Guided bone regeneration in long bone. An experimental study

To assess the satisfaction with the department and hospital services provided by a medium-size community hospital during a 2 month period (April-May 1995), 118 randomly chosen patients were asked to complete a questionnaire designed to reflect their opinions during hospitalization. The principal points of the survey concerned the general perception regarding the services in the department and the hospital, the admission and discharge procedures, the quality of food and sanitary conditions, an evaluation of the physicians' and nurses' skill and attitude, as well as their compliance to patients' needs. Overall satisfaction with the medical care was very high, the physicians' attitude and nurses' compliance being the two most important determinants. The role of this type of questionnaire as an instrument for improving health services is emphasized.     

Compliance issues with the geriatric population: complexity with aging

Nonadherence with the prescribed treatment regimen is a major issue in health care. This article focuses specifically on adherence issues in the geriatric population. The strengths and weaknesses of measurement methods to assess nonadherence with medication regimens are discussed. Determinants of noncompliance with special emphasis on risk factors for geriatric patients are described. Finally, an overview of preventative and restorative compliance interventions is given.     

Trauma care strategies for changing economic forces

Nurses have expertise in wellness, health promotion, delivery of acute care, and rehabilitation. As the venture into healthcare reform deepens, nurses must take a more proactive role in redirecting the delivery of trauma care in such a way that optimal provision of healthcare services is maintained while costs of providing care are reduced across the continuum of care. Efforts must focus on preventing traumatic injuries, restructuring healthcare delivery systems to meet the needs of patients with traumatic injuries, and reducing healthcare expenditures. Table 3 outlines strategies used by our facility to decrease cost without compromising patients' care. The current era is fraught with rapid changes that necessitate a creative, rational, and organized approach to making decisions about the delivery system for patient-focused care. Nurses are in an optimal position to develop and implement interdisciplinary, creative strategies that will maximize the delivery of trauma care services to the community. Each institution must evaluate the processes involved in its delivery of trauma care services. Strategies to contain costs must focus on processes implemented to achieve optimal outcomes of patients' care. The economic marketplace will evaluate care on the basis of outcome statistics and cost analysis. Thus, nurses must continue to be critical evaluators of nursing practice, always striving for the best healthcare delivery system possible during these turbulent economic times.     

A pilot study exploring the effect of discharging cancer survivors from hospital follow-up on the workload of general practitioners

BACKGROUND: The tradition of routine, long-term follow-up of cancer patients in the outpatient clinic has led to busy clinics and long waiting times. Many cancer patients are anxious and have become dependent on the specialist clinic for reassurance. General practitioners (GPs) have been shown to be willing to assume greater responsibility for the routine follow-up of breast cancer patients, but patients have demonstrated a preference for hospital follow-up. If patients are discharged unwillingly, their rehabilitation may be at the cost of an increased demand on GP practices. AIM: To determine the consequences for GPs of discharging long-term cancer patients from a hospital outpatient follow-up clinic. METHOD: A consecutive sample of 65 patients under annual review in a hospital oncology clinic were offered a planned discharge in which their return to the clinic, if necessary, was guaranteed. The 41 patients who accepted discharge were monitored. Anxiety and depression rates were assessed using the Hospital Anxiety and Depression Scale (HADS) at the time of discharge and four months later at a home interview. The GPs of all patients who were discharged were sent questionnaires four and twelve months after discharge to evaluate consultation rates and change in psychological morbidity. RESULTS: The results showed no significant increase in the consultation rates during the 12 months after discharge compared with the previous 12 months. There was no significant change in the level of patients' anxiety or depression at four months after discharge. The great majority of GPs (71%) reported no change in their perception of patients' levels of anxiety or depression. GPs thought there was a need for more specialist Macmillan nurses working in the community and highlighted the importance of fast-track specialist referral. CONCLUSION: Discharging this group of long-term cancer survivors did not increase the workload of GPs. However, GPs' concern over the lack of availability of Macmillan nurses in the community suggests that primary care services may find it difficult to cope adequately with the special requirements involved in cancer patient care. Finally, there is a need to address the further training requirements of GPs in the routine follow-up of cancer patients.     

Profiling care and benchmarking best practice in care of hospitalized elderly: the Geriatric Institutional Assessment Profile

This article reports on a new instrument, the Geriatric Institutional Assessment Profile (GIAP), developed to assess (1) hospital workers' knowledge, attitudes, and perceptions regarding care of geriatric patients, and (2) the perceived adequacy of an institutional environment to serve geriatric patients' needs. Findings are reported from 303 questionnaires completed by health care employees from a 658-bed academic medical center. Internal consistency estimates were consistently high for the various components of the GIAP. Factor analysis was performed to examine underlying dimensions of knowledge and institutional environment. The GIAP has the potential to narrow the gap between actual and best practice in geriatric care by identifying staff information needs and concerns, as well as institutional barriers and facilitators to providing quality geriatric hospital care.     

Differences in treatment of ischemic heart disease at a public and a voluntary hospital: sources and consequences

A study of hospital patients with ischemic heart disease reports that patients in a public hospital received fewer needed diagnostic tests, surgeries, and follow-up visits for their conditions than their private hospital counterparts. Factors in the hospitals' organizational environments and the patients' social backgrounds were observed to have an impact on content of treatment and to affect patient as well as provider perspectives on the quality of care. To facilitate the analysis, data were collected from four sources: direct observation of the care of each patient on rounds and at the bedside; interviews with physicians concerning the rationale for their decisions; a process-oriented chart audit assessing the appropriateness of care; and an extensive home interview with each patient three months following hospital discharge to establish further use of health services, health status, and satisfaction with care.     

Behavioral compliance with dialysis prescription in hemodialysis patients

The relationship between compliance and outcome is poorly understood, partially because there has been no gold standard for measuring compliance in hemodialysis patients. To investigate interrelationships between psychological, medical, and compliance factors, hemodialysis (HD) patients were studied with the Beck Depression Inventory, and a subset, the Cognitive Depression Index, the Perception of Illness Effects scale, and the Multidimensional Scale of Perceived Social Support. Behavioral compliance was measured in three ways: (1) percent time compliance (signifying "shortening behavior"); (2) percent attendance (signifying "skipping behavior) (3) percent total time compliance, assessing patients' time on dialysis normalized for prescribed time, including all shortenings and absences. Standard compliance indicators (predialysis serum potassium and phosphorus concentrations and interdialytic weight gain) were also analyzed. The patients' mean Beck Depression Inventory was in the range of mild depression. The prevalence of depression was 25.5%. Both depression indices correlated with Perception of Illness Effects scale scores. In general, social support was related to both measures of depression and perception of illness effects. Total time compliance was 95.8 +/- 5.0%. Younger patients were more likely to skip treatments compared with older patients. Time compliance comprised a wide spectrum, with most patients relatively compliant, whereas a small proportion received far less than their prescribed dialysis. Skipping and shortening behaviors did not correlate, suggesting that these constitute two separate types of noncompliant behaviors. Time compliance parameters did not correlate with potassium levels or interdialytic weight gain, but did correlate with phosphorus levels. Interrelationships between behavioral compliance measures and other parameters varied between units and patients of different gender. Finally, behavioral compliance patterns were stable over months in patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

A four year study of therapeutical observation of patients with hypertension

We attempt to quantify compliance with hypotension medication regimens in 620 patients with hypertension at the Centros de Salud (community health centers) of Novelda and Elche (in the province of Alicante) and to assess the impact of a mixed-strategy health education program. The method used to evaluate compliance is the self-communicated interview as indicated by Haynes-Sackett. The intervention consisted of individualized instruction, family support, educational leaflets, and written instructions. Among the results obtained, we emphasize the following. First, 64% completed the treatment as prescribed, 16% stopped taking the medication, and 20% followed the regimen in a sporadic fashion, lack of motivation and forgetfulness being the main reasons cited for the latter. Second, 27% of the patients with hypertension--among them, primarily young people and men--do not visit the center for monitoring. Third, the health education program is responsible for a significant increase in blood pressure measurements and in therapeutic compliance, also reducing the number of drop-outs. Fourth, 26% did not come to the unit at the end of the study period (four years) despite phone calls and house visits as reminders.     

Activation of the gene encoding decay accelerating factor following nerve growth factor treatment of sensory neurons is mediated by promoter sequences within 206 bases of the transcriptional start site

This study was designed to develop a quick methodology to assess the healthcare needs of a rural community and to determine what factors make these communities 'happy' or 'unhappy' with respect to medical service provision. Two rural shires of approximately 4000 people each were chosen from different health regions of Western Australia. The methodology consisted of interviews with healthcare providers and key community informants as well as a community questionnaire. The interviewing process showed that key community informants offered no new information in addition to that already provided by the healthcare providers. Furthermore, all key points would have been covered by interviewing approximately 60% of all healthcare providers in each community. Hand delivery of the community questionnaire yielded the highest response rate. The level of community satisfaction with general practitioner (GP) and hospital services determines whether a community is medically 'happy' or 'unhappy'.     

Discharge of psychiatric patients into the community: how many more must die?

Since the advent of community care, mental health services are increasingly coming under scrutiny, particularly the management of people with mental health problems in the community. Several murders committed by psychiatric patients in the community have fuelled public debate. This article reports on a study examining the recommendations of the Department of Health regarding the discharge of psychiatric patients from hospital to community care. It describes the background to events such as the Clunis report and guidance from the Department of Health on the management of mental health services. Semi-structured interviews, questionnaires and document analysis were used to ascertain the views of community psychiatric nurses and managers regarding the discharge of patients into the community. The findings identify areas of good practice and the need for nurses to improve their knowledge of the care-programming approach, risk assessment and inter-agency collaboration.     

Why pain assessment must start with believing the patient

Nursing students may find it difficult to change how a patient's care is managed or even to initiate any changes at all. On a busy surgical ward I attempted to assess and alleviate a patient's uncontrolled post-operative pain using a pain-assessment tool. Patient compliance was good, but ward staff responsible for managing the patient's care took little notice. This was not, I believe, because the pain-assessment tool was ineffective, but because staff gave pain control low priority, and, more fundamentally, because they did not believe the patient when she said she was in pain. This paper follows the postoperative patient from assessment through to discharge. The importance of believing patients' accounts of pain is illustrated.     

The practice of geriatric psychiatry in three countries: observations of an American in the British Isles

The author compares the practice of geriatric psychiatry among three countries: Ireland, the United Kingdom and the United States. The two main areas reviewed are how the practice of geriatric psychiatry is done, and the mental health services available in each country, including organizational characteristics. The US is the most entrepreneurial of the three, Britain's greatest strength is the uniformity and comprehensiveness of its services, and Ireland provides an excellent model for nations of comparable size. Considerable change is occurring in all three countries.     

Behavior–diagnostic analysis of compliance with universal precautions among nurses.

This study used the PRECEDE model (L. W. Green et al, 1980) to examine individual, job–task, and environmental–organizational factors related to compliance with universal precautions (UP) among nurses. Structural equation modeling showed that the hypothesized model did a better job predicting general compliance (R2?=?.41) than compliance with personal protective equipment (PPE; R2?=?.18). All 3 categories of diagnostic factors (predisposing, enabling, and reinforcing) influenced general compliance, but predisposing factors were relatively unimportant for compliance with PPE. With a set of nested models, the greatest improvement in model fit occurred when the indirect effects of reinforcing factors were added. A positive safety climate may increase the likelihood that the work environment will contain features that enable workers to comply with safe work practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metabolical changes induced by adaptation to circumpolar conditions in Spitsbergen

The Home Hospitalization Programme was initiated in Jerusalem in 1991 to provide intensive medical care at home in order to prevent or shorten hospitalizations. The programme was based upon regular home visits by physicians, and nursing assessment to determine the need for regular nursing care. Primary-care physicians and nurses were renumerated by a global monthly fee, and were on 24-h call in addition to their periodic visits. Patients were recruited by senior geriatric physicians from acute hospital wards, as well as from the community, at the family doctor's request. Ancillary services available to the home hospitalization team included laboratory and electrocardiographic testing, specialty consultations, physical occupational or speech therapy, social work and home help up to 3 h daily. Monthly visits by a senior physician provided oversight and further consultation. Home hospitalization grew out of the continuing care division of the Clalit Sick Fund, a health maintenance organization providing umbrella medical insurance and ambulatory care. The programme grew synergistically with the other facilities of continuing care to encompass a network of comprehensive services to acute, subacute and chronic patients both at home and in institutional settings. In 4 years this network succeeded in establishing the focus of subacute intensive care in the community, achieving high levels of patient and family satisfaction, as well as striking economic advantages. In its first 2 years of operation home hospitalization saved S4 million due to reduced hospital utilization, and preliminary data for the subsequent 2 years indicated that this trend continued. Home hospitalization became the hub of a far-reaching system of supportive, intensive and humane care in the community.     

The possibility of preserving the causative agent of plague in soil in resting (nonculturable) form

The purpose of this study was to find criteria characteristic for patients in need of care and social services. The criteria should serve as a guideline for patients and staff to facilitate care planning before discharge. The sample consisted of 49 patients, born before 1925, in need of emergency inpatient treatment, admitted to medical- or orthopaedic wards. Data of the patient's self care needs were collected by interviews, assessment of self care status and need of treatment. The patients could be divided into three groups depending on type of discharge. Group A (n = 27) discharged home, group B (n = 7) discharged to geriatric clinic and group C (n = 15) discharged and in need of further care and social services. Criteria indicating the patients further assistance from the community were in group C (medical- and orthopaedic wards) deficit in daily living activities and locomotion. Group B had an increased need of support from the physiotherapist and the occupational therapist, in locomotion as well as daily living activities The physician's assessment showed that the criteria behind the decision "no further medical treatment appropriate" and "ready for discharge" were not related to medical impairment but to lack of self care, need of care, rehabilitation and social services.     

Comparison of quality of life of schizophrenic patients in different forms of psychiatric care

Health related quality of life and severity of psychopathological symptoms were evaluated in 90 patients with schizophrenia, hospitalized in a psychiatric ward in a day hospital or followed by the therapist in a community care center. No statistical differences were found in the quality of life evaluation between patients from all three settings. The quality of life did not correlate with the severity of schizophrenic symptoms. Older patients and those more frequently hospitalized were more pessimistic in evaluation of their quality of life. Health status transition, as compared to the situation one year before, correlated inversely with patients' age. Male patients as well as patients from schizophrenic families evaluated their quality of life as worse.     

Client factors related to premature termination of psychotherapy.

Investigated client factors related to the premature termination of counseling or psychotherapy. A review of 287 mental health center client files revealed 3 variables that were found to be significantly related to premature termination: diagnosis, presenting problem, and previous psychiatric experience. Early terminators had less previous contact with psychiatric services, were usually not psychotic, and presented with problems in the area of interpersonal relationships. Results suggest that community education activities, informed consent procedures, therapist knowledge of the early terminator's profile, and a wider range of services, including more groups, may improve community mental health center service delivery to these clients. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stroke services in general practice--are they satisfactory?

BACKGROUND: The contribution of general practice and primary care teams to stroke care has received surprisingly little attention despite research evidence on the importance of coordinated care. AIM: To determine general practitioners' (GPs') and their patients' satisfaction with hospital and community services for stroke patients in Grampian Region, Scotland. METHOD: A questionnaire survey of 138 stroke patients and their GPs was carried out six weeks after each patient was discharged home between June 1995 and January 1996. Outcomes measured were GP and patient satisfaction with services, Barthel Index, Hospital Anxiety and Depression scores, London Handicap Score, and Homsat and Hospsat scores (satisfaction with stroke services). RESULTS: Response rates of 95% (131) for GPs and 91% (125) for patients were obtained. GPs and patients were generally satisfied with services. Stroke patients were more likely to have had contact with their GP than with any other service. Adverse comments from GPs focused on problems with hospital discharge letters. At six weeks, patients received an average of 2.5 community services and 1.5 hospital services, but there was wide variation across disability groups. CONCLUSIONS: Levels of satisfaction were high, but the wide range and variation in services used by patients emphasized the complexity of the primary care of stroke patients; the need for coordination, review and effective links with hospital; and the key role of the GP.     

Impression management: Patient perceptions of the efficacy of psychiatric self-presentation.

Studied the perceived efficacy of patients' attempts to influence discharge dates through psychiatric self-presentation as a function of the perceivers' own self-presentation inclinations and length of hospitalization. 40 male patients on an acute treatment ward and 40 on a chronic treatment ward heard 1 of 4 taped interviews on which an ostensible patient revealed that he planned to engage in either healthy or sick self-presentation and that the psychiatrist of this ostensible patient was either in favor of or opposed to discharge. Judgments about when the taped patient would be discharged were influenced by the taped patient's plans but not by his psychiatrist's opinion. Ss' chronicity but not self-presentation inclinations were related to their judgments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)