Solar retinopathy in a hospital-based primary care clinic

BACKGROUND: Most reports of solar retinopathy describe epidemics of patients who go to the eye doctor after viewing a solar eclipse. Rarely is it encountered by the primary eye care provider during a routine eye examination. METHODS: For 26 months, patients who went to the primary care eye clinic and found to have macular lesions consistent with solar retinopathy were identified from the total clinic population. These patients were documented in a coded log and fundus photographs were obtained (when possible). RESULTS: Twenty-six eyes of twenty patients (0.14% incidence) were determined to have macular lesions consistent with solar retinopathy. Visual acuity was 20/25 or better in 100% of the patients and 85% were 20/20. Patients were predominantly men (75%) of middle age (average age, 43 years; SD, 11 years) with a history relevant for solar retinopathy (80%)--consisting of sungazing, 60%; looking at welding light without eye protection, 15%; substance abuse, 15%; and psychiatric condition, 5%. Forty percent had solar lesions in both eyes. Amsler grid testing revealed a defect in only 20%, and macular threshold visual-field testing was normal in all the eyes tested. CONCLUSIONS: This is the first report to characterize solar retinopathy in a primary eye care population. Management includes correct differentiation from other macular disorders, acquisition of a careful detailed history, and provision of patient education regarding the dangers of sungazing.     

Thrombolysis for evolving myocardial infarction in a rural primary care clinic

Early thrombolytic therapy gives maximum benefit in acute myocardial infarction. In remote rural areas with no mobile intensive care service there is a significant delay between onset of symptoms and administration of thrombolytic therapy which has a critical impact on revascularization. Thrombolytic therapy with streptokinase 1,500,000 U was given in a primary care rural clinic to 2 patients with evolving myocardial infarction 45-50 minutes from onset of symptoms. In both patients, who were transported to hospital after the therapy, there were clinical signs of reperfusion. There were no complications during treatment or transportation. We conclude that thrombolytic therapy given for evolving myocardial infarction in a rural primary care clinic is possible and safe.     

Predictors of missed appointments for psychiatric consultations in a primary care clinic

OBJECTIVE: The purpose of the study was to determine predictors of missed appointments for psychiatric consultations among patients in a general medical clinic. METHODS: The charts of 180 patients consecutively referred for psychiatric consultations at a university-affiliated primary care clinic were reviewed. Ninety patients missed appointments for these consultations. Parametric and nonparametric tests were used to compare patients who missed and did not miss appointments on demographic and clinical variables, as well as measures related to patients' interactions with the clinic and the referring clinician. RESULTS: Logistic regression analysis revealed three significant predictors of missed appointments. Patients with mild distress and those with significant resistance to seeing a psychiatrist were more likely to miss appointments, as were those who had to wait longer between the referral and the appointment date. CONCLUSIONS: The results suggest that shortening the wait for a psychiatric consultation, reserving consultation for more severe cases, and working to reduce patients' resistance to consultation will reduce the number of missed appointments.     

Home care triage nurse

OBJECTIVE: To determine the contribution of mechanical factors to the function of different types of fundoplication. DESIGN AND SETTING: An experimental bench-top study using abattoir-sourced pig esophagus and stomach placed on a tray. Preliminary esophageal myotomy ensured free reflux of 'intragastric fluid'. INTERVENTIONS: Anterior, posterior, and total fundoplications were performed on each of ten sets of viscera. MAIN OUTCOME MEASURES: Lower esophageal sphincter pressure was measured using a conventional esophageal manometry catheter. Intragastric pressure was measured with a single channel intragastric manometry catheter, whilst the stomach was inflated with coloured water. The maximum intragastric pressure or the pressure measured when the fundoplication yielded to gastric distension was recorded. RESULTS: All three types of fundoplication restored adequate competence to the gastroesophageal junction, although high-volume gastric infusions resulted in fundoplication yield in 4/10 anterior and 4/10 posterior fundoplications. Gastric distension resulted in fundal dilatation and consequent compression of the adjacent esophagus. Fundoplication generated a median rise of 11-13.5 mmHg in lower esophageal sphincter pressure, comparable to pressures reported in the postoperative clinical setting. Significantly greater intragastric volumes and pressures were tolerated following total fundoplication. CONCLUSIONS: This study suggests that mechanical factors could be major contributors to the ability of a fundoplication to restore gastroesophageal competence. Anterior, posterior and total fundoplications are all effective procedures.     

The prevalence of psychiatric disorders at a primary care clinic in Soweto, Johannesburg

A pilot study to assess the prevalence of psychiatric disorders in a primary care clinic in Soweto was carried out at the Zola Community Health Centre in May 1991. Interviews were carried out by trained primary care clinic staff. The findings were reviewed and analysed by the authors. The prevalence of psychiatric disorders was found to be 14.38%. Methodological problems are listed and the results are discussed.     

Becoming a primary care nurse practitioner: challenges of the initial year of practice

The transition from student to primary care practitioner is exciting and challenging and offers seemingly limitless opportunities. This article presents results of a model generated from a longitudinal study of 35 newly graduated primary care nurse practitioners during their first year of practice. Stages of development include laying the foundation (recuperating from school, negotiating the bureaucracy, looking for a Job, and worrying); launching (feeling real, getting through the day, battling time, and confronting anxiety); meeting the challenge (increasing competence, gaining confidence, and acknowledging system problems); and broadening the perspective (developing system savvy, affirming oneself, and upping the ante). Anticipatory guidance is offered for new graduates and their mentors and colleagues. Mentors can provide crucial information about appropriate expectations and create key structures to facilitate new practitioners' needs for consultation and advice.     

Prevalence and correlates of depressive syndromes among adults visiting an Indian Health Service primary care clinic

Depression is common among patients visiting primary care clinics. In order to describe the prevalence of depressive syndromes in an American Indian primary care clinic population and to help define the clinical correlates of depressive syndromes in this setting, a clinic-based research study of depression was undertaken by the Indian Health Service (IHS). One hundred and six patients from an IHS primary care clinic were systematically enlisted for participation in the study. Participants completed the Inventory for Diagnosing Depression (IDD). Twenty-two (20.7%) responded with answers scoring positive for a depressive syndrome. Nine of these 22 (8.9% of the 106 participants) met IDD criteria for a major depressive syndrome. A diagnosis of depression, a past history of depression, use of mental health facilities, unexplained pains, and antidepressant medication use were associated with the presence of a depressive syndrome.     

Improving certified nurse aide retention. A long-term care management challenge

In the long-term care industry, the turnover rate among nurse aides is extremely high. This adversely affects resident satisfaction, resident care, morale, and finances. It presents a challenge to long-term care administration. Refusing to accept high turnover as an impossible situation allows changes to be made. The authors describe how the staff at one intermediate care facility identified its problems, assessed the causes, and implemented corrective action.     

Improving home care. A survey on physician and nurse communication

Home health care is growing, and phone calls between physicians and home care nurses are essential to successful home care patient management. This preliminary study analyzed several aspects of the physician and home health nurse telephone communication, including effectiveness, time expenditure, percentage of calls resolved by physicians, and documentation of phone contacts between 90 medical/surgical physicians and six home health nurses in Cleveland, Ohio. The phone conversations involved 154 patient contacts during a 3-month period. Overall, we found 75% of the home calls were effective. Eighty-five percent of calls required 15 minutes or less for completion, 47% of nurse-generated calls were resolved by physicians, and 26% of calls were documented in the patient's medical record. Our results illuminated several aspects of home care communication amenable to improvement.     

Contribution of a nurse clinician to office practice productivity: comparison of two solo primary care practices

A comparison of two solo primary care practices with similar patient populations reveals a significant difference in productivity. A nurse clinician was employed in the more productive practice. She independently managed 1,848 patient visits a year that would otherwise have required the time and attention of a physician. She contributed to the productivity of the physician by performing some tasks he would normally have performed during visits they managed jointly. It was primarily because of the assistance he received from the nurse clinician that the physician in practice II was 12 percent more productive than the physician in practice I. The nurse clinician and physician managed 31 percent more patient visits during a standard day than the physician in practice I, or a difference of 2,856 patient visits a year. This annual difference is based on a work schedule that could be matched in other practices: an eight-hour day and a 240-day work year.     

The nurse as senior health care executive

This author describes the advantages of having a nursing, academic, and experiential background for career progression in the health care world. The combination of nursing and business competencies provide for a well-prepared leader in a rapidly changing health care environment. An historical perspective on nurses as leaders in health care as well as competencies required for health care leaders for the future is described.     

Redesigning primary care processes to improve the offering of mammography. The use of clinic protocols by nonphysicians

We have isolated a genomic clone corresponding to a caffeic acid O-methyltransferase (COMT) from barley (Hordeum vulgare L.) using a cDNA for a previously described jasmonate-regulated mRNA showing homology to COMT. Primer extension was used to characterize the 5' end of the mRNA while the 3' end, intron/exon structure and other features of the sequence were deduced by comparison to the cDNA sequence and/or conserved motifs. The gene is mapped to chromosome five and is absent in the barley cultivar Morex. Southern and northern analyses suggest that no differences in genomic structure and jasmonate inducibility exist between the barley cultivar Salome (source of the cDNA clone) and Igri (source of the genomic clone). This genomic clone is thus suitable for promoter studies with respect to jasmonate induction.     

Depression, PTSD, and suicidal ideation among active duty veterans in an integrated primary care clinic.

Active duty veterans increasingly access primary care for needed mental health services, but the relationship among depression, PTSD, and suicidal ideation in this subpopulation remains unclear. The relationship is explored in 120 active duty members treated in a military integrated primary care behavioral health service. Logistic regression analyses resulted in a significant relationship between PTSD and suicidal ideation, but this relationship was fully explained by depression symptoms. The interaction between depression and PTSD symptoms was likewise unrelated to suicidal ideation, and it did not improve overall model fit, suggesting that depression independently explained increased risk for suicidal ideation in the current sample. The authors discuss the differences between suicidal ideation and suicidal behaviors, and how depression and PTSD symptoms might differentially relate to each. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Chronic diseases in immigrants from Russia (CIS) at a primary care clinic and their sociodemographic characteristics

397 new immigrants to Israel ("olim") were under medical treatment at a primary care clinic during the first year (1990-1991) after their immigration to Israel ("aliyah") from 14 republics of the Commonwealth of Independent States (CIS, formerly the Soviet Union). Most of the olim were between 1-19 years of age. More than three-quarters were married and about a third of the women were widowed or divorced. The other patients were bachelors, separated men or women, or divorced men. More than a third had 16 years or more of education. More than a third of the families consisted of 2 members, while more than three-quarters had both parents, and about a quarter only 1 parent, usually the mother. Half the families had children; more than a quarter of the adults had not been employed in the CIS, while in Israel 58.8% were. 464 diagnoses of chronic diseases had been made in the CIS, (1.2/person), of which 75% were verified in Israel. 185 cases (0.5/person) not previously reported were diagnosed or had developed in Israel. The most frequent were cardiovascular, and next digestive tract disease, followed by endocrine, metabolic and musculoskeletal-connective tissue diseases. The overall prevalence rate of ischemic heart disease among men aged 20 < or = 65 years was 18.8%, compared to 5.8% among veteran Israelis. Among women the rates were 9.5% and 4.0%, respectively. The prevalence of hypertension (> or = 160/95) was 14% among men and 21% among women; in veteran Israelis it was 14% for both men and women. The prevalence of diabetes among men was 4.1%, and 5.4% among veteran Israelis.(ABSTRACT TRUNCATED AT 250 WORDS)