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At least 1,405 records · Page 78Linked to original sources
PubMed1994

SF 36 health survey questionnaire: II. Responsiveness to changes in health status in four common clinical conditions.

OBJECTIVE: To assess the responsiveness of the SF 36 health survey questionnaire to changes in health status over time for four common clinical conditions. DESIGN: Postal questionnaires at baseline and after one year's follow up, with two reminders at two week intervals if necessary. SETTING: Clinics and four training general practices in Grampian region in the north east of Scotland. PATIENTS: More than 1,700 patients aged 16 to 86 years with one of four conditions: low back pain, menorrhagia, suspected peptic ulcer, and varicose veins; and a random sample of 900 members of the local general population for comparison. MAIN MEASURES: A transition question measuring change in health and the eight scales of the SF 36 health survey questionnaire; standardised response means (mean change in score for a scale divided by the standard deviation of the change in scores) used to quantify the instrument's responsiveness to changes in perceived health status, and comparison of patient scores at baseline and follow up with those of the general population. RESULTS: The response rate exceeded 75% in a patient population. Changes across the SF 36 questionnaire were associated with self reported changes in health, as measured by the transition question. The questionnaire showed significant improvements in health status for all four clinical conditions, whether in referred or non-referred patients. For patients with suspected peptic ulcer and varicose veins the SF 36 profiles at one year approximate to the general population. CONCLUSIONS: These results provide the first evidence of the responsiveness of the SF 36 questionnaire to changes in perceived health status in a patient population in the United Kingdom.

Adolescent↗
PubMed1997

Integrated primary health care. Opportunities for psychiatric-mental health nurses in a reforming health care system.

As changes in our health care system evolve, making the transition to greater parity of mental and physical health is paramount to move health care in the direction of prevention and health promotion. Although parity is the goal, the most feasible path to reaching it may lie in relinking mental health to physical health in managed care models of primary health care. This article identifies emerging directions in the mental health field and points to new opportunities for advancing the practice of psychiatric-mental health nurses.

Health Care Reform↗
PubMed1976

St. Agnes: a study of a health centre in evolution.

The growth of St Agnes Health Centre is described, with its transition from simple group practice to a comprehensive health centre over a five-year period. Its position in a rapidly growing suburb is analysed and illustrated by usage and referral patterns. The sucessful integration of general practice, sessional specialists and allied health workers under one roof makes it unique as a primary health care project in Australia.

Australia↗
PubMed2004

[Transition model of middle-aged women].

PURPOSE: The purpose of this study was to develop and test a model to explain the transition state for Korean middle-aged women focusing on the transition concept. METHOD: A hypothetical model was constructed based on the transition model of Schumacher & Meleis(1994) and tested. The hypothetical model consisted of 5 latent variables and 11 observed variables. Exogenous variables were demographic characteristics, obstetric characteristics, and health behavior. Endogenous variables were transition state and quality of life with 6 paths. The data from 221 middle-aged women selected by convenience was analyzed using covariance structure analysis. RESULT: The final model which was modified from the hypothetical model improved to GFI=0.97, AGFI=0.94, NFI=0.94, and NNFI=0.95. The transition state was influenced directly by demographic characteristics, quality of life, and also indirectly by health behaviors. However, the influence of obstetric characteristics was not significant. The transition state was accountable for 68% of the variance by these factors. CONCLUSION: These results suggest that enhancing health behaviors of the women are necessary to increase quality of life and it consequently contributes to improving the transition state. This model could be used to explain the health related vulnerability in these ages and to diagnosis individual women.

Adult↗
PubMed1998

Payment reform will shift home health agency valuation parameters.

Changes authorized by the Balanced Budget Act of 1997 have removed many of the payment benefits that motivated past home health agency acquisition activity and temporarily have slowed the rapid pace of acquisitions of home health agencies. The act required that Medicare's cost-based payment system be replaced with a prospective payment system (PPS) and established an interim payment system to provide a framework for home health agencies to make the transition to the PPS. As a consequence, realistic valuations of home health agencies will be determined primarily by cash flows, with consideration given to operational factors, such as quality of patient care, service territory, and information systems capabilities. The limitations imposed by the change in payment mechanism will cause acquisition interest to shift away from home health agencies with higher utilization and revenue expansion to agencies able to control costs and achieve operating leverage.

Accounts Payable and Receivable↗
PubMed2004

Health and psychosocial status of patients with turner syndrome after transition to adulthood: the Belgian experience.

BACKGROUND: Most girls with Turner syndrome (TS) are intensively followed by paediatricians, but are lost to follow-up when they reach adulthood. To gain insight into the adult medical and psychosocial situation, we performed a survey in young adult TS patients. PATIENTS AND METHODS: A questionnaire concerning current health status, education, occupation and living situation was sent to 160 young adult TS women, all treated during childhood with GH and oestrogen if needed. RESULTS: We received 102 completed questionnaires. Mean +/- SD age at reception of the questionnaire was 23.4 +/- 3.3 years, height 153.3 +/- 5.2 cm, body mass index 23.7 +/- 4.9 kg/m(2). Age and auxological parameters were comparable between responders and non-responders. Thirteen (12.7%) responders were not under regular medical care; 15 (14.7%) were seen by a general practitioner, while 28 (27.4%) needed several specialists. Forty-one (40.2%) patients reported health problems. The most frequently reported problem was hypertension (10.7%), followed by hypothyroidism (5.8%) and back problems (4.9%). Twenty-four (23.5%) of the 41 patients were taking medication for the indicated health problems. Twenty-six (25.5%) women had undergone spontaneous puberty; 16 of them reported spontaneous menstruations while 10 received oestrogen replacement therapy. Of the 76 women with induced puberty, 11 (14.5%) were not taking any oestrogen anymore. Compared with the general population, more TS women attended university and more obtained higher education. Forty-six women (45.1%) were working full-time, 7 (6.9%) were unemployed, and 4 (3.9%) received an allocation. Seventy (68.6%) patients were still living with their parents, while 18 (17.6%) were living together or married, and 14 (13.7%) were living alone. CONCLUSIONS: The transition of adolescents with TS to adult medical care is not optimal in Belgium. Although 40.2% of these young women reported health problems, 12.7% did not consult any physician. Many TS women did not take oestrogen replacement therapy. A specialized multidisciplinary approach for adults with TS is needed in order to optimize health and psychosocial status in these women.

Adolescent↗
PubMedDate not supplied

Multi-site study of transition in adolescents with sickle cell disease in the United Kingdom and the United States.

Adolescents with sickle cell disease may have problems of adjustment during the phase of transition from pediatric to adult health care. It is important to identify factors that may help in the development of appropriate interventions. We were interested in possible similarities, in terms of adjustment to transition in two countries where health service provision is quite different. The study employed a cross-sectional survey design, with a sample of adolescents (still in pediatric care) drawn from a U.S.A national sample and a single U.K. site. A battery of validated disease-specific measures was used to assess adolescent perceptions of physical and psychological symptoms, self-efficacy, self-management skills, and gather demographic data. There were no significant demographic differences between the samples of adolescents in the two countries. Taken together, the two populations indicate that adolescent age and educational level were associated with symptoms (physical and psychological). Self-efficacy is not associated with demographic factors, but is predicted by physical symptoms, while different aspects of self-management are predicted by age (responsibility with care), educational level (independence and confidence with care) and psychological symptoms (knowledge about SCD and confidence with care). This study highlights the importance of gathering disease-specific transitional information from adolescents with sickle cell disease in the U.K. and U.S.A. It also shows that demographic variables have to be considered in the development of any intervention programme.

Adolescent↗
PubMed2005

The management of pediatric systemic lupus erythematosus.

Most children and adolescents with systemic lupus erythematosus (SLE) now survive into adulthood, leading the pediatric rheumatology community to focus on preventing long-term complications of SLE, including atherosclerosis, obesity, and osteoporosis, and their treatment. Unfortunately, because of the paucity of data in pediatric SLE, little is known about epidemiology, long-term outcome, and optimal treatment. Most research focuses on adults with SLE, but pediatric SLE differs significantly from adult SLE in many aspects, including disease expression, approaches to pharmacologic intervention, management of treatment toxicity, and psychosocial issues. Children and adolescents with SLE require specialized, multidisciplinary care. Treatment can be optimized by early recognition of disease flares and complications, minimizing medication toxicity, educating families about prevention, promoting school performance, addressing concerns about reproductive health, and negotiating the transition to adult-centered medical care. Developmentally appropriate concerns about pain, appearance, and peers often affect treatment adherence and must be addressed by the health-care team. Research in pediatric SLE is desperately needed and provides a unique opportunity to understand how developmental immunology and the hormonal changes associated with puberty affect the pathophysiology of SLE.

Anti-Inflammatory Agents↗
PubMed1997

Primary care for children with spina bifida.

Primary care providers are recognizing the need to be able to establish protocols for children with complex conditions, such as spina bifida. Best practices are to form partnerships with families to address the complex health care needs for their children who require comprehensive care, coordination of community services and resources, regular communication with interdisciplinary and specialty teams, and preparation for transition into young adulthood. Health status and quality of life for children with spina bifida depends in part on preventing complications or further disability and maximizing functional independence and inclusion in society. The content in this article presents special considerations through guidelines for medical and psychosocial aspects of primary health care for children with spina bifida.

Adolescent↗
PubMedDate not supplied

Adolescent geographic relocation: theoretical perspective.

This article analyzes the literature related to adolescent geographic relocation. A model of transitions developed by Chick & Meleis (1986) is the basis for the analysis. This analysis suggests that adolescent relocation is a type of life transition, and the relocated adolescents constitute an at-risk population for health status alterations. The relocation transition is defined and its dimensions delineated through the literature review. Preventive nursing intervention for future research and theory development related to adolescent geographic relocation are proposed.

Adolescent↗
PubMed1998

The continuum of care: the process and development of a nursing model for stroke education.

A recent focus in health care is to develop a seamless transition for patients between the variety of health care agencies with whom they interact. The continuum of care for patients with stroke is complex and many levels of care are required, from acute intervention through to rehabilitation and reintegration into the community. A group of nurses from a variety of agencies in Southwestern Ontario received funding from the Ontario province Wide Nursing Project to effect a desirable change in the way nurses care for the stroke patient. This article describes the Ontario Province Wide Nursing project and the process of and challenges in developing a nursing model for stroke. The development of a nursing model for stroke patients and their families involved conducting nursing, and patient and family focus groups to identify key issues. Thirty-eight nurses participated in the nursing focus groups, and 8 patients and 18 family members participated in the patient and family focus groups. The common themes were the need for improved communication and the need to better prepare patients and families for the many transitions they experience during their recovery from stroke. A Stroke Education Record, which identifies a comprehensive list of potential learning needs of stroke patients and their families, and a Stroke Education and Resource Guide, which provides a reference for nurses, were developed and will be implemented in September 1998. Implementation of the model included a workshop, staff inservices, a self-learning package, and unit displays. Evaluation of the model will include nursing and patient and family focus groups, a chart review, written nursing evaluations, and patient and family telephone interviews.

Cerebrovascular Disorders↗
PubMed1996

Nutrition services in managed care: new paradigms for dietitians.

Managed care systems are transforming the health care system in the United States. Dietitians will need to review practice opportunities in new and different settings, and develop additional skills to make a successful transition to the transformed health care environment. The shift in health care financing from a fee-for-service model to a capitated system will have the most dramatic impact on the profession. Not all the answers are available, but the focus for the future is clear--customer satisfaction, outcomes research, and cost-effective nutrition services.

Cost-Benefit Analysis↗
PubMedDate not supplied

Behavioral factors affecting HIV prevention for adolescent and young adult IDUs.

Epidemiological and sociobehavioral data regarding HIV-related risk and injection drug use among adolescents and young adults are examined to provide insight and assistance to nurses delivering preventive intervention and community and clinical care. The increase in HIV/AIDS cases among injection drug users (IDUs), adolescents, and African Americans strongly suggests that clinical care providers acquire a better understanding of the sociocultural and behavioral context within which health care is provided. Transition into injection drug use, high-risk injecting and sexual behaviors, sociodemographic differences, and the importance of social networks are discussed. Nurses are encouraged to provide health promotion, disease prevention messages, and health care to IDUs in small nontraditional clinical settings and to seek out the assistance of the IDUs' social network to increase adherence and compliance to complex prevention and therapeutic efforts.

Adolescent↗
PubMed1992

Perinatal care in the Soviet Union: a time of transition.

Recent Soviet reforms in health care policy and financing are expected to have a significant impact on perinatal services. Efforts are under way to upgrade the care of pregnant and birthing women. This paper describes some aspects of the current system of perinatal care and prospects for future change.

Child↗
PubMed2004

Slovene national insurance card system: connecting patient and health care.

The paper outlines a case of an implemented modern IT solution in the health care, that is, the Slovene health insurance card system. The system is in full operation nation-wide and covers all the aspects of health care and health insurance operations. The system allows reliable identification of patients and service providers and, with its design open to enhancements, is a major breakthrough in the process of transition to e-health. The paper addresses both the national and international perspective of such IT solutions, with the main issues and goals being the quality of services to the citizen, the health care system economics and management, and the free movement of people and services in the internal market. Special consideration is devoted to the compatibility and interoperability of national systems with the emerging European health insurance card. Furthermore, the paper outlines the main financial dimensions of the development to date and the changes achieved through the intensive development in terms of quality and accessibility of health care services.

Cost-Benefit Analysis↗