Mental health and aging: The need for an expanded federal response.

Discusses the mental health problems that may occur as elderly people must face adjustments because of bereavement, poor physical health, the demands of caring for an ill spouse, drug/alcohol abuse, dementia and cognitive impairments, and multiple health problems. Negative social stereotypes associated with both elderly patients and mental health care, limited access to and a lack of trained professionals in the area of geriatric mental health care, lack of outreach, inadequate benefits under prepaid health plans, Medicare and Medicaid, and special problems of ethnic minority and rural elderly people all contribute to an inadequate mental health care system. The author, a US representative, suggests a redesigning of the system and outlines an initiative that addresses the development of an effective mental health care system for the elderly, modification of Medicare and Medicaid, and improvements in quality assurance and access protection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The identification of new health care technologies by the Health Council of The Netherlands

The article gives a global overview of the 14 years of signposting experience of the Health Council of the Netherlands. The Council signals new health care technologies and emerging health care problems in briefs, comprehensive reports, and bulletins. Its main purpose is to provide the government with timely information to support rational policy decision making.     

Quality management in medical specialties: the use of channels and dikes in improving health care in The Netherlands

BACKGROUND: In 1989 a Dutch national policy was instituted to ensure that quality management is the responsibility of both health care professionals and management, with input from insurers and patients. In turn, quality management of medical specialists remained to a large extent self-regulatory, with accountability toward third-party payers and patients. Three programs for quality management-peer review, guidelines, and visitation-have sufficiently persuaded patient organizations and care insurers about medical specialists' ability to ensure the quality of the care they provide. PEER REVIEW: Operational since 1976, the national program for peer review in hospitals has stressed the need for explicit evaluative mechanisms. This program led to the foundation of the National Organization for Quality Assurance in Hospitals (CBO), which conducts peer review activities but also support efforts aimed at quality assurance in hospitals. Once it is linked with the other two quality management programs, peer review will realize its full potential as a profession-based method for standardizing and rationalizing medical specialty practice. PRACTICE GUIDELINES: Since 1982, more than 60 consensus guidelines have been developed for and by medical professionals, with input from patient organizations and third-party payers. Medical specialty associations have also created their own guidelines. Although the guidelines' impact has not been evaluated systematically, studies have shown effects on behavioral change and health outcomes. Solid, credible guidelines continue to be developed, although the successful implementation of these guidelines needs to be studied. VISITATION PROGRAM: Visitation, or onsite assessment of specialty practice sites (in training and non-training hospitals), has been a hot issue in Dutch medical quality assurance. All 28 scientific societies have visitation programs, focusing on areas for improvement such as process management, use of guidelines, and evaluation of patient satisfaction and treatment outcomes. Closely linked to other medical quality assurance activities, visitation programs also incorporate clinical guidelines into evaluations. CONCLUSIONS: Profession-driven peer review, practice guidelines, and visitation programs have been effective support tools for quality management in The Netherlands. Future challenges involve creating more synergy among these programs and between the profession-based quality management approaches and recently introduced hospital-based quality systems and maintaining the trust between third-party payers and patients.     

Caring for the older patient, Part IV: The value of nuclear medicine in meeting the needs of an aging society

This is the last article of a four-part series on gerontology and its applications to the care of elderly patients in nuclear medicine. This article reviews selected nuclear medicine procedures that are more commonly performed on older patients. On completion of this article, the reader should be able to: (a) identify nuclear medicine procedures commonly performed on older patients; (b) give examples of how normal age-related anatomic and physiologic changes may affect various nuclear medicine procedures and findings; and (c) identify new or developing nuclear medicine techniques that may have future applications in the elderly population.     

Nursing research and patient outcomes: tools for managing the transformation of the health care delivery system

This paper outlines strategies for all nurses to participate in nursing's research agenda, which aims to enhance the scientific basis of nursing practice. The emphasis here is on generating data for the outcomes movement as a tool for transforming the American health care delivery system.     

Complementary and alternative therapies for our aging society

Gerontological nurses are dynamic individuals who recognize the necessary changes needed to reform a biotechnology-driven health care system to become a relationship-centered, care-driven healing system with elders. They must continue to take action to enhance caring and healing at personal levels and in various professional levels of clinical practice and health care reform. As gerontological nurses pursue personal, clinical, educational, and research approaches to holistic nursing and caring-healing modalities, they increase their knowledge and skills of holism and the complex body-mind-spirit interconnections, and provide relationship-centered care (Tresolini, 1994). Gerontological nurses then truly blend the art and science of caring with elders, and lead to a deeper understanding of healing as a lifelong journey into wholeness (Achterberg, Dossey & Kolkmeier, 1994).     

Clinical psychologists in the primary health care system in the Netherlands.

Discusses the Dutch health system, focusing on the increasing number of clinical psychologists who are offering their services to the public as private practitioners. This move toward primary health care given by the "first-line psychologist" results from a generalistic frame of reference in which a wide range of psychic, psychosocial, and psychosomatic difficulties are treated with a time-limited framework. In this way, the clinical psychologist contributes to changing the habits and lifestyles of a broad population. Responses to the system are encouraging, and the government has begun to respond positively to the system. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing care in ambulatory methadone programs. A comparative literature study between The Netherlands and The United States

In this article, the results are discussed of a literature study on nursing care for heroin addicts in out-patient methadone maintenance clinics in the Netherlands and the United States. In the Netherlands, the most important aim of methadone maintenance is to limit the harm caused by heroin use. Community based methadone maintenance is the subject in several Dutch evaluation studies. Care is described in these studies, however the medical role is not distinguished from the nursing role and functions. Research variables are basic care assumptions and client satisfaction. In the USA, heroin misuse is considered a disease more than in the Netherlands. Nurses in the American methadone maintenance clinics have a more independent function compared with the nurses in the Netherlands. The main variables in the American studies on nursing care in the out-patient methadone maintenance clinics are the nursing process as well as the development and testing of nursing interventions. Further nursing research concerning the methadone maintenance clinics in the Netherlands is needed because the nursing contribution in maintaining and improving the basic health status of the heroin misuser is of vital importance. The American nursing research and the associated outcomes could be used as a guideline.     

Telomerase and the aging cell: implications for human health

Recent research has shown that inserting a gene for the protein component of telomerase into senescent human cells reextends their telomeres to lengths typical of young cells, and the cells then display all the other identifiable characteristics of young, healthy cells. This advance not only suggests that telomeres are the central timing mechanism for cellular aging, but also demonstrates that such a mechanism can be reset, extending the replicative life span of such cells and resulting in markers of gene expression typical of "younger" (ie, early passage) cells without the hallmarks of malignant transformation. It is now possible to explore the fundamental cellular mechanisms underlying human aging, clarifying the role played by replicative senescence. By implication, we may soon be able to determine the extent to which the major causes of death and disability in aging populations in developed countries-cancer, atherosclerosis, osteoarthritis, macular degeneration, and Alzheimer dementia--are attributable to such fundamental mechanisms. If they are amenable to prevention or treatment by alteration of cellular senescence, the clinical implications have few historic precedents.     

The current state of health care in the former Soviet Union: implications for health care policy and reform

OBJECTIVE: To study planning of movement in Parkinson's disease. METHODS: The spatiotemporal pattern of movement related desynchronisation (MRD) preceding a self paced voluntary wrist flexion was compared between two groups of 10 untreated right and left hemiparkinsonian patients receiving no treatment and 10 control subjects. The MRD was computed in the 9 to 11 Hz frequency band from 11 source derivations covering the frontocentral, central, and parietocentral areas, during two successive left and right experimental conditions. RESULTS: In the two patient groups the desynchronisation appeared over the primary sensorimotor area contralateral to the affected side with a shorter latency (750 ms before movement onset for the right hemiparkinsonian group and 875 ms for the left hemiparkinsonian group) than in the control group (1750 ms), only when the movements were performed with the akinetic hand. For the non-affected hand, the same latency as in the control group was noted (1750 ms). CONCLUSION: The delay of appearance of MRD in Parkinson's disease confirmed that the programming of movement is affected, thus partially explaining akinesia.     

Post polio syndrome: an update for the primary health care provider

Post Polio Syndrome, or PPS, is defined as a clinical syndrome of new weakness, fatigue, and pain in people who have previously recovered from acute paralytic poliomyelitis. Other common symptoms include cold intolerance, dysphagia, dyspnea, and overuse syndromes. PPS afflicts an estimated 50% of polio survivors, a population estimated at 1.6 million people, and begins roughly 30 years after the acute disease. The main impact of PPS is on mobility related activities affecting one's daily routine. With an insidious onset, and several differential diagnoses for each symptom, PPS can be difficult to diagnose and to validate. However, once identified, there are treatment plans and many avenues of support for this disabling syndrome. The purpose of this article is to provide an overview of the pathophysiology of both acute paralytic poliomyelitis as well as PPS. This article also reviews the current literature concerning the etiology and pathophysiology of both poliomyelitis and PPS, symptom evaluation and differential diagnoses, and treatment recommendations. The psychosocial impact and care of the client are also identified, and several resources for support and education of both the client and provider are provided.