programming of arm movements towards the neglected hemispace to neglect behaviour. Two reaction time tasks -- a "perceptual" task and a "motor" task -- were performed by right brain-damaged (RBD) patients with left hemispatial neglect, RBD patients without signs of neglect and control subjects. The perceptual task consisted of lateralized visual stimuli and central motor responses, whereas the motor task consisted of visual stimuli presented on the vertical midline and hand responses to be produced in either hemispace. Neglect patients showed a rightward bias on the perceptual task, but only two RBD patients (showing no signs of severe neglect) were consistently slowed in producing leftward motor responses. Different reference frames may thus be used in perceptual tasks and tasks involving arm movements. We conclude that hemispatial neglect commonly results from attentional impairments operating upon a visual perceptual frame of reference; additional deficits appear to be necessary to produce a directional motor disorder.     

The 1-hour advising session: helping students choose family practice

A case of chronic brucella endocarditis of a prosthetic valve is reported. The diagnosis of this infection was established by positive blood cultures and high brucella agglutination titre. The patient was successfully managed by combination of medical therapy (consisting of streptomycin, trimethoprim-sulphamethoxazole, rifampin and tetracycline) and surgery.     

Endoesthetics. Part 1: Intra-radicular rehabilitation

The flared canal, whether due to age, carious extension, pulpal pathology or endodontic access, presents a restorative management problem. Intra-radicular rehabilitation prior to post fabrication and/or cementation, increases the chance for operative success. This is the first in a series of articles that introduces the concept of esthetic considerations in post-endodontic restorative therapy.     

Occlusion and restorative dentistry: Part 1

Dentists are responsible for the health of the masticatory system--the musculature, temporomandibular joints, and the dentition. The influence of occlusion in restorative dentistry would appear to be directly proportional to the complexity of the treatment. The criteria of a mutually protected and optimum occlusion provide sets of sound guidelines for analysis of the occlusion and for subsequent procedures. In occlusal analysis, it is important to record the several characteristics of mandibular movements made during "empty mouth" movements, and later treat when necessary, because these movements can be more damaging to the masticatory system than mastication of food.     

Occupational role stress in the Canadian forces: Its association with individual and organizational well-being.

Studies on workplace stress have been conducted in various occupational environments. However, published reports exploring occupational stress in the military are rare. This study examines occupational stress in the Canadian Forces within the framework of social role theory and its relation to employee health, job satisfaction, and organizational commitment. Ss were 1,068 Regular Forces military members who completed a survey questionnaire. Of interest were the psychological resources (e.g., individual coping skills, workplace leadership, and perceived organizational support) that have the potential to alter the perception of work stress and/or alleviate its association with individual and organizational outcomes. Regression analyses indicated a negative association between occupational role stress and both individual (strain) and organizational (job satisfaction and organizational commitment) well-being. No moderating effects were found for coping strategies, workplace leadership, or perceived organizational support, although these factors had direct relationships with both individual and organizational well-being The results are discussed in terms of the potential of organizational resources and role stress to cascade across organizational levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of dental amalgam: a review of the literature. Part 2: Mercury exposure in dental practice

This is the second article in a series of seven on the future of dental amalgam. It describes the means of exposure to mercury which can occur in dental surgeries from the storage of mercury, preparation and placement of dental amalgam restorations, polishing dental amalgam restorations, the removal of amalgam fillings and the storage of waste amalgam. It also reports on the monitoring of dental practices and studies on the mercury air levels in dental surgeries and blood and urine levels in dentists and their staff. Also, studies which compare these levels with the health and neurobehaviour of dentists and their staff are included. In addition, it discusses post-mortem studies of the mercury levels in body organs in dentists and controls. It then recommends methods for the safe handling of mercury and dental amalgam. Finally, it discusses the issues surrounding the release of mercury into the environment from dental practices and industry.