'Out of the sighs'--an existential-phenomenological method of clinical supervision: the contribution to palliative care

This paper describes a method of clinical supervision that engages a Macmillan home care nurse in an existential-phenomenological exchange. A synthesis of Egan's method of problem management and phenomenological interviewing, is offered as an approach to clinical supervision considered appropriate for palliative care nursing. Through a case study approach the author affords glimpses into the life world of palliative care nursing. It is suggested that conflicts experienced in the field both manifest themselves in the supervisory encounter and parallel the nurse's and supervisor's own existential struggles. The discussion as such throws light on what is, frequently, the heart rending nature of palliative care nurses' chosen area of work and illuminates the mutual profundity of the experience of palliative care.     

Stepped care as a heuristic approach to the treatment of alcohol problems.

A stepped care approach to treatment decisions for alcohol problems consists of the application of decision rules derived from practice in other areas of health care. The treatment used should be (a) individualized, (b) consistent with the research literature and supported by clinical judgment, and (c) least restrictive but still likely to be successful. Used in this way, stepped care emphasizes serving the needs of clients efficiently but without sacrificing quality of care. Issues concerning stepped care are discussed, and the application of a stepped care approach to alcohol treatment services is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Clinical study on the cell kinetics of gastric cancer using bromodeoxyuridine labeling index--its relations with DNA ploidy pattern and epidermal growth factor

The prime objective of dental care is maintaining a natural functional dentition for life. It is expected that a growing group of adults will keep their dentition into old age. Although routine prosthodontic care will still be important in the future the treatment strategy for older adults and elderly people with a reduced dentition does require a different approach. The traditional approach in prosthetic therapy was guided primarily by morphological criteria aimed at preservation of complete dental arches, which resulted in emphasis on quantity in dental care. Nowadays requirements such as aesthetics and functional comfort are considered more important and more easily achieved. In the presented principles for treatment planning the importance of a thorough preliminary treatment is stressed. Furthermore, needs for tooth replacement are discussed and guidelines are given for a preventive prosthodontic treatment approach in severely broken-down dentitions and edentulous patients.     

Smooth muscle cells isolated from the neointima after vascular injury exhibit altered responses to platelet-derived growth factor and other stimuli

Health promotion is gaining widespread recognition throughout the world as the most efficacious practice in achieving health for all. In Canada, the philosophy of health promotion is driving both federal and provincial health initiatives. Such a philosophy is derived from a human science paradigm and is in direct opposition to the natural science paradigm from which the biomedical approach to health care emerged. There now exists a tension between these contrasting paradigms as health care shifts to embrace a health-promotion perspective. The nursing process is based in the natural science paradigm and on a biomedical approach to health care. In order for nurses to embrace health promotion fully, they must move away from the philosophy of the natural sciences and adopt a human science perspective. Such a shift requires a radical transformation in nursing practice as nurses move away from the 'top-down' approach of the nursing process and adopt a 'bottom-up' approach to health-promoting nursing practice. The purpose of this paper is to compare and contrast the nursing process with the principles of health promotion, and to challenge our use of the nursing process in current nursing practice. In particular, a framework for health-promoting nursing practice will be provided.     

Major causes of death and hospitalization in Canadian seniors

The case management approach is described for children with nonorganic failure to thrive in the pediatric tertiary care setting. An advanced practice nurse facilitated the organization of a planning committee, the construction of a care path, and the evaluation of the case management model. A 4-day care path is presented to show staff nursing functions in the nurse case manager role. Special issues are discussed for developing care paths for organic-based failure to thrive where parent reports can help guide health care interventions.     

An office system for organizing preventive services: a report by the American Cancer Society Advisory Group on Preventive Health Care Reminder Systems

Despite increasing recognition of the importance of preventive services, such services are not provided in primary care practice as often as recommended. One of the most important reasons is the lack of a systematic, organized approach within practices. The American Cancer Society Ad Hoc Advisory Group on Preventive Health Care Reminder Systems reviewed evidence-based reports and expert opinion to summarize current knowledge about office systems for clinical preventive services. This article describes the process of developing an office system for preventive care, beginning with writing a practice policy, auditing charts for baseline performance, developing and implementing a plan for efficient delivery of preventive care, involving office staff, and monitoring progress. Strategies for dissemination of this approach to a wide range of primary care practices may involve professional medical organizations and managed care companies.     

Stepped care treatment for eating disorders.

A stepped care approach would link different patient needs to therapeutic modalities that range from simple advice to intensive inpatient care. Brief methods, including self-help and psychoeducation, may be effective for a subset of patients with bulimia nervosa and binge eating disorder. Identifying this subset remains a challenge. It is unclear how patients who fail to respond to evidence-based, first-line treatments should be treated. Given the absence of data on effective treatment of anorexia nervosa (AN), discussion of a stepped care approach is speculative. Because AN typically demands expert and sustained treatment, the lower levels of stepped care models are inapplicable for these patients. A stepped care approach poses methodological challenges for clinical research and raises important clinical issues, such as when to switch from 1 level of treatment to another. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The costs and consequences of neglected medically necessary oral care

Oral diseases and conditions may adversely affect general health, and certain medical conditions may have a negative effect on oral health. However, little attention has been given to assessing the economic costs and consequences associated with care that is a direct result of, or has a direct impact on, an underlying medical condition and/or its resulting therapy. The costs can be significant for patients; their families; third-party payers such as insurance companies, Medicare, and Medicaid; and society. The health consequences of such conditions may dramatically affect function, morbidity, quality of life, and survival. This paper reviews one possible approach for identifying and measuring the costs and consequences associated with medically necessary oral health care and presents a framework for evaluating medically necessary oral health care. The paper also describes the cost components of care and the dimensions of health consequences. Finally, an example illustrates this approach. The summary information presented here is meant to offer concepts and ideas important in assessing the costs and health consequences associated with medically necessary oral health care. Individuals interested in a more detailed discussion of economic evaluation of health care programs and outcomes assessment are referred elsewhere. 10-23     

Representation of change in controlled medical terminologies

Computer-based systems that support health care require large controlled terminologies to manage names and meanings of data elements. These terminologies are not static, because change in health care is inevitable. To share data and applications in health care, we need standards not only for terminologies and concept representation, but also for representing change. To develop a principled approach to managing change, we analyze the requirements of controlled medical terminologies and consider features that frame knowledge-representation systems have to offer. Based on our analysis, we present a concept model, a set of change operations, and a change-documentation model that may be appropriate for controlled terminologies in health care. We are currently implementing our modeling approach within a computational architecture.     

An introduction to music therapy: helping the oncology patient in the ICU

Oncology and critical care patients have unique and complex problems. With the explosion of technology and advances in medicine, many intensive care units are seeing an increase in oncology patients. Intensive care units are stressful and frightening; music therapy is a noninvasive holistic approach to bridging the gap between oncology patients and intensive care units.     

The principles of augmenting the cardiac output in adults

Augmentation of the patient's cardiac output to optimize tissue oxygenation is a primary role of intensive and cardiac care nurses. This involves three approaches: the use of intravenous colloids and occasionally crystalloids, creating a passive stretching of the myocardium to increase cardiac output, the use of inotropic agents which directly stimulate the heart and finally and less commonly the use of cardiac assist devices, notably the intra aortic balloon pump. The choice of method will be dictated by the presenting clinical data and the perceived benefits to the patient of each approach. The role of nurses as part of the health care team is to practice safe, informed care, through an understanding of both the advantages and disadvantages of each approach to the clinical scenario encountered. This paper contains exploration of each of the three principles with a case study approach, allowing the reader to consider a variety of presenting clinical data and appropriate haemodynamic manipulation.     

Incidence of frontal sinusitis following partial middle turbinectomy

Agricultural activity occurs within many medium size towns in developing countries. Rural influences and urbanization, which may be well or poorly managed, combine to create new health problems. A geographical approach is useful for evaluating the ability of the health care system to deal efficiently with these problems. Such an approach should take into account the urban environment and human population, health care and spatial differentiation factors. Relevant health indicators were selected to analyze the geographical patterns of health risk and of the health care system. These factors were analyzed according to area, at various levels. Field studies were carried out and aerial photographs and the various available maps were also studied. Results were compared to determine whether the health care system was appropriate for the health needs of the town. Urinary schistosomiasis is a useful example for assessing the value of the suggested methodology. The risk of transmission of this disease is high so its early detection is vital. The ability of the health care system to detect infection was assessed.     

Children's Mental Health as a Primary Care and Concern: A System for Comprehensive Support and Service.

In response to the serious crisis in mental health care for children in the United States, this article proposes as a priority for psychology a comprehensive approach that treats mental health as a primary issue in child health and welfare. Consistent with the principles of a system of care and applying epidemiological, risk-development, and intervention-research findings, this approach emphasizes 4 components: easy access to effective professional clinical services for children exhibiting disorders; further development and application of sound prevention principles for high-risk youths; support for and access to short-term intervention in primary care settings; and greater recognition and promotion of mental health issues in common developmental settings and other influential systems. Integral to this approach is the need to implement these components simultaneously and to incorporate family-focused, culturally competent, evidence-based, and developmentally appropriate services. This comprehensive, simultaneous, and integrated approach is needed to achieve real progress in children's mental health in this country. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

SDM95--reducing aggregate care team costs through optimal patient placement

The authors describe a new approach that designs optimal patient placement rules and staffing-to-demand scheduling schemes. The placement rules enable care teams to deliver care at census levels that maximize the productivity of current care models across aggregated units and reduces the number of units experiencing census variation. The scheduling schemes ensure that staff is available to meet patient needs so that work schedules become predictable and premium pay virtually is eliminated.     

Ultrastructure of HIV-1 genomic RNA

The traditional acute care health care environment does not meet the needs of chronically ill patients and their families. The classic paternalistic approach encourages dependence on the health care team. This report reviews several innovative types of patient care delivery models, including patient-focused care, family-centered care, cooperative care, and Program Planetree. The core concepts of these various models are described and compared. Related research is presented. A synthesis of these existing models to meet the needs of chronically ill medical patients holistically is proposed. The implementation of the holistic model with chronically ill patients and their families is depicted.     

A primary care nurse clinic

A nurse-driven clinic that uses a client-centered approach evolved from an independent ambulatory care program. The clinic operates 4 to 5 hours per day and provides patient counseling, health care maintenance, primary care, patient education, and therapeutic care.     

Integrated care management: aligning medical call centers and nurse triage services

Successful integrated delivery systems must aggressively design new approaches to managing patient care. Implementing a comprehensive care management model to coordinate patient care across the continuum is essential to improving patient care and reducing costs. The practice of telephone nursing and the need for experienced registered nurses to staff medical call centers, nurse triage centers, and outbound telemanagement is expanding as the penetration of full-risk capitated managed care contracts are signed. As health systems design their new care delivery approaches and care management models, medical call centers will be an integral approach to managing demand for services, chronic illnesses, and prevention strategies.     

Giant cell granulamatous hypophysitis with remarkable uptake on Gallium-67 scintigraphy

Security of personal health care is of concern to patients, health care staff and informaticians alike. Nevertheless, their awareness of the appropriate measures for protection of such data have been found wanting. The development and implementation of an information and security policy in the health care environment must therefore take into account the attitudes of staff and their educational needs. The approach adopted in one large District General Hospital was to combine risk analysis with surveys of users attitudes to proposed measures and a participational approach to development of security procedures using an adaptation of the ETHICS soft systems methodology. As a result of several years of effort, a 'security culture' has begun to emerge in the organization. However, this can only be sustained by continual promotion of the policy and a willingness to adapt procedures to suit the operating environment.     

Employer-based innovations in behavioral health benefits.

Since the early 1980s, employers have been developing processes to more effectively manage their behavioral health care expenditures. Initially, employers focused their cost-containment efforts on inpatient admissions or substance abuse rehabilitations. Over time, employers realized that finding a solution with the greatest impact entailed a more comprehensive approach to the problem. They developed cost-containment strategies to the employer carve-out, an all-encompassing managed care approach focused on psychiatric and substance abuse conditions. The results of employer-initiated carve-outs have been dramatic. If passed, President Clinton's health care bill would have discouraged employer incentives for similar innovations, and would have ended this chapter in health care when the programs developed on behalf of employers achieved marked improvement in controlling health care costs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)