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PubMed2003

Addressing patient concerns about intravenous iron therapy.

Hemodialysis patients may not fully understand the relationship between anemia and kidney disease and the role of intravenous (i.v.) iron therapy in anemia management. To address this, nephrology nurses have willingly undertaken the role of patient educator in addition to technical expert. This responsibility is challenging because nurses need to understand the rationale for i.v. iron therapy and the efficacy and safety characteristics of the available i.v. iron therapies, which include iron dextran, iron sucrose, and sodium ferric gluconate. Nurses must then be able to effectively communicate this knowledge to their patients in an understandable fashion. This manuscript offers suggestions to nurses for approaches to address patient concerns about i.v. iron therapies, the latest information regarding the efficacy and safety of i.v. iron treatments, and strategies to communicate this information to patients.

Anemia, Iron-Deficiency↗
PubMed2003

Addressing the spiritual dimension in Canadian undergraduate nursing education.

The purpose of this study was to identify the extent to which the spiritual dimension is addressed in Canadian university undergraduate nursing curricula. An exploratory descriptive design was used to gather data from faculty members at Canadian university schools of nursing. Eighteen (62%) of the 29 eligible schools participated. The findings indicate that conceptual confusion exists and that the spiritual dimension is rarely defined or included in curricular objectives. However, they also indicate that the spiritual dimension is more frequently evident in course objectives and that a number of creative methods are used to address it. Testing in this area is sporadic and limited. The results indicate that greater attention could be given to this dimension.

Canada↗
PubMed2003

Addressing areas of common concern.

John Turnbull FREng introduces, in this article, three reports on various aspects of risk and engineering. The reports were produced by a number of working groups consisting of Fellows of The Royal Academy of Engineering and social scientists. Each addressed areas of common concern arising from a series of seminars on risk. The reports are titled "The Societal Aspects of Risk", "Common Methodologies for Risk Assessment & Management", and "Risks Posed by Humans in the Control Loop". The reports can be downloaded from The Royal Academy of Engineering's web site--www.raeng.org.uk Feedback on the reports is welcomed, and suggestions for addressing other areas of risk will be considered. Many of the recommendations considered in the reports are forming part of an ongoing work programme in this area.

Engineering↗
PubMed2003

A specialty organization addresses the nursing shortage.

The Association of periOperative Registered Nurses (AORN) has committed organization resources to address the worsening shortage of qualified professional registered nurses in the operating room. Organizationally, the efforts have addressed assisting members to recruit new staff and provide orientation and educational experiences that prepare competent practitioners for this specialty. As well, the organization has developed educational programs, membership programs, and other services to support AORN members to develop mentoring relationships with students and new staff. Other organizational efforts include legislative activities and collaborative relationships with other organizations.

Curriculum↗
PubMed2004

Addressing the needs of patients with multiple chronic illnesses: the case of diabetes and depression.

OBJECTIVES: To review the literature on comorbid depression and diabetes (DM/D) and present a conceptual framework for integrating depression management with diabetes care in a managed care environment. STUDY DESIGN: Literature review. RESULTS: Depression affects diabetes management by 1) directly affecting patients' health-related quality of life, 2) reducing physical activity levels, 3) limiting adherence to self-care regimens, and 4) impairing patients' ability to communicate effectively with clinicians. Small randomized trials suggest that both antidepressant medication and cognitive behavioral therapies (CBTs) or related approaches may improve not only DM/D patients' depressive symptoms, but their physical health as well. CONCLUSIONS: An effective DM/D management strategy should include the following elements: 1) systematic identification of DM/D patients and quality-of-care reviews, 2) proactive patient monitoring between outpatient encounters, 3) intensive efforts to coordinate treatment across providers, 4) increased access to CBT or related therapies addressing patients' depressive symptoms and diabetes self care, and 5) an emphasis on promoting physical activity to address both depressive symptoms and physiologic dysregulation. The conceptual framework developed for the care of DM/D patients offers general insights into the management of patients with multiple chronic medical disorders

Antidepressive Agents↗
PubMed2004

The future of human embryonic stem cell research: addressing ethical conflict with responsible scientific research.

Embryonic stem (ES) cells have almost unlimited regenerative capacity and can potentially generate any body tissue. Hence they hold great promise for the cure of degenerative human diseases. But their derivation and the potential for misuse have raised a number of ethical issues. These ethical issues threaten to paralyze pubic funding for ES cell research, leaving experimentation in the hands of the private sector and precluding the public's ability to monitor practices, research alternatives, and effectively address the very ethical issues that are cause for concern in the first place. With new technology being inevitable, and the potential for abuse high, government must stay involved if the public is to play a role in shaping the direction of research. In this essay, I will define levels of ethical conflict that can be delineated by the anticipated advances in technology. From the urgent need to derive new ES cell lines with existing technology, to the most far-reaching goal of deriving genetically identical tissues from an adult patients cells, technology-specific ethical dilemmas can be defined and addressed. This staged approach provides a solid ethical framework for moving forward with ES cell research. Moreover, by anticipating the moral conflicts to come, one can predict the types of scientific advances that could overcome these conflicts, and appropriately direct federal funding toward these goals to offset potentially less responsible research directives that will inevitably go forward via private or foreign funding.

Bioethics↗
PubMed2004

Characteristics of household addresses that repeatedly contact 911 to report intimate partner violence.

OBJECTIVES: To determine whether households that generate several 911 calls differ in important ways from those that make a single call and to determine whether households that generate repeat 911 calls for intimate partner violence (IPV) experience more severe violence than those that do not. METHODS: All cases of police-documented IPV were reviewed and linked with their respective 911 calls. Each incident report was reviewed to determine the relationship between the offender and victim, demographic characteristics of the offender and victim, weapon and substance involvement, prior incidents of IPV, and violence severity. RESULTS: Of the 1,505 IPV addresses identified during the 12-month study interval, 1,010 (67.1%) placed more than one phone call to report IPV. Sixty-nine percent of African American victims, 50.6% of white victims, and 36.8% of Hispanic victims were repeat callers (p < 0.001). There were no differences between addresses that generated repeat calls versus single calls with respect to offender alcohol or drug involvement, presence of children, victim age, or offender age. Sixty-seven percent of households with severe violence and 66.9% of households with minor violence generated repeat 911 calls (p = 0.98). CONCLUSIONS: Ethnic differences in 911 use for IPV exist between African Americans, whites, and Hispanics. However, unknown societal, economic, or cultural issues could have influenced this finding. Households that repeatedly contacted 911 during the study interval to report IPV were not more likely to experience severe violence than those that placed a single 911 call.

Black or African American↗
PubMed2004

Addressing health disparities through dental-medical collaborations, Part III: Leadership for the public good.

This is the third in a series of articles featuring dental-medical collaborations to reduce oral health disparities. Previous articles have targeted disparities among children, the elderly, and those with mental retardation and developmental disabilities and the importance of cultural factors in health disparities. Articles in this third group describe projects that originated in the public health sector or utilize public health approaches. They include training of non-dental providers and Head Start/Early Head Start workers in children's oral health promotion; case management to ensure early preventive medical, dental, and developmental services for children; and a dental school-led outreach, training, and research effort to address oral cancer disparities. In this introductory article, we review lessons learned from the entire series of projects reported in these articles. The primary take-home message is that educational changes are needed in dental and medical training to better address oral health disparities. Other important lessons include the value of local or state-specific data, the need for partnerships with key stakeholders, and the role of financial incentives in leveraging change. We recommend more attention to outcome assessments in educational initiatives, greater partnering with families and patients, and utilization of change-management methodologies with systems, providers, and patients. We also advocate increased collaboration with the public health sector and bold leadership in dental education.

Adolescent↗
PubMed2004

Nutrition interventions to address cardiovascular outcomes in chronic kidney disease.

The high mortality in chronic kidney disease has been linked to cardiovascular risk and these patients are considered at high risk. Dietary intervention can directly address nutritional risk factors in lipid management, calcium-phorphorus balance, and body composition to reduce risk of cardiovascular disease. Nutrient intake can also indirectly address less overt risks of dental health, nutritional supplements, and compliance issues.

Cardiovascular Diseases↗
PubMed2005

Taking a comprehensive approach to addressing Minnesota's leading cause of death. Cancer Plan Minnesota 2005-2010.

Cancer is now the leading cause of death in Minnesota. Half of all Minnesotans will develop a potentially life-threatening cancer in their lifetime, and the number of people diagnosed with cancer is projected to increase by 22% between 2000 and 2010. In 2003, health care providers, health plan representatives, patient care advocates, public health professionals, members of volunteer organizations, and cancer researchers came together to begin crafting the state's first plan to address the full spectrum of cancer control--from prevention and early detection to treatment, palliative care, and survivorship. The resulting plan is intended to serve as a framework for action by policymakers, planners, health care providers, and others, and is grounded in the notion that better integration and coordination of cancer control activities and programs will result in more effective efforts to address the burden of cancer in Minnesota.

Cause of Death↗
PubMed2005

Perceptions and attitudes of athletic training students toward a course addressing psychological issues in rehabilitation.

In 1999, athletic training adopted new educational competencies and clinical proficiencies addressing the following domains: (1) risk management, (2) assessment and evaluation, (3) acute care, (4) general medical conditions and disabilities, (5) pathology of illness and injury, (6) pharmacologic aspects of injury and illness, (7) nutritional aspects of injury and illness, (8) therapeutic exercise, (9) therapeutic modalities, (10) health care administration, (11) professional development and responsibilities, and (12) psychosocial development and responsibilities. These newly adopted competencies and proficiencies have improved the academic preparation of future certified athletic trainers. However, the addition of the 12th domain, psychosocial development and responsibilities, still may not provide athletic training students with a thorough understanding of the complex issues surrounding psychological adjustment to injury. This research study examined athletic training students' perceptions and attitudes before and after completing a new course addressing psychological issues of injury.

Adult↗
PubMed2002

Addressing HIPAA across the continuum.

HIPAA is an issue in hospitals across the nation, but what about other kinds of facilities--such as long-term care, behavioral health, or home care organizations? They, too, need to address HIPAA. We asked three HIM professionals who work in these settings to briefly address how HIPAA is changing the way they work.

Confidentiality↗
PubMed2005

An approach to addressing ethical issues in a community-based risk assessment for HIV: a case from Chennai, India.

Community-based assessment of HIV prevalence and behavioural risk factors is the basis for deciding priorities of prevention and care programmes. Here, upholding the human rights of participants in assessment is of utmost importance. The objective of the paper was to describe the process of implementation of an epidemiological survey to assess HIV-related behavioural and biological factors in Chennai city in South India and to suggest an ethical framework for conducting similar assessment activities in developing-country settings. A survey was conducted with participation from residents (n=1,659) of low-income urban communities (slums) as part of a community-based HIV/STD-prevention trial. Administration of the survey was preceded by extensive community contact and household visits to inform community members about the trial and assessment activities. Formative research further strengthened rapport with community, highlighted community concerns, and identified HIV-related risk behaviours that informed questionnaire design. The process of obtaining informed consent began before assessment activities and provided an opportunity for individuals to discuss participation with their families and friends. Privacy during assessment, comprehensive follow-up care for those who tested positive for HIV/STDs, such as nutritional and prevention counselling, referral services for opportunistic infections, and antenatal-care options for pregnant women increased trust and credibility of the project. The sustained availability of trial staff to facilitate access to resources to address non-HIV/STD-related felt-needs further strengthened participation of the community members. These resources included liaison services with local government to obtain public services, such as water and electricity and resources, to address concerns, such as alcohol abuse and domestic violence. Based on this experience, an ethical framework is suggested for conducting HIV epidemiological risk assessment in developing countries. This framework discusses the role of community participation, transparent and comprehensive informed consent, timely dissemination of results, and access to follow-up care for those living with HIV/STDs.

Adolescent↗
PubMed2005

Handling intensity and the short- and long-term survival of elephant seals: addressing and quantifying research effects on wild animals.

This study addresses the consequences of repeated human handling on the survival of an endangered phocid, the southern elephant seal and the implications for wildlife research. Southern elephant seal pups were repeatedly handled during the first six weeks of their lives. The possibility that such anthropogenic research may have altered the very parameters that were being investigated is a topical and relevant study area that we address here. Our results show that there were no measurable effects on pups that were repeatedly handled and subjected to invasive research methods with respect to survivorship in the short term (the 24-day nursing period) nor in the long term (the first year of life and beyond) and hence fitness one year after handling. In support of this conclusion we were unable to detect any significant differences in the survival rates of the most intensively handled seals and the least intensively handled seals.

Animals↗
PubMed2004

Addressing the cancer control needs of Pacific Islanders: experience of the Pacific Islander Cancer Control Network.

PURPOSE: This paper describes the accomplishments of the Pacific Islander Cancer Control Network (PICCN). PICCN's objectives fall under two broad categories: increasing cancer awareness and enhancing cancer control research among Samoans, Tongans, and Chamorros. METHODS: PICCN established an infrastructure for addressing the goals that include the University of California, Irvine; the UCI Chao Family Comprehensive Cancer Center; and community-based organizations (CBOs) in areas where large numbers of Pacific Islanders live. Activities that increase cancer awareness include assessing existing cancer education materials, developing new culturally-sensitive materials, and distributing the materials in a culturally-sensitive manner. Activities that enhance cancer control research include training Pacific Islander investigators and providing them with mentors to help with the development of research projects. RESULTS: During the four project years, PICCN has conducted more than 180 cancer awareness activities in its six study sites: Carson, CA; San Mateo, CA; San Diego, CA; Salt Lake City, UT; American Samoa; and Guam. PICCN members have also participated in conferences and lead discussions about the importance of clinical trials for Pacific Islanders. In addition, the Network has trained nine Pacific Islander investigators (three individuals from each ethnic group) in its cancer control academy. Finally, PICCN investigators are conducting pilot research projects that will answer important questions regarding the cancer control needs of these Pacific Islanders and set the stage for interventions aimed at addressing the needs. CONCLUSION: PICCN is advancing the national goal of eliminating cancer-related health disparities through its cancer awareness and research activities for Pacific Islanders.

American Samoa↗
PubMed2006

Addressing intimate partner violence in primary care: lessons from chronic illness management.

Though many studies have documented the high prevalence, morbidity, mortality and costs attributable to intimate partner violence (IPV), it is still unclear how our health care system should address this major public health problem. Many have advocated for routine screening, yet there is still insufficient evidence that routine IPV screening can lead to improved outcomes. Though recognition of IPV is very important, a screening paradigm may not be the optimal way to approach IPV within the health care system. For many patients, exposure to violence is a chronic condition, characterized by long-term abusive relationships, histories of childhood and community violence, multiple associated chronic symptoms, and extra barriers to addressing their other chronic illnesses. Thus, there may be important lessons to be learned from work being done in the area of chronic care. We explore how Wagner's Chronic Care model may guide efforts to improve health care for IPV survivors and may serve as a framework for future research studies.

Adult↗
PubMed2006

Supporting wellness through policy and advocacy: a case history of a working group in a community partnership initiative to address depression.

This paper describes the implementation of a collaborative project with community and academic partners in Los Angeles, focusing on the experiences of the Supporting Wellness (SW) working group in a depression outreach/ education initiative (the Witness for Wellness project). The first-year activities of the SW group involved infrastructure development to prepare for policy and advocacy work. Scribe notes from monthly meetings along with the authors' observations are the primary source of data for this article. One of the major accomplishments of the group was to obtain a position on a countywide stakeholder committee that makes recommendations to policymakers on mental health spending for the county. One significant challenge for the academic group members has been providing guidance and support for potential research projects. Although community partnerships with academia are a potentially useful approach for developing health interventions to address community needs and priorities, the experiences of this group illustrate that a substantial amount of time is required to develop the infrastructure for efforts to be successful. In addition, we learned the "community perspective" is essential to developing interventions that can address barriers to depression care that are unique to communities with high numbers of under-served, unserved, and inappropriately served residents.

Community Mental Health Services↗
PubMed2006

Minimal intervention dentistry: part 2. Strategies for addressing restorative challenges in older patients.

Minimal intervention dentistry (MID), a modern, evidence-based approach to caries management in dentate patients, uses a medical model whereby disease is controlled by the "oral physician" and an affiliated dental team. Geriatric MID helps clinicians to address the ever-increasing restorative challenges presented by older patients, including erosion, abrasion, demineralization, rampant coronal and root caries, retained roots, recurrent caries (necessitating crowns and other repairs), subgingival caries, "wet" oral environments, salivary dysfunction, disruptive behaviours, poor compliance with preventive care, high plaque levels, and financial and other restrictions on care options. The main components of a geriatric approach to MID are assessment of the risk of disease, with a focus on early detection and prevention; external and internal remineralization; use of a range of restorations, dental materials, and equipment; and surgical intervention only when required and only after disease has been controlled. This second in a series of 2 articles describes direct restorative strategies to address the challenges of geriatric caries management, including choice of material, placement of glass ionomers, sandwich technique, techniques for the management of erosion and abrasion, tunnel and slot preparations, techniques for "wet" subgingival environments, vital pulp therapy and geriatric atraumatic restorative technique.

Aged↗