Risk in infancy: Origins and implications.

This article focuses on biological risks that can adversely influence development during infancy and later. In the first part of the article, the origins of risks and their potential consequences are discussed relative to prepregnancy, prenatal, perinatal, and postnatal periods. Epidemiological data are presented. The second part of the article addresses issues pertaining to assessment of infant development and interventions provided for infants whose development may be in jeopardy. Finally, goals for prevention are highlighted and the need for a nationally derived data base on risk and outcomes is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fast tracking in cardiac surgery: implications for practice

Even though economic incentives might have been the impetus for its revival, fast tracking offers numerous other benefits, not the least of which is improved patient care. However, its benefits can be realized only through specific perioperative management, including preoperative assessment, identification and selection of appropriate candidates, optimal intra- and postoperative management and interdisciplinary discharge planning. Through interdisciplinary collaboration, the maximum benefits of fast tracking can be reaped by both the patient and the healthcare team.     

Post-intensive care interviews: implications for future practice

The measurement of outcome from intensive care, including the long-term physiological and psychological effects of disease and intensive therapy has tended to receive scanty attention. Little consideration has been given to the implications this may have for the patients, relatives and for future practice. Patients were interviewed in their own homes after 6 months of recovery, to allow freedom of expression and comfort within their own environment (territory). This study demonstrates that data generated by face-to-face interviews can be of immense importance to intensivists in assessing the effectiveness of services and promoting changes in clinical practice. It also shows a need for a long-term follow-up service encompassing community and hospital.     

Nutrition and endothelial cell integrity: implications in atherosclerosis

Loss of functional integrity of the vascular endothelium may be one of the initiating events in the etiology of atherosclerosis. Endothelial cells interact with blood components and the abluminal tissues, thus playing an active role in many aspects of vascular functions, such as permeability and vessel tone regulation. Endothelial cells constantly are exposed to nutrients which can modulate enzymes, receptors, transport molecules and various vasoactive mediators, resulting in significant functional changes of the endothelium and the underlying tissues. Nutrition may play an important role in the atherosclerotic disease process. There is evidence that certain vitamins and minerals prevent some metabolic and physiological perturbations of the vascular endothelium. This review focuses on selected lipids which cause endothelial cell injury or dysfunction and on nutrients which may exhibit antiatherogenic properties by being able to function as antioxidants or membrane stabilizers.     

Children''s palliative care services: implications for everyone''s practice

When the time came for Enid to make the transition into long term care the profile of Enid with her biography and behaviour modes was passed on to staff in the nursing home, thus enabling them to start from a point of knowing Enid as an individual. During her time at Burford, Enid managed to communicate and express herself sufficiently to keep a good degree of self-agency. Her dementia mapping scores showed her to be generally in a state of well-being. This article has attempted to show how it is possible to listen and learn from people with dementia and that care staff must want to learn about and from the person with dementia if they are to care for them in a person centred way.     

Depression in elders with dementia: implications for home healthcare practice

In addition to severe cognitive decline, depressive symptoms occur in almost 50% of patients with dementia. Depressive symptoms can be treated successfully, thereby reducing clinical manifestations of coexisting dementia and improving quality of life for these patients and their families. Practical assessment, interventions, and referral guidelines are presented for home healthcare nurse generalists whose caseloads include elders with both cognitive decline and depressive symptoms.     

Acute pain management clinical practice guideline: implications for nurse anesthetists

Millions of operative procedures are performed in the United States each year. One of the greatest concerns for the surgical patient is postoperative pain. Despite traditional efforts to alleviate this pain, clinical studies indicate that postoperative pain is not relieved in most patients. The federal Agency for Health Care Policy and Research (AHCPR) developed a clinical practice guideline, Acute Pain Management: Operative or Medical Procedures and Trauma to help clinicians, patients, and patient's families understand the assessment and treatment of postoperative acute pain in both adults and children. Certified registered nurse anesthetists (CRNAs) can use the guideline to improve acute pain management within their institutions. Effective pain management can be accomplished through a collaborative, interdisciplinary approach using an individualized proactive pain control plan. Frequent assessment and reassessment of pain, use of drug and nondrug therapies, and implementation of an institution-wide program using CQI/QA methods in necessary. Implications for CRNAs include providing patient and staff education, establishing standards of care for pain management, and adapting an aggressive "no pain, much gained" clinical practice.     

Trust in leadership: Meta-analytic findings and implications for research and practice.

In this study, the authors examined the findings and implications of the research on trust in leadership that has been conducted during the past 4 decades. First, the study provides estimates of the primary relationships between trust in leadership and key outcomes, antecedents, and correlates (k=106). Second, the study explores how specifying the construct with alternative leadership referents (direct leaders vs organizational leadership) and definitions (types of trust) results in systematically different relationships between trust in leadership and outcomes and antecedents. Direct leaders (e.g., supervisors) appear to be a particularly important referent of trust. Last, a theoretical framework is offered to provide parsimony to the expansive literature and to clarify the different perspectives on the construct of trust in leadership and its operation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interventions for intimate partner violence: Review and implications for evidence-based practice.

The objective of this article was to survey available intimate partner violence (IPV) treatment studies with (a) randomized case assignment, and (b) at least 20 participants per group. Studies were classified into 4 categories according to primary treatment focus: perpetrator, victim, couples, or child-witness interventions. The results suggest that extant interventions have limited effect on repeat violence, with most treatments reporting minimal benefit above arrest alone. There is a lack of research evidence for the effectiveness of the most common treatments provided for victims and perpetrators of IPV, including the Duluth model for perpetrators and shelter–advocacy approaches for victims. Rates of recidivism in most perpetrator- and partner-focused treatments are approximately 30% within 6 months, regardless of intervention strategy used. Couples treatment approaches that simultaneously address problems with substance abuse and aggression yield the lowest recidivism rates, and manualized child trauma treatments are effective in reducing child symptoms secondary to IPV. This review shows the benefit of integrating empirically validated substance abuse and trauma treatments into IPV interventions and highlights the need for more work in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The national occupational therapy practice analysis: findings and implications for competence

OBJECTIVE: This article reports some of the findings from a national study of occupational therapy practice conducted by the National Board for Certification in Occupational Therapy (NBCOT) as part of its fiduciary responsibility to ensure that its entry-level certification examination is formulated on the basis of current practice. METHOD: The NBCOT developed a survey with input from approximately 200 occupational therapy leaders and then used it to solicit information about current practice from 4,000 occupational therapists and 3,000 occupational therapy assistants. The sample included geographical location, experience level, and practice area distributions. RESULTS: Approximately 50% of the sample responded to the survey. Data indicate similarities and differences in occupational therapist and occupational therapy assistant practice (e.g., occupational therapists spend more time conducting evaluations, planning interventions, and supervising, whereas occupational therapy assistants spend more time providing interventions), an increased emphasis on population-based services (e.g., serving a business or industry rather than an individual worker), and an emphasis on occupation as a core knowledge base for practice. From a continuing competency perspective, the data can be useful to the profession; we can plan continuing education to address topics that practitioners have indicated are critical to their practice. CONCLUSION: The findings will be useful for revising the entry-level certification examination and may guide thinking about the parameters of continuing competence because the responses represent a cross-section of the profession.     

When people with pre-existing disabilities age in place: implications for social work practice

Dental implants are subject to large and highly complex loads of varying magnitude, duration and vector. Bridge performance is closely related to load transmission both at the bone to implant interface and between components within the implant-abutment-bridge cylinder complex. The design of the interface between components within this complex may have a profound influence on the long term function of the implant supported prosthesis. An in vitro evaluation of implants 3.5 mm in diameter, utilizing an internal conical interface has demonstrated increased resistance to bending moments at the fixture-abutment interface (P = 0.00010) and at the abutment-bridge cylinder interface (P < 0.01), when compared to a standard 3.75 mm implant with a hex mediated, butt joint interface. The relatively small values for coefficient of variance measured in both systems would confirm that whilst the size of data is small, it is nonetheless a reliable indication of the relative strength of these implant designs.     

Longer-term adjustment in children of divorce: Converging findings and implications for practice.

Reviews research on the impact of divorce on the long-term adjustment of children and adolescents. Variables associated with postdivorce outcomes include conflict, the adjustment of the custodial parent, the relationship with the noncustodial parent, child-rearing practices and child care, remarriage, and the type of custody arrangement. It is suggested that a balanced relationship with each parent that incorporates relevant aspects of the child's life should be developed after divorce. Parents should understand that it is the conditions created by divorce rather than divorce itself that determine their child's adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)