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At least 793 records · Page 44Linked to original sources
PubMed1993

Poisoning in the elderly: characterization of exposures reported to a poison control center.

OBJECTIVE: To determine the incidence of poison center calls involving the elderly, characterize these poisonings, and compare them with poisonings that occur in people younger than 60 years of age. DESIGN: Concurrent, observational survey. SETTING: The Virginia Poison Center in Richmond, Virginia. PARTICIPANTS: All persons 60 years of age and older who were involved in a poison exposure reported to the Virginia Poison Center from October 1, 1991 through March 31, 1992. MEASUREMENTS: Incidence, type, route, location, management site, medical outcome of exposures and reasons for these exposures. RESULTS: Exposures in persons 60 years of age and older accounted for 2.3% of all poison center calls during the 6-month study period. These calls were most likely to involve women who unintentionally ingested extra doses of medications. The majority of these exposures occurred in the home and resulted in either no effect or minor effects. For those exposures that necessitated an emergency room visit, elderly persons were more likely to be admitted to the hospital than younger persons (P < 0.05). CONCLUSIONS: The majority of poisonings that occur in persons 60 years of age and older are unintentional and may be amenable to poison prevention education.

Age Factors↗
PubMed1999

From randomized trial to community-focused practice.

PURPOSE: To describe the use of findings from a randomized trial--a nursing intervention using telephone contacts to reduce the incidence of low-birth-weight and preterm births--in four community settings in North Carolina, to show that implementing research into practice is important. Low-birth-weight and preterm births are the major cause of high infant mortality in the United States. Rates are highest among African-American women. Telephone intervention as a strategy for preventive health care can be cost effective, reduce low-birth-weight and preterm births in African-American women, and provide a means of health consultation for parents of children age five and under. ORGANIZING FRAMEWORK: Four community programs are discussed in relation to five phases of implementing and sustaining research in communities: research, transfer, transition, regeneration, and empowerment. Modification from the original research, bonuses, and barriers are described for each program. METHODS: The randomized trial was conducted from 1990-1995. Randomized trial data and data for subsequent projects were collected from telephone interviews and health care records from 1994-1998. A successful adaptation was made from the original randomized trial to the four programs by (a) educating the staff for each program about the methods and findings in the original research, and (b) working with program staff to make appropriate modifications for each site. CONCLUSIONS: Findings from a randomized trial can be used in a variety of settings. By working together, researchers and community-health nurses can integrate research findings into community-health nursing practice.

Black People↗
PubMed1995

Women's reports of breast implant problems and silicone-related illness.

OBJECTIVE: The safety of silicone breast implants recently has been questioned. Increasing numbers of women have reported a variety of health problems that they attribute to their implants. The purpose of this descriptive study was to explicate the phenomenon of silicone-related illness as reported by women who have had breast implants. DESIGN: A qualitative design was grounded in the theoretical framework proposed by McBride and McBride (1981), the core of which is the first-person, lived experiences of women as interpreted and explained by the women themselves. PARTICIPANTS: Participants were recruited through Command Trust Network, an international support group for women with breast implant problems. The sample consisted of 55 women from 19 states and Canada who experienced health problems they attributed to their implants. Eighteen percent labeled themselves as disabled. RESULTS: Themes emerging from responses to 10 questions are discussed in terms of circumstances leading to initial implantation, understanding risks and benefits, health problems and symptoms, physician response, choices made about implant removal, and psychosocial and emotional consequences. CONCLUSIONS: Findings included dissatisfaction with implants, similarity of health problems, and recurrent surgical and nonsurgical procedures. Dominant themes included lack of informed consent, physician denial of health problems, and the decision to remove implants. Further research should be directed at recipients of implants who report silicone-related illness to determine the number of women affected and the nature of their problems.

Adult↗
PubMedDate not supplied

A new paradigm for postpartum care.

Shortened hospital stays have decreased women's access to postpartum nursing care. Providers and payers together must address clinical and cost issues to develop a model of maternity care that covers the postpartum period. A short-stay maternity program was developed in 1989 by Professional Nurse Associates, Inc., in conjunction with Kaiser Permanente. The program includes prenatal preparation of families, a brief hospital stay, postpartum home visits, and postvisit case management. Readmission rates or mothers and newborns in the program have been less than 1%. The program has saved about $1 million a year since 1991, and consumer satisfaction has been measured at 99%.

Cost-Benefit Analysis↗
PubMed1994

Schizophrenia--a national emergency: preliminary observations on SANELINE.

In May 1992 the British mental health charity SANE inaugurated a telephone helpline for people suffering from or copying with severe mental illness. From its first days the line has been inundated by people needing information and help about their illness. The line is open from 1400 to midnight every day of the year, and is manned by almost 100 trained volunteers supervised by professional staff. In total more than 100,000 people have called the SANELINE number since it opened. For every call taken, a detailed log is written up immediately. The service is, of course, confidential. We recognized even before the line was opened that these logs would provide unique information on which a wide range of research could be based. One of the most frequent problems about which callers told us was dissatisfaction with the medication they were given. Many callers complained about the negative symptoms of schizophrenia. We have been working on a pilot study to determine the problems sufferers find with their medication, which may throw light on the concept of the neuroleptic-induced deficit syndrome.

Antipsychotic Agents↗
PubMed2005

Barriers and facilitators influencing call center nurses' decision support for callers facing values-sensitive decisions: a mixed methods study.

BACKGROUND: Call center nurses triage symptoms and provide health information. However, information alone is not adequate for people facing values-sensitive health decisions. For these decisions, effective interventions are evidence-based patient decision aids and in-person nurse coaching using a structured process. Little is known about the quality of decision support provided by call center nurses. AIMS: To identify the barriers and facilitators influencing the provision of decision support by call center nurses to callers facing values-sensitive health decisions at a Canadian province-wide health call center. METHODS: A mixed qualitative and quantitative descriptive study from December 2003 to January 2004 using key informant interviews (n= 4), two focus groups (n= 7), a barriers assessment survey (n= 57), and analysis of simulated patient calls (n= 38) were carried out. Triangulation of these data was conducted using a conceptual content analysis method. RESULTS: Participants indicated positive attitudes toward call center nurses preparing callers facing values-sensitive decisions. Facilitators included decision support resources, nurses' ability to recognize callers having difficulty, and having a supportive organizational infrastructure. The most frequently identified barriers were (a) limited usability of patient decision aids via telephone; (b) lack of a structured process to guide nurses during these types of calls; (c) nurses' inadequate knowledge, skills, and confidence in providing values-sensitive decision support; (d) unclear program direction; (e) organizational pressure to minimize call length; and (f) low public awareness of the services. CONCLUSIONS AND IMPLICATIONS: Despite call center nurses having positive attitudes, several modifiable barriers were interfering with nurses' current approaches to supporting callers facing values-sensitive decisions. Nurses wanted educational opportunities to further develop their decision support knowledge and skills, and decision support resources that are easier to use via telephone. As well, changes to organizational policies that address identified barriers could further facilitate the provision of decision support.

Attitude of Health Personnel↗
PubMed2004

Compliance with advice and appropriateness of emergency presentation following contact with the HealthDirect telephone triage service.

OBJECTIVE: Evaluation of compliance with advice and appropriateness of emergency presentation following contact with a telephone triage service (HealthDirect). METHODS: Compliance rates, triage distributions and admission rates were determined using linked HealthDirect and ED records for patients living within 2 km of an ED that presented during 2000. RESULTS: Of 13 019 presentations, 842 (6.5%) were HealthDirect contacts. In the HealthDirect group there were a greater proportion of patients under the age of 15 (290, 34% vs 1598, 13.1%) and women (481, 57% vs 5610, 46%). The triage distributions and admission rates for HealthDirect contacts and other patients were similar (HealthDirect 37.6% admitted, 95% CI 34-41, others 38.4% admitted, 95% CI 38-39, Pchi2 = 0.67). Of 3996 callers to HealthDirect, 3167 (79%) complied with advice with 963 (61%) complying with advice to present and 212 (9%, 95% CI 8-10%) presenting despite advice to defer presentation. Triage distributions and admission rates for compliers and non-compliers were similar (compliers 38% admitted, 95% CI 34-41, non-compliers, 37% admitted, 95% CI 30-44, Pchi2 = 0.89). CONCLUSIONS: HealthDirect contacts were of similar appropriateness to non-HealthDirect presenters and appear to attend the ED independent of HealthDirect advice. HealthDirect has a limited capacity to influence ED utilization or workload.

Adolescent↗
PubMedDate not supplied

Political issues in emergency medicine: the United Kingdom.

A recent issue of this Journal published two papers on political issues facing the specialty of emergency medicine in the USA and in Canada. This paper continues the theme from a UK perspective. In recent years there has been significant change in the National Health Service, which has had (or will have) both direct and indirect consequences for the specialty of emergency medicine and the delivery of emergency care in the UK. This article describes some of the recent National Health Service initiatives and their implications for emergency medicine.

Advisory Committees↗
PubMed2004

A Swedish telephone help-line for sexual problems: a 5-year survey.

INTRODUCTION: Telephone help-lines for people with sexual problems have been established in many European countries during the late decade. They, however, have very different modes of operation, and very few reports focusing on the way they function have been published internationally. AIM: To describe the methods and activities of a Swedish help-line for sexual problems. METHODS: In the 5 years, from 1999 to 2003, 27,387 persons called the Swedish toll-free help-line for "impotence and sexual problems" that operates around the clock. The majority of callers appeared to be looking for information on erectile dysfunction. A counseling option staffed by experts in sexual medicine counseled 2,817 (men 73%, women 27%). A further 478 callers were professionals wanting information or advice. RESULTS: Among a wide spectrum of problems associated with the callers' sexual life, sexual dysfunctions were the most frequent. Calls about sexual abuse, sexual preference, paraphilias, and other subjects were also received. Among those with sexual dysfunction, 33% of men and 41% of women had more than one sexual dysfunction. These were often concomitant with a frequently drug-treated, medical condition. In addition to counseling, the majority of callers were advised to contact physicians or specialists in sexology/sexual medicine for further help. CONCLUSION: Competent person-to-person telephone counseling in the multifaceted bio-psycho-social field of sexual problems requires broad knowledge on sexual medicine.

Adult↗
PubMed2005

Women's sexual concerns: data analysis from a help-line.

PURPOSE: To report female sexual problems and concerns, as presented by women calling a help-line, and to evaluate women's help-seeking behavior regarding sexual matters. MATERIALS AND METHODS: The study included all telephone calls from women who called for sexual concerns to a help-line dedicated to sexual problems during a 5-year period. During the call, the counselor addresses demographic characteristics of the caller, the sexual problem reported, their sexual function, any previous doctor contacts, coexisting physical and mental health problems, couple's relationship, and lifestyle factors that may influence sexual function. Data processing employed descriptive statistics and logistic regression analysis in order to detect possible associations between categorical variables. RESULTS: Of a total of 3,523 calls made by women, 2,287 full forms were analyzed, reflecting a response rate of 64.9%. Most women (46.6%) called for problems encountered by their partners, 45.1% called for their own sexual problems, while 5.9% were calling for their children. Only 34.3% of them had already consulted a doctor. The most frequently reported difficulties were achieving orgasm (25.6%), reduced sexual desire (16.9%), and pain during intercourse (6.1%). Women in the 40-49 age group had the higher odds ratios for the sexual problems reported (reduced sexual desire: odds ratio [OR] 5.0; difficulties achieving orgasm: OR 6.3; pain during intercourse: OR 5.8). Both married and single women had high risk of experiencing low levels of sexual desire (40% and 30%, respectively). CONCLUSIONS: Women's sexual concerns are not devoted to their sexual problems, but also their partner's and children's problems. Most frequently reported sexual problems are difficulties in reaching orgasm and reduced sexual desire. However, women are reluctant to seek medical advice on their sexual concerns. There is a need for general practitioners and family doctors to become aware of the possibility of a sexual problem and to be trained on how to manage this at a primary care level.

Adult↗
PubMedDate not supplied

Parent Line: nurse telephone intervention for parents and caregivers of children from birth through age 5.

PURPOSE: To describe the development and implementation of Parent Line, a program to improve the health and development status of children through periodic telephone contact by nurses. POPULATION: Low-income parents of children from birth through age 5. CONCLUSION: Telephone contact with a nurse, combined with peer counselor contact when no telephone is available, is welcomed by parents and can address needs in a timely way that might be unmet otherwise. Telephone intervention can provide social and emotional support, education, and advocacy for families. PRACTICE IMPLICATIONS: The telephone can be of value to pediatric nurses in providing anticipatory guidance and health teaching, and be a support to parents throughout the preschool years.

Child Health Services↗
PubMed2006

Tobacco prevention in children and cessation in family members.

PURPOSE: To examine the effects of a theory-driven tobacco prevention program in sixth-grade children with a family tobacco cessation component implemented by school nurses in conjunction with the initiation of a statewide toll-free Quit Line. DATA SOURCES: Self-report questionnaires completed by the sixth-grade children and their parents/guardians (N= 1024) representing largely rural southern school systems from disparate areas with high prevalence rates of tobacco use and lung cancer diagnoses. Pre- and posttest measures that evaluated the impact of both student and parent/guardian interventions were obtained over a 10-week period. Paired t-tests were used to examine differences between pre- and posttest scores for all student and parent/guardian variables. Repeated-measures analysis of variance was used to examine the effect of parent/guardian smoking on student pre- and posttest scores. CONCLUSIONS: The student program resulted in significant improvements in drug knowledge, refusal skills, attitudes, normative expectations, assertiveness, and anxiety reduction techniques. In addition, the effectiveness of several components of the tobacco prevention program for the children was impacted by the smoking status of their parents/guardians. Drug-use intentions and behaviors were lower at posttest for children from homes of nonsmokers versus children from homes of smokers. Parents/guardians consistently reported that smoking was detrimental to themselves, the public, and their children. Of those parents/guardians who identified themselves as smokers (26%) and received cessation materials, 46.4% indicated that the information motivated them to want to quit. IMPLICATIONS FOR PRACTICE: Tobacco use continues to be the leading cause of preventable death in the United States, with greater than 2000 new youth becoming regular smokers each day. School nurses and nurse practitioners are in various pivotal positions to address tobacco and its related health concerns through delivery of effective family interventions that target children for tobacco prevention and parent/guardian smokers for cessation.

Attitude to Health↗
PubMed2000

ChildLine--the first twelve years.

This brief article aims to give a history and overview of ChildLine's work in the first 12 years of its existence and to provide references to more detailed information on a range of issues that children and young people themselves have identified as important. All callers' names and identifying details have been changed to preserve confidentiality.

Child↗