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Biomedical subjects

A Jacox

Publications and source records attributed to A Jacox.

At least 19 recordsLinked to original sources
PubMed2000

Prevalence and types of wounds among children receiving care in the home.

The purpose of this study was to determine the number of children with wounds receiving home care, determine the types of wounds among these children, and identify wound care products used in the treatment of children. This study was a multi-site, descriptive, cross-sectional, collaborative, study involving 13 home healthcare agencies and a university. Nurses (n = 281) were systematically selected to collect data for patients receiving home care visits during a 1-week period. The nurses recorded data on 77 children who ranged in age from less than 1 year to 18 years (mean = 3.1 years, SD = 4.72). The children included 47 males and 30 females, most of whom were African-American (n = 59). Among the 77 children, 16.9% had wounds. Children with wounds were significantly older and had more reasons for the home healthcare visit than children without wounds. The presence of a wound was not significantly related to the length of the visit, gender, or race. The most common wound was a surgical incision. The wound care treatments used most were tap water and gauze. In conclusion, wound care is frequently part of the care for a child in the home. Therefore, nurses need to be aware of wound assessment and wound care protocols that match a child's growth and development and family needs.

Adolescent↗
PubMed1999

Wound prevalence, types, and treatments in home care.

OBJECTIVE: To ascertain the number of home care patients with wounds, determine the types of wounds being treated in the community, and identify wound care treatments used at home. DESIGN: Descriptive, multisite, collaborative project. SETTING: 13 home care agencies located throughout lower Michigan that had voluntarily formed a research consortium. The location of patients visited was 43% urban, 39% suburban, 16% rural, and 2% unaccounted. PATIENTS: Systematic sampling was used to select nurses in each agency to collect data. Nurses (n = 281) recorded information about adult patients visited during the 1 week of the study. Data were recorded about 2847 patients, M age = 72.5 years. They included 1793 women and 1040 men (gender was not recorded for 14 patients); most patients in the sample (72%) were white. MAIN PLANNED OUTCOMES: A significant number of home visits would include wound care and that wound care would be primarily done with tap water and gauze. RESULTS: Wounds were present in 36.3% of patients. Of the patients with wounds, 58.3% had 1 wound and 41.7% had multiple wounds. Wound types included surgical (62.4%), pressure ulcers (24.9%), and vascular leg ulcers (22.2%). Tap water and gauze were the most-used wound care treatments. Patients with wounds had significantly longer home care visits than patients without wounds. CONCLUSIONS: Patients with wounds are commonly found in home care. There is a low utilization of specialty dressings and commercial irrigation solutions across all wound types. Nurses who follow patients with wounds may need additional time to provide the care.

Adult↗
PubMed1997

Cost considerations in patient-controlled analgesia.

Patient-controlled analgesia (PCA) is the use of a portable infusion pump activated by the patient to inject an analgesic drug intravenously, subcutaneously or epidurally. PCA permits a patient to deliver a small bolus of opioid to achieve prompt relief without over sedation. Use of PCA for pain management is increasing in hospitals and home settings, largely because it can provide equivalent or better analgesia than conventional methods, and patients are more satisfied with its use. This article reports on studies published between January 1984 and December 1995 which considered cost aspects of PCA. Most studies compared the direct costs of administering PCA with the cost of other forms of drug delivery, usually intramuscular injections. A few studies have included indirect costs such as length of stay and adverse effects associated with the use of PCA. The research on cost considerations of PCA is dominated by case reports, descriptive studies and poorly designed quasi-experimental studies. The most complete and well conducted studies usually have included only drug, equipment and labour costs. Only 6 randomised controlled trials were reported, all of which were conducted on postoperative patients. The cost effectiveness of PCA for pain management is an unresolved question because of the variability in methods used to determine costs and expenses, the different settings and patient populations in which PCA is applied, the different means to organise its management and the fact that it is a rapidly evolving technology during an era of changing reimbursement practices. There is substantial variation in the cost of drugs used in PCA and in the devices themselves, which influences the comparison of costs across studies. Also, researchers do not include the full scope of costs associated with the use of PCA in comparison with conventional drug delivery methods and some do not measure the level of pain relief achieved. Of the few complete and well designed published studies found, PCA was reported to produce superior analgesia at a higher cost than conventional intramuscular therapy in 3 studies, but to be more costly and produce less pain relief than intramuscular therapy in 1 study. There is a pressing need for cost-effectiveness, cost-utility and cost-benefit analyses to determine the appropriate clinical and cost circumstances for the use of PCA.

Analgesia, Patient-Controlled↗
PubMed1994

Cancer pain guidelines: now that we have them, what do we do?

Addressing the what, who, when, where, and how of implementing the AHCPR guidelines is an attempt to simplify what may be an overwhelming process. Use the suggestions presented in Figure 1 to formulate an action plan, and remember to assign a time frame and individual accountability. The commitment to moving the guidelines from the bookshelf to the bedside begins now. Using a process such as this will assist efforts to improve care of patients in pain. It is our hope that a year from now the copy of the AHCPR cancer pain guidelines on your shelf will not be covered with dust but rather will be a well-worn text translated to practice.

Clinical Protocols↗
PubMed1993

Developing clinical practice guidelines: an interview with Ada Jacox. Interview by Barbara Bednar.

In 1992, the Agency for Health Care Policy and Research (AHCPR) released the first in a series of clinical practice guidelines designed to assist hospitals, practitioners, insurers, and consumers in learning more about which medical practices work and how that knowledge should be applied to delivering health care. In this interview, Ada Jacox, PhD, RN, co-chair of the pain management panel, discusses the development of clinical practice guidelines, their importance to health care professionals and consumers, and their possible impact on future practice.

Clinical Competence↗