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PubMed1986

[From Italy to Québec : impact of the Italian psychiatric reform.].

This article has two aims: 1) to help in the understanding of the much discussed Italian reform in psychiatry. 2) to offer for review, discussion or action, a certain number of implications uncovered by this reform with regard to the ongoing discussions on the reorganization of Mental Health Services in Quebec. On the first aim, the key message is as follows: it is possible to create another psychiatry if society in general and those actually participating really want such a project. On the second aim, the main conditions of success for a global and deinstitutionalized psychiatry seem to be as follows: Sufficient resources, freedom to develop policies (a deep decentralisation of the decision making process and the organization) that are central to the integration of the services in a given territory; a dedicated study of the culture and the local social live; a continuous presence (intime and space) of the service in the territory; a total response (and deinstitu-tionalization) to the patient's needs; a democratic team work. However, there are no miracles in Italy; in the cooled down society of the 80's there is room for experimentation.

English Abstract↗
PubMedDate not supplied

Biopsychosocial consequences of sweetened drink consumption in children 0-6 years of age.

North American children consume an extraordinary amount of sweetened drinks--sodas, juice drinks, and "ades." Health care providers, educators, and parents have long been concerned about the effects sweetened drink consumption (SDC) has on the bodies and minds of children. This review of the literature will examine the current evidence regarding the factors contributing to excess SDC, and the health consequences of SDC consumption in children, especially infants and children under 6 years of age, with the goal of informing clinical pediatric nursing, future research, and policy development aimed at reversing the long-standing trend of rising SDC.

Beverages↗
PubMedDate not supplied

Drug-related overdose deaths in British Columbia and Ontario, 1992-2004.

OBJECTIVE: To compare rates of fatal drug-related overdose death (OD) cases--a major harm outcome of illicit substance use--in the two provinces of British Columbia (BC) and Ontario, and the two largest municipalities in those provincial jurisdictions, namely the cities of Vancouver and Toronto, between 1992 and 2004. METHODS: Provincial coroners' data of drug-related OD cases for the provincial jurisdictions of BC and Ontario, and the municipal jurisdictions of Vancouver and Toronto, are descriptively presented and compared. RESULTS: After drastic increases in the initial part of the observation period, OD rates in BC have been declining; moreover, due to major reductions of OD cases in Vancouver, the ratio of OD cases between Vancouver and the province of BC has fallen considerably. Conversely, OD rates in Ontario have remained stable at low levels, whereas Toronto has seen a slight decline in such rates during the observation period. INTERPRETATION: The recent establishment and expansion of treatment and harm reduction interventions may have influenced the decline of ODs in BC, yet similar interventions in Ontario did not have a similar effect, perhaps due to different patterns of illicit drug use. OD rates in jurisdictions across Canada need to be monitored and analyzed to inform evidence-based policy development.

British Columbia↗
PubMed1991

Time spent in state-recommended functions by consultant dietitians in Wisconsin skilled nursing facilities.

In this study we determined how consultant dietitians working in Wisconsin skilled nursing facilities distributed their time among contracted duties. At the time of the study, the 400 skilled nursing facilities in Wisconsin employed 160 consultant dietitians. Of these, 135 consultant dietitians were eligible to participate in the study. A mailed questionnaire was used to collect data on educational background, experience, and actual time spent in state-recommended functions, additional resident-care functions, and additional non-resident-care functions. Completed, usable questionnaires were returned by 65 (48%) of the 135 consultant dietitians. Data were analyzed statistically and presented as medians, means, and standard deviations. Mean time (minutes) consultant dietitians spent per resident admission activity was as follows: data collection, 31.3; care planning, 28.9; resident counseling, 18.5; medical record review, 17.7; discharge referral, 15.4. Mean time (minutes) consultant dietitians spent per month in other activities was as follows: facility evaluation, 75.3; student training, 120; allied staff training, 38.7; foodservice staff training, 46.8; technician training, 128; menu planning, 76.9; diet manual review, 21.6; quality assurance programs, 31.8; quality assurance audits, 34; report preparation for facility administrator, 33.4; and policy development, 32.8. Mean times reported in this study may be used as time guidelines by the state of Wisconsin for evaluating how skilled nursing facilities contract for services of consultant dietitians. Other state and federal regulatory agencies could use the time guidelines for comparison and verification until future studies provide more data on time standards for state-recommended functions, additional resident-care functions, and additional non-resident-care functions.

Consultants↗
PubMed1991

Childhood sexual learning and sex education in schools.

This article reviews the multiple sources of childhood sexual learning, including intrapersonal constructs and the role of external factors such as the family, peers, culture, and the media. A comprehensive definition of sexuality and sexual health is described. Data on the recent national survey of school-based sex education programs by the Alan Guttmacher Institute is reviewed. Building on this information, a justification for sexuality education within the context of comprehensive health education is addressed. Implications for nursing practice are discussed to include formalized linkages between the education and health professions within the domains of policy development, research, advocacy, program development, and clinical services.

Child↗
PubMed1990

Validation of oral status indicators.

In planning programmes and developing policy, dental public health officials rely on epidemiological data in the form of composite measures such as the DMFT index. However, the DMFT is often not sufficiently sensitive to detect differences in oral health between population groups. Measures that selectively weight components of the DMFT may be better dental indicators. Sheiham, Maizels and Maizels (1987) suggested a functional measure (FM) that weights filled and sound teeth equally and a tissue health (T-health) measure that differentially weights decayed, filled, and sound teeth. For the present analysis, these indicators were divided by 28 to make their range 0 to 1. The modified indexes are called FMI and THI. Carpay et al. (1988) also suggested a dental health index (DHI) that scores a subset of teeth. Data from 797 participants in the 1980 Iowa Survey of Oral Health that included eight independent variables were used to perform stepwise regression on DMFT, FMI, THI, and DHI to assess how well the independent variables correlated with these four dental indicators. R-square values were 0.37 for FMI and 0.36 for THI, but only 0.19 for DHI and 0.12 for DMFT, suggesting that the FMI and THI were more sensitive as dental health indicators. In addition, calculations made on aggregate data published from three national surveys show that the FMI and THI can detect changes in oral health over time. Because the FMI and THI are as easy to measure and calculate as the DMFT, but appear to be more sensitive, they show promise as indicators of oral health status.

Adolescent↗
PubMedDate not supplied

Multidisciplinary management of vascular access devices.

Many problems associated with the use of vascular access devices (VADs) can be circumvented with an organized, systematic approach to management. This paper describes an approach that includes several key components: 1) A nurse coordinator of parenteral therapy (CPT) follows all patients with a VAD; records demographic and clinical data on an ongoing basis; monitors complications and outcomes; serves as a consultant for VAD-related questions; develops policies, procedures, and guidelines for catheter care; and oversees inservice nursing and basic patient education. 2) A data coordinator enters all data into a data base management system, compiles complication and other statistics on a periodic basis, and retrieves selected data for specific purposes. 3) A VAD Committee, composed of the above two individuals, a nurse epidemiologist, and physicians representing medical oncology, hematology, transplantation, pediatrics, and surgery, meets monthly to collectively evaluate and assign cause for complications, consider new products, and discuss policy changes regarding VADs. As a result of this multidisciplinary process, responsibility and accountability for VAD insertion and care are appropriately placed, statistics on complications are compiled, and treatment and policy decisions are made. These outcomes have resulted in a significant reduction in complications, an increase in average catheter life, enhancement of quality assurance, and overall improved patient care.

Algorithms↗
PubMed1990

Impact of an organ donor and tissue donor advocacy program on community hospitals.

A crucial shortage of organ donors exists in the United States. The majority of donor referrals come from large (greater than 500) beds) hospitals and trauma centers. To determine whether a significant number of donors who are not being recognized or referred also existed in medium-sized (300 beds) community hospitals, a Donor Advocacy Program was instituted at Francis Scott Key Medical Center in May 1987. This team developed policies and procedures to identify potential donors and conducted educational programs for physicians and nurses. A designated "Donor Advocate" made daily rounds on the inpatient units to maintain donor awareness and facilitate potential donations. After the first year, the program was evaluated. In comparison to the average of the previous three years, donor referrals increased by approximately 400 per cent and tissue donations increased over 500 per cent. Four organs were retrieved from two donors. It is concluded that an increase in referrals and tissue donations can be achieved at community hospitals through a structured donor awareness program. Recommendations are made to further examine the age group most often eligible for organ and tissue donations in community hospitals and target educational efforts accordingly. Commitment of hospital administration is vital to a positive outcome in such a program.

Baltimore↗
PubMed1990

Planning processes and outcomes for an aging population with developmental disabilities.

Needs analysis research and planning projects were reviewed for the purpose of identifying planning concepts, processes, outcomes, and issues regarding the growing population of older adults with developmental disabilities. Themes and issues identified through a content analysis of planning reports and documents were presented along with goals for future planning and public social policy development efforts.

Aged↗
PubMed1989

[Information and counseling by rehabilitation carriers].

Based on an overview of the rehabilitation carriers' responsibilities within the social-political system of the Federal Republic of Germany, the contents and organization of counselling by the rehabilitation carriers are set out, along with the approaches taken for staff qualification in this respect. The importance of rehabilitation counselling is pointed out, which, in the face of already discernible labour market and social policy developments, is going to increase even further.

Chronic Disease↗
PubMedDate not supplied

Nurses in management: new challenges, new opportunities.

Nurses are often constrained by the past as they grapple with the present and reach for the future. They must have a vision of the future, and nursing's place in it. Below is a glimpse of a new tomorrow that promises a significant role for nurses as nurse managers and as leaders in health policy development, general management and the broader health service. But, as Sally Shaw emphasizes, nurses must fullheartedly believe in that role and go after it.

Adaptation, Psychological↗
PubMed1989

Assessment of nutritional status: effects of different methods to determine age on the classification of undernutrition.

The evaluation of nutritional status using anthropometry has been widely employed in field studies and nutritional surveillance programmes. Two of the primary indicators used, weight-for-age and height-for-age, require accurate age information for proper assessments to be made. Three data sets on nutritional status were evaluated using different methods to determine age: rounding to the most recently attained month, rounding to the nearest whole month, and ages computed from birth dates and visit dates. The impact of these different methods on the classification of nutritional status were found to be dramatic, especially in infants during the first year of life. In some cases, when ages are rounded to the most recently attained month, as few as 43% of the children classified as malnourished based on the indicator, height-for-age, and the cut-off point, less than -2 Standard Deviations from the reference median, are identified relative to when ages are computed from birth and visit dates. Beyond the discrepancies in estimating prevalence below specific cut-off points to designate undernutrition, the use of the different methods also affects entire distributions. The problem of using different methods to estimate age, and the impact they have on the classification of undernutrition are of critical public health importance, especially when this information is used to identify individuals and groups as well as for planning and policy development.

Africa↗
PubMed1989

Resource allocation decisions in critical care nursing.

One of the major challenges for critical care nurses is to distribute their professional services in a manner that is consistent with the moral imperatives of nursing. The central values of respect for individual patients, patient-centered beneficence, full beneficence, and justice must be woven together into an ethical framework that assists nurses in allocating their skills. Professional organizations, such as the AACN, are actively trying to order this ethical disorder by proposing guidelines that, on the one hand, acknowledge societal interests in cost-effective utilization of health care resources, and on the other hand, safeguard the interests and well-being of individual patients. In addition to the guidance from professional organizations, health care institutions should address the inequities in health care by developing policies that guide the health care team through an ethical decision-making process. Nurses, as members of the multidisciplinary health care team and as members of an essential and scarce resource, should participate in formulating these directives. Not only is bedside and institutional involvement important, but participation at the local, state, and national levels will empower nurses to influence decisions of resource allocation at the micro and macro levels.

Beneficence↗
PubMed1989

Impaired nurses: a cost analysis.

Although the literature reflects a continuing concern about impaired practice and its associated costs, no attempt has yet been made to examine those costs in a comprehensive manner. This analysis was undertaken to determine the specific economic impact of impaired nursing practice on the employing agency, the individual nurse, and the state regulatory body. It will provide valuable data for policy development and for planning cost-effective approaches to early recognition and intervention.

Alcoholism↗
PubMed1988

Providing clinical pharmacy services in an AIDS--oncology ambulatory-care clinic.

The activities of a pharmacist in an ambulatory-care AIDS-oncology clinic are described. In December 1984, the chief of the AIDS Activities Division of San Francisco General Hospital's Department of Medicine hired a clinical pharmacist to develop the pharmacokinetics sections of investigational drug protocols, provide drug therapy consultations, and supervise the reorganization of the drug storage and inventory system. Since joining the clinic staff, the pharmacist has become active in a variety of clinical, research, and educational activities. The pharmacist conducts weekly medication refill clinics and developed drug information sheets for clinic patients and health-care professionals. The pharmacist also supervises timely collection of blood samples for serum drug concentration determinations and helps to prepare the investigational drugs for dispensing. The pharmacist developed policies and procedures for the safe handling of antineoplastic agents and standardized the accountability procedures for investigational drugs. The pharmacist also serves as a liaison between the clinic and the hospital's department of pharmacy and as a preceptor of pharmacy students and residents. A clinical pharmacist can make an important contribution to the research and patient-care activities in an AIDS-oncology clinic.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Immunization of children infected with human T-lymphotropic virus type III/lymphadenopathy-associated virus. Recommendations of the Immunization Practices Advisory Committee. Centers for Disease Control, Department of Health and Human Services.

This document is intended to summarize available information and to assist health-care providers in developing policies for the immunization of children infected with human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) [now known as the human immunodeficiency virus], the virus that causes acquired immunodeficiency syndrome (AIDS). These policies may vary depending upon the prevalence of HTLV-III/LAV infection and the incidence of vaccine-preventable diseases in the community, individual assessment of a child's health status, and the risks and benefits of immunization in a particular situation. This discussion considers the risks and benefits of immunization for children residing in the United States based on the risks of vaccine-preventable diseases and the prevalence of HTLV-III/LAV infection and is intended for use by health-care providers in the United States. The recommendations may not pertain to other countries with different risks of vaccine-preventable diseases and prevalence of HTLV-III/LAV infection among children. Since these recommendations are based upon information and knowledge available at this time, periodic reassessment and revision will be required as more data concerning risk and benefits associated with immunization of HTLV-III/LAV-infected children become known and as the prevalences of specific vaccine-preventable diseases and HTLV-III infection change.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Hospital swing-bed care in the United States.

As a result of federal legislation implemented in 1982, hospital beds that are used to provide both long-term care and acute care are now proliferating rapidly throughout the country. Termed swing beds, such beds are currently restricted to rural areas. However, due largely to the impacts of Medicare DRG reimbursement, pressure is mounting to expand the swing-bed approach to urban settings. Swing beds appear to fill a significant gap between the relatively intense medical needs of post-acute care patients (now discharged earlier) and the capacity of our current nursing home delivery system to meet such needs. The evolution of swing beds is marked by an unusual blend of experimentation, scientific investigation, and public policy response to community and personal health care needs. This article summarizes that evolution, highlighting research findings and key policy developments. It concludes with the current status of the national swing-bed program and issues pertinent to future directions.

Bed Conversion↗
PubMed1987

Nutrition services in the continuum of health care.

Nutrition services are important components of all phases of the continuum of health care services to older persons. Nutrition and food services can play a major role in improving the health status of older individuals, maintaining their independence and dignity, reducing the rate and length of institutionalization, and possibly lowering health care costs. Nutrition screening and assessment are beneficial to consider when the individual enters the health care system. Monitoring nutritional status periodically helps define the change in the individual's needs over time and provides direction to nutritional care. Nutrition interventions, including clinical nutrition care, counseling, education, and food programs, are important options to consider in attempting to alleviate nutritional problems in the older population. Providing easy access to nutrition services in institutional and community-based health care settings will promote well-being in the older population. Evaluation of food and nutrition services should be routine and conducted with objective measurement techniques. It is important to review the available institutional and community-based health and social programs that serve older individuals and incorporate appropriate, professional nutrition services. The provision of an optimal mix of nutrition services will require significant changes in state regulations and modifications in current program operations. As future health policies develop, the appropriate types and levels of nutrition services are important to consider. The potential benefits of nutrition services in the older population should stimulate the design of a coordinated system of nutrition services in the continuum of community and institutional services for the older population.

Aged↗