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Biomedical subjects

M D Harris

Publications and source records attributed to M D Harris.

At least 109 records · Page 6Linked to original sources
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Effect of dehydroepiandrosterone on mitogen-induced lymphocyte proliferation and cytokine production in young and old F344 rats.

The steroid hormone intermediate, dehydroepiandrosterone (DHEA), has been proposed as a therapeutic agent for the treatment of immunosenescence in mouse model. In the present study, the in vitro effect of DHEA on mitogen-induced lymphocyte proliferation and cytokine production was evaluated in a rat model. Spleen lymphocytes were isolated from young (4-6 months) and old (24-26 months) F344 rats and were incubated with DHEA for 30 min. The induction of lymphocyte proliferation, interleukin-2 (IL-2), and interferon-gamma (IFN-gamma) production by concanavalin A (Con A) was measured in a culture medium supplemented with either fetal calf serum (FCS) or with serum-free medium (Nutridoma-SR, N-SR). The induction of lymphocyte proliferation and IL-2 production by Con A decreased significantly with age, whereas induction of IFN-gamma increased with age. Treatment of lymphocytes with DHEA did not significantly alter Con A-induced proliferation or the production of IL-2 or IFN-gamma by spleen lymphocytes isolated from either young or old rats. These data indicate that in vitro DHEA treatment appears to have no immunomodulatory effect on the age-related changes in mitogen-induced proliferation or cytokine production in rat lymphocytes.

Aging↗
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The impact of one federal regulation on productivity in a home health agency.

One major factor with potential impact on improved staff productivity was the introduction of Medicare's Physician's Plan of Treatment forms 485, 486, and 487 in September 1985 and the revised forms in the spring of 1988. To assess the impact of these forms on the AV/D, statistics were compared over a period of time. Data support the general impression that there was a drop in visits per day and an increase in office time with the introduction of the new forms.

Documentation↗
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The physician connection.

The home health care nurse is a vital link between the patient and physician when home care is needed. The sharing of information related to the clinical, administrative, and regulatory aspects of home care benefits the patient, the physician, the nurse, and the home health agency.

Communication↗
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Nursing research in home health agencies.

It is appropriate and feasible for home care agencies to conduct research. They have a ready population and sample. Many aspects of home care need to be studied to improve the quality of care and the quality of life. The rewards of research can more than justify the burdens. The practical benefits are the strengthening of staff knowledge and expertise through exposure to the process of investigation and to the clinical applications and implications of the findings. The bottom line will be improved patient care.

Data Collection↗
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The ethical dilemmas.

This column has posed the issues and identified resources that home care nurses can use in an attempt to resolve the moral, social, economic, and professional factors that are confronted each day. Ethical dilemmas have been presented. The editor and I invite you to share your success (or lack of it) in resolving the issues you have experienced in caring for your patients. We look forward to hearing from you in an effort to benefit from your experiences.

American Nurses' Association↗
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Medicare and the nurse. The peer review organization (PRO).

The PRO process is just one of the many reviews that HHAs are subjected to at any given time. On a practical level, HHA should incorporate PRO criteria and GQSs into its QA program. At present, there is no mechanism in place for denial of payment for substandard care, although proposed regulations were published in the January 18, 1989 Federal Register. Medicare certification, and therefore payment, could be lost if the facility or HHA were sanctioned. The Medicare law requires PROs to coordinate their activities with other review organizations. HCFA, however, has not established procedures for providing reports from fiscal intermediaries and PROs to the state survey agencies or coordinating state surveys with PRO reviews. HHAs should have structure and process criteria in place (either manual or computerized) to identify selected records for review. This enables the agency to monitor its internal quality assurance activities so that it has confidence that the GQSs will be met when reviewed by external agencies, including the PRO. This internal monitoring will also enable the agency to document patient outcomes. This is an important aspect of the evaluation process, since the emphasis of certification and accreditation programs and site visits will be focused on patient outcomes in the 1990s.

Home Care Services↗
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Structure and process criteria assist with goal attainment.

The GQSs can be considered both structural and process criteria. These screens provide the framework and activities that help to identify patient outcomes. When both components are in place, the agency will be in a position to utilize multiple methods to identify and measure patient outcomes. Home health agency administrators, supervisors, and staff must strive for excellence in all aspects of home healthcare. A commitment to quality from the standpoint of structure, process, and outcome criteria by all members of the home care team will enable the staff and agency to meet all of the standards and regulations imposed by the Medicare Conditions of Participation, accrediting and licensing agencies, PROs, professional, agency, and individual standards.

Home Care Services↗
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Angels of the hospice.

Explore the source record for details and available documents.

Community Health Nursing↗
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Educating and orienting nurses for home healthcare.

Orientation to the specialty of home healthcare nursing in a Medicare-certified agency is not easy. In addition to clinical competency, the nurse must be able to document for and communicate with the fiscal intermediary. Documentation must be completed to meet the requirements of the site visitors from the site certifying agency as well as accrediting agencies. More recently, quality of care issues are of interest to the peer review organizations. Administrators, supervisors, and staff must be involved in this important process to attract and retain new as well as experienced nurses. A comprehensive orientation program that addresses the expectations of the agency as well as the external reviewing organizations and prepares the staff to meet these expectations is essential for providing quality home healthcare services.

Clinical Competence↗
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The revised survey process.

The implementation of the requirements of OBRA 87 has resulted in many changes for HHAs and home healthcare nurses. These include the patient bill of rights, training and competency evaluation of home healthcare aides, and the revised certification/recertification process. It is important that sound structural and process criteria be in place in an HHA. These will provide the foundation for successful site visits during which patient-focused outcomes can be identified. Increased knowledge should also decrease the nurses' apprehension about the revised process.

Accreditation↗