Nurse education. How to ... evaluate a short course.
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Education, Nursing↗
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Effectiveness of an asthma management program for pediatric members of a large health maintenance organization.
OBJECTIVE: To assess the impact of an asthma management program on the dispensing of inhaled corticosteroids, hospitalizations, and emergency department (ED) visits on children, adolescents, and young adults. DESIGN: We used medical record and pharmacy data for the 18 months after initiation of a pilot asthma management program. Two intervention offices were matched with 2 control offices on pediatric volume, number of pediatricians or family practitioners, and specialist availability. SETTING: Primary care offices at Kaiser Permanente Colorado, in Denver and Boulder. PATIENTS: We identified 298 patients, 18 years or younger,who were listed in an asthma registry between February 1 and July 31, 1997, as having moderate or severe asthma. INTERVENTION: The Kaiser Permanente Colorado Asthma Care Management Program is an outpatient-based program that provides comprehensive evaluation, education, and follow-up to patients identified from an asthma registry or referred by providers. MAIN OUTCOME MEASURES: The proportion of patients who received more than 1 dispensing of inhaled corticosteroid during the observation period. Additional outcomes measured the proportion of patients with 1 or more hospitalizations or ED visits. RESULTS: A significantly greater proportion of patients from the intervention group received more than 1 dispensing of inhaled corticosteroid compared with controls (relative risk [RR], 1.41; 95% confidence interval [CI], 1.08-1.72). We found no significant difference in the proportion of patients who were hospitalized (RR, 1.37; 95% CI, 0.48-3.71) or visited the ED (RR, 0.86; 95% CI, 0.49-1.40). CONCLUSIONS: The presence of an asthma management program may improve dispensing of inhaled corticosteroids to young patients with moderate or severe asthma, as recommended by national guidelines. This type of program may not have an effect on hospitalizations or ED visits.
Administration, Inhalation↗
Sequelae of SCI after discharge from the initial rehabilitation program.
The purpose of this study was to identify sequelae that occurred in persons with spinal cord injuries 11 weeks to 5 years after discharge from two initial rehabilitation programs. The investigator-developed instrument was first administered to a convenience sample of 21 subjects (Adamski, 1983). The modified version of the instrument was administered to a probability sample of 19 subjects in the present study. The results demonstrated that respondents experienced a higher incidence of medical sequelae than has been documented in the literature. These findings have important implications for nursing practice in developing and evaluating educational programs for persons with spinal cord injuries.
Aftercare↗
Attention deficit hyperactivity disorder in teens and adults: they don't all outgrow it.
Attention deficit hyperactivity disorder (ADHD) has been long recognized and well established in children, but its continuation into adulthood has only recently been supported by the research. ADHD symptoms and concerns typically appear differently in adults, but treatment options, conceptually at least, are similar to those used for children who have ADHD. This article introduces the issue of Journal of Clinical Psychology: In Session devoted to ADHD in teens and adults. It presents the prevalence and manifestations of the disorder and then reviews the subsequent articles on the comorbidity, evaluation, education, psychopharmacology, and psychosocial treatments of ADHD for teens and adults. The issue concludes with an article on neurobiofeedback, a relatively new treatment option.
Adolescent↗
Measuring self-care independence in children with cystic fibrosis: the Self-Care Independence Scale (SCIS).
We describe the development and psychometric properties of a survey tool designed to evaluate children's level of independence in their cystic fibrosis (CF) treatment. Children's self-care autonomy is important to measure and may have a direct effect on children's active involvement in their treatment and their adherence. Existing instruments that evaluate children's independence in their CF treatment fail to yield practical information that can help research and patient management. The Self-Care Independence Scale (SCIS) is a 44-item questionnaire that is completed by parents. The SCIS was completed by the parents of 76 patients with CF (ages 4-17 years). Youths completed two structured interviews, which screened patients for average or higher cognitive functioning (an inclusion criterion) and measured their CF treatment knowledge. Parents completed two other self-report questionnaires. Results indicated that the SCIS has acceptable internal consistency and good test-retest reliability. The construct validity of the SCIS was supported by positive correlations between patient age, number of years since diagnosis, and SCIS total scores. The concurrent validity of the SCIS was supported by correlations between a measure of nonillness-specific dependence and a measure of patient self-care knowledge. Children's SCIS total scores per age group are presented. This study supports the SCIS as a psychometrically sound measure of self-care independence in CF. This measure has several uses. For example, the SCIS may be a screening tool for adolescents who are preparing to transition to adult CF centers and who will need to assume more independence in their self-care. The SCIS may also be used to evaluate educational programs that promote self-care knowledge and skill in children with CF.
Activities of Daily Living↗
Pacific northwest regional newborn screening: a paradigm of prevention.
We describe the use and early results of the Oregon Public Health Laboratory computer to monitor hospital and practitioner compliance with state newborn screening recommendations. The system tracks five major categories of screening practice in which 18 types of errors affecting screening test quality have been identified. Results show that 47.3% of newborn screening specimens were submitted incorrectly according to current state recommendations. The program will be used to improve screening practices and to evaluate educational efforts.
Diagnostic Errors↗
Curriculum development and evaluation in medical education.
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Curriculum↗
A decision support system for AIDS intervention and prevention.
In recent years, the importance of information systems has been identified as a vital issue to continuing success in AIDS intervention and prevention (AIP). The advances in information technology have resulted in integrative information systems including decision support systems (DSS). The concept of DSS for AIP was created at the intersection of two trends. The first trend was a growing belief that AIP information systems are successful in automating operations in AIP programs. The second was a continuing improvement in modeling and software development in the AIP area. This paper presents an integrated DSS for AIP. The system is integrated with a database and achieves its efficiency by incorporating various algorithms and models to support AIP decision processes. The application examples include screening AIDS-risky behaviors, evaluating educational interventions, and scheduling AIP sessions. The implementation results present evidence of the usefulness of the system in AIP.
AIDS Serodiagnosis↗
A nursing approach to the treatment of drug addicts: evaluation of an educational programme.
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Connecticut↗
Systematic reviews in laboratory medicine: principles, processes and practical considerations.
BACKGROUND: Systematic reviews and meta-analyses are generally accepted to represent the highest level of evidence, and are a cornerstone in practising evidence-based medicine. So far, these efforts have been largely confined to the evaluation of the efficacy and effectiveness of therapeutic and preventive interventions. Systematic reviews in laboratory medicine are scarce and many of them do not meet essential quality criteria [Clin. Chem. Lab. Med. 38 (2000) 577]. Most of these problems are related to the poor design and heterogeneity of primary research, and that there are no agreed methods or quality standards for making systematic reviews in laboratory medicine. AIMS AND OBJECTIVES: For better evidence in laboratory medicine, not only higher quality primary studies but also standardized methodologies for designing, conducting and reporting systematic reviews in diagnostics are needed. The aim of this review is to present the general principles and provide a step-by-step process of systematic reviewing in laboratory medicine. METHODS: This narrative review is based on the overview of the medical literature on the methodology of systematic reviewing and that of the "state of the art" of evidence-based diagnosis. RESULTS: Systematic reviews of diagnostic interventions differ from that of therapeutic interventions in the methods of question formulation, the choice of study design, the assessment of study quality and the statistical methods used to combine results. Therefore, the general principles of systematic reviewing are adapted to the specialist field of laboratory medicine. The process of systematic reviewing consists of six key steps: (1) preparation for the review, (2) systematic search of the primary literature, (3) selection of papers for review, (4) critical appraisal of the selected literature, (5) analysis and synthesis of data, and (6) interpretation of data. The most important technical and methodological aspects of each step and the essential elements of a good systematic review in laboratory medicine are presented. CONCLUSIONS: Systematic reviews of diagnostic interventions support clinical and policy decisions, the development of practice guidelines, clinical audit, technology assessment, economic evaluations, education and training, and identify gaps in our knowledge for future research. Systematic reviewing of laboratory data is expected to result in better, bigger and more reliable primary studies, which hopefully will support the diffusion of new diagnostic technologies with scientifically proven efficacy and effectiveness in the future.
Clinical Laboratory Techniques↗
How patient-centred am I? A new method to measure physicians' patient-centredness.
OBJECTIVE: To describe a new method to determine physicians' self-perceived degree of patient-centredness. A pilot study combining qualitative and quantitative methods. METHODS: Forty-one general practitioners (GPs) answered a questionnaire consisting of three open-ended questions about their view of the consultation and by choosing among 28 roles of the physician in the physician-patient relationship. Twenty of the GPs had participated in Balint groups while 21 had had no access to Balint group. Patient-centredness is central to Balint groups and consequently Balint group participants would be expected to be patient-centred. RESULTS: The answers to the two parts were divided into three groups each, patient-centred, non-patient-centred and intermediary, and analysed statistically. Significantly more Balint participants were patient-centred than the reference group. CONCLUSION: The instrument describes physicians' self-perceptions of their patient-centredness and can distinguish a group of patient-centred physicians from a group of non-patient-centred physicians. PRACTICE IMPLICATIONS: The instrument can be useful to evaluate educational programmes and detect decline in patient-centredness as early sign of burnout.
Attitude of Health Personnel↗
[Failed evaluation of two educative interventions on coxibs prescription in one healthcare area].
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Cyclooxygenase 2 Inhibitors↗
Functional limitation immediately after cast immobilization and closed reduction of distal radius fractures: preliminary report.
The majority of research on distal radius fractures consists of retrospective, descriptive studies of patients with unstable fractures requiring fixation. The purpose of this investigation was to report on impairments in flexibility, grip strength, and motor control and on the presence of swelling and atrophy immediately after cast immobilization of closed reductions of simple distal radius fractures. Sixteen adult subjects from Kaiser Permanente Medical Center, San Francisco, entered the study, and 13 completed it. At the initial evaluation, upper extremity ranges of motion, grip strength, forearm circumferences, two-point discrimination, and motor reaction times were measured on the uninvolved side. The same measurements were taken on the affected side within 48 hours after cast removal. All but one subject worked throughout the casting period. There were significant postcasting impairments in forearm rotation (40% deficit in pronation and supination); wrist flexion, extension, and radial and ulnar deviation (50% reduction in all motions); grip strength (-32 kg, or approximately 24% of the strength of the unaffected side); and forearm circumference (-1.1 cm) and wrist circumference (+1.5 cm). Patients complained of awkwardness of the involved hand. These measured impairments immediately after immobilization of simple radius fractures were greater than the reported impairments in patients after reduction of radius fractures with fixation 6 to 27 months after injury. To prevent long-term disability and recover flexibility, strength, and function, patients with simple distal radius fractures should be referred to a hand, occupational, or physical therapist for evaluation, education, and treatment after immobilization. Longitudinal studies are needed to quantify long-term functional recovery with regard to the type of fracture and the degree of impairment measured immediately after casting.
Adult↗
Upper extremity venous thrombosis.
Upper extremity venous thrombosis is unusual, but the occurrence rate is increasing. Nurses must be aware of the predisposing factors for thrombosis, diagnostic modalities, treatment options, and follow-up treatment for these patients. Nurses are responsible for patient evaluation, education, and monitoring for side effects of therapy.
Arm↗
The role of biomedical and psychosocial factors for the prediction of pain and distress in patients undergoing high-dose therapy and BMT/PBSCT.
Recent research has shown that cancer patients undergoing bone marrow transplantation (BMT) experience moderate to severe mouth pain due to treatment-related mucositis in spite of morphine therapy. Treatment-related emotional distress in BMT patients is also described widely. This study examined several biomedical, psychological and social variables as possible predictors for the intensity of treatment-related mouth pain and anxious mood in 63 cancer patients undergoing BMT or stem cell transplantation (SCT) within a prospective longitudinal design. Biomedical predictors included biomedical risk, mucositis, the mode of transplantation, total body irradiation, age and gender. Psychological predictors were depression (BDI), BMT-related distress, chronic stress and resources in everyday life (KISS), pain-related coping behaviour (KPI-17) and social support (ISSS). Among the social variables we evaluated education, being married and the living situation. Criteria variables were the intensity of mouth pain and anxious mood which were assessed daily by numeric self-rating scales for 24 days after transplantation. Results of stepwise multiple regressions indicated that psychological and social variables were important predictors of mouth pain, besides biomedical variables. Whereas the biomedical variables revealed the most predictive power during the second week after BMT, psychological predictors were more important during the early and late phases of the treatment. Daily anxious mood was best predicted by psychological and social variables. Among the biomedical variables mucositis was most strongly related to mouth pain besides mode of transplantation, risk, TBI and age. Among the psychological variables BMT-related distress was the most important predictor, with resources in private life or at work and pain-related coping modes as further significant predictors. These results imply that relevant predictors should be assessed as high risk factors for an increased vulnerability for treatment-related side-effects before treatment starts indicating an additional offer of psychological treatment in high risk patients.
Adult↗
The diagnosis of language disorders in bilingual children: surface-oriented and pragmatic criteria.
Certain pragmatic criteria were compared with traditionally employed surface-oriented criteria for the diagnosis of language disorders in bilingual children. Subjects were 10 Spanish/English bilingual children between 6 and 8 years of age who had been referred by bilingual classroom teachers for a special education evaluation. Spontaneous language samples were obtained from each child in both languages. The samples were transcribed and then examined for normalcy according to surface-oriented criteria and pragmatic criteria. The surface elements examined in both languages included morphological and syntactic structures. The pragmatic criteria included nonfluencies, revisions, delays, specificity of referential terms, abrupt topic shifts, inappropriate responses, and the need for multiple repetition of prompts. As expected, it was possible to demonstrate that the two sets of criteria identified different subgroups as language disordered. To test the accuracy of the disparate diagnoses, academic achievement was tested both before and after an average of 7 months of mainstreaming in essentially monolingual English classroom settings. Teacher ratings of English language development and socialization were also examined before and after the 7-month period. Results revealed that the pragmatic criteria were superior predictors of both achievement and teacher ratings. Traditional diagnostic criteria appear to need supplementation by pragmatic criteria.
Achievement↗
Pharm-ing cyberspace: the Internet as a tool for evidence based pharmacotherapy.
Although the Internet lacks many of the features of a desirable drug information system, it has increasing potential to inform evidence-based patient management. This article considers three contributions that the Internet can make to evidence-based pharmacotherapy; as a delivery mechanism for textual documents, as a complementary source of intelligence and as a source of value-added information. Focusing on exemplar sites, rather than on drug and information sources in general, the author reviews the usefulness and availability of current resources. While limitations of the technology presently constrain its use for direct patient care and the quality of any information must be critically appraised, the Internet has already proved a valuable source for drug evaluation, education, research and audit.
Drug Information Services↗
A review of sharps injuries and preventative strategies.
Exposure to bloodborne pathogens from sharps injuries continues to pose a significant risk to healthcare workers (HCW). The number of sharps injuries sustained by HCW is still unclear, primarily due to under-reporting. In this review a mean rate of 4.0% (range 1.0-6.2%) sharps injuries per 10000 HCW was calculated from eight studies involving more than 7000 HCW. Nurses and doctors were most at risk of sharps injuries, frequently from hollow-bore needles. Approaches to reduce this risk have included education and training on the safe handling and disposal of sharp devices, awareness campaigns and legislative action. More recently, preventative strategies have focused on needle protective devices, which may reduce the rate of sharps injuries. Introducing needle protective devices should be considered particularly in high-risk areas, after training, education, evaluation and cost-benefit analysis.
Blood-Borne Pathogens↗