Effect of body hydration on renal function according to renographic findings in healthy children

The background and tasks of occupational health nurses in North Dakota vary considerably. Those entering the field have little or no previous exposure to occupational health nursing and must develop skill through seminars, corporate training or area associates. In most instances, the nurse represents the occupational safety and health program for the firm and must take on additional roles such as safety director or assistant plant manager. In addition, the occupational health nurse performs numerous in-plant medical services ranging from emergency medical care to counseling and education. The occupational health nurse in North Dakota generally does not record family histories, take throat cultures, take routine x-rays, make hospital or home visits nor perform air sampling or noise level measurements.     

Applying management principles to the occupational health unit

This paper presents the occupational health unit as a subsystem competing with other subsystems in the organization for limited resources. By applying management principles the nurse can design a program to show management its results in dollar terms. This will enable the health unit to compete more favorably with the other subsystems for limited resources. An example of how this approach can be applied to the problem of absenteeism is presented.     

Ecosystem health as a clinical rotation for senior students in Canadian veterinary schools

A research nurse interviewed 55 practice staff in 11 general practices to ascertain their views about their needs for occupational health care. In a second parallel study, a specialist in occupational medicine undertook an in-depth audit of occupational health provision in five other general practices with respect to the organization, the health and safety process, the services and the working environment. In the first study, the majority of practice staff reported the need for various aspects of occupational health care, particularly stress at work. In the second study, general practitioners and practice managers possessed a basic awareness of occupational health matters such as Health and Safety legislation, but their limited knowledge was not translated into effective management. General practice staff did not know where to obtain occupational health advice; most practices had no policies or procedures in place to manage health and safety. Both studies illustrate the need for expert occupational health advice in primary care.     

Nurse managed occupational health centers: an overview

1. Nurse managed centers provide clients with direct access to professional nursing care. 2. Lillian Wald, Mary Breckenridge, and Margaret Sanger established nurse managed centers at the beginning of this century. 3. Primary, secondary, and tertiary prevention programs and services are based on the mission, outcomes, staffing, and financing of the occupational health center. 4. Essential parameters for comprehensively evaluating an occupational health nurse managed center include, client outcomes, client satisfaction, and cost-benefit.     

Factors in improved survival from paediatric cancer

OBJECTIVES: The cost of providing services is the traditional criteria used by payers in making selective contracting decisions regarding home care providers in general, and home infusion therapy (HIT) vendors specifically for this analysis. This approach assumes comparable health outcomes, for which adequate measures often are unavailable. In practice, poor quality can result in a need for remedial services. The objective of this research is to develop a method to use health insurance claims data to incorporate the hidden costs of adverse outcomes into an analysis of the costs of a vendor's HIT. METHODS: The Home Infusion Therapy/Relative Benefit Index (HIT/RBI) model incorporates measures of both the cost of providing HIT services as well as the cost of remedial treatment for the adverse outcomes that may result from HIT care, eg, emergency room visits. The data source for the analysis is the health care claims for a sample of managed care patients of national insurer for the period 1990 to 1994. RESULTS: The analysis confirms that adverse clinical outcomes can lead to additional demand for remedial health care with resultant negative financial consequences. When the cost of the adverse outcomes is incorporated into the analysis, vendors who appeared to be low cost on the basis of HIT services, in fact were higher cost vendors, whereas vendors with a high cost of services but with few adverse events were low cost vendors. CONCLUSIONS: Payers should consider both the clinical and economic consequences of providing care into account in selecting vendors. The HIT/RBI model is a useful tool for incorporating the cost of adverse outcomes into a comprehensive comparison of the cost multiple vendors of HIT services.     

AIDS control and the workplace: the role of occupational health services in South Africa

AIDS interventions typically fail to address the disjuncture between private behaviors and the social determinants of HIV infection. Data from a telephone survey of manufacturing companies and a postal survey of occupational health nurses in the Western Cape, South Africa, were used to explore the possible role of occupational health services in prevention and control of AIDS. The author found limited evidence of worker involvement in AIDS programs, particularly in companies with occupational health professionals. The management of sexually transmitted diseases was incomplete. Mandatory pre-employment testing of workers for HIV was not widespread. Respondents' opinions on priorities for AIDS prevention and control reflected a preoccupation with knowledge transfer. To ensure their effectiveness, workplace AIDS programs must improve worker participation and integrate AIDS prevention in general workplace health and safety programs. In addition, education programs must develop objectives within a critical theoretical understanding of the behavioral issues relevant to AIDS prevention, and must emphasize the empowerment of women in the workplace. In the context of the present restructuring of health services in South Africa, occupational health services, using the strategies outlined, can make a major contribution to national AIDS prevention and control.     

Case management and preventive services among infants from low-income families

To determine the impact of an experimental approach to case management on use of child health clinic and immunization services, a nonequivalent control group with covariate measures design was employed in a sample of 98 infants from low-income families. The innovative pattern of care featured continuity of care; a single public health nurse (PHN) provided child health care to an infant by integrating case management and preventive services. In contrast, the customary pattern of child health care was characterized by fragmentation of services. Case management was segregated from preventive services, and multiple PHNs delivered care to an infant. As predicted, experimental-group infants (44%) were more likely to achieve adequate child health clinic services than control-group infants (8%) (p < 0.001). Moreover, the cost-effectiveness (C/E) ratio (dollar cost per effective intervention) for adequate child health clinic visits in continuous care ($523) was one-fifth of that in fragmented care ($2,900). The C/E ratio related to adequate immunization was 8% less in continuous care ($359) than in the fragmented approach ($386), although the difference in rates of adequate immunization was nonsignificant (experimental group, 64%; control group, 60%). These findings suggest that continuous PHN care with integrated case management is a more effective, cost-efficient approach to critical child preventive services than the customary, segregated case-management approach.     

Intraocular pressure control after contact transscleral diode cyclophotocoagulation in eyes with intractable glaucoma

In the child health promotion program in Sweden, the public health nurse is responsible for the majority of the work. The purpose of this study was to test the following hypotheses: (1) there are differences in CHP program utilization between mothers in different social positions; (2) there are differences in CHP program utilization between Swedish and foreign-born mothers; (3) there are differences in the way mothers in different social positions value formal and informal social support as a means for solving health problems; and (4) there are differences in the way Swedish and foreign-born mothers value formal and informal social support as a means to solve health problems. A random sample was drawn of 10% of all children born in a particular month. A national postal questionnaire was sent to 850 mothers with children about four to five months old. The response rate was 80%. The CHP program was utilized by 99.6% of the families. When given scenarios describing various problem situations, the mothers stated that they mostly would turn to the public health nurse irrespective of the type of problem. There was no support in this study for the first two hypotheses that there are differences in CHP program utilization between mothers in different social positions and between Swedish and foreign-born mothers. There was support in this study for the two last hypotheses that there are differences in the way mothers in different social positions and the Swedish and foreign-born mothers value nurses, other health care services, relatives/friends, and literature/mass media as a means to solve health problems.     

Integrating mental health services into primary medical care

Primary care clinicians occupy a strategic position in relation to the emotional problems of their patients. Integrating mental health and primary medical services promotes available, coordinated, accessible, and less stigmatizing treatment by recognizing an indivisibility of the total person in illness and in health. Federal efforts to encourage Health Maintenance Organization (HMO) development as part of a national health program prompts serious attention to organizational arrangements for developing such an integrated program for medical-mental health care. We have found a team collaborative model in which mental health providers are members of a primary care team to be useful and promising. Supportive services are provided on a continuing basis through patterned relationships. Shared responsibility for patient care between physicians, nurse practitioners, physician assistants, and mental health workers provides built-in peer review and encourages intrateam consultation.     

The role of the clinical specialist in an adult congenital heart disease program

As the specialty of adult congenital heart disease (CHD) develops, there is concern regarding the training of the health professional who will be responsible for patient management. Integral to the program is the role of the clinical nurse specialist. An advanced practice role, the clinical nurse specialist provides her or his expertise to both the daily operation of the program and to the clinical management and education of patients and their families. The educational preparation and roles of a clinical specialist in adult CHD are described.     

Needs assessment and implementation of an employee assistance program: promoting a healthier work force

1. The functions of a continuous quality improvement tool used by Deming--the Plan, Do, Check, Act Cycle--can be applied to the assessment, implementation, and ongoing evaluation of an Employee Assistance Program (EAP). 2. Various methods are available to assess the need for an EAP. As much data as possible should be collected to qualify and quantify the need so that management can make an informed decision and develop measures to determine program effectiveness. 3. Once an EAP is implemented, it should be monitored continually against the effectiveness measures initially developed. Using a continuous quality improvement process, the occupational health nurse and the EAP provider can establish a dynamic relationship that allows for growth beyond the original design and increased effectiveness of service to employees.     

A questionnaire study on improving occupational safety and health services provided by part-time industrial physicians

In order to evaluate factors improving part-time industrial physicians' services, a questionnaire study on occupational safety and health services was conducted on 237 part-time industrial physicians (PIPs) and 628 enterprises in Kochi. PIPs who received physician's fees visited enterprises and consulted with employees about their health conditions, communicated with employers and licensed occupational health supervisors (LOHSs) in enterprises more frequently than PIPs who did not receive physician's fees (p < 0.1-0.001). The rates of performing regular duties related on occupational safety and health, and PIPs' participations in health promotion programs and health consultations with employees among enterprises which paid physician's fees were significantly higher than those among enterprises which did not pay physician's fees (p < 0.05-0.001). Significantly higher rates of health consultation with employees and communications with employers and LOHSs, participation in occupational safety and health committees, recommendations of health promotion programs were found where physicians visited enterprises frequently(p < 0.1-0.01). Although no significant changes in PIPs' occupational safety and health services were observed for hazardous risk factors in enterprises, the rates of performing regular duties on occupational safety and health, and walk-through inspections by LOHSs and PIPs, estimating PIPs' advice and suggestions in enterprises with hazardous risk factors were significantly higher than those in enterprises without hazardous risk factors (p < 0.05-0.001). It is important for PIPs to have a written contract concerning physicians' fees and occupational safety and health services with enterprises and visit enterprises frequently in order to improve PIPs' occupational safety and health services and promote occupational safety and health programs in enterprises.     

Case managed mental health care in the San Antonio catchment area: the crisis-intervention unit

Through the use of government nursing case management, this crisis-focused inpatient psychiatric program provided cost-effective and therapeutically directed services to Civilian Health and Medical Program for the Uniformed Services (CHAMPUS)-eligible beneficiaries in the San Antonio catchment area. Using managed care principles and a continuum-based case management model, these services were provided in local contracted civilian facilities. This acute care mental health program directly saved Brooke Army Medical Center 1.1 million mental health dollars and saved 7.7 million CHAMPUS dollars in total cost avoidance. Program costs were minimal, resulting in a 557% return on investment. A joint Army/Air Force endeavor, the program was originally administered by the Coordinated Care Division, Brooke Army Medical Center as a CHAMPUS recapture initiative. Currently under TRICARE management, the program continues intact as a managed care mental health service alternative.     

Nurse managed occupational health services: a primary care model in practice

1. Managed care focus on delivering health care which values prevention, early intervention, continuity of care, commitment to quality care, and outcomes, as well as client satisfaction. Occupational health nurses routinely integrate these values into their practice. 2. An on-site model of primary health care delivery, incorporating the fundamentals of occupational health nursing, can bring significant savings to the organization in health related costs. 3. Case management may provide the greatest potential for growth in occupational health nursing. It is a method that can be used together with managed care to maximize quality health care services. 4. Viewing health related costs as an investment as opposed to part of a benefit plan, influences employees to make positive choices. It also impacts the delivery of health care services on a systematic, global level, which affects total health care costs.     

Occupational health and the the provision of nursing care for older adults

Providing nursing care to the senior citizen is a rewarding and exciting area of nursing. Care is provided in a vast array of settings from home health and day care to extended residential care sites. These challenges require health care workers to be adaptive and innovative, attentive to detail, compassionate teachers, and promoters of safety for their patients and for themselves. An understanding of the transmission of microorganisms, knowledge of protective mechanisms, and a focus on safety will help ensure good health for the nurse and the elder client. Maintenance of occupational safety and health are combined efforts for the employee and the employer working together to ensure a safe environment for those who need services and those who provide them.     

Memory function in aging and Parkinson''s disease--an event-related potential study]

PURPOSE: Though case management has been recommended to improve the outcomes of patients with costly or morbid conditions, it has seldom been studied in controlled trials. We performed a randomized, controlled clinical trial of an intensive, multidisciplinary case management program for patients with chronic renal insufficiency and followed patients for 5 years. PATIENTS AND METHODS: We enrolled 437 primary-care patients (73% of those eligible) with chronic renal insufficiency (estimated creatinine clearance consistently < 50 mL/min with the last serum creatinine level > 1.4 mg/dL) who were attending an urban academic general internal medicine practice. The intensive case management, administered during the first 2 years after enrollment, consisted of mandatory repeated consultations in a nephrology case management clinic staffed by two nephrologists, a renal nurse, a renal dietitian, and a social worker. Control patients received usual care. Primary outcome measurements included serum creatinine level, estimated creatinine clearance, health services use, and mortality in the 5 years after enrollment. Secondary measures included use of renal sparing and potentially nephrotoxic drugs. RESULTS: There were no differences in renal function, health services use, or mortality in the first, second, or third through fifth years after enrollment. There were significantly more outpatient visits among intervention patients, mainly because of the added visits to the nephrology case management clinic. There were also no significant differences in the use of renal sparing or selected potentially nephrotoxic drugs. The annual direct costs of the intervention were $89,355 ($484 per intervention patient). CONCLUSION: This intensive, multidisciplinary case-management intervention had no effect on the outcomes of care among primary-care patients with established chronic renal insufficiency. Such expensive and intrusive interventions, despite representing state-of-the-art care, should be tested prospectively before being widely introduced into practice.     

Chemical synthesis of 15 beta-hydroxytestosterone and its derivatives using a (4-methoxyphenyl)methyl protecting group

This article describes the Community Nursing Organization, a federal health care model designed to provide specific ambulatory and outpatient services to medicare beneficiaries via a nurse managed delivery system under capitated financing. A primary nurse provider, working with the elderly client, family, physician, health care service providers, and community organizations, assesses the need for care and arranges for appropriate services. This nurse must also authorize payment of those services covered by the Community Nursing Organization (CNO). A 3-year demonstration project is currently under way. Findings at 1 year indicate that the system may have a positive effect on client health status.     

Consulting to the intelligence community: An employee assistance program model.

Over the past 2 decades, the agencies and employees of the U.S. Intelligence Community (IC) have increasingly come to appreciate the organizational, counterintelligence, and occupational health value added by employee assistance programs (EAPs). The author presents the rationale for such programs; discusses their core components; mentions some of the key professional and ethical challenges faced by consulting psychologists who provide these services; discusses the unique obstacles that must be overcome, in light of the common concern among IC employees that use of mental health services will adversely affect their continuing eligibility for a security clearance and/or their career; gives examples of policies and practices that encourage the use of services by IC employees; and suggests areas for further program development and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)