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Family-centered care coordination for children with special needs across multiple settings.

Care coordination is a process that involves assessment, planning, implementation, evaluation, education, monitoring, support, and advocacy. Pediatric nurse practitioners (PNPs) are well positioned to coordinate care but may not be well educated about potential conflicts of interest in balancing cost-containment constraints with obtaining maximum quality and quantity of care for children and families with complex needs. The philosophy of family-centered care is embodied in some care coordination models and absent in others. PNPs who aim to support families of children with special health care needs need to understand the complexity of interacting with multiple care coordination models across health and educational settings. PNPs may act as change agents to infuse family-centered care principles into existing and future care coordination models.

Child↗

The pharmacist's role in the recognition and management of insomnia.

Pharmacists, in collaboration with physicians, are in a unique position to assist the many patients who complain of disturbed sleep and/or impaired daytime functioning. The aim of this article are to familiarize physicians with the role that is and can be played by the pharmacist and to reinforce for practicing pharmacists their multifaceted approach to the insomniac patient. Suggestions are made for pharmacist involvement in patient evaluation, education, and monitoring, and for other possible roles of the pharmacist in dealing with the insomniac patient and the appropriate use of hypnotics.

Databases, Bibliographic↗

Assessing communication competence: a review of current tools.

BACKGROUND: The assessment of communication competence has become a major priority of medical educational, policy, and licensing organizations in the United States and Canada. Multiple tools are available to assess communication competence, but there are few studies that compare the tools. METHODS: A consensus panel of six family medicine educators evaluated 15 instruments measuring the physician-patient interview. The primary evaluation criteria came from the Kalamazoo Consensus Statement (KCS), which derived from a multidisciplinary panel of experts that defined seven essential elements of physician-patient communication. We evaluated psychometric properties of the instruments and other assessment criteria felt to be important to family physicians (exploring family issues, interview efficiency, and usability/practicality). RESULTS: Instruments that received the highest ratings on KCS elements were designed for faculty raters and varied in their practicality/usability ratings and psychometric properties. Few instruments were rated high on psychometric properties or exploring family issues. CONCLUSIONS: The process successfully reviewed and provided a framework for assessing communication skills instruments. There is a need to expand the study, including use of a larger cohort of reviewers to provide more validity to the results and minimize potential biases.

Aptitude Tests↗

Alternate forms of HIV prevention attitude scales for teenagers.

The purpose of this study was to develop valid, alternate-form scales to measure teenagers' attitudes toward prevention of the transmission of human immunodeficiency virus (HIV). Using a three-component attitude model, a two-way table of specifications was constructed as a theoretical framework for generating attitudinal items relevant to HIV and HIV prevention. Thus, a large pool of Likert-type items was generated, reviewed for clarity and content validity, and prepared for the preliminary scale with 50 items. The scale was administered to 210 high school students. As a result of extensive analyses, two alternate forms with 15 items each were developed. The two forms were simultaneously administered to a sample of 600 high school students. The collected data were subjected to item analyses, factor analysis, and reliability estimation. The results of the analyses provided strong evidence of internal consistency, content validity, and comparability of both forms. The alternate reliability across the form was .82. The alpha reliability coefficients for forms A and B was .78 and .77 and the split-half .76 and .69, respectively. It is concluded that these alternate forms produce valid, reliable, and comparable results for measuring teenagers' attitudes toward HIV prevention. These forms are ideal for pretest/posttest designs used for evaluating educational approaches to HIV control.

Adolescent↗

Assessing awareness and knowledge of breast and cervical cancer among Appalachian women.

INTRODUCTION: West Virginia is the only state that lies entirely within Appalachia. West Virginians tend to be poorer and more likely to lack health insurance than the general U.S. population. The purpose of this qualitative study was to 1) obtain an understanding of attitudes about breast and cervical cancer screening among women aged 25 to 64 years; 2) determine factors that motivate women to be screened for breast and cervical cancer; and 3) evaluate educational materials about breast and cervical cancer screening for use in this population. METHODS: The West Virginia Breast and Cervical Cancer Screening Program (WVBCCSP) is a comprehensive public health program, funded by the Centers for Disease Control and Prevention, dedicated to removing barriers to breast and cervical cancer screening and providing screenings to underserved women aged 25 to 64 years. The program partnered with RMS Strategies, Inc, to conduct six focus groups in three communities in West Virginia. Women were recruited by telephone based on program eligibility guidelines. RESULTS: Results indicated that women were concerned about health care costs and lack of health insurance. Cost, fear, and embarrassment were identified as the top barriers to breast and cervical cancer screening. Participants believed that community-based educational campaigns would increase screening and promote use of the WVBCCSP. CONCLUSION: Understanding why low-income Appalachian women do not get screened for breast and cervical cancer and determining motivational factors that encourage screening are important to increase screening rates among this population. Breast and cervical cancer efforts that use the words, knowledge, and suggestions of the women they serve are more likely to be effective and have a larger impact.

Adult↗

Sexuality and menopause.

A majority of women experience some change in sexual function during the years immediately before and after the menopause. Common sexual complaints include loss of desire, decreased frequency of sexual activity, painful intercourse, diminished sexual responsiveness, and dysfunctions of the male partner. Sexual function is influenced by biologic and nonbiologic factors. Sexual arousal, including sensory perception, central and peripheral nerve discharge, peripheral blood flow, and the capacity to develop muscle tension, as well as sexual desire and frequency of sexual activity, can all be influenced by ovarian hormone levels. Sexual function is also influenced by the interplay of psychological, sociocultural, and interpersonal factors. Health care professionals can play an important role in the evaluation, education, counseling, and treatment of the menopausal woman.

Cardiovascular System↗

Adult hearing loss.

Identification and evaluation of adult hearing loss is an important task for primary care physicians. Recent studies reporting the reliability and validity of simple testing instruments reinforce this conclusion. Although most cases will be secondary to noise exposure or age-related and benefit from amplification, a diligent search for more unusual causes, some of which have specific curative therapy, is always needed. The initial prescription and fitting of hearing aids is the realm of the audiologist. The primary care physician can enhance the treatment program by providing global evaluation, educating the patient as to likely therapy and realistic expectations of results, and providing long-term follow-up and functional assessment of hearing aid use. The burden of hearing loss is particularly heavy in the nursing home population. In this arena, the physician can ease the burden by being attentive to the possibility of hearing loss causing unexpected behavior, searching for, and when possible, treating reversible causes, and using assistive devices and behavioral techniques to enhance communication when the hearing impairment cannot be corrected.

Adult↗

Review of human immunodeficiency virus infection in women in the United States.

In this review, available human immunodeficiency virus (HIV) seroprevalence data are presented for United States women attending clinics related to reproductive health and for women in other settings. At family planning clinics, prenatal clinics, and in delivery room settings (cord blood testing), studies that have not targeted women at high risk for HIV infection have shown prevalence rates ranging from 0-4.3%. Higher rates (greater than 1%) have been observed in more urban areas--Newark, New York City, Baltimore, Miami, and San Juan; rates at settings outside these areas have generally been below 1%. Filter-paper testing for maternal HIV antibodies from neonatal heel-stick specimens has been conducted statewide in Massachusetts and New York; prevalence rates were 0.3% in Massachusetts in 1987, and 0.2% in upstate New York and 1.3% in New York City in 1987-1988. Prevalence rates of female military applicants and female blood donors are below 0.03% and 0.1%, respectively, and have been relatively stable over time. Where age data are available, prevalence rates are near 0 in women below age 20 years, are higher for young adult and early middle-aged women, and decline thereafter. Studies have also been conducted using blood samples from women undergoing premarital testing for syphilis serology, from women attending sexually transmitted disease clinics and drug treatment centers, and from patients at sentinel hospital sites. Information on the prevalence of HIV infection in United States women is useful to identify specific populations at risk for HIV infection and to target and evaluate education and prevention efforts.

Acquired Immunodeficiency Syndrome↗

Surgeon and family physician opinions of the general surgical needs of family practice residents: a pilot study.

There is a lack of data assessing needs and evaluating educational objectives in general surgery for family practice residents. Studies suggest that family practice residency graduates feel underprepared in some surgical areas. This study provides results of a survey of 28 surgeons, practicing family physicians and family practice residents in the Northeast regarding the importance of 166 surgical objectives. The groups are compared to each other to detect differences in perceptions about what family practice residents should be taught in general surgery. Surgeons attached significantly less importance to nine of 21 general categories of learning objectives (e.g. emergency skills) than did practicing family physicians or family practice residents. No differences in ratings of surgical objectives were observed for 12 of 21 general categories.

Clinical Competence↗

Heterosexual and perinatal transmission of human immunodeficiency virus in a low prevalence community.

Six previously unidentified cases of human immunodeficiency virus (HIV) infection were found during an investigation and follow-up of three clusters of heterosexually and perinatally transmitted HIV infections. The investigations were to identify those infected, to interrupt the transmission of HIV, to attempt to reduce the likelihood of the development of the acquired immunodeficiency syndrome among those found to be seropositive, and to show the usefulness of traditional disease control strategies during this epidemic. Our findings indicate the value of contact tracing for HIV infections and the need to provide and evaluate educational activities regarding the transmission of HIV in low prevalence populations.

Acquired Immunodeficiency Syndrome↗

Research activities of clinical nurse researchers.

A nationwide telephone survey was carried out on 34 nurses employed as researchers in clinical settings (CNRs). CNRs reported current involvement in over 200 projects with a range from 1 to 29 projects. Projects were categorized into the following types: clinical practice, nursing administration, evaluation, education, or methodology. Almost half (47%) of the projects were in clinical practice. Type of involvement in research was used as a basis for conceptualizing the CNR's role as traditional scientist, associate, or facilitator. Results are discussed regarding the variations found in how the CNR role is enacted across settings and the focus of the research in which CNRs are engaged.

Adult↗