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Biomedical subjects

M A Anderson

Publications and source records attributed to M A Anderson.

At least 163 records · Page 9Linked to original sources
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Medicare and the financing of nursing education: implications of Board of Trustees v Sullivan.

In 1991 a federal court decided a case of first impression about the appropriateness of reimbursement to programs of nursing education under Medicare. The court confirmed that the University of Mississippi could continue receiving Medicare reimbursement for a proportionate share of the costs of clinical education for nurses in its affiliated hospital. However, it ruled that the $2 million in costs for classroom nursing education incurred by the School of Nursing would not be reimbursed despite the fact that both the hospital and nursing school were controlled by the same entity, the university system. This article reviews the court's decision in Board of Trustees of State Institutions of Higher Learning v Sullivan within the context of the available nursing literature on this topic. It describes the provisions of the Medicare statute, which allow for reimbursement of programs of nursing education, and the implications of the court's decision for nursing education. Finally, it suggests directions for additional research and discussion about the availability of an additional source of federal funding.

Education, Nursing↗
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Contribution of intraoperative enteroscopy in the management of obscure gastrointestinal bleeding.

Obscure gastrointestinal bleeding remains a significant diagnostic challenge. Our aims were (1) to determine the efficacy of intraoperative enteroscopy (IOE) in identifying lesions responsible for obscure gastrointestinal bleeding and (2) to determine the outcome of patients after treatment of these lesions. We retrospectively reviewed all patients who underwent IOE for obscure gastrointestinal bleeding from 1992 to 1998. Patients were divided into those with overt and those with occult gastrointestinal bleeding. Follow-up was complete in 67 patients (96%), with a median of 32 months (range 1 to 91 months). Seventy patients (52 overt and 18 occult) underwent IOE after extensive preoperative evaluation. Median duration of bleeding was 12 months, requiring a median of 14 blood transfusions. Risk factors for bleeding were identified in 46 patients (61%). A lesion was identified and treated in 52 patients (74%)-39 in the overt group and 13 in the occult group. Lesions identified were vascular (54%), ulcerations (31%), tumors (11%), and small bowel diverticula (4%). Overall, 35 patients (52%) were found to have one or more lesions at IOE that were treated surgically and had no further bleeding. IOE, through a mid-small bowel enterotomy, has low morbidity and is effective in that it identified a treatable lesion in 74% of patients, which led to cure of bleeding in 52%.

Adolescent↗
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A legal primer on affirmative action in nursing education.

Affirmative action policies are under challenge. To date, judicial concerns must be understood historically. The legal question is to define the conditions under which racial categories may be used for remedial or beneficial purposes to overcome the effects of past discrimination. Beyond exercising strict scrutiny over the use of racial classifications, courts have supported the diversification of academe. For nursing programs, the challenge is to develop policies and procedures to broaden participation without reliance on racial categories. The benefits of diversifying the nursing work force need not be discarded in response to judicial and political reaction to affirmative action.

Civil Rights↗
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A polymorphic DNA marker genetically linked to Huntington's disease.

Family studies show that the Huntington's disease gene is linked to a polymorphic DNA marker that maps to human chromosome 4. The chromosomal localization of the Huntington's disease gene is the first step in using recombinant DNA technology to identify the primary genetic defect in this disorder.

Chromosome Mapping↗
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Style self-incompatibility gene products of Nicotiana alata are ribonucleases.

Self-incompatibility in flowering plants is often controlled by a single nuclear gene (the S-gene) having several alleles. This gene prevents fertilization by self-pollen or by pollen bearing either of the two S-alleles expressed in the style. Sequence analysis shows that three alleles of the S gene of Nicotiana alata encode style glycoproteins with regions of defined homology. Two of the homologous regions also show precise homology with ribonucleases T2 (ref. 4) and Rh (ref. 5). We report here that glycoproteins corresponding to the S1, S2, S3, S6 and S7 alleles isolated from style extracts of N. alata are ribonucleases. These style S-gene-encoded glycoproteins account for most of the ribonuclease activity recovered from style extracts. The ribonuclease specific activity of style extracts of the self-incompatible species N. alata is 100-1,000-fold higher than that of the related self-compatible species N. tabacum. These observations implicate ribonuclease activity in the mechanism of gametophytic self-incompatibility.

Alleles↗
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Unplanned hospital readmissions: a home care perspective.

BACKGROUND: The extensive literature concerning hospital readmissions is grounded in a medical or hospital perspective, and fails to address hospital readmissions during home care. OBJECTIVES: To describe clients who have unplanned returns to an inpatient setting during the first 100 days of home care service delivery. METHOD: Using the Hospital Readmission Inventory (HRI), an audit tool with previously established validity and reliability, 916 medical records for clients from 11 midwestern home care agencies were reviewed retrospectively. RESULTS: Typically, clients were referred for their first home care admission after a 9-day hospital length of stay for a cardiovascular, respiratory, or neoplastic disorder. After an average 18-day length home care stay, clients were readmitted to the hospital, usually due to the development of a new problem, or due to deterioration in health status related to the primary or to a secondary medical diagnosis. Significant respiratory, cardiovascular or GI symptoms were generally present at hospital readmission. Typically, readmitted clients were 75 year old married females, who had been able to care for themselves at home. At hospital readmission, home care nurses judged these clients to be moderately ill, and likely in need of acute care. CONCLUSIONS: Chronic illness appears to be the best indicator for hospital readmission. The crucial time period for hospital readmission during home care is the first 2-3 weeks following hospital discharge. Intensive study of home care service arrangements utilized by readmitted patients, as well as agency variations, are needed. Study findings concerning patients readmitted from home care point to similarities with rehospitalized patients generally. Findings may assist home care clinicians in targeting high risk patients who could benefit from interventions aimed at minimizing unplanned returns to the hospital.

Adolescent↗
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An assessment of discharge planning models: communication in referrals for home care.

A home care referral generated upon hospital discharge communicates essential patient care information, links service providers, and facilitates continuity of patient care. The literature however, reveals that communication efforts are often inadequate and may even fail in this system. The purpose of this research was to examine whether various discharge planning models employed by hospitals resulted in differences in the quantity and quality of communication about patients referred for home health care. Kelly and McClelland's (1985) typology of discharge planning models provided the framework for the study. Using instruments designed specifically for this project, six referring hospitals' functional discharge planning models were labeled and 300 closed home care records of referrals were reviewed to ascertain the amount and type of data transmitted. Results indicated that only slightly more than half of the data recommended by the literature was actually transferred and that data was primarily background in nature. The hospital discharge planning model did make a significant difference in the amount and type of data shared, with liaison nurses sending the greatest amount of data. However, both conceptually and in practice, the discharge planning models simply describe an allocation of responsibility among various health personnel. They are not operational models in the traditional sense.

Communication↗
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A comparison of nonthreaded, enhanced threaded, and Ellis fixation pins used in type I external skeletal fixators in dogs.

Three different pin types (Ellis, enhanced threaded, and nonthreaded) were used in type 1 external skeletal fixation after transverse osteotomy of the radius and ulna in 12 skeletally mature dogs. Dogs were placed into three groups of four dogs based on the pin type used. Axial extraction forces were determined for each of the pin types after 8 weeks of weight bearing (chronic study). Nine contralateral radii were used to determine axial extraction forces for nine of each pin type not subjected to weight bearing forces (acute study). The force required for extraction of the enhanced threaded and Ellis pins in the chronic and acute studies was not significantly different. The force required to extract the nonthreaded pins was significantly less than that required for the other two pin types. Ground reaction forces had returned to levels measured before surgery by 2 weeks after surgery in the enhanced threaded and Ellis pin groups, however, dogs in the nonthreaded pin group required 4 weeks until normal ground reaction forces were measured. Radiographic evaluations 1, 2, 4, 6, and 8 weeks after surgery showed no difference among groups in the number of pin tract radiolucencies, however, the enhanced threaded pins had caused more trans-cortical chip fractures than the other two pin types. None of the pins broke during the eight-week chronic study.

Animals↗
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Evaluation of pulse oximeter probes and probe placement in healthy dogs.

Placement of two different pulse oximeter probes, a finger (f) probe and a multisite (s) probe, was evaluated in six healthy, anesthetized beagles. Concurrent arterial blood gas values were compared to determine the most consistent (repeatable) and accurate (compared to calculated hemoglobin saturations) pulse oximeter probe and probe placement sites for subsequent use in awake dogs. Hemoglobin oxygen saturation was determined from arterial blood gas analysis (SaO2) and by pulse oximetry (SpO2) at full hemoglobin saturation (mean, 99.5% SaO2) and at moderate desaturation (mean, 92.9% SaO2). Each probe was evaluated with three independent readings at seven different body sites (Achilles, ear, flank, lip, tail, toe, and tongue). Values for SpO2 obtained with the s probe demonstrated a significant correlation with SaO2 values (p = 0.014, R = 0.712) compared to the SpO2 values obtained with the f probe (p = 0.108). The best probe placement sites for the clip-on probes in this study were on the lip and tongue using the s probe; however, the ear, tail, and toe may be acceptable sites in awake dogs using a probe which maintains good contact across these vascular beds.

Animals↗
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Extraskeletal osteosarcomas in dogs: a retrospective study of 169 cases (1986-1996).

Extraskeletal osteosarcomas (EOSs) are rare tumors that arise in various soft-tissue sites (e.g., gastrointestinal tract, subcutaneous tissue, spleen, liver, skin, kidney, urinary bladder, muscle, thyroid gland, eye, and mammary glands). Soft-tissue osteosarcomas (STOs) occur in older dogs with no sex predilection; beagles and rottweilers are at higher risk. Mammary gland osteosarcomas (MGOs) occur in older females; mixed-breed dogs, German shepherd dogs, and miniature poodles are at higher risk. The median survival time for cases with STO was 26 days, and the major cause of death was local recurrence (92%). The median survival time for cases with MGO was 90 days, and the major cause of death was pulmonary metastasis (62.5%).

Animals↗
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Feline osteosarcoma: 145 cases (1990-1995).

Feline osteosarcoma (OSA) is a rare tumor in cats. Ninety (62%) of feline OSAs detailed in this study arose from the skeleton, and 55 (38%) arose from extraskeletal sites. Fifty OSAs originated in the appendicular skeleton, and 40 OSAs originated in the axial skeleton. Extraskeletal OSA sites included subcutaneous sites (n=44), with an apparent prevalence for sites commonly used for vaccination. Other locations included ocular/orbital (n=4), oral (n=3), intestinal/omental (n=3), and mammary sites (n=1). Survival data was available for 74 cases. When considered as a group, cats with either appendicular (mean, 11.8 mos) or extraskeletal (mean, 12.67 mos) OSA survived longer than those with axial (mean, 6.07 mos) OSA. Regardless of the type of feline OSA, aggressive surgical excision with or without ancillary therapy appeared to be the most effective form of treatment.

Animals↗
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Communication: an outcome of case management.

Case management is a healthcare delivery model emphasizing coordination and networking of patient care services across multidisciplinary providers and various care settings. This requires effective communication to overcome traditional barriers to information exchange. This study investigates communication as an outcome of case management. The classic communication model of sender-message-channel-receiver is used as a conceptual framework. Using a closed medical record review, the amount and type of referral information exchanged between a hospital using a case management model to coordinate care and a home health agency accepting the case-managed patient is described. In addition, the influence of selected organizational and medical condition factors on communication is explored.

Case Management↗