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PubMed1997

The effect of administered crystalloid fluid temperature on aural temperature of moderately and severely injured children.

OBJECTIVE: Warm intravenous fluid (W-IVF) administration is the standard of care to prevent hypothermia in injured adults. It is argued that such administration may not be helpful for treating injured children, because children often do not require as much intravenous fluid (i.v.f.) as adults. The purpose of this study was to compare the effects of W-i.v.f. to room temperature intravenous fluid (RT-i.v.f.) administration on aural temperature (Ta) in injured children during the first hour of trauma resuscitation. DESIGN: A randomized, controlled repeated-measures trial. SETTING: Emergency department, intensive care unit, and diagnostic areas in a level I pediatric trauma center. SAMPLE: Thirty moderately or severely injured children, ranging in age from 2 to 17 years (mean age = 8.9 years; SD = 4.4). METHODS: Eligible children were randomly assigned to receive either W-i.v.f. or RT-i.v.f. on ED arrival. Warmed IVF was administered with the Hotline fluid warmer (SIMS Level 1, Rockland, Mass). Aural temperatures were measured on arrival and every 10 minutes for 1 hour with a Core-Check Tympanic Thermometer (IVAC Medical Systems, San Diego, Calif). The level of significance for hypothesis testing was set at 0.05 (two-tailed). RESULTS: Groups were comparable in age, gender, weight, amount of infused i.v.f., Revised Trauma Score, room temperature, and baseline Ta. On average, Ta for the W-i.v.f. group increased by 0.25 degree C from baseline to final Ta, whereas Ta for the RT-i.v.f. group decreased by 0.32 degree C from baseline to final Ta. Repeated-measures analysis of covariance, treating baseline Ta as a covariate, demonstrated that Ta response profiles were similar (p = 0.06). CONCLUSIONS: When comparing the changes between baseline and final Ta for the W-i.v.f. and RT-i.v.f. groups, the standardized difference in temperature change was 0.62. Although results of the repeated measures analysis of covariance were not statistically significant, the standardized difference in temperature changes was large enough to warrant administration of W-i.v.f., even at slow flow rates, to prevent hypothermia in injured children.

Adolescent↗

PubMedDate not supplied

A preliminary study of staff perception of psychiatric services in general hospitals.

There has been increasing recognition of the importance of integrating physical and psychiatric care under growing economic pressure. We conducted a survey of staff perception on psychiatric services in four general hospitals. The purpose of this study was to see differences among the staff in their recognition and expectation of the role of the psychiatric department and the need for psychiatric and other staff to work more closely together. Although 81% of psychiatrists recognized their role in acute psychiatry, only 42.6% thought that acute psychiatry was the most important role of psychiatry. Mood disorders were recognized as a psychiatric category in 95.2% of psychiatrists and 54.8% of nonpsychiatrist physicians. Overall satisfaction with psychiatric services in psychiatric and other staff were 54.0% and 68.2%, respectively. Although 85.7% of psychiatrists answered that they supported staff in other departments that have psychiatric or psychological problems, only 53.5% of those staff in other departments were satisfied with their support. Staff in other departments expected psychiatric staff to establish consultation hotlines and to visit other departments regularly. Our results suggest that there are discrepancies between psychiatric and other staff in their perception of psychiatric services, and it is our belief that those gaps must be bridged for better collaboration in general hospitals.

Attitude of Health Personnel↗

PubMed1997

Management of suicidal behavior in children and adolescents.

Many therapeutic approaches to managing suicidal behavior among youth have been used, including in-school education programs, screening programs, telephone hotlines, cognitive behavioral therapies, medication management, and inpatient milieux treatment programs. These interventions have been applied based on educational and therapeutic principles drawn from prior work with adolescents in varied scholastic and psychiatric settings. This article reviews: the assessment of risk factors among suicide attempters, emotional states, family, social isolation, interpersonal loss, substance and alcohol abuse, and treatment strategies.

Adolescent↗

PubMed2000

Women's opinions about domestic violence screening and mandatory reporting.

BACKGROUND: The purpose of this paper is to describe women's opinions and policy preferences concerning domestic violence screening and mandatory reporting. METHODS: This case-control study included 202 abused women and 240 randomly selected non-abused women recruited from a large metropolitan health maintenance organization who were interviewed by telephone. Of these women, 46.6% had a college degree, 53.4% were white, and 60% had a household income of $50,000 or more. RESULTS: Forty-eight percent of the sample agreed that health care providers should routinely screen all women, with abused women 1.5 times more likely than non-abused women to support this policy. For mandatory reporting, 48% preferred that it be the woman's decision to report abuse to the police. Women thought it would be easier for abused women to get help with routine screening (86%) and mandatory reporting (73%), although concerns were raised about increased risk of abuse with both screening (43%) and reporting (52%) policies. Two thirds of the sample thought women would be less likely to tell their health care providers about abuse under a mandatory reporting policy. Interventions offered in managed care settings that would be well received, according to the women in this study, include counseling services, shelters, and confidential hotlines. CONCLUSIONS: Women expressed fears and concerns about negative consequences of routine screening and, even more so, for mandatory reporting. Domestic violence policies and protocols need to address the safety, autonomy, and confidentiality issues that concern women.

Adult↗

PubMed1995

The incident reporting system does not detect adverse drug events: a problem for quality improvement.

OBJECTIVES: The objectives of this study were 1) to determine the frequency with which adverse drug events result in an incident report (IR) in hospitalized patients; and 2) to determine if there were differences between quality assurance administrators, nurse leaders in quality assurance, and staff nurses as to whether an incident report should or would be filed for each adverse drug event. STUDY DESIGN: All patients admitted to five patient care units (one medical intensive care unit, two surgical intensive care units, and two medical general care units) in one academic tertiary care hospital were studied between February and July 1993. The main outcome measures used were adverse drug events (ADEs) and IRs. Consensus voting was used by senior hospital administrators, nursing leaders, and staff nurses to determine whether an adverse drug event should have been reported and would have been reported. RESULTS: Of 54 adverse drug events identified by the study, only 3 patients (6%) had a corresponding incident report submitted to the hospital's quality assurance program or called into the pharmacy hotline. One additional ADE was identified by an IR, but not by the ADE study. Of the 55 ADEs, 15 were preventable, and 26 were serious or life-threatening, yet only 2 of the 26 led to an incident report. The three voting groups agreed that most ADEs justified an IR, but judged that in actual practice, an IR would infrequently have been filed. CONCLUSIONS: Voluntary reporting identified only a small fraction of ADEs. Using IRs for quality assurance/quality improvement will lead to significant bias when assessing quality of care.

Adverse Drug Reaction Reporting Systems↗

PubMed1999

Heart failure update.

The RUSSLAN study, which randomised 504 patients with post-infarction heart failure in whom intravenous inotropic support might be deemed appropriate, was presented for the first time in a hotline session at the annual meeting of the Working Group on Heart Failure of the European Society of Cardiology. The study suggested that levosimendan, a new calcium sensitising agent, could be used safely in patients with post-infarction heart failure in the absence of severe hypotension and that it appeared to improve symptoms and survival. If these results can be confirmed it would render it unique among intravenous inotropic agents.

Blood Pressure↗

PubMedDate not supplied

Casting health messages in terms of responsibility for dietary change: increasing fruit and vegetable consumption.

OBJECTIVE: To compare the effectiveness of messages emphasizing the importance of either personal or social responsibility for dietary behavior change in increasing fruit and vegetable intake. DESIGN/SETTING: Randomly assigned individually or socially oriented messages were delivered at baseline, 1 week, and 2 and 3 months later. Telephone surveys were conducted at baseline and 1 and 4 months later. PARTICIPANTS: 528 callers to a cancer information hotline who were not meeting the "5 A Day" dietary recommendation. INTERVENTIONS: A brief telephone-delivered message and 3 mailings of pamphlets and promotional items encouraging fruit and vegetable intake that emphasized either personal or social responsibility. MAIN OUTCOME MEASURES: Fruit and vegetable intake 1 and 4 months post baseline. ANALYSIS: Chi-square, t tests, and analyses of variance and covariance. RESULTS: Both types of messages increased intake substantially (P =.01). To some extent, the social responsibility message continued to motivate increased intake over time compared with the personal responsibility message. CONCLUSIONS AND IMPLICATIONS: These minimal interventions had a substantial impact on fruit and vegetable intake. Health messages might be more effective over the longer term if they are designed to emphasize the importance of social responsibility, although further study is needed to confirm the robustness of these findings.

Female↗

PubMed2003

Pharmacy provision of emergency contraception: the Ontario emergency contraception pilot project.

OBJECTIVES: To develop and evaluate a program to provide emergency contraception (EC) directly in pharmacies that would recruit and train pharmacists and physician partners, and inform women about the availability of EC in pharmacies. METHODS: Pharmacists and physicians working in the Scarborough, Rexdale, and North York regions of Toronto were recruited to receive a training program on EC. The pharmacists in each pharmacy were linked with a designated physician who retrospectively authorized prescriptions provided under the protocol. Client eligibility for EC was determined using a self-administered questionnaire that was reviewed by the pharmacist. A poster and radio campaign advertised the service, and a telephone hotline informed users of their nearest participating pharmacy. Data on the client's age, reasons for requesting EC, time elapsed from intercourse until presentation, and requests for follow-up referral were analyzed using descriptive methodology. User satisfaction was determined through a mail-back questionnaire. RESULTS: A total of 146 pharmacists practising in 40 pharmacies were linked with 34 physicians. In the 1 year of the project, 6931 prescriptions for EC were provided. Fifty-four percent of the women accessed EC within 24 hours of intercourse. The majority of women were very satisfied with the service, and 21.1% indicated that had they not obtained EC in this way, they would not have obtained it elsewhere. More information about birth control was desired by 10.2% of the women. CONCLUSION: Direct pharmacist provision of EC is an effective pregnancy-prevention strategy that is well accepted by the women who access it.

Adolescent↗

PubMed2000

Reducing unintended pregnancy by increasing access to emergency contraceptive pills.

OBJECTIVES: National and state data on the health, social, and economic consequences of unintended pregnancy prompted Washington policy makers to identify strategies to reduce such pregnancies. Though not well known, emergency contraceptive pills (ECPs) are a safe and effective contraceptive method that can prevent pregnancy if taken within 72 hr after unprotected intercourse. A coalition conceived the idea of enabling pharmacists to prescribe ECPs directly to women through collaborative drug therapy agreements (CDTAs) with physicians. METHODS: Following a feasibility study, five agencies initiated a novel pilot project in western Washington. Key components included informing pharmacists about ECPs and CDTAs; developing tools, providing training, and developing systems to establish pharmacist/ prescriber collaborative agreements; conducting a public awareness campaign; evaluating the impact of the project; and disseminating the results. RESULTS: More than 1000 pharmacists received training in all aspects of providing ECPs and 140 pharmacies participated in the project, with more than 145 CDTA on file. In the 16 months of pharmacy service provision, 11,969 ECP prescriptions were provided, possibly preventing 700 or more unintended pregnancies. The media launch led to 200 broadcast stories and increased calls to the ECP Hotline from 116 to an average of 1160 per month. CONCLUSION: Enabling pharmacists to provide ECPs directly to women is a convenient delivery system for a time-limited therapy. It increases the chances that women will use the therapy effectively and connects women without a provider to a source of care. By increasing access to an effective contraceptive, this projects supports the Washington State goal of reducing unintended pregnancy.

Contraceptives, Postcoital↗

PubMed2002

What's in a condom?---HIV and sexual politics in Japan.

Utilizing a range of ethnographic data from an AIDS hotline, a women's shelter, a night club, AIDS campaigns, news articles, and interviews with health bureaucrats, this paper explores the history of AIDS in Japan and the ways in which official practices reproduce systems of domination. This paper examines the official categories of "foreign woman" and "prostitution" as discursive strategies of containment, and argues that nationalist discourses and representations of sexuality are closely linked in maintaining relations of power.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Receipt of home health care after early discharge: results from a national managed care organization.

OBJECTIVES: To determine the frequency of home visits during the postpartum period among women discharged within 24 hours after childbirth, to identify characteristics of women who received at least one home visit, and to examine whether a home visit was related to postpartum experiences. METHOD: Women who were enrolled in a Prudential HealthCare plan and had a recent normal vaginal delivery completed a 15-minute telephone survey (N = 5201). Only women who were discharged within 24 hours after delivery were included in this analysis (N = 3121). Selected variables, including maternal characteristics, pregnancy-related and postpartum experiences, and social support factors, were compared for women who received visits and those who did not receive visits within two weeks after delivery. RESULTS: Slightly more than 30% of women participating in the survey received at least one home health care visit within 2 weeks after delivery discharge. Women who received a home visit were more likely to be Black, employed, primaparous, enrolled in a health maintenance organization, or not living in the Southern United States. Compared with women who did not receive a home visit, women who received a visit were more likely to have their newborn receive a phenylketonuria test after discharge, receive a follow-up phone call or housekeeping service, and access to a 24-hour hotline. CONCLUSIONS: Managed care organizations as well as other organized systems of care should be focused on improving the quality of prenatal and postpartum services, and increasing satisfaction of women using these services.

Adult↗

PubMed2004

The impact of schools on juvenile substance initiation and use.

We use data from the two rounds of the NLSY97 and the corresponding QED data to examine the effectiveness of school endowments and curricula in targeting juvenile use of tobacco, alcohol, and marijuana. Our results support the notion that schools matter in reducing juvenile involvement in substance use. Higher discretionary dollars per pupil are linked to reduced rates of juvenile initiation and repetitive use rates of cigarettes and marijuana. Additionally, school curricula, as indicated by the implementation of year round classes and some innovative and after-school programs--such as gifted and talented, attendance monitoring, homework hotline, international baccalaureate, extended-day, and mentoring, programs, affect both juvenile initiation to tobacco and alcohol use and juvenile repetitive use of tobacco and alcohol. In particular, we find that juvenile initiation to cigarette use is approximately between 2 percentage points and 3 percentage points lower among youths attending schools with gifted and talented and international baccalaureate programs. In addition, juvenile repetitive cigarette use is approximately 54%, 52%, and 48% lower among youths attending schools offering year round classes, international baccalaureate, and twenty-first century programs, respectively. Finally, juvenile initiation to alcohol use and juvenile repetitive use of alcohol are approximately 3% and 20% lower, respectively, among youths in schools offering gifted and talented programs. In sum, while these programs are not implemented to address substance use problems among the student body, we find that the implementation of these programs is often accompanied by a reduction in juvenile initiation and repetitive substance use.

Adolescent↗

PubMed1999

Suicide prevention in adolescents and young adults: the Geneva University Hospitals' Program.

In Switzerland, suicide has become the leading cause of death among the 15- to 24-year-olds. All strategies aiming at preventing suicide are most challenging, but few have demonstrated efficacy. In Geneva, we founded a Unit for Suicide Prevention as a joint venture between the Geneva University Hospitals and a charitable foundation called "Children Action." Our prevention program duplicates prevention strategies that are known to be effective: tutorials for health professionals and postvention aimed at those who have been exposed to a suicide (or suicide attempt) of a family member or a friend. But it also introduces a new strategy: a hotline for all those in the community who are in contact with a suicidal adolescent. This paper describes our experiences.

Adolescent↗

PubMed2005

Matching health messages to monitor-blunter coping styles to motivate screening mammography.

This study examined whether providing messages matched to women's monitor-blunter coping styles is effective in encouraging mammography utilization. Female callers to a cancer information hotline were assessed at the end of their regular telephone call and classified as monitors or blunters. A randomly assigned message promoting mammography utilization, tailored for monitors or blunters, was delivered on the telephone, and a similarly tailored brochure and refrigerator magnet were mailed to participants immediately after their call. Women were telephoned 6 and 12 months later to determine whether they had obtained a mammogram. Messages matched to a woman's monitor-blunter coping style encouraged mammography after 6 months more effectively than mismatched messages and were significantly more effective for blunters but not for monitors.

Adaptation, Psychological↗

PubMed2000

Breastfeeding failure in a longitudinal post-partum maternal nutrition study in Hong Kong.

OBJECTIVE: To describe factors associated with breastfeeding failure during the first 6 months post-partum in a sample of Hong Kong Chinese women participating in a longitudinal study of maternal nutrition. METHODOLOGY: Forty-four Hong Kong Chinese lactating mothers who intended to breastfeed exclusively for at least 3 months were recruited and followed for 6 months post-partum. Demographic data were compared with 20 mothers who intended to use formula feeding. Mothers were followed up at 2 and 6 weeks and 3 and 6 months and details of infant feeding practices were obtained. Information was sought on breastfeeding management in hospital, reasons for discontinuation of breastfeeding or for providing supplements to babies and intention to seek, and sources of, lactation support. RESULTS: Thirty-nine mothers who planned to breastfeed completed the follow up. Compared with mothers in the formula-feeding group, breastfeeding mothers were more likely to be professionals or housewives. Continuation of any breastfeeding (total and partial) was noted in 30 (77%), 22 (57%), 16 (41%) and 12 (31%) mothers at 2 and 6 weeks and 3 and 6 months post-partum, respectively. The majority (97%) of mothers stated that they were given information on the benefits and management of breastfeeding. However, late initiation of breastfeeding and providing supplements to babies were common. Perceptions of insufficient milk supply (44%), breast problems (31%) and being too tired (28%) were the main reasons stated for stopping breastfeeding or for providing supplements to babies. Midwives from the postnatal wards and hotlines were the main sources of lactation support. CONCLUSIONS: These results highlight difficulties in sustaining breastfeeding, either exclusive or partial, in Hong Kong Chinese women. Despite being recruited on the basis of intending to exclusively breastfeed for 3 months, less than half these mothers were still breastfeeding and only approximately one-third were exclusively or predominantly breastfeeding at 3 months. More needs to be done within the hospital environment to initiate breastfeeding immediately after birth and to avoid giving unnecessary supplements and more effort is needed to foster a mother's confidence, commitment and knowledge of breastfeeding.

Adult↗

PubMedDate not supplied

Healthcare professionals' awareness of cancer support services.

PURPOSE: This study was conducted to provide baseline information about the awareness, attitude, and willingness of oncology healthcare providers (HCPs) to recommend quality-of-life cancer education and support services to their patients. DESCRIPTION OF STUDY: A brief survey questionnaire was mailed to a random sample of 2000 physicians, nurses, and social workers who were active members of their respective oncology associations. RESULTS: A total of 1241 questionnaires were returned (62% reply rate), resulting in a final sample of 1180 HCPs (61% response rate). Among HCPs who referred patients to cancer organizations, the American Cancer Society (ACS; 83%), the National Cancer Institute (NCI; 55%), and the Leukemia and Lymphoma Society ([formerly Leukemia Society of America] 42%) ranked at the top. More than 70% of HCPs indicated that they had heard about specific ACS programs and services or the NCI information hotline. Less than 60% of HCPs recommended or thought these same services were helpful to patients. Awareness, referrals, and attitudes toward cancer support services among HCPs were significantly related (P <.001). Qualitative comments qualified quantitative results. CLINICAL IMPLICATIONS: Although a surprising number of HCPs were aware of support services, fewer recommended or reported satisfaction with these services. HCPs' referrals and attitudes toward cancer psychosocial support services may be improved by assembling a concise directory of locally available resources, directing this information to HCPs who refer directly to cancer organizations, improving collaboration between agencies, increasing staff support, and targeting particular services in specific areas of the country for program monitoring and development.

Awareness↗

PubMed2000

[Model project for updating neonatal screening in Bavaria: concept and initial results].

The newborn screening programme in Bavaria was confronted with several problems. Number of disorders and process quality no longer complied with screening guidelines. Mixed financing, distributed between the state (PKU, galactosaemia) and health insurances (hypothyroidism) had promoted an increasing dissipation of the system. Notified participation rates had dropped to < 80%. Increasing need for a second screening due to early discharge was an additional challenge. To overcome these problems, and considering the availability of improved screening methodology (tandem mass spectrometry) the programme was reorganised. The project, which started on Jan 1, 1999, is based on a cooperation model between laboratory (logistics, analysis), universities (treatment, scientific evaluation), and public health services (coordination, tracking). Time of blood sampling was predated to the third day of life. Screening was extended to biotinidase deficiency, congenital adrenal hyperplasia (CAH) and by introduction of tandem mass spectrometry for screening of many other disorders (besides PKU). Insurances now finance complete laboratory analysis which was transferred to the private sector. To enable all newborn to participate, the names of screened children are matched against birth lists by public health services on a regional basis. Recalls and conspicuous results are consistently followed up until disorders are either excluded or confirmed. Two clinical hotlines were established in the children's hospitals of the universities in Munich (Southern Bavaria) and in Erlangen (Northern Bavaria). Written consent is required for participation in the programme. Participation in the new programme could be continually increased; coverage is > 95% since April. In several cases screening was made up for not tested children by contacting their parents. Omitted screening was mostly due to misunderstandings regarding testing responsibility or lost samples. Altogether 52 cases of disorder were found in the 87,000 newborn screened until August 1999. Hence, the detection rate of children affected by inborn errors of metabolism was about twice as high than before changes. Among the newly screened diseases CAH was detected most often (11 cases). In 22 cases diagnosis was based on the use of tandem mass spectrometry. Among these (besides PKU, 9 cases) MCAD deficiency (6 cases) was detected most frequently. Whereas recall rates of most disorders were < 0.1%, screening for CAH still revealed a high recall rate, particularly in premature births. Second screening due to early discharge (< 48 h) was required in 1.3%. About 20% of pending recalls required contacting birth hospitals, doctors, midwives or parents. So far all affected children could be brought to treatment in time.

Female↗

PubMed2000

[Value of reflecting disposable insulation (Thermodrape) in preventing perioperative hypothermia].

OBJECTIVE: The aim of the study was to evaluate the value of reflecting disposable insulation for the prevention of perioperative hypothermia. METHODS: After approval by the local ethics committee 36 patients undergoing long lasting urological intraabdominal surgery were studied. Anaesthesia was performed using etomidate, fentanyl, midazolam, pancuronium and succinylcholine. Patients were randomly assigned to 4 groups. These groups were treated as follows: Gr. 1: Infusion warmer (Hotline HL-90 with System L-70, Level 1 Technologies Inc., Marshfield, USA) and standard O.R. draping with two layers of cotton drapes. Gr. 2: Infusion warmer and reflecting disposable insulation (Thermadrape, O.R. Concepts Inc., Roanoke, USA) covering the legs, upper body, arms and head. Gr. 3: Infusion warmer and convective air warming with upper body blanket (WarmTouch, Mallinckrodt Medical, Hennef/Sieg, Germany). Gr. 4: Infusion warmer, convective air warming and reflecting disposable insulation. RESULTS: After 2 hours of surgery patients of groups 1 and 2 became hypothermic with core temperatures of 35.1 and 35.6 degrees C respectively. No relevant difference could be found between the two groups. The combination of an infusion warmer and convective air warming was an effective method to prevent hypothermia in groups 3 and 4. After 2 hours of surgery these patients had core temperatures of 36.6 and 36.4 degrees C respectively. Reflecting disposable insulation did not improve the effect of convective air warming. CONCLUSION: Reflecting disposable insulation was insufficient in the investigated operative setting.

Adult↗