This study was designed to identify and describe the prescribing practices of advanced practice psychiatric nurses. Part I describes the demographic, educational, and clinical setting characteristics. A survey method ...
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This study was designed to identify and describe the prescribing practices of advanced practice psychiatric nurses. Part I describes the demographic, educational, and clinical setting characteristics. A survey method was used with N = 88 nurses representing seven different states. Nurse prescribers were: younger than nonprescribers, employed in community mental health settings, and voluntarily using a consulting physician arrangement. Limitations on practice included: statute formulary, controlled substances, and formulary/protocols with a consulting physician. Results suggest nurses' prescribing practices are used in outpatient settings, viewed as conservative, with a value on physician collaboration even in the absence of legal mandates. Copyright (C) 2001 by W.B. Saunders Company.
The noncooperative character of resource allocation in a national health service may contribute to excessive waiting lists. A theory of hospital waiting lists is derived from this idea. Waiting lists imply loss of eff...
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The noncooperative character of resource allocation in a national health service may contribute to excessive waiting lists. A theory of hospital waiting lists is derived from this idea. Waiting lists imply loss of efficiency;the hospital's resources are drawn away from medical work. Although there is scope for Pareto improvements, the structure of budget allocation may prevent these improvements from being achieved. Some reforms of the institutional structure are suggested.
This study was designed to provide a description of individuals incarcerated in a county jail and referred for mental health services. A standardized intake form was completed for 598 inmates who had contact with the ...
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This study was designed to provide a description of individuals incarcerated in a county jail and referred for mental health services. A standardized intake form was completed for 598 inmates who had contact with the mental health counselor. Analysis of the mental health status of inmates suggests that the presence of a counselor in the jail may serve an important function. Specifically, inmates referred ro the counselor were not in acute distress. This suggests they may be better served by an on-site counselor rather than through the traditional method of being transported to the hospital emergency room or community mental health center for evaluation.
The volume of non-cancer related clinical services and referrals for medical care of women as a consequence of their enrollment in a federally-sponsored breast and cervical cancer screening program was examined. We ra...
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The volume of non-cancer related clinical services and referrals for medical care of women as a consequence of their enrollment in a federally-sponsored breast and cervical cancer screening program was examined. We randomly sampled 100 medical records from among 389 individuals who received cancer screening services through the Connecticut Breast and Cervical Cancer Early Detection Program. Medical record audits tabulated occasions when women were offered or received diagnostic or therapeutic procedures as a by product of their program participation, Breast screening was provided to 100 women and 49 individuals received cervical cancer screening. In addition, 87 percent of the sample were offered or received one or more non-cancer related health services. Physical exams were provided to 86 women, laboratory tests were ordered for 11 individuals and 55 referrals were made to address a myriad of specific medical needs that were uncovered incidental to breast and cervical cancer screening. Among 26 women who did not heed recommendations for follow-up care, cost, inconvenience and beliefs that medical problems were not immediate concerns were cited. Local screening program sponsors should be cognizant that the health care needs and limited resources of some target populations may be substantial. Mechanisms to assure that needed health care is available to individuals should be built and into all categorical health service programs.
The paper focuses on the interprofessional relationships which developed between general practitioners (Gps) and complementary practitioners (Cps) during a pilot project where GPs referred to acupuncturists, osteopath...
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The paper focuses on the interprofessional relationships which developed between general practitioners (Gps) and complementary practitioners (Cps) during a pilot project where GPs referred to acupuncturists, osteopaths and chiropractors. It is based on interviews with GPs and CPs, that took place at the beginning and end of an evaluative study on patients referred with musculoskelal conditions. Referrals to hospital orthopaedic outpatients departments and pain clinics were also examined. The most common relationship that developed was where the GP delegated responsibility for treatment to the CP. One CP and GP developed a more interactive relationship which included a shared diagnostic role. The NHS reforms offer opportunities for different types of working relationships to develop between health professionals. They also offer opportunities for professionals who have not traditionally worked in the NHS to do so. The findings discussed here are exploratory. Further research to identify the types of relationships developing between Cps and Gps and to establish whether the type of relationship has an impact on secondary referrals and treatment outcomes is recommended.
Objectives: To identify the sociodemographic characteristics of women seeking termination of pregnancy through a public hospital service and explore issues of accessibility to the service. Method: An audit of the Preg...
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Objectives: To identify the sociodemographic characteristics of women seeking termination of pregnancy through a public hospital service and explore issues of accessibility to the service. Method: An audit of the Pregnancy Advisory Service (PAS) at the Royal Women's Hospital in Melbourne from January to March 1996. Data were collected from 1,088 intake forms of women seeking an abortion. Results: The women were of low socioeconomic status, with 437 (40.2%) living on a government pension or benefit and 55.6% holding a Health Benefits Card. However, only 33.8% were given an appointment for an abortion in the public clinic, with most (63.7%) referred to private services. Conclusions: The demand for this public hospital abortion service exceeds its capacity and economically disadvantaged women are required to seek abortion in private services. Implications: There is a role for regional health authorities to ensure adequate distribution of public hospital pregnancy termination services.
Aim To fmd out how many patients for whom dental general anaesthesia was requested actually needed it in order to complete treatment. Design Analysis of clinical outcomes supported by telephone canvassing of parents. ...
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Aim To fmd out how many patients for whom dental general anaesthesia was requested actually needed it in order to complete treatment. Design Analysis of clinical outcomes supported by telephone canvassing of parents. Method In summer 1998, eighty two child patients were seen in the Community Dental Service in Rochdale with a request for the provision of dental general anaesthesia (DGA) for the extraction of teeth. Their ages ranged from 3 to 14 years and all were required to attend for a pre-anaesthetic visit. Unless objective indicators of a need for DGA applied, the parents and children were actively discouraged from having DGA, and the alternative of local anaesthetic (LA) was offered. Clinical outcomes and parent satisfaction were recorded after treatment was finished. Results In 75% of cases it proved possible to complete the extractions without need for DGA;in the 10% of cases where DGA was necessary, it was to deal with the sequelae of dental caries. Fifteen percent of subjects failed to complete treatment. Subjects found to have a need for DGA tended to be younger and with treatment required in more than one sextant. Pain as a presenting symptom, young age and multiple treatment needs were found to be poor predictors of need for DGA and did not automatically preclude successful treatment without DGA. The satisfaction ascertained from users of the service was high and explanation of proposed treatments, especially the comparative risks and benefits of DGA versus LA, was well received. Conclusion There is score for significant reduction. in provision of dental general anaesthesia if current professional guidelines are followed.
Although older adults typically underutilize mental health services, problems associated with dementing illnesses, chronic medical illnesses, affective disorders, social isolation, and multiple medication use, among o...
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Although older adults typically underutilize mental health services, problems associated with dementing illnesses, chronic medical illnesses, affective disorders, social isolation, and multiple medication use, among other phenomena, have increased referrals of the elderly to psychiatric emergency services. The present study reviewed characteristics of elderly adults referred to a psychiatric emergency outreach/screening service. Of all individuals for whom a referral was made, 24% were aged 60 or older. Among those older adults referred, 63% were seen by screening service personnel, 37% did not meet screening criteria or voluntarily sought mental health services. Diagnoses of individuals evaluated included dementia (27%), affective disorders (27%), schizophrenia (16%), psychosis (12%), alcohol abuse (7), and diagnosis deferred (11%). Findings highlight the limited options available for mental health care of the aged.
作者：
McGloin, HAdam, SKSinger, MUCL
Sch Med Rayne Inst Bloomsbury Inst Intens Care MedDept Med London WC1E 6JJ England UCL Hosp
NHS Trust Intens Care Unit London England
Objectives: (i) To determine the incidence of unexpected deaths occurring on general wards, and whether any were potentially avoidable;(ii) to assess whether the quality of care on general wards prior to admission to ...
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Objectives: (i) To determine the incidence of unexpected deaths occurring on general wards, and whether any were potentially avoidable;(ii) to assess whether the quality of care on general wards prior to admission to intensive care affected subsequent outcome. Design: Six-month audit in teaching hospital. Review of medical, nursing and physiotherapy notes, bedside charts and laboratory data in ward patients either dying unexpectedly tie not having a prior 'do not resuscitate' order) or requiring intensive care unit (ICU) admission. Panel assessment of quality of ward care prior to unexpected ward death or ICU admission. Subjects: Adult general ward patients admitted to ICU or dying unexpectedly. Outcome measures: ICU and hospital mortality. Results: (i) In the six-month study period, 317 of the 477 hospital deaths occurred on the general wards, of which 20 (6%) followed failed attempts at resuscitation. Thirteen of these unexpected deaths were considered potentially avoidable: gradual deterioration was observed in physiological and/or biochemical variables, but appropriate action was not taken;(ii) in the same period, 86 hospital inpatients were admitted on 98 occasions to the ICU, 31 of whom received suboptimal care pre-ICU admission due either to non-recognition of (the severity of) the problem or to inappropriate treatment. Both ICU (52% vs 35%) and hospital (65% vs 42%) mortality was significantly higher in these patients compared to well managed patients (p <0.0001). Conclusions: Patients with obvious clinical indicators of acute deterioration can be overlooked or poorly managed on the ward. This may lead to potentially avoidable unexpected deaths or to a poorer eventual outcome following ICU admission. Early recognition and correction of abnormalities may result in outcome benefit, but this requires further investigation.
Objective: To characterize the pattern, content, and management of after-hours telephone interactions between obstetrician-gynecologists and patients. Methods: In a prospective observational study, 12 resident and nin...
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Objective: To characterize the pattern, content, and management of after-hours telephone interactions between obstetrician-gynecologists and patients. Methods: In a prospective observational study, 12 resident and nine private physicians practicing obstetrics and gynecology completed data cards for after-hours telephone interactions with patients. Chief complaints were categorized as related to either women's health or primary care and on whether women were pregnant postpartum or not pregnant. Triage dispositions (evaluate now, office follow-up, or home care) were compared between groups. Women also were asked what they would have done if they had been unable to contact their physicians by telephone. Results: One hundred ninety-two of 276 calls evaluated (69.6%) were from pregnant women, 20 (7.2%) were from postpartum women, and 64 (23.3%) were from nonpregnant women. Calls were related to primary care health issues in 24.1% (n = 45) of pregnant women, 40% (n = 8) of postpartum women, and 28.1% (n = 18) of nonpregnant women. There were no differences between residents and private physicians in the proportion of women triaged to immediate evaluation for pregnancy (35.1% [n = 40] versus 41.9% [n = 31], P = .74) or postpartum (11.1% [n = 1] versus 10% [n = 1], P = .96) problems. Among 139 women triaged to office follow-up, 41% (n = 57) would have come to the hospital for emergency evaluation if they had been unable to reach their physicians. Conclusion: Resident and private obstetrician-gynecologists provide primary care and women's health care advice during after-hours telephone calls from patients. More than one third of after-hours telephone calls from pregnant women are triaged to immediate evaluation. (Obstet Gynecol 2000;96:459-64. (C) 2000 by The American College of Obstetricians and Gynecologists.).
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