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PubMed2004

Ischemic stroke subtypes: a population-based study of incidence rates among blacks and whites.

BACKGROUND AND PURPOSE: Blacks have an excess burden of stroke compared with whites; however, data comparing ischemic stroke subtypes among the 2 groups are limited and typically involve relative frequencies. The objective of this study is to compare the incidence rates of ischemic stroke subtypes between blacks and whites within a large, representative, biracial population. METHODS: The Greater Cincinnati/Northern Kentucky Stroke Study is designed to measure incidence rates and trends of all strokes within a well-defined, large, biracial population. Hospitalized cases were ascertained by International Classification of Disease (9th revision; ICD-9) discharge codes. Out-of-hospital events were ascertained by prospective screening of emergency department admission logs, review of coroners' cases, and monitoring all public health and hospital-based primary care clinics. A sampling scheme was used to ascertain events from nursing homes and all other primary care physician offices. All potential cases underwent detailed chart abstraction and confirmed by physician review. Based on all available clinical, laboratory, and radiographic information, ischemic stroke cases were subtyped into the following categories: cardioembolic, large-vessel, small-vessel, other, and stroke of undetermined cause. Race-specific incidence rates were calculated and compared after adjusting for age and gender, and standardizing to the 1990 US population. RESULTS: Between July 1, 1993, and June 30, 1994, 1956 first-ever ischemic strokes occurred among blacks and whites in the study population. Small-vessel strokes and strokes of undetermined cause were nearly twice as common among blacks. Large-vessel strokes were 40% more common among blacks than whites, and there was a trend toward cardioembolic strokes being more common among blacks. CONCLUSIONS: The excess burden of ischemic strokes among blacks compared with whites is not uniformly spread across the different subtypes. Large-vessel strokes are more common and cardioembolic stroke are as common among blacks, traditionally thought to be more common among whites.

Aged↗
PubMed1997

Fire safety in health care facilities.

All healthcare facilities must have a plan for the protection of all persons on their premises and for their evacuation from the building in case of fire. Written copies of this plan must be available to all supervisory personnel. All employees must periodically trained and informed of their duties in implementing the plan. All beds must be easily movable should evacuation be necessary. Emphasis should be placed on moving patients who are in he room of fire origin and others who are directly exposed to the fire, and on maintaing in their rooms the patients who are not immediately threatened during the fire. Fire exist drills must include actual transmission of a fire alarm signal alongwith a simulation of a fire alarm signal alongwith a simulation of a fire alarm signal alongwith a simulation of a fire condition. Quarterly drills on all shifts are required. All personnel including administrative staff, maintenance personnel and internal must be trained, as well as the nurses on duty each shift. A minimum of 12 drills must behold each year. All employees must be instructed in life safety procedures and use of devices.

Building Codes↗
PubMed2004

Financing of health care services in Hungary.

In this paper we give a practical overview of the changes in the financing of health care in Hungary. We describe the financing system of general practitioners, home care (nursing), out-patient care and the acute and chronic care of hospitals. We show how the financial system has changed after the political changes of 1990. The global budget approach of the 1980s was replaced by performance-related financing methods including the ICPM (International Classification of Procedures in Medicine) code system of the WHO (World Health Organization) in out-patient care and the introduction of HBCS (Homogen Betegsegcsoportok, "Homogeneous Disease Groups") in in-patient care. We underline that the efforts made towards reforming health care financing resulted in an activity-related financing system.

Adolescent↗
PubMed2004

Evaluating alternative risk-adjustment strategies for surgery.

BACKGROUND: Comparison of institutional health care outcomes requires risk adjustment. Risk-adjustment methodology may influence the results of such comparisons. METHODS: We compared 3 risk-adjustment methodologies used to assess the quality of surgical care. Nurse reviewers abstracted data from a continuous sample of 2,167 surgical patients at 3 academic institutions. One risk adjustor was based on medical record data (National Surgical Quality Improvement Program [NSQIP]) whereas the other 2, the DxCG and Charlson Comorbidity Index (CCI), primarily used International Classification of Disease-9 (ICD-9) codes. Risk-assessment scores from the 3 systems were compared with each other and with mortality. RESULTS: Substantial disagreement was found in the risk assessment calculated by the 3 methodologies. Although there was a weak association between the CCI and DxCG, neither correlated well with the NSQIP. The NSQIP was best able to predict mortality, followed by the DxCG and CCI. CONCLUSION: In surgical patients, different risk-adjustment methodologies afford divergent estimates of mortality risk.

Evidence-Based Medicine↗
PubMed1995

A new paradigm for computer-based nursing information systems twenty care components.

This paper describes a new paradigm for computer-based nursing information systems. Twenty Care Components provide a means for coding, classifying, and statistically analyzing nursing taxonomies. They provide the structure for documenting the nursing process using a holistic approach. They can be used to assess, document, cost, evaluate, as well as link the nursing process phases. The components are classes and can be used to compare nursing care across health care settings, nationally and internationally. They make it possible for nurses around the world to communicate on-line and interact with each other.

Computer Communication Networks↗
PubMed2002

Stop female genital mutilation: appeal to the international dermatologic community.

Female genital mutilation (FGM) is a traditional cultural practice, but also a form of violence against girls, which affects their lives as adult women. FGM comprises a wide range of procedures: the excision of the prepuce; the partial or total excision of the clitoris (clitoridectomy) and labia; or the stitching and narrowing of the vaginal orifice (infibulation). The number of girls and women who have been subjected to FGM is estimated at around 137 million worldwide and 2 million girls per year are considered at risk. Most females who have undergone mutilation live in 28 African countries. Globalization and international migration have brought an increased presence of circumcised women in Europe and developed countries. Healthcare specialists need to be made aware and trained in the physical, psychosexual, and cultural aspects and effects of FGM and in the response to the needs of genitally mutilated women. Health education programs targeted at immigrant communities should include information on sexuality, FGM, and reproduction. Moreover, healthcare workers should both discourage women from performing FGM on their daughters and receive information on codes of conduct and existing laws. The aim is the total eradication of all forms of FGM.

Circumcision, Female↗
PubMed2004

ICD-9-CM coding changes for home care: effective October 1, 2004.

Changes in ICD-9-CM codes for all health providers for 2005 go into effect and are to be implemented on October 1, 2004, with no transition period. This article outlines specific coding changes that may be applicable to home care patients. You'll find the new codes, backgrounds of the disease/condition, and a list of invalid diagnosis codes that can be used as a handy reference for clinicians, managers, and office staff.

Community Health Nursing↗
PubMedDate not supplied

A CQI intervention to change the care of depression: a controlled study.

CONTEXT: Although new strategies for managing depression in primary care (e.g., nurse telephone calls, collaborative care) have been shown to be effective, no models are available for their systematic implementation in the "real world." OBJECTIVE: To test whether a continuous quality improvement (CQI) intervention could be used to implement systems in primary care clinics to improve the care and outcomes for patients diagnosed with depression. DESIGN: Before-after study with concurrent controls. INTERVENTION: A multidisciplinary team from the three intervention clinics developed and implemented a graded set of five care management options, ranging from watchful waiting (nurse telephone call in 4 to 6 weeks) to mental health management, which clinicians could order for their patients with depression. SETTING: 9 primary care clinics in greater Minneapolis-St. Paul, Minnesota. PATIENTS: Outpatients 18 years of age and older whose primary care clinic visit included an International Classification of Diseases, 9th revision, code for depression and who completed baseline and 3-month follow-up surveys before and after the intervention. MAIN OUTCOME MEASURES: Measures of process of care (follow-up depression visits to physician, mental health visits, follow-up telephone calls) and outcomes of care (improved depression symptoms over 3 months, satisfaction with care). RESULTS: Although the CQI team appeared to function well, only 30 of the 257 patients identified from depression-coded visits for this study were referred to the new system during the 3-month evaluation period. In both the intervention and control clinics, follow-up visits, mental health referrals, and follow-up telephone calls did not improve significantly from the preintervention levels of about 0.5 for a primary care visit, 0.4 for a mental health visit, or 0.1 for a follow-up phone call per person. The same was true of patient outcomes: The proportion of patients in the intervention and control clinics who had improved depression symptoms and those who were very satisfied with their depression care did not change significantly from the preintervention levels of 43% and 26%, respectively. CONCLUSIONS: Our attempt to improve the primary care management of depression failed because physicians used the new order system so infrequently. Whether a greater leadership commitment to change or a different improvement process would alter our findings is an open question.

Adolescent↗
PubMed1981

Health problems encountered by nurse-practitioners and physicians in obstetric-gynecologic ambulatory care clinics.

This study documents the distribution of health problems managed by obstetric-gynecologic nurse-practitioners (OB-GYN NPs) and obstetrician-gynecologists in community-based ambulatory care settings, and examines the effects of provider group on the distribution of health problems. A proportional sampling technique was used in selecting a sample of 3,873 visits for analysis from a total of 5,889 patient visits made to three community-based clinics during an 18-week period from February to June, 1978. A Patient Encounter Form was devised to record basic encounter data and the health problems managed by providers. The International Classification of Diseases, 9th revision (ICD-9-CM) was used as the coding system. Results indicated: (1) in each clinic, the distribution of health problems based on the three-digit headings of ICD-9-CM differed significantly between the OB-GYN NPs and the obstetrician-gynecologists; (2) the distributions of frequently reported health problems were clinically similar for OB-GYN NPs and obstetrician-gynecologists; and (3) the distributions of health problems with V codes were clinically similar for the two provider groups. Data indicate the OB-GYN NP caseloads are similar to those of obstetrician-gynecologists in frequently managed health problems and in wellness emphases. Nurse-practitioners are appropriate collaborators with obstetrician-gynecologists in the provision of primary health care for women.

Adolescent↗
PubMed1995

A sociological analysis of the extent and influence of professional socialization on the development of a nursing identity among nursing students at two universities in Brisbane, Australia.

Professions make extraordinary demands on its practitioners. Professionals are required to master substantive theory and technical skills. They also develop their own unique subcultures, demanding specific normative standards from their members, which are symbolized by professional ethical codes. In the health professions, ethical codes include strong altruistic elements. Professional normative standards are learnt on a formal level (for example, at a university) and informal level (during the process of professional socialization and contact with the peer group, as well as informal sanctions). The transformation process of a novice to a professional is essentially an acculturation process during which the values, norms and symbols of the profession are internalized. Acculturation can be so strong that it may cause personality transformation, which the French refer to as 'deformation professionelle', usually displayed by stereotypes, which are almost always exemplified by members of professions as ideal professionals, those who have internalized the profession's culture completely. The question is, what is the extent of normative standards and professional characteristics that nursing students are exposed to during professional socialization, and to what extent are these standards and characteristics internalized so that a nursing 'deformation professionelle' develops? A reliable Likert-type measurement scale was developed to measure this phenomenon. One of the most important findings of this study was that students at both universities are highly professionally socialized.

Acculturation↗
PubMed2000

A population-based study of the prevalence, clinical characteristics and effect of ethnicity in epilepsy.

UNLABELLED: The aim of this study was to determine the prevalence and clinical characteristics of epilepsy and seizure disorders in Bradford. The method used was a community-based cross-sectional study. Case ascertainment was by review of medical records identified by searching practice databases using diagnostic codes and from repeat prescribing data. A specialist epilepsy nurse reviewed the records in 39 practices covering a population of 225 439. Clinical review was undertaken where there was limited information available in the records. In total, 1643 cases of epilepsy were identified (prevalence 7.3/1000). The prevalence of epilepsy increased with age. Classification of patients by internationally agreed definitions showed 1013 (62%) of cases with active epilepsy (prevalence 4. 5/1000); 421 (26%) with epilepsy in remission on treatment and 209 (13%) with epilepsy in remission off treatment. The standardized rate for all patients of South Asian origin was 3.6/1000 compared to 7.8/1000 in the rest of the population (OR 0.46; 95% CI 0.38, 0.57). An underlying aetiology was identified in 29.5% of cases. Cerebrovascular disease and head injuries were the commonest causes. CONCLUSIONS: The prevalence of epilepsy supports previous epidemiological estimates and highlights the public health importance of epilepsy. The low prevalence in the South Asian population is a surprising finding and further research into cultural attitudes to epilepsy and the impact of stigma in the South Asian population in the UK is required.

Adolescent↗
PubMed2001

Baby-Friendly Hospital Initiative. Protecting, promoting, and supporting breastfeeding in the twenty-first century.

The BFHI is a global UNICEF/WHO-sponsored effort to promote breastfeeding by ensuring that all women are provided with sound information regarding their infant feeding choices and that those who elect to breastfeed their infants are given physiologically sound, evidence-based advice and skilled assistance prenatally and as they begin nursing their infants during their postpartum hospital or birth center stay. The initiative is based on ten policy or procedure statements, The Ten Steps, which were jointly developed and published in 1989 by the sponsoring agencies in consultation with international experts. In 1990, the Ten Steps were accepted as the central theme of the Innocenti Declaration and, later that year, endorsed at the World Summit on Children. In 1992, UNICEF and WHO launched a major international campaign to encourage all hospitals with maternity services to accept the Ten Steps as basic maternity and newborn infant care policies and procedures. These Ten Steps were reviewed briefly in this article. Official designation as Baby Friendly requires a careful assessment completed by a trained external team to confirm that the institution is truly carrying out all Ten Steps and conforming to the International Code of Marketing of Breastmilk Substitutes. During the 8 years since the initiative began, more than 15,000 hospitals in 136 countries have been designated as Baby Friendly. Twenty-seven of these officially designated institutions are in the United States, where the campaign has been active only since 1996. The BFHI is considered one of the most successful international efforts ever performed to protect, promote, and support breastfeeding. Although it does not ensure that mothers will aspire to or achieve the widely accepted goal of approximately 6 months of exclusive breastfeeding, it helps mothers to initiate exclusive nursing, an essential step in the right direction.

Breast Feeding↗
PubMed1994

Evaluation of a training program for improving adherence promotion skills.

A workshop for improving the adherence counseling skills of health professionals was developed and evaluated. Target audiences have included medical students, nursing students, dietetic interns, and practising nurses and dietitians. Four categories of skills are taught: relationship building, interviewing, problem diagnosis, and behavioral intervention. Teaching methods include faculty demonstration, participant rehearsal, and group and individual feedback. The Adherence Promotion Training (APT) workshop has been offered as a 3- to 5-day intensive course and as a semester-long elective. A reliable coding system was developed to assess these skills from videotaped provider-patient interactions. A standardized patient task was given to 60 subjects before and after participation in the adherence counseling skills workshop. Videotapes were coded by trained raters, who were masked to whether the tape came from before or after the workshop. Significant short-term improvements were observed in all four core skills. This uncontrolled evaluation suggests that the Adherence Promotion Training program is a promising way to enhance the ability of health professionals to care for nonadherent patients.

Clinical Competence↗
PubMed1992

Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.

Administrative databases are increasingly used for studying outcomes of medical care. Valid inferences from such data require the ability to account for disease severity and comorbid conditions. We adapted a clinical comorbidity index, designed for use with medical records, for research relying on International Classification of Diseases (ICD-9-CM) diagnosis and procedure codes. The association of this adapted index with health outcomes and resource use was then examined with a sample of Medicare beneficiaries who underwent lumbar spine surgery in 1985 (n = 27,111). The index was associated in the expected direction with postoperative complications, mortality, blood transfusion, discharge to nursing home, length of hospital stay, and hospital charges. These associations were observed whether the index incorporated data from multiple hospitalizations over a year's time, or just from the index surgical admission. They also persisted after controlling for patient age. We conclude that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.

Aged↗
PubMedDate not supplied

A review of major nursing vocabularies and the extent to which they have the characteristics required for implementation in computer-based systems.

Building on the work of previous authors, the Computer-based Patient Record Institute (CPRI) Work Group on Codes and Structures has described features of a classification scheme for implementation within a computer-based patient record. The authors of the current study reviewed the evaluation literature related to six major nursing vocabularies (the North American Nursing Diagnosis Association Taxonomy 1, the Nursing Interventions Classification, the Nursing Outcomes Classification, the Home Health Care Classification, the Omaha System, and the International Classification for Nursing Practice) to determine the extent to which the vocabularies include the CPRI features. None of the vocabularies met all criteria. The Omaha System, Home Health Care Classification, and International Classification for Nursing Practice each included five features. Criteria not fully met by any systems were clear and non-redundant representation of concepts, administrative cross-references, syntax and grammar, synonyms, uncertainty, context-free identifiers, and language independence.

Evaluation Studies as Topic↗