Biomedical subjects
Publications and source records attributed to A Minnick.
As part of a three-site cooperative physical restraint reduction program in acute-care hospitals, a multidisciplinary team created a survey instrument to measure staff's knowledge, unit beliefs about practice patterns, ethical concerns, and more.
Differences in the costs of health care systems among industrialized countries has been the focus of several studies. Labor costs, specifically the amount of resources used for administration, are considered to contribute to differences in overall health care costs. To determine differences in the use of labor resources, especially administrative and managerial, among American, Austrian and German hospitals, we use a convenience sample of one Austrian, one German and two United States (US) tertiary care centers. In our analysis we used payroll data of the four hospitals. First, we categorized job titles and created job categories. Subsequently, we calculated full time equivalents (FTEs) per job category and compared them across countries. Adjustments were made for differences in health systems. The main outcome measures were FTEs per patient day and per discharge in each job category. In the US hospitals > 19% of FTEs were in administrative categories as compared with < 8% in the European hospitals. For administrative managers, US hospitals used > 11 times the labor per patient day of the European institutions. Among administrative areas, the largest absolute FTE difference was in financial operations. US hospitals used > 5 FTEs of personnel per 10,000 patient days versus < 1.0 FTE in the European hospitals. Given the kinds of administrative work done in US hospitals compared to Austria and Germany, differences in the organization and financing of these countries' health care systems may account for an important part of the higher number of US personnel.
Avenues for the preparation of nurses who wish to pursue administrative careers continue to be debated. The author reports changes in the numbers and enrollments of master of science in nursing/master of business administration (MSN/MBA) programs as well as trends in MSN in nursing administration programs since 1993. Respondents to a survey of all U.S. nursing graduate programs indicated that both types of programs have undergone substantial changes on a variety of measures. The author considers these results in suggestions for building new approaches to administrative preparation.
OBJECTIVE: To determine if DNA ploidy, hormone receptors, vascular space invasion (VSI), perivascular lymphocytes (PVL), and the oncogenes HER-2/neu, p53, and bcl-2 are independent prognostic indicators for lymph node metastasis and cancer recurrence in clinical stage I endometrial carcinoma. METHODS: Among 349 patients with clinical stage I endometrial cancer 31 patients either had lymph node metastases when surgically staged or developed recurrent cancer. Using a case-control matched-pair technique, controls were selected for each of 24 cases by matching for age, histological grade, depth of myometrial invasion, performance of node dissection, and use of adjuvant radiation therapy. In a blinded fashion a pathologist reviewed all histopathology, and all molecular tests were performed on paraffin-embedded tissue samples. Statistical analysis was performed by chi2 and McNemar's tests. RESULTS: VSI was the only histopathological factor significantly related to positive lymph nodes and cancer recurrence (P = 0.01), independent of grade and myometrial invasion. Aneuploidy, oncogene expression (p53, HER-2/neu, bcl-2), and hormone receptors were not significantly related to lymph node metastasis and cancer recurrence. CONCLUSIONS: The presence of vascular space invasion is a pathological factor independently associated with a risk of nodal metastasis and cancer recurrence in clinical stage I endometrial cancer. DNA ploidy, oncogene expression, and hormone receptor status do not have more predictive value than standard staging pathological criteria.
The recognition of the effects of a failure to attain continuity of care is driving many of the changes in U.S. health care. This article explores the relationship of continuity of care and the broader concept of a continuum of care. Actions that advanced practice nurses, educators, and organizations can take to influence its developmental are described within the context of three issues: (1) recognition of continuity of care myths, (2) the use of financial mechanisms to promote the construction of a continuum of care, and (3) the development of continuum of care building skills of advanced practice nurses.
The present study was designed to test the hypothesis that endogenous angiotensin II (ANG II) influences baroreflex control of heart rate (HR) and renal sympathetic nerve activity (RSNA) early in life and to determine whether these actions are mediated by angiotensin AT1 or AT2 receptors. To test this hypothesis, we studied the effects of systemic and central administration of losartan, a selective AT1 receptor antagonist, and PD-123319, a selective AT2 antagonist, on baroreflex-mediated control of HR and RSNA in conscious newborn lambs. Systemic administration of losartan decreased resting mean arterial blood pressure (MABP) from 70 +/- 3 to 58 +/- 4 mmHg (P < 0.05) without producing reflex increases in HR or RSNA. The baroreflex response curves were shifted to the left as indicated by a decrease in the arterial pressure at the midpoint of the curve for HR (83 +/- 3 to 75 +/- 4 mmHg) and RSNA (74 +/- 2 to 69 +/- 3 mmHg; P < 0.05 for both). Losartan also reset HR and RSNA baroreflex curves when changes in baseline blood pressure were prevented by simultaneous infusion of phenylephrine. In contrast, a sustained decrease in arterial pressure of 10-12 mmHg with nitroprusside failed to shift the baroreflex function curves. PD-123319 had no effect on baseline HR, MABP, RSNA, or baroreflex responses. Lateral ventricle administration of losartan but not PD-123319 also produced a decrease in arterial pressure (81 +/- 4 to 73 +/- 3 mmHg, P < 0.05) and reset the baroreflex for HR and RSNA toward lower pressure. These results demonstrate that, early in life, endogenous ANG II exerts a tonic effect on baroreflex control of HR and RSNA to shift the curves toward higher pressure levels. The alterations in arterial baroreflex function appear independent of direct ANG II effects on arterial pressure and are mediated by AT1 receptors.
During a 13-month successful introduction of unit-based, multiskilled environmental workers at an academic medical center, responsibility for environmental support services migrated from centrally managed departments to more than 30 patient-care units. The authors discuss six project management lessons that may be used by clinicians and managers as they participate in service reorganization. Points related to the identification of committed leaders, exploration of barriers, planning, continuous training, negotiation, and communication are presented. Professional nurses who demonstrate their ability to work with these types of service innovations while clearly identifying clinical aspects best left unincorporated in such job descriptions will be in demand as participants in redesign efforts.
Although the use of physical restraint has declined in nursing homes, the practice remains widespread in hospitals. The use of physical restraint in hospitals was reviewed to identify the current clinical, legal, and ethical issues and the implications for policy and further research. Clinicians use physical restraints to prevent patient falls, to forestall disruption of therapy, or to control disruptive behavior, but they vary in how they determine to institute these restraints. The evidence to support the reasons for their determinations is not compelling. Fear of litigation remains a powerful motivator. The ethical dilemma of autonomy versus beneficence has not been resolved satisfactorily for patients in this setting. The lack of large-scale studies in any of these areas makes it difficult for policy makers to determine whether it is necessary to address hospital physical restraint practices through additional regulation.
Everyone involved in work redesign must recognize the need to plan for change, thus breaking the myth that new job descriptions primarily affect only the new worker. As part of redesign, specific questions regarding task analysis and job bundling need to be asked. Implementation of a new work design in a medical center applying these principles is described.
This paper uses the reports of more than 2,000 adult medical/surgical patients drawn from 17 randomly selected hospitals within a midwestern major metropolitan area to (1) describe the differences between patients' reports and ratings of car, (2) determine the influence of service failures on patients' recommendations of a hospital to family and friends and (3) suggest constructive managerial responses to current patient satisfaction monitoring strategies.
This paper describes a framework for compliance the regulatory agency requirements and internal service standards in response to service decentralization and institution of a multi-task environmental worker role. Initiation and maintenance of the compliance system and the coordination of institutionally specific service standards are described. Five keys for success are detailed.
The value of graduate programs that enable nurses to earn masters degrees in nursing (MSN) and business administration (MBA) through coordinated courses of study has been debated repeatedly. This article describes the subsequent development of the dual degree option (MSN/MBA) within US nursing graduate programs, explores the opportunities and problems reported by programs offering this form of education, and considers the future development of these types of programs. The article is based on a survey of 167 schools of nursing offering graduate programs. The authors describe the challenges to these programs' continued expansion and the role that healthcare reform may have in shaping the education market.
Three medical/surgical units in a Midwestern medical center introduced a two-way wireless communication system to test its effect on environmental noise, staff communication, timeliness of response to patient requests, nurse fatigue and job satisfaction. Data were collected through focus groups, surveys, pedometer studies and work sampling. Results provide for nurse managers the first objective evaluation of the potential of this new device and a framework for designing other nursing evaluations of the effects of a new technology.
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Cysticercosis is the most common parasite affecting the central nervous system and is a serious health problem in many parts of the world. An increase in immigrants to the United States from areas with a high incidence of cysticercosis has made it a relatively common diagnosis at neurological centers. This article describes the etiology of cysticercosis and assessment, treatment, and follow-up care of these patients.