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The Pew Commission Report: nursing's challenge to address it.

The Pew Health Professions Commission was established in the Spring of 1989 and is administered by the University of California at San Francisco, Center for the Health Professionals. The Commission is charged with assisting health professionals, workforce policy makers, and educational institutions in responding to the challenges of the changing health care system. The Commission's work will identify and explore how regulations protect the public's health, and will propose a new approach to health professionals' licensure, certification, and regulations. In December 1995, the Commission released a full report, Reforming Health Care Workforce Regulation: Policy Considerations for the 21st Century, including 10 recommendations. These recommendations are found in Table 1. In her presentation made during ANNA's 28th National Symposium in Minneapolis on April 28, 1997, Barbara Donaho--a Commissioner on the Pew Health Professions Commission--challenged nephrology nurses to address issues brought up in the Commission Report. The fundamental concepts in Ms. Donaho's keynote presentation were: Articulate the issues that are critical to nurses' licensure as reform is considered. Describe public and professional forces of change if licensure is going to protect the public. Discuss the alternatives that may need to be considered when reform is undertaken by the states to ensure that professionals may practice nursing throughout the country without regulatory and licensing barriers. In this article, based on her ANNA keynote presentation, Ms. Donaho makes it clear that nursing's response to proposed health care reform must be aggressive and swift.

Certification↗

Imbalance of morphologically addressed telophases reflects interphase DNA aneuploidy in tumorigenesis.

Chromosome division figures (CDFs) are quantitatively different from normal mitoses and represent a novel cytogenetic phenomenon. This investigation was focused on morphologically addressed bipolar telophases in histologically defined human biopsies and in the tumour breast cell-line MDA231. Single cell nuclei were recorded by image microphotometry on inflamed and premalignant lesions of skin (49 cases), oral mucosa (43) and colon mucosa (46). DNA content and replication status were analysed in interphase nuclei as well as in mitoses and in CDFs. In contrast to inflamed lesions, premalignancies were characterised by pronounced endoreplication, when the rate exceeding 5 c was > or = 10% in interphase nuclei. CDFs from the corresponding lesions showed an aberrant DNA content beyond 5 c even more frequently. DNA profiles of metaphases and telophases resembled those of prophases. Therefore, the DNA content of corresponding telophase hemispheres was measured. Severe differences averaged 0.3 c in MDA231 and up to 0.5 c in premalignant lesions. The mean difference between two corresponding hemispheres was 0.39 +/- 0.09 c in Bowenoid keratosis (n = 31), 0.40 +/- 0.08 c in high-grade dysplasia of oral mucosa (n = 16) and 0.21 +/- 0.03 c in high-grade dysplasia of colon adenoma (n = 65 telophases). As a control, the telophase difference was only 0.07 +/- 0.02 c (n = 23) in foetal liver and 0.06 +/- 0.01 c in 24 amnion cells. Thus, genomic instability and, in consequence, genomic imbalance can best be quantified from the DNA profiles of telophase CDFs and from the various DNA amounts in their hemispheres. A strong selection against telophases was observed in neoplasias developing DNA aneuploidy. Those aberrant telophases which escape selection are thought to enhance tumour progression.

Aneuploidy↗

Addressing comorbidity in adults with attention-deficit/hyperactivity disorder.

Psychiatric comorbidity complicates the accurate diagnosis and effective treatment of attention-deficit/hyperactivity disorder (ADHD) in adults. This paper examines the influence of comorbidity on treatment responsiveness in ADHD adults, the neurobiological underpinnings of comorbidity, and the potential of different pharmacologic agents to address comorbid states in ADHD. A categorical schema for neurobiological classification of ADHD subtypes is integrated with literature associating specific neurotransmitters with corresponding neurobehavioral abnormalities. Dopamine, for example, is one of several neurotransmitters implicated in bipolar disorder. Serotonin and norepinephrine are implicated in major depression and anxiety disorders, while self-medication for dopamine dysfunction may relate to substance abuse. Norepinephrine and serotonin have each been linked to aggression and impulsive antisocial behaviors. The effective treatment of ADHD with comorbid psychiatric disorders requires knowledge of the neurochemical underpinnings of each disorder and expertise in the application of appropriate pharmacologic tools. Controlled studies assessing treatment outcomes for both comorbid disorders will assist in the development of improved treatment strategies for adults with complicated ADHD.

Adolescent↗

Are health-based payments a feasible tool for addressing risk segmentation?

As they attempt to increase health insurance coverage and improve the efficiency of the market, researchers, policymakers, and health plan representatives have been addressing the issue of risk segmentation. Many risk assessment tools and risk-adjusted payment methodologies have been developed and demonstrated for a variety of populations and payers experiencing various market constraints. The evidence shows that risk-adjusted payments are feasible for most populations receiving acute care, while technical obstacles, political issues, and some research gaps remain.

Health Care Sector↗

Addressing the sexual concerns of patients following myocardial infarction.

The review explores the dimension of sexuality for patients with a myocardial infarction. It discusses the role of the nurse in addressing issues of sexuality for this group. Potential reasons for the apparent difficulties faced by nurses and patients when dealing with this issue are considered. Tentative recommendations are made for closing the apparent gap between principles and practice.

Adult↗

Addressing bias in the forensic assessment of sexual harassment claims.

This article addresses unique biases that arise in the assessment of sexual harassment claims by forensic psychiatrists. These include gender biases, diagnostic biases, sociopolitical biases, and bias that arises from lack of knowledge regarding sexual harassment or lack of formal psychiatric training. Forensic psychiatrists are ethically obligated to strive for objectivity and honesty in their assessments. By becoming aware of these biases and attempting to minimize them, we can meet our ethical obligations as forensic psychiatrists. In addition, we can provide more credible and valuable assessments to the courts in this increasingly litigated and partisan issue.

Disability Evaluation↗

Home care: addressing the needs of people living with AIDS and their caregivers.

Home care has become an important community resource for the care of people living with AIDS (PLWA). Another important resource to maintaining PLWAs in the home environment is the availability of informal caregivers who are willing to provide support and assistance in the home setting. Because of the stressful nature of AIDS care, home care nurses must anticipate and address the needs of both PLWAs and their caregivers.

Caregivers↗

Primatology comes of age: 2002 AAPA Luncheon Address.

The growth of primate field studies has occurred along multiple dimensions representing expansion in the number of species studied, comparative studies of different populations of the same species, and populations and groups studied over time. The accumulation of data on a broader taxonomic diversity of primates has contributed to advances in the use of comparative methods for gaining insights into interspecific variation in behavior patterns, but the incorporation of intraspecific variation into comparative models of behavior has lagged behind. This delay can be attributed, in part, to the slow rate at which the interacting effects of life history and demography on behavior emerge in slow-growing, long-lived primates. It may also reflect the anthropocentric foundation of field primatology, which historically focused on interspecific comparisons with humans instead of interpopulation variation among primates. Conservation concerns have stimulated new thinking about the importance of populations and the range of behavioral variation that populations maintain. The integration of intra- and interspecific behavioral variation will distinguish the next generation of comparative models in primatology, and set a new agenda as field primatology comes of age.

Animals↗