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PubMed1994

Results of the ACSUS for pediatric AIDS patients: utilization of services, functional status, and social severity.

OBJECTIVE: This study describes demographic characteristics of pediatric AIDS patients, describes hospital and community-based service utilization patterns, and analyzes medical and social support service usage patterns with respect to patient demographic characteristics, clinical trial participation, functional/developmental status, and social environment. DATA SOURCES AND STUDY SETTING: Data reported in this study are from the AIDS Costs and Service Utilization Survey (ACSUS) and cover the six-month period beginning March 1991 (N = 135). Pediatric patients who sought care for HIV-related problems were sampled at seven different hospitals in five metropolitan regions of the United States. All of the participating hospitals had clinics specifically serving pediatric patients infected with HIV. The sample consists of HIV-positive patients who had had at least one HIV-related symptom or condition. STUDY DESIGN: A stratified probability sample design guided the sampling strategy, which included oversampling in two large hospitals from two of the five metropolitan areas. Survey data cover an 18-month time period of health care utilization, cost, and financing information from HIV-infected patients and their providers. Utilization measures are standardized to a six-month period. Per capita income, family structure, informal personal network, functional status, and clinical trial participation are tested for associations with patterns of utilization. In addition, a weighted ten-point social severity scale was developed to assess family/household stability. DATA COLLECTION: Data were collected through a screener instrument completed by the person accompanying the child to a hospital clinic visit (usually a a parent), and through two interviews conducted in person with the patients' primary caregivers. Data from the questionnaires were coded and assembled into computerized SAS analysis files by WESTAT: PRINCIPAL FINDINGS: Children in this sample are 62 percent African American, 25 percent Hispanic, and 10 percent White. Medicaid is the primary payer for 92 percent. Mean per capita income is $3,440. Fewer than one-half (41 percent) of the families of the children receive Aid to Families with Dependent Children (AFDC). (AFDC). Within the six-month period, approximately one-third of the sample (29.6 percent) was hospitalized. Mean length of stay was 16.0 days. Clinical trial participation was positively related to mean number of hospital clinic visits and receipt of formal (paid) home care. There were no differences in use of community clinic, mental health, and inpatient facilities by clinical trial status. Participation in clinical trials was positively related to income and negatively related to social severity. In four cities, emergency room use was consistently lower for clinical trial participants than for nonparticipants. CONCLUSIONS: Data from the first six months of the ACSUS pediatric sample suggest that participation in clinical trials may bring about access to social services that appear to reduce emergency room use. However, the findings reported here are descriptive and exploratory. Further multivariate, nonparametric analyses of the full 18-month provider-patient merged data set are necessary to confirm the simple correlations found in this study.

Acquired Immunodeficiency Syndrome↗
PubMed1994

AIDS treatment costs during the last months of life: evidence from the ACSUS.

OBJECTIVE: The volume and cost of services consumed by persons with AIDS (PWAs) during their last months of life are examined in this study. DATA SOURCES: This study utilizes data from the AIDS Costs and Service Utilization Survey (ACSUS). The ACSUS is the most comprehensive survey of medical services that are consumed by persons with HIV. STUDY DESIGN: This study is restricted to persons with AIDS who survived the fifth time period (an approximately three-month period in the early spring and summer of 1992). The types and costs of services consumed during the fifth time period by PWAs who did survive (609) and who did not survive (79) the sixth time period are compared. DATA COLLECTION: The ACSUS consists of six interviews over an 18-month period from Spring 1991 to Fall 1992. PRINCIPAL FINDINGS: Decedents were hospitalized more than four times as many days and experienced more than four times the number of home health visits as survivors. Both the average length of stay (19.3 days for decedents and 10.3 for survivors) and the frequency of hospitalization during the fifth time period (.70 for decedents and .28 for survivors) were higher for decedents than survivors. The levels of outpatient care (including emergency room care) and of prescription drug use were similar for decedents and survivors. CONCLUSIONS: This study shows that the cost of treating decedents is more than three times the cost of treating survivors.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Strategic groups, performance, and strategic response in the nursing home industry.

OBJECTIVE: This study examines the effect of strategic group membership on nursing home performance and strategic behavior. DATA SOURCES AND STUDY SETTING: Data from the 1987 Medicare and Medicaid Automated Certification Survey were combined with data from the 1987 and 1989 Pennsylvania Long Term Care Facility Questionnaire. The sample consisted of 383 Pennsylvania nursing homes. STUDY DESIGN: Cluster analysis was used to place the 383 nursing homes into strategic groups on the basis of variables measuring scope and resource deployment. Performance was measured by indicators of the quality of nursing home care (rates of pressure ulcers, catheterization, and restraint usage) and efficiency in services provision. Changes in Medicare participation after passage of the 1988 Medicare Catastrophic Coverage Act (MCCA) measured strategic behavior. MANOVA and Turkey HSD post hoc means tests determined if significant differences were associated with strategic group membership. FINDINGS: Cluster analysis produced an optimal seven-group solution. Differences in group means were significant for the clustering, performance, and conduct variables (p < .0001). Strategic groups characterized by facilities providing a continuum of care services had the best patient care outcomes. The most efficient groups were characterized by facilities with high Medicare census. While all strategic groups increased Medicare census following passage of the MCCA, those dominated by for-profits had the greatest increases. CONCLUSIONS: Our analysis demonstrates that strategic orientation influences nursing home response to regulatory initiatives, a factor that should be recognized in policy formation directed at nursing home reform.

Analysis of Variance↗
PubMed1994

A reevaluation of risk of in utero exposure to lithium.

OBJECTIVE: To reevaluate the risk associated with in utero exposure to lithium. DATA SOURCES AND STUDY SELECTION: Data were obtained from all published studies, in multiple languages, referenced in MEDLINE, Toxline, and the Lithium Information Center databases. Unpublished studies were not included. The search terms were lithium, pregnancy, teratogen, abnormalities (drug induced), Ebstein's anomaly, and adverse effects. DATA EXTRACTION AND SYNTHESIS: In the 1970s a very strong association was suggested between maternal lithium treatment during pregnancy and Ebstein's anomaly of the heart in the offspring. The relative risk for Ebstein's anomaly among such children was estimated to be 400 on the basis of data collected from a registry of voluntarily submitted cases. More recent controlled epidemiologic studies have consistently shown a lower risk. No women who took lithium during pregnancy were found among four case-control studies of Ebstein's anomaly involving 25, 34, 59, and 89 affected children, respectively. In two cohort studies, risk ratios of 3.0 (95% confidence interval [CI], 1.2 to 7.7) and 1.5 (95% CI, 0.4 to 6.8) for all congenital anomalies have been observed. The risk ratios for cardiac malformations in these studies were 7.7 (95% CI, 1.5 to 41.2) and 1.2 (95% CI, 0.1 to 18.3), respectively. CONCLUSION: While initial information regarding the teratogenic risk of lithium treatment was derived from biased retrospective reports, more recent epidemiologic data indicate that the teratogenic risk of first-trimester lithium exposure is lower than previously suggested. The clinical management of women with bipolar disorder who have childbearing potential should be modified with this revised risk estimate.

Abnormalities, Drug-Induced↗
PubMed1993

Isolating fetal cells from maternal blood. Advances in prenatal diagnosis through molecular technology.

OBJECTIVES: To review the rationale for and progress toward the goal of isolating and analyzing fetal cells circulating in maternal blood, and to explore the feasibility of this method in providing noninvasive prenatal cytogenetic diagnosis. DATA SOURCES: Critical review of data published since the first report (1969) of fetal metaphases in maternal blood. Emphasis is placed on data since the demonstration by polymerase chain reaction (PCR) in 1989 and 1990 that fetal cells indeed exist in maternal blood. DATA SYNTHESIS: Clinical evaluations have not yet been conducted, but it is already clear that molecular technologies have allowed the unequivocal demonstration of fetal cells in maternal blood. Using PCR, our own group and others have demonstrated Y sequences and single gene sequences (eg, hemoglobin LeporeBoston) in maternal blood. Thus, fetal DNA sequences indeed exist in maternal blood. Among the various candidate cells, the most promising appear to be fetal nucleated red blood cells. We isolated nucleated red blood cells on the basis of flow-sorting for the transferrin receptor and glycophorin-A. Enriched samples were then subjected to fluorescence in situ hybridization with chromosome-specific probes. This approach allowed us to detect trisomy 21 and trisomy 18, work later confirmed by others. CONCLUSIONS: Isolating and analyzing fetal cells from maternal blood is clearly possible. Several key biologic questions remain--the optimal cells for isolation, frequency of cells in maternal blood, timing during gestation for maternal blood sampling, and the likelihood of persistence of fetal cells after delivery. Clinical evaluations planned by the National Institute of Child Health and Human Development will determine the sensitivity and specificity of this method and its precise role in prenatal cytogenetic diagnosis.

Aneuploidy↗
PubMed1993

The use of health services by women with HIV infection.

OBJECTIVE: The purpose of this study is to determine whether women who have been diagnosed with HIV utilize the same volume of medical care services as men who have been diagnosed with HIV. DATA SOURCES: This study uses data from the first wave of interviews of the AIDS Cost and Service Utilization Survey (ACSUS) conducted between May and July of 1991. The first wave of interviews involved 1,949 adults and adolescents, of whom 359 were women. STUDY DESIGN: The ACSUS sample was selected from 26 sites (hospitals, clinics, and physician offices) in ten cities chosen from the 25 cities with the most AIDS cases. Cities are located throughout the nation, and in low, medium, and high prevalence areas. The sites in each city are generally those that treat the highest number of persons with HIV infection. Patients at each site were chosen using disease stage (asymptomatic, symptomatic, and AIDS) and gender as the selection criteria. Utilization equations are estimated for AZT use, outpatient care, and hospitalization. DATA COLLECTION: The ACSUS involves six in-person interviews over an 18-month period. Interviews include questions about the use of medical and support services, insurance status, functional status, and barriers to care during the prior three-month period. PRINCIPAL FINDINGS: A male injection drug user (IDU) with AIDS is 20 percent more likely to be hospitalized than a woman with AIDS, and the hospital cost of treating a male IDU with AIDS is $9,180 more per year than the hospital cost of treating a woman with AIDS. CONCLUSIONS: This study shows that, even after being diagnosed and after having accessed the medical care system, women with AIDS receive fewer services than men with AIDS.

Adolescent↗
PubMed1993

Diabetes prevalence from health insurance data: evaluation of estimates by comparison with a population-based diabetes register.

UNLABELLED: At present in Germany, data on the prevalence of diabetes can only be obtained by modelling health insurance data. The National Diabetes Register of the former (East) German Democratic Republic which, between 1960 and 1990, monitored approximately 98% of all diabetic subjects, provides a tool for evaluating epidemiological estimates from other data sources. Therefore, the following data bases were compared for the year 1988: (1) a 5% random-sample (n = 6478) of all subjects insured at a local statutory health insurance company in the city of Dormund; (2) related data from the population-based diabetes register of former East-Berlin and (3) of the former German Democratic Republic. All data were standardized by sex and age according to the 1988 population statistics of the Federal Republic of (West) Germany thus resulting in the apparent diabetes prevalence of the Western part of Germany at that time. RESULTS: total prevalence rates were (1) 4.8%, (2) 4.9%, and (3) 4.4% (p < 0.05). The percentages of insulin-treated patients were (1) 18%, (2) 19%, and (3) 16%, respectively. 54% (1), 37% (p < 0.05) (2), and 42% (p < 0.05) (3), of the patients received oral antidiabetic drugs. It is concluded that the three samples are comparable and that the diabetes prevalence rates as estimated from health insurance data and from the two population-based registers give corresponding conclusions. Sample-based health insurance data may provide a useful and reliable tool for epidemiological studies on diabetes mellitus.

Adult↗
PubMed1993

Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction. An overview of results from randomized controlled trials.

OBJECTIVE: To investigate the effects of prophylactic therapy with antiarrhythmic agents on mortality in patients with myocardial infarction. DATA SOURCES AND STUDY SELECTION: Data were obtained from all completed, published or unpublished, randomized, parallel controlled trials of antiarrhythmic agents, regardless of sample size. Investigators were contacted for data on patients excluded after randomization. DATA EXTRACTION: Data on mortality were extracted by one author and confirmed where necessary by the others. DATA SYNTHESIS: Mortality data from 138 trials on 98,000 patients were combined by the Yusuf-Peto adaptation of the Mantel-Haenszel method. There were 660 deaths among 11,712 patients allocated to receive class I agents and 571 deaths among 11,517 corresponding control patients (51 trials: odds ratio [OR], 1.14; 95% confidence interval [CI], 1.01 to 1.28; P = .03). Of 26,973 patients allocated to receive beta-blockers (class II agents), 1464 died compared with 1727 deaths among 26,295 control patients (55 trials: OR, 0.81; 95% CI, 0.75 to 0.87; P = .00001). Of 778 patients allocated to receive amiodarone (a class III agent), 77 died compared with 101 deaths in 779 control patients (eight trials: OR, 0.71; 95% CI, 0.51 to 0.97; P = .03). There were 982 deaths in 10,154 patients allocated to receive a class IV agent (calcium channel blockers) and 949 deaths in 10,188 control patients (24 trials: OR, 1.04; 95% CI, 0.95 to 1.14; P = .41). CONCLUSIONS: The routine use of class I antiarrhythmic agents after myocardial infarction is associated with increased mortality. beta-Blockers have been conclusively demonstrated to reduce mortality. The limited data on amiodarone appear promising. Data on calcium channel blockers remain unpromising.

Anti-Arrhythmia Agents↗
PubMed1993

Could distance be a proxy for severity-of-illness? A comparison of hospital costs in distant and local patients.

OBJECTIVE: We test the hypothesis that hospital costs, after adjusting for DRG mix, are higher in distant patients than in local patients. DATA SOURCES AND STUDY SETTING: Data were obtained from the Washington State Commission Hospital Abstract Reporting System (CHARS) and included all patients discharged from 15 metropolitan hospitals in the state of Washington during fiscal year 1987 (N = 181,072). STUDY DESIGN: Distant patients were initially defined as those patients residing outside a 15-mile radius of the hospital from which they were discharged; all other patients were considered local. Distance was determined using the patient's residence zip code. Hospital charge, calculated for all patients regardless of payer, served as a proxy for cost and was adjusted using the DRG weight. PRINCIPAL FINDINGS: Average charge (adjusted for DRG weight) was higher for distant patients in all but two hospitals. Overall adjusted charge for distant patients was 15 percent higher (p < .001). This finding persisted when different distances were used to dichotomize distant and local patients. When the 20 most common DRGs were examined individually, little charge difference was found in surgical DRGs that require tertiary center services (tertiary DRGs) and in those DRGs with both moderate and predictable resource use (routine DRGs); the charge difference seemed most prominent in those DRGs with a wide array of possible resource use (heterogeneous DRGs). CONCLUSIONS: Results suggest that patients traveling long distances use more resources and incur higher hospital charges than local patients. This is not accounted for in prospective payment. We postulate that distance might serve in part as a proxy for severity-of-illness.

Catchment Area, Health↗
PubMed1993

Side posture manipulation for lumbar intervertebral disk herniation.

OBJECTIVES: The objective of this article is to review the status of side posture manipulation for lumbar intervertebral disk herniation. DATA SOURCES, STUDY SELECTION AND DATA EXTRACTION: The data presented in this article are from our Back Pain Clinic at the Royal University Hospital and the articles cited are those which we feel are important in reviewing this subject. CONCLUSIONS: The treatment of lumbar intervertebral disk herniation by side posture manipulation is both safe and effective. Further research is required to understand more fully the effects of this treatment on the intervertebral disk.

Chiropractic↗
PubMed1995

Impact of Medicare payment reductions on access to surgical services.

OBJECTIVE: This study evaluates the impact of surgical fee reductions under Medicare on the utilization of surgical services. DATA SOURCES: Medicare physician claims data were obtained from 11 states for a five-year time period (1985-1989). STUDY DESIGN: Under OBRA-87, Medicare reduced payments for 11 surgical procedures. A fixed effects regression method was used to determine the impact of these payment reductions on access to care for potentially vulnerable Medicare beneficiaries: joint Medicaid-eligibles, blacks, and the very old. DATA COLLECTION/EXTRACTION METHODS: Medicare claims and enrollment data were used to construct a cross-section time-series of population-based surgical rates from 1985 through 1989. PRINCIPAL FINDINGS: Reductions in surgical fees led to small but significant increases in use for three procedures, small decreases in use for two procedures, and no impact on the remaining six procedures. There was little evidence that access to surgery was impaired for potentially vulnerable enrollees; in fact, declining fees often led to greater rates of increases for some subgroups. CONCLUSIONS: Our results suggest that volume responses by surgeons to payment changes under the Medicare Fee Schedule may be smaller than HCFA's original estimates. Nevertheless, both access and quality of care should continue to be closely monitored.

Black or African American↗
PubMed1995

The effect of an Rx-to-OTC switch on medication prescribing patterns and utilization of physician services: the case of vaginal antifungal products.

OBJECTIVE: We examined the impact of over-the-counter (OTC) availability of vaginal antifungal products, beginning in January 1991, on medication prescribing patterns and utilization of physician services. DATA SOURCES AND STUDY SETTING: Data on utilization of health care services and prescription medications by female members (ages 11 and older) of the Fallon Community Health Plan (FCHP), a group model health maintenance organization and a component of the Fallon Health Care System of central Massachusetts. The census for such individuals increased from 49,551 in January 1990 to 67,365 in December 1992. DESIGN: Time-series analyses were employed to assess changes in prescribing patterns of vaginal antifungal products and physician visits for vaginitis from January 1, 1990 through December 31, 1992. Monthly numbers of prescriptions for vaginal antifungal products and physician visits per 100 members were measured. Monetary savings relating to the prescription-to-OTC switch were also estimated. DATA COLLECTION METHODS: The computerized management information system of FCHP contains records on utilization of all health care services and prescriptions filled, collected as part of routine fiscal activities. We identified all vaginally administered products on the FCHP formulary used for the treatment of vaginal candidiasis and determined the number of prescriptions filled for these agents during each month of the study period. We also identified the number of physician office visits characterized by the ICD-9-CM code 616.10 ("vaginitis and vulvovaginitis, unspecified") occurring during each month of the study period. PRINCIPAL FINDINGS: For the one-year period after OTC availability of vaginal antifungal products (January 1991 through December 1991), we estimated that the number of prescriptions dispensed for these products was reduced by 6.42 per 100 female FCHP members ages 11 and older. Physician visits for vaginitis were reduced by 0.66 per 100 members. Estimated savings to the Fallon Health Care System for the one-year period following OTC availability were $42,528 in medication costs and $12,768 to $25,729 for costs associated with physician visits, depending on use of laboratory testing in patient evaluations. CONCLUSIONS: The findings of this study suggest that the prescription-to-OTC switch of vaginal antifungal treatments reduced health care costs to the insurer in the managed care setting. These favorable effects on costs for the insurer need to be weighed against shifts in medication costs to consumers and potential adverse consequences to the patient relating to errors in self-diagnosis.

Adolescent↗
PubMed1996

Reactions of salaried physicians to hospital decline.

OBJECTIVE: To examine the Exit, Loyalty, Voice, and Neglect (ELVN) reactions of full-time salaried physicians to the decline of their employing hospital, and to explore factors possibly associated with the choice of reactions. DATA SOURCE: The study analyzes data collected in a larger survey of work attitudes of 703 hospital physicians, constituting a representative national sample of (every tenth) salaried hospital physicians in Israel. DATA COLLECTION: Data were collected through a self-administered mail questionnaire with return envelopes attached. STUDY DESIGN: A survey design was used. Survey questionnaires included composite measures of the ELVN reaction as well as of the main predictors of reaction choice: job satisfaction, hospital commitment, job investment, alternatives, tenure, and managerial and senior positions. PRINCIPAL FINDINGS: The reactions of salaried physicians to hospital decline include the whole range of ELVN reactions. The choice of each reaction was found associated with a different set of disposition, situation, and position predictors. CONCLUSIONS: The ELVN typology is relevant for examining physicians' reactions to hospital decline, which appear to extend beyond the simple stay/leave dichotomy commonly used. The reactions of Exit, Loyalty, Voice, and Neglect are different in nature, and appear to reflect the different sets of circumstances that salaried physicians may face. Implications of these results for coping with hospital decline, hospital-physician relationships, and integration strategies are discussed.

Attitude of Health Personnel↗
PubMed1996

Medical insurance claims as a source of data for research: accuracy of diagnostic coding.

Validation of diagnostic codes in a sample of Hawaii medical insurance claims in 1986 to 1987 revealed 96% accuracy in hospital claims, high enough to supply data for research purposes. In physician claims the accuracy was only 62%. Initiation of two feedback loops to physicians from the insurer in 1989 resulted in a marked improvement of diagnostic coding accuracy by 1992 to 1994.

Communicable Diseases↗
PubMed1996

Hospital financing and neonatal intensive care.

OBJECTIVE: To investigate the relationship between hospital financing patterns and hospital resources for the care of babies born at low birthweight in New York City. DATA SOURCES AND STUDY SETTING: Data on neonatal care beds in New York City hospitals for 1991, obtained from the Greater New York Hospital Association, which were matched to 1991 hospital-specific birthweight and payment distributions from the New York State Department of Health. STUDY DESIGN: Statistical analyses were used to assess the relationship between insurance and beds across all hospitals and across hospitals classified by ownership and teaching status. PRINCIPAL FINDINGS: After adjusting for low birthweight and other measures of patient need and for hospital affiliation, the study finds that hospitals with more privately insured patients, especially those with more privately insured low-birthweight newborns, have statistically significantly more neonatal intensive care beds than do those with fewer such patients. This result persists within hospital affiliation categories. CONCLUSIONS: These results suggest that differences in the care received by privately insured, Medicaid insured, and uninsured low-birthweight babies may stem from differences in the resources available to the hospitals that treat these patients.

Catchment Area, Health↗
PubMed1997

Teenage pregnancies, 1974 to 1994.

OBJECTIVES: This article provides an overview of trends from 1974 to 1994 in pregnancies among women aged 15 to 19. DATA SOURCES: Vital statistics, abortion data, and hospital morbidity files maintained by Statistics Canada were used to develop estimated of pregnancies, live births, abortions, and stillbirths/miscarriages. ANALYTICAL TECHNIQUES: Rates of pregnancy, live birth, abortion and stillbirth/miscarriage are based on the female population aged 15 to 19. MAIN RESULTS: In 1994, there were an estimated 46,800 teenage pregnancies. This marked the continuation of an almost steady rise from 1987, when the number was 39,300. As well, there has been an increase in the percentage of teenage pregnancies ending in an abortion.

Abortion, Induced↗
PubMed1998

Nursing home performance under case-mix reimbursement: responding to heavy-care incentives and market changes.

OBJECTIVE: To examine the effect of case mix-adjusted reimbursement policy and market factors on nursing home performance. DATA SOURCES AND STUDY SETTING: Data from Medicaid certification inspection surveys, Medicaid cost reports, and the Kentucky State Center for Health Statistics for the years 1989 and 1991, to examine changes in nursing home performance stemming from the adoption of case mix-adjusted reimbursement in 1990. STUDY DESIGN: In addition to cross-sectional regressions, a first-difference approach to fixed-effects regression analyses was employed to control for facility differences that were essentially fixed during the survey years and to estimate the effects of time-varying predictors on changes in facility expenditures, efficiency, and profitability. PRINCIPAL FINDINGS: Facilities that increased the proportion of Medicaid residents and eliminated excess capacity experienced higher profitability gains during the beginning phase of case-mix reimbursement. Having a heavy-care resident population was positively related to expenditures prior to reimbursement reform, and it was negatively related to expenditures after the case-mix reimbursement policy was introduced. While facility-level changes in case mix had no reliable influence on costs or profits, nursing homes showing an increased prevalence of poor-quality nursing practices exhibited increases in efficiency and profitability. At the market level, reductions in excess or empty nursing home beds were accompanied by a significant growth in home health services. Moreover, nursing homes located in markets with expanding home health services exhibited higher increases in costs per case-mix unit. CONCLUSIONS: Characteristics of the reimbursement system appear to reward a cost minimization orientation with potentially detrimental effects on quality of care. These effects, exacerbated by a supply-constrained market, may be mitigated by policies that encourage the expansion of home health service availability.

Certification↗
PubMedDate not supplied

Improving oncology nursing practice through understanding and exploring the Internet.

PURPOSE/OBJECTIVES: To provide an overview of the evolution of computer technology, a brief history of the Internet, and guidelines for searching the Internet. DATA SOURCES: Literature, electronic online sources, and personal experience. DATA SYNTHESIS: Vast collections of resources are available on the Internet that can enhance many aspects of oncology nursing practice. These resources are stored on computers, rarely published as print documents, and only available to those oncology nurses who learn to navigate the Internet. IMPLICATIONS FOR NURSING PRACTICE: Specific Internet-based oncology nursing resources can enhance clinical practice, improve education, and facilitate oncology nursing research. CONCLUSIONS: Because a significant number of valuable resources are available on the Internet, it is critical that oncology nurses understand it, be aware of the resources, and have the skills to access the appropriate information.

Clinical Nursing Research↗