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At least 1,171 records · Page 65Linked to original sources
PubMed1994

Epidemiologic characteristics of drivers, vehicles, pedestrians and road environments involved in road traffic injuries in rural Thailand.

This report presents descriptive epidemiology of vehicle-related crashes that caused severe injuries in a defined geographical area in northern Thailand, conducted to determine the nature of injuries and factors that contributed to the crashes. In each incident, the driver and other victims were identified and interviewed by a trained public health worker using a standard investigation form. During 1991, 286 single-vehicle crashes (66.4%), 117 crashes with other vehicles (27.1%), and 28 crashes involving pedestrians (6.5%) occurred in the area. These crashes injured 581 persons (551 vehicle occupants and 30 pedestrians), of whom 36 (6.2%) died. The vehicles involved in the crashes included 11 bicycles (2.3%), 371 motorcycles (78.6%), and 90 other motor vehicles (ie, pick-up trucks, lorries, and cars) (19.1%). Motorcycle-related crashes accounted for the majority of injuries and deaths. Driver risk factors for traffic injuries, such as alcohol consumption, lack of a valid driving licence, limited driving experience, and being a teenage driver, occurred more commonly among drivers of motorcycles than of other motor vehicles. Poor vehicle conditions and road environments reported in some incidents may have posed additional risks. Pedestrian factors, including young and old age, and alcohol use, may also have contributed to the occurrence of pedestrian injuries. Our system of data collection using an investigation form can provide relevant information, leading to the development of appropriate accident prevention programs for the community.

Accident Prevention↗
PubMed1994

Information revolution in nursing and health care: educating for tomorrow's challenge.

Current emphasis on the national electronic highway and a national health database for comparative health care reporting demonstrates society's increasing reliance on information technology. The efficient electronic processing and managing of data, information, and knowledge are critical for survival in tomorrow's health care organization. To take a leadership role in this information revolution, informatics nurse specialists must possess competencies that incorporate information science, computer science, and nursing science for successful information system development. In selecting an appropriate informatics educational program or to hire an individual capable of meeting this challenge, nurse administrators must look for the following technical knowledge and skill set: information management principles, system development life cycle, programming languages, file design and access, hardware and network architecture, project management skills, and leadership abilities.

Computer User Training↗
PubMed1994

Mammography screening controversies.

Some organizations in the U.S. recommend mammography screening at 1- to 2-year intervals for those aged 40 to 49 and annually from the age of 50. In Canada and Europe, screening mammography is not recommended for women aged 40 to 49, and mammography every 2 to 3 years for women aged 50 to 69. The screening studies in Europe show no evidence of effectiveness of mammography screening in women aged 40 to 49 in the first 8 to 10 years after initiation of screening. Although at 12 years the recent Swedish overview analysis shows a 13% reduction, this is nonsignificant and the confidence intervals are wide. In the National Breast Screening Study (NBSS) in Canada, annual two-view mammography and physical examinations by carefully trained health professionals were given. In women aged 40 to 49 the ratio of proportions of deaths was 1.36 (95% CI 0.84, 2.21). For women aged 50 to 59, the NBSS evaluated the contribution of mammography over and above physical examination. In spite of detecting many more cancers, mammography did not result in a reduction in breast cancer mortality at 7 years (OR 0.97; 95% CI 0.62, 1.52). Although these results suggest the benefit from screening may be less than assumed, for women over 50, biennial screening to age 74 is probably appropriate in population programs, although careful monitoring will be necessary to ensure that the anticipated effect is achieved.

Adult↗
PubMedDate not supplied

Staff education can prevent OR fires.

1. Every operating room has the elements necessary to start a fire: oxidants (O2, N2O), ignition sources, and fuel. 2. A team approach, including nursing, anesthesia and surgery members, should be used in assessing fire safety in the operating room. 3. Staff knowledge of fire safety can be assessed by written tests. An appropriate fire safety program can be developed based on the test results. 4. Fire evacuation drills and hands-on use of fire extinguishers should be included in any OR fire safety program.

Education, Continuing↗
PubMed1977

Unusual sites of metastases.

Unusual metastases occur in a significant percentage of patients with malignant disease. In large measure, they represent a preterminal event. This is not always the case, however. In patients who have metastases to the skin, the event is generally preterminal particularly when the primary is the lung. In that instance the time between appearance of the metastasis and death is between 1.5 and 2.6 mo. Metastases to the skin occurring in patients with carcinoma of the cervix also represents a preterminal event with a time from diagnosis to death of 3 mo. In patients with carcinoma of the esophagus, the time from diagnosis to death is 4.3 mo, on the average. On the other hand, metastases to the skin from primary malignant tumors involving the colon, bladder, kidney, and ovary do not represent preterminal events. The time form diagnosis to death varies from 7.3 mo in carcinoma of the ovary to 12.7 mo in carcinomas of the kidney. Therefore, it is important when a patient presents with metastases to the skin to establish the primary source, the extent of the metastatic lesions and devise treatment programs that are appropriate to the pattern of the metastasis and the primary diagnosis...

Abdominal Neoplasms↗
PubMed1993

Alcohol and trauma.

Alcohol usage is an integral causal factor in all types of trauma. Additionally, both the acute and to a much greater extent chronic usage of alcohol impair the body's normal physiologic responses to injury. Emergency physicians are painfully aware of the relationship between alcohol and trauma. However, we occasionally fail to appreciate the body's altered response and physical state due to alcohol. We frequently fail to use this opportunity to confront patients with the fact that they have a problem and refer them appropriately to rehabilitation programs.

Abdominal Injuries↗
PubMed1996

Physician experience with pediatric inpatient care in Washington State.

OBJECTIVE: To determine the frequency with which pediatricians and family physicians in Washington State serve as attending physicians for pediatric inpatients. DESIGN: Retrospective review of statewide hospital discharge data. SUBJECTS: Attending physicians for all patients younger than 18 years of age with nonsurgical diagnoses discharged from civilian hospitals in Washington State during 1989 and 1990. RESULTS: Using medical rosters, the self-identified specialty of the attending physician was determined for 93% (n = 181,581) of discharges. Pediatricians and family physicians were listed as attending for 61% and 28%, respectively, of all eligible patients. Statewide, 97% (n = 555) of all pediatricians and 86% (n = 939) of all family physicians served as attending physicians for at least one inpatient, including healthy newborns, during the 2-year study period. The median annual number of discharges per physician was 78 for pediatricians and 14.5 for family physicians. Excluding healthy newborns, the median annual number of discharges was 25 for pediatricians and 3 for family physicians. Five percent of the physician attending group provided inpatient care for 50% of all children hospitalized with diagnoses other than healthy newborn; 50% of attending physicians cared for 95% of the patients. In rural hospitals, where family physicians served as attending physicians for 44% of pediatric inpatients, children were 3.3 times more likely to receive their care from family physicians than those hospitalized in urban centers. CONCLUSIONS: Most pediatricians and family physicians serve as inpatient attending physicians for hospitalized children only infrequently. These findings question whether the emphasis on inpatient care in many pediatric and family medicine training programs remains an appropriate goal.

Adolescent↗
PubMed1996

The pattern of growth and obesity in Saudi Arabian male school children.

OBJECTIVE: To determine the prevalence of overweight and obesity among male school children in Saudi Arabia and provide a growth chart for males 6-18 y old. DESIGN: Three stage stratified cluster sampling procedure. SUBJECTS: The study population was 9061 male school children, attending public schools in Saudi Arabia. Their ages ranged from 6-18 y and covered all the 12 grade levels of school. Children with evidence of chronic or acute diseases were excluded from the study. MEASUREMENT: Structured questionnaire, including: location of school, socio-demographic characteristics and age of the student. Anthropometric measurements of weight and height was done for all the study sample. Growth charts were designed through fitting the polynomial regression model of degree three. The percentage of body mass index (BMI) of expected BMI at the 50th percentile for each age group was computed. The 50th percentile of The National Center for Health Statistics/Center for Disease Control reference population was used as the expected standard population values for defining childhood overweight and obesity. RESULTS: The overall prevalence of overweight was 11.7% and obesity 15.8%. There was a statistically significant variation in the regional distribution of overweight and obesity (P < 0.01). The highest prevalence (18.0%) was recorded in Riyadh, capital of Saudi Arabia, and the lowest was in Sabea (11.1%) located in the Southern region. CONCLUSION: These findings of a high prevalence of childhood obesity when compared with the NCHS/CDC calls for an early health education program on the appropriate choice of diets for growth, health and longevity. However, because of the possible ethnic differences between the Saudi and American populations, the growth charts presented could serve as a better reference for future comparisons.

Adolescent↗
PubMedDate not supplied

Attitudes of Australian nurses toward the implementation of a clinical information system.

A computerized clinical information system (CIS) used for the majority of patient charting and medical records was installed in six of 15 beds in the intensive care unit (ICU) of a large Australian hospital in November 1993. Staff acceptance was identified as integral to the success of the system. A survey was issued to all nursing staff of the ICU to identify factors that affected attitude toward computers in the critical care environment. Factors resulting in negative attitudes then could be targeted through training and support for users. The factors considered that potentially could influence attitudes were age, nursing experience, intensive care nursing experience, and education. The study showed that nursing experience had a statistically significant effect on motivation to use computers. A strong relation was evident between the concepts of beliefs, attitudes, and motivation. A less apparent association was present between knowledge and the other concepts. Orientation and in-service education programs should provide appropriate and applied information to optimize the motivation, beliefs, and computer literacy of nurses using CIS frameworks.

Adult↗
PubMed1997

[Video stereophotography of the optic papilla. A practice-oriented documentation].

Video documentation of the posterior pole using a camera installed in the ocular part of a slitlamp provides visualization of the optic disc from two different angles by changing the ocular part with the camera from the right to the left. Using the appropriate video printer program (split 4) two pictures of the right optic disc are stored on the upper half, one shooting from the right the other from the left. The lower half of the print is reserved for the left optic disc. Thus stereoscopic perception of the optic discs can be achieved. By this means a simple procedure has been provided for improved follow up of glaucoma patients.

Documentation↗
PubMed1997

Neuromuscular retraining for facial paralysis.

Neuromuscular retraining is an effective method for rehabilitating facial musculature in patients with facial paralysis. This nonsurgical therapy has demonstrated improved functional outcomes and is an important adjunct to surgical treatment for restoring facial movement. Treatment begins with an intensive clinical evaluation and incorporates appropriate sensory feedback techniques into a patient-specific, comprehensive, home therapy program. This article discusses appropriate patients, timelines for referral, and basic treatment practices of facial neuromuscular retraining for restoring function and expression to the highest level possible.

Adult↗
PubMedDate not supplied

Diabetes in African American women: the silent epidemic.

Non-insulin-dependent diabetes mellitus is a serious metabolic disorder that affects an estimated 16 million Americans. Among African American women, diabetes has reached epidemic proportions, with 1 in 4 black women 55 years and older having diabetes. It is only within the last decade that diabetes research has begun to examine racial differences in the etiology, treatment, and long-term complications of diabetes. This review bring together the research that focuses on African American women within the context of diabetes research in the general population. Particular emphasis is placed on diabetes risk factors, complications of diabetes, and pharmacologic and nonpharmacologic treatment approaches. Diabetes prevention and public health issues related to diabetes and the African American women are discussed. The literature reviewed points to the importance of screening and early detection of diabetes among high-risk African American women, as well as the need for improved quality of care and patient educational services and programs in diabetes appropriate to the needs of African American women.

Black or African American↗
PubMedDate not supplied

[Development in the National Hospice Care Service in Korea].

The urgent needs to establish hospice care systems in Korea arise from the following reasons: (1) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e.g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accommodate other medical insurance beneficiaries: (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life: (6) medical and nursing care of AIDS patient in terminal stage: (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage, grouped in hospice and non-hospice care patients, reveal what they want visiting nursing care to help their pain control, psychological, social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains, the non-hospice care patients, in addition to their desire for pain control, demanded more psychological, social and spiritual helps as well. The results of this research could be utilized to (1) define the standard of hospice care, (2) provide the guidance for hospice medical care costs, (3) establish the database of hospice care systems, (4) develop softwares, (5) build communication network through Medinet, and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy, nursing care, and social welfare programs.

Acquired Immunodeficiency Syndrome↗
PubMed1976

The Waterston anastomosis with no deaths in the neonate.

The Waterston anastomosis has been performed with no deaths in 11 consecutive neonates during the past 24 months. Seven neonates had pulmonary atresia with either single ventricle or hypoplastic right ventricle, 3 had tetralogy of Fallot, and one had severe pulmonary stenosis with a normal right ventricle. Six neonates were one day old and only one was older than 7 days. All have obtained symptomatic and documented (increase Po2) benefit. This level of success is attributed to (1) minimal delay between the recognition of cyanosis and operation (mean time between hospital admission and catheterization was 3 hours and between catheterization and operation, 4 hours); (2) correction of any base deficit prior to, during, and after operation; (3) accurate construction of the anastomosis to avoid excessive size, and (4) careful postoperative management of the pulmonary subsystem by experienced personnel. We have demonstrated that the high mortality rate previously reported for the Waterston anastomosis in the neonate can be markedly improved by an appropriate patient management program.

Aorta, Thoracic↗
PubMed1998

[Lead exposure: risk evaluation for the general Italian population in 1990].

The second Italian campaign for the biological surveillance of the general population against the risk of lead intoxication has been carried out according to the regulations contained in the Presidential Decree DPR 496/82. The investigations of the second campaign--based on the measurement of blood lead levels (PbB)--have been carried out mainly between 1992 and 1996 by various operating centers in some Italian regions. A work group from the Istituto Superiore di Sanità (Italian National Institute of Health) coordinated the activity of the various centers and organised an appropriate quality control program to guarantee the quality of the analytical data collected. A total of 7749 non exposed subjects (4346 females and 3403 males) has been examined, 1170 of which (559 females and 611 males) were under 15 years of age. The median PbB was, for adults, 86 micrograms/l in males and 53.5 micrograms/l in females. As for subjects under the age of 15, PbB levels were 50 micrograms/l and 43 micrograms/l in males and females, respectively. Our investigation confirms the correlation between blood lead levels, wine, and cigarette smoking. The comparison with the results of previous investigations shows a reduction between 40% and 50% of PbB in the general Italian population during the 1985-96 period. It should be pointed out that in certain areas more than 5% of subjects under 15 years of age had PbB exceeding the level (100 micrograms/l) considered safe for avoiding irreversible injury to the central nervous system.

Adolescent↗
PubMed1998

Health status and practices of urban Caribbean Latinos with diabetes mellitus.

Although Caribbean Latinos are more likely than non-Hispanic whites to develop diabetes, their health status has been poorly characterized. Information on diabetes management, metabolic control, dietary habits, and diabetes knowledge was gathered from a group of urban Caribbean Latinos with diabetes in order to characterize the nutritional behaviors, diabetes attitudes, health perceptions, and metabolic control of this high risk group. Interviews and medical record reviews were conducted among seventy low-income urban Caribbean Latinos with type 2 diabetes mellitus. Patients attending outpatient clinics were interviewed by bilingual interviewers. Medical records were reviewed to ascertain prevalence of diabetes-related complications, medications, and metabolic parameters. Participants were primarily Spanish-speaking and of Puerto Rican origin. Eighty-one percent were unemployed, and only 27% had completed high school or higher educational levels. Average hemoglobin A1c was 10.6%. Among those with hypertension and hyperlipidemia, many were not receiving treatment. Participants' estimation of their own degree of metabolic control was poor, as was their understanding of desirable blood glucose and weight goals. A second evening meal was common. Diets were higher in fat and sugar content than currently recommended. More effective treatment strategies for both patients and providers are needed to improve glycemic control and cardiovascular risk factors among indigent urban Caribbean Latinos. Essential features of such strategies for patient programs include culturally appropriate dietary counseling and low literacy materials to better communicate glycemic and weight goals and dietary guidelines. Provider education is needed regarding established guidelines and cultural influences on diabetes-related practices.

Attitude to Health↗
PubMedDate not supplied

Collaboration between community pharmacists and family physicians: lessons learned from the Seniors Medication Assessment Research Trial.

OBJECTIVES: To learn about the experiences of specially trained expanded role pharmacists (ERPs) and family physicians in a program in which they worked together to optimize drug therapy for elderly patients (aged 65 and older) and to identify shortcomings of the program, obstacles to its implementation, and strategies to overcome these obstacles. DESIGN: Qualitative opinion analysis. PARTICIPANTS: Six family physicians and six community-based ERPs who had participated in a randomized controlled trial (Seniors Medication Assessment Research Trial [SMART]). INTERVENTION: In-depth interviews. MAIN OUTCOME MEASURES: Themes that emerged from the interviews regarding the strengths and weaknesses of and ways to improve the program. RESULTS: ERPs and physicians differed in their perceptions of appropriate roles for ERPs. ERPs saw the program as an opportunity to take on new professional roles. Physicians appreciated the information they received from ERPs about their patients' adherence and use of nonprescription medications, but they did not want ERPs to directly counsel their patients. Some physicians questioned the value of the program for some patients, since the inclusion criteria for patients were broad and not all patients meeting the criteria needed intense interventions by ERPs. Both ERPs and physicians identified the need to refine the referral process and to work out professional role relationships and ongoing collaboration more fully. If the program were to be implemented as a routine service, physicians were concerned about the demands on their staff and office space and the need for an external compensation mechanism. CONCLUSION: Issues to be addressed for future programs include clarification of the roles of pharmacist and physician when the professionals work together, targeting of appropriate patients for the program, identification of a more efficient way to deliver recommendations, and development of an appropriate compensation mechanism.

Aged↗