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PubMed2002

John M. Eisenberg Patient Safety Awards. System innovation: Concord Hospital.

BACKGROUND: The Cardiac Surgery Program at Concord Hospital (Concord, NH) restructured clinical teamwork for improved safety and effectiveness on the basis of theory and practice from human factors science, aviation safety, and high-reliability organization theory. A team-based, collaborative rounds process--the Concord Collaborative Care Model--that involved use of a structured communications protocol was conducted daily at each patient's bedside. METHODS: The entire care team agreed to meet at the same time each day (8:45 AM to 9:30 AM) to share information and develop a plan of care for each patient, with patient and family members as active participants. The cardiac surgery team developed a structured communications protocol adapted from human factors science. To provide a forum for discussion of team goals and progress and to address system-level concerns, a biweekly system rounds process was established. RESULTS: Following implementation of collaborative rounds, mortality of Concord Hospital's cardiac surgery patients declined significantly from expected rates. Satisfaction rates of open heart patients scores were consistently in the 97th-99th percentile nationally. A quality of work life survey indicated that in every category, providers expressed greater satisfaction with the collaborative care process than with the traditional rounds process. Practice patterns in the Cardiac Surgery Program at Concord Hospital have changed to a much more collaborative and participatory process, with improved outcomes, happier patients, and more satisfied practitioners. A culture of continuous program improvement has been implemented that continues to evolve and produce benefits.

Awards and Prizes↗

PubMed1995

Determinants of infant mortality in Malawi: an analysis to control for death clustering within families.

The 1988 Malawi Traditional and Modern Methods of Child Spacing Survey data are used to identify determinants of infant mortality in Malawi. The logistic binomial analysis shows that socioeconomic factors are significant even during the neonatal period while the length of the preceding birth interval is significant in the post-neonatal period only. There is a strong familial correlation of mortality risks during both the neonatal and post-neonatal periods but the effect of geographical area of residence is stronger in the post-neonatal period.

Adult↗

PubMed1993

Contraception in women older than 40 years of age.

Women older than 40 years have high rates of unwanted pregnancy and abortion and traditionally have had limited choices of contraception agents. In today's market, oral contraceptives should be considered as should IUDs in properly screened candidates. Sterilization is effective for the couple who knows that they will have no more children. Mechanical methods are effective if used when intercourse tends to be a planned event and infrequent. With the variety of agents available in today's market, there is no reason why the unwanted pregnancy rate and abortion rate of the women older than 40 should not be reduced dramatically.

Adult↗

PubMedDate not supplied

Knowledge of reproductive physiology and modern contraceptives in rural Peru.

This report is based on fieldwork conducted in a Peruvian community in 1986, which investigated Quechua-speaking Indians' knowledge of the female reproductive organs, perceptions of the way contraceptives work in the body, folk beliefs about conception and menstruation, and opinions about modern contraceptives. The findings reveal that the men have a more accurate knowledge of the female reproductive organs than the women do. However, the women are more knowledgeable about the action of modern contraceptives in the body. Most respondents perceived modern contraceptive methods as the best methods available, but the majority reported using the calendar rhythm method. This preference for rhythm is based on its economic advantage and on its adaptability to folk beliefs about physiology. The men's dominant role in reproductive behavior is related to cultural norms that emphasize traditional gender roles and that prohibit communication about sexual matters between men and women. Educational material, based on the respondents' knowledge of reproduction and taking into account their folk beliefs, might help to decrease the fear of contraceptive side effects and increase understanding of the function of contraceptives.

Contraceptive Agents, Female↗

PubMed1977

The snare method of laparoscopic sterilization: an analysis of 1,000 cases with 4 failures.

The snare method has proven to be an effective method of tubal resection for sterilization. In the most experienced hands, significant complications are indeed rare. However, the failure rate appears to be higher than that of the coagulation-alone method, at least in the postabortal patient. The necessity for pathologic confirmation, a tradition of surgery, is critically questioned. Additional coagulation of the tubal ends after resection is now recommended, especially in the patient seeking abortion as well as sterilization. The authors await the comparative long-term results of bipolar forceps and the newer mechanical methods of laparoscopic tubal sterilization. It is conceivable that the snare and other unipolar electrosurgical instruments designed for female sterilization will become obsolete.

Adolescent↗

PubMed1991

Health workers' attitudes can create communication barriers.

In Sudan's South White Nile Province the development of a communication strategy for the diarrhoeal disease programme was preceded by the collection of data from community members and health personnel. A majority of health workers had only a limited knowledge of the community's methods of dealing with diarrhoea. Most of these workers had very negative attitudes towards mothers and home interventions. This information was vital for planning a comprehensive educational scheme for both health workers and communities.

Attitude of Health Personnel↗

PubMed1998

Postpartum contraceptive use in Bangladesh: understanding users' perspectives.

Qualitative and quantitative data are used to explore postpartum contraceptive use in two populations in Bangladesh. Findings from in-depth interviews with contraceptive users illustrate that women are primarily concerned with their own and their newborn child's health and well-being in the period following childbirth. In addition, women are aware of a diminished risk of pregnancy during the period of postpartum amenorrhea. These perceptions, plus a belief that modern methods of contraception are "strong" and potentially damaging to health, mean that the majority of women are reluctant to adopt family planning methods soon after birth, despite a desire to avoid closely spaced pregnancies. Supplementation of the child's diet is also shown to be an important factor determining the timing of postpartum contraceptive initiation. The findings suggest that current policies promoting contraception to women in the immediate postpartum period are inappropriate for many Bangladeshi women.

Adolescent↗

PubMed1997

Ovarian pregnancy; relationship to an intrauterine device.

Ovarian pregnancy is a rare form of ectopic pregnancy in which the gestational sac is implanted within the ovary. The incidence is 0.5 to 3% of all ectopic gestations. In contrast to patients with tubal pregnancies, traditional risk factors, such as pelvic inflammatory disease and prior surgical procedure upon the pelvis, may not play a role in the aetiology. In the 2 cases reported here, it seems that using an intrauterine contraceptive device was an important factor.

Adult↗

PubMed2004

The "every child deserves a medical home" training program: more than a traditional continuing medical education course.

OBJECTIVES: 1) To develop and implement an innovative, interactive, and nontraditional continuing medical education (CME) curriculum to educate primary care physicians, pediatric office staff, child health advocates, allied health care professionals, and parents of children with special health care needs (CSHCN) about the medical home concept of care and 2) to identify key partners in communities to plan the CME program and ultimately plan for fostering medical homes at the community and state levels. METHODS: Participant outcomes for the CME program and planning process include 1) explaining the elements of the medical home concept as applied to their practice environment or child's care; 2) understanding the concepts, skills, and information necessary to care successfully for CSHCN who are enrolled in managed care organizations; 3) accurately describing trends and developments in caring for CSHCN; 4) identifying programs in the community that serve CSHCN; and 5) assessing and, if necessary, improving pediatric office practices to ensure that they are sensitive to families of children and youths with special health care needs. CONCLUSION: A diverse national committee that included physicians, nonphysicians, and family members developed the Medical Home Training Program curriculum. The medical home curriculum was written to meet the needs of the local community. The training program can offer CME credit and use a direct, outcome-based adult learning technique (eg, determine short- and long-term goals). Furthermore, the program parallels and complements the Healthy People 2010 goals and objectives.

Child↗

PubMed1992

Health needs of a suburban community: a nursing assessment approach.

Community health nursing can play an important role in conducting community needs assessments that provide critical data upon which programming, planning, and evaluation should be based. The community health services developed for any given community should be planned with the specific needs of the community residents in mind. A community needs survey is one method that should be periodically employed to ascertain the specific needs and concerns of community residents. Nursing conceptual models developed by CHNs are very appropriate to the assessment of all aspects of community life related to health and well-being. Comprehensive community needs surveys should include assessment of environmental, psychosocial, and physiological aspects of health as well as indicators of health-related behaviors in the population. The Omaha classification system adapted for this study provides a broad conceptual framework that facilitates the development of comprehensive programs of assessment. Public health services are in a state of crisis in many states. Traditional program offerings may no longer be the key to providing the types of services most needed by some communities. Analysis of data on problems related to personal and family well-being in one upper middle class suburban community indicate a need for health promotion and services focused on many of the psychosocial aspects of health. The stress experienced by younger community residents appears to be related to issues of parenting and balancing the dual roles required at work and home. Families of elders are also confronted by issues concerning the decreasing independence of these individuals and the need to find additional support services for them. Community health services must be designed that take these factors into account. Professional nurses can provide the leadership necessary to assess health needs and current public health practices in these communities and to recommend and implement programs appropriate to the needs of the present and the goals of the future.

Adult↗

PubMed1979

A comparison of gross and microsurgical techniques for repair of cornual occlusion in infertility: a retrospective study, 1968-1978.

A 10-year experience is recounted moving from traditional gross implantation methods to microsurgical anastomosis in the repair of cornual occlusion in infertility. Two gross surgical implantation techniques, one involving reaming out the intramural portion of the uterine tube and the other dissecting it out via a transfundal incision, are compared with microsurgical uterotubal anastomosis. The author reports a 4.7 times improvement in the term pregnancy rate after turning to microsurgery and describes his method for anastomosing the transected ampulla or isthmus to the intramural portion of the tube.

Fallopian Tubes↗

PubMedDate not supplied

[Elderly women with reference to professional careers: life expectations and coping patterns].

Recent studies of retirement-patterns often concentrated on men's lives. Especially in this field of research, we have to be aware of a "gender-bias". The intention of this study is to correct this omission. The interaction between cognitive and motivational variables within the person and biographical factors were investigated. 106 women born between 1923 and 1933 participated at the follow-up study with three different measurement points. The investigation was realized by using the biographical method developed by H. Thomae. From the biographical background of the women, we could point to close associations between attitudes, motivations, and plans developed during the occupational career and coping-patterns in the process of retirement. Very strong intragroup differences were found. The process of dealing with retirement varies among women, depending on different life-perspectives. The life-perspectives depend upon biographically developed self-definitions and life-interpretations during life-course. In general, the results show that lifelong employment does not necessarily lead to a turning away from traditional gender-biased stereotypes and to a change in the identity of elderly former employed women.

Adaptation, Psychological↗

PubMed2000

Pregnancy intention and pregnancy happiness: are they different?

OBJECTIVES: This study examines the relationship among pregnancy intention and attitudes, inconsistent contraceptive use, and plans for potential pregnancy among 311 women who presented at local health departments to seek a pregnancy test and for whom a pregnancy would be unintended. METHODS: Women were surveyed prior to receiving pregnancy tests. Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies. Frequency distributions and chi-square tests were computed to examine and compare rates of happiness about the pregnancy among women with mistimed or unwanted pregnancy and to compare rates of inconsistent contraceptive use and plans for the pregnancy by intention and level of happiness. RESULTS: Although all of the women selected for our sample stated that their pregnancies would be unintended, almost half (46%) were inconsistent contraceptive users. Further, 48% reported that they would be somewhat or very happy about a pregnancy. The proportion of women who were uncertain about the future of a pregnancy and who considered adoption or abortion was highest among those for whom a potential pregnancy was mistimed and who were unhappy about the pregnancy. CONCLUSIONS: Differentiating between pregnancy intention and happiness has practice implications for family planning and prenatal providers. Additional research should further elaborate these distinctions.

Abortion, Induced↗

PubMed2004

Experience of parenthood, couple relationship, social support, and child-rearing goals in planned lesbian mother families.

BACKGROUND: The phenomenon of planned lesbian families (i.e., two-mother families in which the child was born to the lesbian relationship) is relatively new and very little research has been conducted among those families. The overall aim of this research was to examine whether planned lesbian mother families differ from heterosexual families on factors that are assumed to influence the parent-child relationship, such as experience of parenthood, child-rearing goals, couple relationship, and social support. METHOD: A hundred lesbian two-mother families were compared with 100 heterosexual families having naturally conceived children. A variety of measures were used to collect the data, including questionnaires and a diary of activities kept by the parents. RESULTS: Lesbian parents are no less competent or more burdened than heterosexual parents. Both lesbian and heterosexual parents consider it important to develop qualities of independence in their child. However, 'conformity' as a child-rearing goal is less important to lesbian mothers. Furthermore, lesbian social mothers feel more often than fathers in heterosexual families that they must justify the quality of their parenthood. CONCLUSION: There are few differences between lesbian couples and heterosexual couples, except that lesbian mothers appear less attuned to traditional child-rearing goals and lesbian social mothers appear more to defend their position as mother.

Adult↗

PubMed2000

[Resource diagnosis with children].

Traditionally the task of diagnosis in psychotherapy with children is the description of the disturbed behavior and the analysis of its causes. But the deficit-oriented perspective leads as a rule to a neglection of the clients', positive potentials, whose inquiry and therapeutic use for the success of therapy is however, following new findings of therapeutic effect research, of eminent significance. By this article a concept of resource diagnosis is introduced that demonstrates by several examples from the practice different methods of resource analysis with children based on a resource taxonomy. Finally a detailed case presentation illustrates the enlarged possibilities which are offered by the combined application of deficit and resource analytic results for therapy planning and intervention.

Absenteeism↗

PubMed1989

Measuring the quality and duration of contraceptive use: an overview of new approaches.

This paper provides an overview of recently developed approaches to the measurement of contraceptive continuation and failure rates, using retrospective survey data rather than the data from clinical trials or program statistics which are more traditionally used. The approaches fall into 2 categories, 1 relying on retrospective contraceptive histories and the other on current status information. The 1st section of the paper discusses the need for new methodologies; conventional applications using clinic and acceptor data are described, some recent results from developed countries presented, and their limitations illustrated. In the 2nd section, each new approach is presented in terms of its data requirements, methods of calculation, and empirical applications. Finally, potential sources of bias and the ability of the approaches to accommodate them are discussed.

Bias↗

PubMed1994

Religious affiliation and fertility in Liberia.

This study examines fertility differentials by religious affiliation in Liberia, within the context of two competing hypotheses: the characteristic and particularised theology. Using a subsample of currently married women from the 1986 Liberian Demographic and Health Survey, the study examines the fertility of five religious groups: Catholic, Protestant, Moslem, traditional, and other women. Overall, the findings are more consistent with the characteristic hypothesis, because the small fertility differentials by religious affiliation are largely accounted for by differences in the socioeconomic and demographic characteristics of these women.

Adolescent↗

PubMedDate not supplied

Patient priorities and needs for diabetes care among urban African American adults.

PURPOSE: This study was conducted to determine diabetes care priorities and needs in a group of urban African American adults with type 2 diabetes mellitus. METHODS: One hundred nineteen African American adults with type 2 diabetes, aged 35 to 75, received behavioral/educational interventions from a nurse case manager, a community health worker, or both. Priorities and needs were assessed during 3 intervention visits. RESULTS: The most frequently reported priorities for diabetes care were glucose self-monitoring (61%), medication adherence (47%), and healthy eating (36%). The most frequently addressed diabetes needs were glucose self-monitoring and medication adherence. Most of the intervention visits (77%) addressed non-diabetes-related health issues such as cardiovascular disease (36%) and social issues such as family responsibilities (30%). CONCLUSIONS: Participants' self-reported priorities for diabetes care directly reflected the diabetes needs addressed. Needs beyond the focus of traditional diabetes care (social issues and insurance) are important to address in urban African Americans with type 2 diabetes. Interventions designed to address comprehensive health and social needs should be included in treatment and educational plans for this population.

Adult↗