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Preceptor rewards: How to say thank you for mentoring the next generation of nurse practitioners.

PURPOSE: To answer the question how do faculty nurture and reward clinical preceptors and what supports do preceptors require? DATA SOURCES: Data came from the literature and from surveying a purposive sample of 26 faculty members teaching clinical courses and arranging precepted experiences for nurse practitioner (NP) students at 26 public and private institutions across the United States. The vehicles for the survey were personal contact and e-mail. CONCLUSIONS: Schools offer preceptor rewards varying widely in their monetary value, from tuition and continuing education vouchers, verification of hours toward recertification, access to services and events on campus, reduced price or free admission to museums, cultural and sports events, and lectures. Faculty nurture preceptors by nominating them for awards, providing letters of reference, editing manuscripts, and collaborating on research projects. Supports for preceptors from the literature reflected National Organization of Nurse Practitioner Faculties guidelines (2000), and the policies of schools and clinical agencies, such as providing copies of program objectives and student credentials. IMPLICATIONS FOR PRACTICE AND EDUCATION: As NP programs have proliferated, there is increased pressure on faculty to find, nurture, reward, and retain good preceptors. Faculty must continue to work with program and agency administrators to comply with policies and create preceptor rewards to recognize their gifts to us, to our schools, and to the profession.

Awards and Prizes↗

Impact of upward social mobility on population mortality: analysis with routine data.

OBJECTIVE: To examine the contribution of changes in the distribution of social class to the mortality of the whole population between 1970-2 and 1991-3. DESIGN: Examination of routine data at two time points: 1970-2 and 1991-3. DATA SOURCE: Data provided by the Office for National Statistics. MAIN OUTCOME MEASURES: Difference for the total population in the number of deaths between 1971 and 1991. Proportion of difference accounted for by change in population size, change in risk of death within each social class, or change in distribution of population across social classes. RESULTS: Reductions in mortality between 1970-2 and 1991-3 among men in England and Wales were partially (16% of all deaths) attributable to increases in the proportion of men in higher social classes, representing 3943 fewer deaths per year or one less death for every 3056 men in 1991-3 compared with 1970-2. CONCLUSION: Some of the observed reduction in mortality seen between 1970-2 and 1991-3 can be accounted for by improved overall socioeconomic status of the population.

Adult↗

Comparing estimates of cost effectiveness submitted to the National Institute for Clinical Excellence (NICE) by different organisations: retrospective study.

OBJECTIVE: To assess the association between different types of organisation and the results from economic evaluations. DESIGN: Retrospective pairwise comparison of evidence submitted to the technology appraisal programme of the National Institute for Clinical Excellence (NICE) by manufacturers of the relevant healthcare technologies and by contracted university based assessment groups. DATA SOURCES: Data from the first 62 appraisals. MAIN OUTCOME MEASURE: Incremental cost effectiveness ratios. RESULTS: Data from 27 of the 62 appraisals could be compared. The analysis of 54 pairwise comparisons showed that manufacturers' estimates of incremental cost effectiveness ratios were lower (suggesting a more cost effective use of resources) than those produced by the assessment groups (25 were lower, 29 were the same, none were higher, P < 0.01). Restriction of this dataset to include only one pairwise comparison per appraisal (27 pairs) produced a similar result (21 were lower, two were the same, four were higher, P < 0.001). CONCLUSIONS: The estimated incremental cost effectiveness ratios submitted by manufacturers were on average significantly lower than those submitted by the assessment groups. These results show that an important role of NICE's appraisal committee, and of decision makers in general, is to determine which economic evaluations, or parts of evaluations, should be given more credence.

Academies and Institutes↗

Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patients.

OBJECTIVE: To develop a method of identifying patients at high risk of readmission to hospital in the next 12 months for practical use by primary care trusts and general practices in the NHS in England. DATA SOURCES: Data from hospital episode statistics showing all admissions in NHS trusts in England over five years, 1999-2000 to 2003-4; data from the 2001 census for England. Population All residents in England admitted to hospital in the previous four years with a subset of "reference" conditions for which improved management may help to prevent future admissions. DESIGN: Multivariate statistical analysis of routinely collected data to develop an algorithm to predict patients at highest risk of readmission in the next 12 months. The algorithm was developed by using a 10% sample of hospital episode statistics data for all of England for the period indicated. The coefficients for 21 most powerful (and statistically significant) variables were then applied against a second 10% test sample to validate the findings of the algorithm from the first sample. RESULTS: The key factors predicting subsequent admission included age, sex, ethnicity, number of previous admissions, and clinical condition. The algorithm produces a risk score (from 0 to 100) for each patient admitted with a reference condition. At a risk score threshold of 50, the algorithm identified 54.3% of patients admitted with a reference condition who would have an admission in the next 12 months; 34.7% of patients were "flagged" incorrectly (they would not have a subsequent admission). At risk score threshold levels of 70 and 80, the rate of incorrectly "flagged" patients dropped to 22.6% and 15.7%, but the algorithm found a lower percentage of patients who would be readmitted. The algorithm is made freely available to primary care trusts via a website. CONCLUSIONS: A method of predicting individual patients at highest risk of readmission to hospital in the next 12 months has been developed, which has a reasonable level of sensitivity and specificity. Using various assumptions a "business case" has been modelled to demonstrate to primary care trusts and practices the potential costs and impact of an intervention using the algorithm to reduce hospital admissions.

Aged↗

Has the relation between income inequality and life expectancy disappeared? Evidence from Italy and top industrialised countries.

OBJECTIVE: To investigate the relation between income inequality and life expectancy in Italy and across wealthy nations. DESIGN AND SETTING: Measure correlation between income inequality and life expectancy at birth within Italy and across the top 21 wealthy countries. Pearson correlation coefficients were calculated to study these relations. Multivariate linear regression was used to measure the association between income inequality and life expectancy at birth adjusting for per capita income, education, and/or per capita gross domestic product. DATA SOURCES: Data on the Gini coefficient (income inequality), life expectancy at birth, per capita income, and educational attainment for Italy came from the surveys on Italian household on income and wealth 1995-2000 and the National Institute of Statistics information system. Data for industrialised nations were taken from the United Nations Development Program's human development indicators database 2003. RESULTS: In Italy, income inequality (beta = -0.433; p<0.001) and educational attainment (beta = 0.306; p<0.001) were independently associated with life expectancy, but per capita income was not (beta = 0.121; p>0.05). In cross national analyses, income inequality had a strong negative correlation with life expectancy at birth (r = -0.864; p<0.001). CONCLUSIONS: In Italy, a country where health care and education are universally available, and with a strong social safety net, income inequality had an independent and more powerful effect on life expectancy at birth than did per capita income and educational attainment. Italy had a moderately high degree of income inequality and an average life expectancy compared with other wealthy countries. The cross national analyses showed that the relation between income inequality and population health has not disappeared.

Adult↗

Adolescent and young adult tobacco prevention and cessation: current status and future directions.

OBJECTIVE: To summarise the evidence on adolescent and young adult prevention and cessation, and provide future directions for research. DATA SOURCES: Data were collected from published literature. Searches for adolescent prevention were conducted using PubMed, PsycInfo, and ERIC; and for cessation, PubMed, and two major reviews that span January 1978 to May 2002. PubMed, PsychInfo, and SCCI were searched for young adults from January 1990 to May 2002. STUDY SELECTION: Data included smoking prevention studies published from January 1990 to May 2002 and conducted in the USA; all identified smoking cessation studies for adolescents. Young adult data were limited to initiation and cessation studies. DATA EXTRACTION: Extraction of data was by consensus of the authors. DATA SYNTHESIS: Results of the review are qualitative in nature using a consensus approach of the authors. CONCLUSIONS: School based curricula alone have been generally ineffective in the long term in preventing adolescents from initiating tobacco use but are effective when combined with other approaches such as media and smoke-free policies. Prevention research should consider multiple approaches and the social conditions that influence the development of youth problem behaviours including tobacco use. Because youth smoking cessation has been understudied to date, scientifically rigorous adolescent smoking cessation studies need to be conducted with attention to high risk smokers and less than daily smokers. Tobacco prevention and cessation for young adults needs focused attention. Prevention and cessation programmes need to address other tobacco products in addition to cigarettes.

Adolescent↗

[Analysis of studies published on hypertension treatment non-compliance in Spain between 1984 and 2005].

OBJECTIVE: To analyse therapy non-compliance in hypertension treatment in Spain, after a review of studies published between 1984 and 2005. DESIGN: Systematic review. DATA SOURCES: Data searches used Internet (Medline and Spanish index on doctoral these), a manual search of several Spanish journals, and bibliographic references to compliance from detected articles and through personal contact with experts. Descriptors used were: hypertension and patient compliance, compliance, adherence, patient drop-outs, treatment refusal, and their combinations. SELECTION OF STUDIES: Studies conducted in Spain and published between 1984 and 2005 were included, along with original articles, congress abstracts or doctoral theses, which used as a method of measurement pill count or counting of spaces in electronic monitoring systems, and which defined as non-compliers patients with a compliance percentage <80% and >110%. DATA EXTRACTION: The percentage of non-compliers was calculated, with 95% confidence intervals and weighted average of the percentage of non-compliers in each study. RESULTS: Twenty-six research studies published in Spain, excluding 2 analytical studies, were found. A total of 3553 patients with hypertension were included, of which 32.53% were non-compliers (n= 1156; 95 CI, 29.83-35.23) and 67.47% were compliers (n=2397; 95% CI, 65.67-69.27). The weighted average of non-compliance was at 32.78%. CONCLUSIONS: The percentage of therapy non-compliance in the treatment of hypertension in Spain has fallen in recent years, although it continues to be high.

Antihypertensive Agents↗

Wrestling injuries.

OBJECTIVE: The purpose of this chapter is to review critically the existing studies on the epidemiology of pediatric wrestling injuries and to discuss suggestions for injury prevention and further research. DATA SOURCES: Data were obtained from the sports medicine and science literature since 1951. Literature searches were performed using the National Library of Medicine, Pubmed, Medline, Grateful Med, Sports Sciences, SportsDiscus. Keywords used included "Wrestling, Wrestle, Wrestling Injuries, Fractures, and Dermatologic". MAIN RESULTS: Only eight prospective or retrospective studies were found dealing with pediatric wrestling injuries and that provided sufficient information to allow the estimation of injury rates. Exposure-based injury rates were between 6.0 and 7.6 injuries per 1,000 athletic-exposures. Injury rates increased with age, experience, and level of participation. The head/spine/trunk was the body region that incurred the greatest frequency of injuries, followed by the upper and lower extremities. CONCLUSIONS: There are several potential areas for decreasing injury risk in wrestlers, including equipment, coaching, officiating and training. However, informed decisions with regard to preventing injuries are dependent upon the quality of the basic epidemiological data available, and at this time, analyses of risk factors and potential preventive measures are lacking.

Adolescent↗

Isradipine--another calcium-channel blocker for the treatment of hypertension and angina.

OBJECTIVE: To review the pharmacology, pharmacokinetic disposition, dose recommendations, adverse effects, drug interactions, and efficacy of isradipine in patients with hypertension or ischemic heart disease. DATA SOURCES: Data from scientific literature were extracted, evaluated, and summarized for presentation. A MEDLINE search was conducted using the following indexing terms: isradipine, calcium-channel blockers, hypertension, and angina pectoris. Experiences from studies evaluating isradipine reported in the form of articles, abstracts, or proceedings involving patients or healthy subjects were considered for inclusion. STUDY SELECTION: Special consideration was given to clinical studies that had been designed in a blind, randomized fashion. Studies that compared the effectiveness and safety of isradipine with another antihypertensive or antianginal agent or placebo were included. DATA EXTRACTION: Data from human studies published in the English language were evaluated. Trials were evaluated according to sample size, design, and adequacy of description of therapeutic response. DATA SYNTHESIS: Isradipine is a new dihydropyridine calcium-channel blocker that appears to exert less negative inotropic activity than nifedipine and to selectively inhibit sinoatrial conduction. Pharmacokinetic parameters are quite variable and considerably more work is needed to better describe the kinetic disposition of isradipine. Antihypertensive efficacy has been demonstrated extensively in a number of short-term trials. Antianginal efficacy also has been observed in a few short-term trials and is comparable to that of isosorbide dinitrate and nifedipine. Extensive experience with isradipine is minimal and no clear-cut advantages over existing compounds have been noted thus far. CONCLUSIONS: The place of isradipine in the therapy of hypertension and myocardial ischemia is unclear and its routine use cannot yet be recommended based solely on clinical grounds.

Angina Pectoris↗

Nabumetone: a "nonacidic" nonsteroidal antiinflammatory drug.

OBJECTIVE: To review the pharmacology, pharmacokinetic disposition, dosage recommendations, adverse effects, drug interactions, and efficacy of nabumetone in patients with selected rheumatic disorders and soft-tissue injuries. DATA SOURCES: Data from scientific literature were extracted, evaluated, and summarized for presentation. A MEDLINE search was conducted using the following indexing terms: antiinflammatory agents, nonsteroidal, nabumetone, rheumatoid arthritis (RA), and osteoarthritis (OA). Studies evaluating nabumetone reported in articles, abstracts, or proceedings involving human subjects were considered for inclusion. STUDY SELECTION: Special consideration was given to clinical studies using double-blind, randomized, parallel, controlled designs. Studies comparing the effectiveness and safety of nabumetone with placebo and other nonsteroidal antiinflammatory drugs (NSAIDs) were included. DATA EXTRACTION: Data from human studies published in the English language were evaluated. Trials were assessed according to study design, sample size, and description of outcomes. DATA SYNTHESIS: Nabumetone is a nonacidic prodrug that is metabolized to an active nonsteroidal antiinflammatory moiety, 6-methoxy-2-naphthylacetic acid (6-MNA). 6-MNA is a structural analog of naproxen. Like naproxen and other NSAIDs, 6-MNA possesses analgesic, antipyretic, and antiinflammatory activity, 6-MNA has a prolonged elimination half-life, ranging from 17 to 74 hours, which allows for once-daily dosing. The efficacy of nabumetone for treating symptoms of RA and OA has been established in controlled clinical trials. Nabumetone also has been studied in ankylosing spondylitis and soft-tissue injuries. Adverse effects associated with nabumetone are similar to those associated with other NSAIDs. Gastrointestinal reactions occur most frequently in the form of abdominal pain or indigestion, nausea, or vomiting. Central nervous system adverse effects occur less frequently, and are followed in order of occurrence by rashes. CONCLUSIONS: Nabumetone is a prodrug metabolized to an active metabolite structurally related to naproxen. Studies have demonstrated the efficacy of nabumetone, but no advantages over the many other NSAIDs now available.

Anti-Inflammatory Agents, Non-Steroidal↗

Meaningful interpretation of risk reduction from clinical drug trials.

OBJECTIVE: To illustrate the concepts of relative and absolute risk reduction, and by example, present and discuss the results of prevention trials that have evaluated the impact of drug therapy on cardiovascular disease. Additional approaches to evaluating the results of prevention trials are also presented. DATA SOURCES: Data were gathered from eight frequently quoted major cardiovascular intervention trials. CONCLUSIONS: Reference to large reductions in relative risk in review papers, newspapers, and at professional meetings can lead to false expectations among clinicians and patients regarding the potential impact of the treatment in individual patients. When making decisions about preventive drug therapy, clinicians are encouraged to examine measures other than relative risk reduction and to include the patient in the decision process. Educators should emphasize these other measures of outcome and not rely solely on relative risk reduction in discussing particular areas of therapeutics.

Canada↗

Tacrolimus, a new immunosuppressant--a review of the literature.

OBJECTIVE: To review the clinical pharmacology, pharmacokinetics, adverse effects, therapeutic uses, and current status of tacrolimus. DATA SOURCES: Data from scientific literature were identified by a MEDLINE search. The data were extracted, evaluated, and summarized for presentation. Experiences from studies evaluating tacrolimus in the form of articles, abstracts, letters to the editor, or proceedings were considered for inclusion. STUDY SELECTION: Open and controlled clinical and animal trials were reviewed in evaluating the pharmacology, pharmacokinetics, and adverse effects of tacrolimus. DATA EXTRACTION: Data from animal and human studies published in the English literature were evaluated. DATA SYNTHESIS: Tacrolimus is an 822-kDa macrolide antibiotic that has potent immunosuppressive properties. The mechanism of action is similar to that of cyclosporine in that it ultimately blocks the production of interleukin 2, thereby inhibiting further T-lymphocyte proliferation. Tacrolimus is metabolized solely in the liver and the metabolites are primarily excreted in the bile. The elimination half-life of tacrolimus is approximately 8.5 h, and is prolonged in hepatic dysfunction. Tacrolimus has shown efficacy in the prophylaxis of allograft rejection in both animals and human clinical trials, and has been used effectively to rescue patients who have exhibited refractory rejection failing cyclosporine prophylaxis. Adverse effects requiring tacrolimus dosage adjustment include nephrotoxicity, neurotoxicity, alterations in glucose metabolism, and infection or susceptibility to malignancy. CONCLUSIONS: To date, trials comparing tacrolimus with cyclosporine are not available in the literature; however, tacrolimus appears to be useful in rescuing grafts, particularly liver grafts that fail cyclosporine-based immunosuppression. Direct comparisons with cyclosporine are needed to define the role of tacrolimus as primary transplant therapy.

Absorption↗

Tacrine: first drug approved for Alzheimer's disease.

OBJECTIVE: To review the pharmacology, biopharmaceutics/pharmacokinetics, clinical efficacy, adverse effects, and therapeutic considerations regarding the use of tacrine in patients with Alzheimer's disease. DATA SOURCES: Data from the scientific and professional literature were analyzed, interpreted, and summarized. Citations were obtained by performing a MEDLINE search using the following indexing terms: tacrine, tetrahydroaminoacridine, and Alzheimer's drug therapy. Data also were obtained from a summary of the New Drug Application (Summary Basis of Approval of Cognex) and from the approved product labeling. STUDY SELECTION: Studies in Alzheimer's disease have been plagued by methodologic inconsistencies and deficiencies. Only efficacy studies subsequent to the Food and Drug Administration's (FDA) issuance of recommendations for studies in Alzheimer's disease (1991) were used. Therefore, only double-blind, placebo-controlled, parallel design studies of at least three-month's duration using the Alzheimer's Disease Assessment Scale-Cognitive Subscale and the Clinical Interview-Based Impression of Change as efficacy parameters were included. DATA EXTRACTION: Trials were assessed according to the criteria listed above. Results were evaluated on the basis of both completed patients and last observation carried forward models. DATA SYNTHESIS: Tacrine is a cholinesterase inhibitor that increases the availability of acetylcholine in muscarinic neurons. It has a mean bioavailability after oral administration of about 17 percent and an elimination half-life of approximately three hours. Although drug interactions are poorly studied, tacrine is metabolized by isoenzyme P-450IA2 and may interact with other drugs metabolized by this isoenzyme. Tacrine has been shown to have efficacy in mildly to moderately impaired Alzheimer's patients on both psychometric testing and a clinician's structured interview. Although efficacious, its effects are not dramatic, and it does not affect the ultimate course of the disease. Adverse effects are frequent, and significantly elevated hepatic transaminase concentrations may occur in approximately 25 percent of patients. CONCLUSIONS: Tacrine is the first drug approved by the FDA for treatment of Alzheimer's disease. Although it may improve psychometric test scores in mild to moderately impaired patients, it is not a panacea and does not affect the course of the disease. Patients must be monitored closely for elevated transaminase, cholinergic adverse effects, and interactions with drugs metabolized through P-450IA2.

Alanine Transaminase↗

Cigarette smoking and clinically significant drug interactions.

OBJECTIVE: To review clinically significant drug interactions associated with cigarette smoking. DATA SOURCES: Data from scientific literature were identified by using a MEDLINE search. Data were extracted, evaluated, and summarized for this review. STUDY SELECTION: Findings and experiences were selected from clinical, epidemiologic, and pharmacokinetic studies; review articles; case studies; abstracts; letters to the editor, and proceedings. DATA EXTRACTION: Data from human studies published in English were evaluated. Only interactions deemed clinically significant are included in this review. Conclusions derived from review articles on the subject of smoking and drug interactions also were used. DATA SYNTHESIS: Cigarette smoking can affect drug therapy via pharmacokinetic and pharmacodynamic mechanisms. Pharmacokinetic drug interactions are presented for theophylline, tacrine, insulin, flecainide, propoxyphene, propranolol, diazepam, and chlordiazepoxide. Pharmacodynamic interactions are described for antihypertensive and antianginal agents, antilipidemics, oral contraceptives, and histamine2-receptor antagonists. CONCLUSIONS: Cigarette smoking can reduce the efficacy of certain drugs or make drug therapy more unpredictable. Pharmacokinetic interactions may cause smokers to require a larger dosage of certain drugs through an increase in plasma clearance, a decrease in absorption, an induction of cytochrome P450 enzymes, or a combination of these factors. Pharmacodynamic interactions may increase the risk of adverse events in smokers with cardiovascular or peptic ulcer disease, and in women who smoke and use oral contraceptives. Healthcare professionals should pay special attention to patients with these profiles and should try to prevent cigarette smoking or encourage patients to discontinue this addictive habit.

Clinical Trials as Topic↗

Pharmacotherapy of aggressive behavior.

OBJECTIVE: To review the definition, clinical characteristics, prevalence, etiology, neurochemistry, and pharmacologic treatment of aggressive behavior, and provide recommendations regarding the use of specific pharmacologic agents for treating aggressive behavior. DATA SOURCES: Data from the scientific literature were analyzed, interpreted, and summarized. An English-language MEDLINE search yielded clinical trials, case reports, letters, and review articles addressing the etiology and pharmacotherapy of aggression. STUDY SELECTION: Because few well-controlled studies are available in aggression research, all literature addressing the pharmacologic treatment of aggressive behavior, as well as the neurochemistry and psychobiology of aggressive behavior, was reviewed. DATA EXTRACTION: The literature was reviewed on the basis of the particular pharmacotherapy and the specific population used. A separate review of the treatment of aggressive behavior in the elderly was included. DATA SYNTHESIS: The literature was assessed for applicability to clinical practice and usefulness to the general clinician. Recommendations were made from the primary literature in conjunction with trends in clinical practice. Pharmacotherapy is a primary mainstay of treatment for aggressive patients. In individuals for whom behavioral intervention alone is unsuccessful, drug therapy should be initiated along with continued nonpharmacologic intervention. Short-acting benzodiazepines and high-potency antipsychotic agents are effective in treating acute aggression on a short-term or as needed basis. Agents such as lithium, beta adrenergic blockers, carbamazepine, valproic acid, buspirone, trazodone, serotonin reuptake inhibitors, and clozapine may be useful in the chronic management of aggressive behavior. Every attempt should be made to streamline drug therapy in patients with chronic aggression and comorbid psychiatric disorders. CONCLUSIONS: On the basis of available research and extensive clinical experience, lithium or propranolol should be considered as first-line antiaggressive agents in patients without comorbid psychiatric disorders. A minimum trial period for assessing drug efficacy should last at least 6-8 weeks at maximum tolerated dosages. Patients responding to pharmacotherapy should be reevaluated every 3-6 months, and periodic medication tapers and/or drug-free periods should be attempted.

Aggression↗

Hot flash experience in men with prostate cancer: a concept analysis.

PURPOSE/OBJECTIVES: To provide a clear definition of the hot flash experience in men with prostate cancer receiving hormonal treatment. DATA SOURCES: Articles, book chapters, and electronic sources. DATA SYNTHESIS: The hot flash experience has not been explored previously in men with prostate cancer. The physiologic and psychological scopes of the phenomenon are described as a multidimensional experience. CONCLUSIONS: The essential attributes of hot flashes in men consist of physiologic (e.g., warmth, sweating, chills) and psychological (e.g., anxiety, impaired memory, agitation) factors. Antecedents to the experience include demographics, disease, and treatment modality. Consequences include effects on sleep, cognition, and health-related quality of life. IMPLICATIONS FOR NURSING: Evaluation of the hot flash experience in men receiving hormonal ablation should include assessment of the symptoms associated with the treatment modality and nursing interventions to help ameliorate symptoms. Future research is needed to focus on providing symptom management to decrease the severity or prevent the occurrence of multiple symptoms related to androgen ablation therapy.

Aged↗

Operationalizing symptom distress in adults with cancer: a literature synthesis.

PURPOSE/OBJECTIVES: To address inconsistencies in the definition and operationalization of symptom distress by synthesizing the literature on cancer-related symptom distress in adults. DATA SOURCES: Electronic nursing, psychology, and medicine databases; online meeting abstracts; and various print sources. DATA SYNTHESIS: Eight distinct methods of operationalizing the concept were identified. Gender, ethnic, developmental, cultural, and individual differences in symptom distress have not been identified. Relationships among symptom frequency, intensity, and distress are unclear. CONCLUSIONS: Lack of clarity and consensus in defining and operationalizing symptom distress hinder meta-analysis, research synthesis, and research utilization. Symptom distress may be emerging as a component of the multidimensional symptom experience. IMPLICATIONS FOR NURSING: Defining and operationalizing symptom distress consistently will enhance research synthesis and assist clinicians with more effectively meeting the needs of people with cancer. Research is needed to identify the meanings of symptom distress to patients with cancer and to differentiate symptom distress from symptom frequency and intensity.

Cultural Characteristics↗

Characteristics of medical surge capacity demand for sudden-impact disasters.

OBJECTIVES: To describe the characteristics of the demand for medical care during sudden-impact disasters, focusing on local U.S. communities and the initial phases of sudden-impact disasters. METHODS: Established databases and published reports were used as data sources. Data were obtained to describe the baseline capacity of the U.S. medical system. Information for the initial phases of a sudden-impact disaster was sought to allow for characterization of the length of time before a U.S. community can expect arrival of outside assistance, the expected types of medical surge demands, the expected time for the peak in medical-care demand, and the expected health system access points. RESULTS: The earliest that outside assistance arrived for a community subject to a sudden-impact disaster was 24 hours, with a range from 24 to 96 hours. After sudden-impact disasters, 84% to 90% of health care demand was for conditions that were managed on an ambulatory basis. Emergency departments (EDs) were the access point for care, with peak demand time occurring within 24 hours. The U.S. emergency care system was functioning at relatively full capacity on the basis of data collected for the study that showed that annually, 90% of EDs were boarding admitted inpatients, and 75% were diverting ambulances. CONCLUSIONS: As part of planning for sudden-impact disasters, communities should be expected to sustain medical services for 24 hours, and up to 96, before arrival of external resources. For effective medical surge-capacity response during sudden-impact disasters, there should be a priority for emergency medical care with a focus on ambulatory injuries and illnesses.

Disasters↗