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Ambulatory nursing

Cynthia R Niesen, Donna M Olson, Kimberly D Nowdesha, Desiree A Tynsky, Conor G Loftus, Sonja J Meiers
Chronic disease accounts for three-quarters of today's medical expenditures. Functional abdominal pain (FAP) syndrome and associated gastrointestinal symptoms affect 0.5% to 2% of North Americans. Persons with FAP routinely seek healthcare, with little resolution of symptoms, despite high costs. National reports advocate for innovative redesign of ambulatory care services. Cognitive-behavioral therapy (CBT) is a low-cost, effective self-management approach. The objective of this study was to implement a registered nurse-led CBT approach to enhance self-management and satisfaction with care for adults with functional gastrointestinal disorder (FGID)...
July 2018: Gastroenterology Nursing: the Official Journal of the Society of Gastroenterology Nurses and Associates
Stacy M Baldwin, Sharon Zook, Julie Sanford
PURPOSE/OBJECTIVES: Today's health care climate is composed of patients who experience complex conditions with multiple comorbidities, requiring higher utilization of acute care services. It is imperative for acute care and primary care landscapes to bridge silos and form collaborative relationships to ensure safe and effective transitions of care from hospital to home. An interprofessional, posthospital follow-up clinic (Discharge Clinic) is one approach that can be used to improve transitions of care and decrease preventable hospital readmissions...
September 2018: Professional Case Management
Shin Sasaki, Masashi Kanai, Taku Shinoda, Hidemi Morita, Shinichi Shimada, Kazuhiro P Izawa
Background The health utility score in patients with stroke relates to physical, psychological, and various other factors. However, the relationship between the health utility score in patients with stroke and objective physical activity has not been clarified. Objective To clarify the relation between the health utility score and objective physical activity in community-dwelling ambulatory patients with stroke. Design A cross-sectional study. Method Patients who received outpatient consultation from a stroke certified nurse after discharge were recruited...
July 24, 2018: Topics in Stroke Rehabilitation
Yukari Uemura, Shiro Tanaka, Teruhiko Miyazaki, Mayumi Tsukiyama, Teruki Sone, Akira Taguchi, Satoshi Soen, Satoshi Mori, Hiroshi Hagino, Toshitsugu Sugimoto, Masao Fukunaga, Hiroaki Ohta, Toshitaka Nakamura, Hajime Orimo, Masataka Shiraki
We planned to conduct multi-center, open-labeled, blinded-endpoints, head-to-head randomized trial of minodronate and raloxifene to compare incidences of vertebral and non-vertebral fractures. The study is the Japanese Osteoporosis Intervention Trial protocol number 4 (JOINT-4). Here, we present the pre-fixed study design. The inclusion criteria are ambulatory older women with osteoporosis, aged > 60 years, and without pre-specified risk factors for secondary osteoporosis and dementia. The subjects who meet selection criteria will be randomly allocated to the raloxifene (60 mg/day) or minodronate (1 mg/day or 50 mg/4 weeks) groups using the central registry...
July 17, 2018: Journal of Bone and Mineral Metabolism
Martin R Salazar, Walter G Espeche, Carlos E Leiva Sisnieguez, Betty C Leiva Sisnieguez, Eduardo Balbín, Rodolfo N Stavile, Carlos March, Ricardo D Olano, Adelaida Soria, Osvaldo Yoma, Marcelo Prudente, Soledad Torres, Florencia Grassi, Claudia Santillan, Horacio A Carbajal
OBJECTIVE: The aim of this study was to test if hypertension detected by ambulatory blood pressure monitoring (ABPM) performed at mid-pregnancy, is a useful predictor for preeclampsia/eclampsia (PEEC). METHODS: The study was performed in women coursing high-risk mid-pregnancies. Office blood pressure (BP) was estimated as the mean of three values, taken by a specialized nurse after a 15-min interview, and office hypertension defined as at least 140/90 mmHg. Immediately after, an ABPM was started...
July 13, 2018: Journal of Hypertension
Jerry Y Du, Alexander S Rascoe, Randall E Marcus
BACKGROUND: In an era of increasing healthcare costs, the number and value of nonclinical workers, especially hospital management, has come under increased study. Compensation of hospital executives, especially at major nonprofit medical centers, and the "wage gap" with physicians and clinical staff has been highlighted in the national news. To our knowledge, a systematic analysis of this wage gap and its importance has not been investigated. QUESTIONS/PURPOSES: (1) How do wage trends compare between physicians and executives at major nonprofit medical centers? (2) What are the national trends in the wages and the number of nonclinical workers in the healthcare industry? (3) What do nonclinical workers contribute to the growth in national cost of healthcare wages? (4) How much do wages contribute to the growth of national healthcare costs? (5) What are the trends in healthcare utilization? METHODS: We identified chief executive officer (CEO) compensation and chief financial officer (CFO) compensation at 22 major US nonprofit medical centers, which were selected from the US News & World Report 2016-2017 Hospital Honor Roll list and four health systems with notable orthopaedic departments, using publicly available Internal Revenue Service 990 forms for the years 2005, 2010, and 2015...
July 10, 2018: Clinical Orthopaedics and related Research
Hunaina Shahab, Hamza Sohail Khan, Aysha Almas, Mayera Tufail, Khawar Abbas Kazmi, Aamir Hameed Khan
OBJECTIVE: Our previous study showed that post-clinic blood pressure (BP) taken 15 min after a physician-patient encounter was the lowest reading in a routine clinic. We aimed to validate this reading with 24 h Ambulatory Blood Pressure Monitoring (ABPM) readings. A cross-sectional study was conducted in the cardiology clinics at the Aga Khan University, Pakistan. Hypertensive patients aged ≥ 18 years, or those referred for the diagnosis of hypertension were included. RESULTS: Of 150 participants, 49% were males...
July 11, 2018: BMC Research Notes
Maria López-Parra, Dolors Gil-Rey, Esmeralda López-González, Eva-Maria González-Rodríguez, Isabel Simó-Sánchez, Francisco Zamora-Carmona, Lidia Roqueta-Andreu, Marta Arizu-Puigvert, Dolors Abril-Sabater, Àngels Moreno-Álvarez, Àngels López-Bonet, Gisela López-Hidalgo, Helena Costa-Ventura, Laura García-Pardo, Mireia Rico-Liberato, Miriam García-Borràs, Maria Teresa Arnal-Leris, Mònica Sianes-Gallén, Roser Vives
BACKGROUND: Surgical wounds are covered to prevent bleeding, absorb the exudates, and provide a barrier against external contamination. Currently, in our hospital, after orthopedic surgery, traditional occlusive dressing of sterile gauze and non-woven hypoallergenic adhesive tape is placed. Some of the newest dressings have been shown to reduce the incidence of blisters compared with traditional dressing or colloid adhesive dressings. However, there are no comparative evaluations between the different types of dressings and their contribution to the overall results of the healing process...
July 5, 2018: Trials
Marjorie Bowman, Sarah St Cyr, Adrienne Stolf I
OBJECTIVE: To understand how health-care providers' (HCPs) religious preferences influence their willingness to undertake advance care planning (ACP) with patients and their acceptance of other HCP's involvement. METHODS: Online anonymous survey distributed to HCPs in hospital, ambulatory offices, and hospice settings in Dayton, Ohio. We evaluated the associations of HCP religion with their personal ACP, willingness to facilitate ACP, and acceptance of other HCPs' ACP participation...
January 1, 2018: American Journal of Hospice & Palliative Care
Yvonne C van der Zalm, Fabian Termorshuizen, Peter F Schulte, Jan P Bogers, Machteld Marcelis, Iris E Sommer, Jean Paul Selten
Purpose: To our knowledge, no study has examined in a structured way the extent of underprescription of clozapine in ambulatory patients with Non-Affective Psychotic Disorder (NAPD). In the Netherlands, psychiatric care for such patients is provided by Flexible Assertive Community Treatment (FACT) teams and by early intervention teams. In 20 FACT teams and 3 early intervention teams we assessed the proportion of patients who: use clozapine (type 1 patients), previously used this drug (type 2), have an unfulfilled indication for this drug, by type of indication (type 3), or were at least markedly psychotic, but had not yet received two adequate treatments with other antipsychotic drugs (type 4)...
2018: Frontiers in Psychiatry
Siobhan Sundel, Emerson E Ea
BACKGROUND: Nurses are the main providers of patient education in inpatient and outpatient settings. Unfortunately, nurses may lack knowledge of chronic medical conditions, such as heart failure. METHOD: The purpose of this one-group pretest-posttest intervention was to determine the effectiveness of teaching intervention on nurses' knowledge of heart failure self-care principles in an ambulatory care setting. The sample consisted of 40 staff nurses in ambulatory care...
July 1, 2018: Journal of Continuing Education in Nursing
Kathryn Lawton, Karen Royals, Kristin V Carson-Chahhoud, Fiona Campbell, Brian J Smith
BACKGROUND: Specialist nursing roles to manage stable disease populations are being used to meet the needs of both patients and health services. With increasing cost pressures on health departments, alternative models such as nurse-led care are gaining momentum as a substitute for traditional doctor-led care. This review evaluates the safety, effectiveness, and health outcomes of nurses practising in autonomous roles while using advanced practice skills, within the context of bronchiectasis management in subacute, ambulatory, and/or community care...
June 20, 2018: Cochrane Database of Systematic Reviews
Ulrich J Spreng, Vegard Dahl, Johan Ræder
Background and objective Perioperative low-dose ketamine has been useful for postoperative analgesia. In this study we wanted to assess the analgesic effect and possible side-effects of perioperative low-dose S (+) ketamine when added to a regime of non-opioid multimodal pain prophylaxis. Methods Seventy-seven patients scheduled for haemorrhoidectomy were enrolled in this randomized, double-blind, controlled study. They received oral paracetamol 1-2 g, total intravenous anaesthesia, intravenous 8 mg dexamethasone, 30 mg ketorolac and local infiltration with bupivacaine/epinephrine...
April 1, 2010: Scandinavian Journal of Pain
R Lenssen, K Schmitz, C Griesel, A Heidenreich, J B Schulz, C Trautwein, N Marx, C Fitzner, U Jaehde, A Eisert
BACKGROUND: Elderly patients are vulnerable to adverse drug reactions (ADRs). Drug-related readmissions (DRRs) can be a major consequence of ADR. Therefore, this study aimed to investigate the effects of a ward-based, comprehensive pharmaceutical care service on the occurrence of DRRs as the endpoint in dependent-living elderly patients. METHODS: A randomized, controlled trial was performed at a German University Hospital. Patients fulfilling the following criteria were eligible: admission to a cooperating ward, existing drug therapy at admission, 65 years of age and older, home-care or nursing home residents in ambulatory care, and a minimum hospital stay of three days...
June 4, 2018: BMC Geriatrics
Artur Dalfó-Pibernat, Antoni Dalfó Baqué, Francisco Javier Pelegrina Rodríguez, Olatz Garin, Xavier Duran, Mercè Cladellas Capdevila, Josep Comin Colet
INTRODUCTION: Ambulatory blood pressure monitoring (ABPM) is fundamental to diagnosing and monitoring arterial hypertension (HTN), yet it is not known how effective training could be in improving knowledge of ABPM. PURPOSE: The purpose of this study was to evaluate ABPM knowledge before and after a training activity. METHODOLOGY: A before-and-after intervention study of 116 professionals. Data was collected on age, sex, occupational category, work setting, and work experience...
June 1, 2018: European Journal of Cardiovascular Nursing
Beth A Lown
Compassion, the foundation of Nursing, is a source of both healing for those who suffer and of purpose and meaning for those who seek to heal others. Increasingly, however, the fast pace and volume of care and documentation requirements diminish time with patients and families and hinder the enactment of compassion. These issues and other aspects of the work environment decrease the satisfaction and well-being of professional caregivers and are contributing to a rising tide of burnout. Research suggests that employee engagement emerges from their satisfaction and well-being; however, it is difficult for an individual to engage when she or he feels depleted and unsupported...
July 2018: Nursing Administration Quarterly
Lindon M H Wing, Enayet K Chowdhury, Christopher M Reid, Lawrence J Beilin, Mark A Brown
BACKGROUND: Numerous studies have shown a stronger relationship between ambulatory blood pressure (ABP), particularly night ABP, and cardiovascular events/mortality than for office blood pressure (OBP). A previous clinical trial (Syst-Eur) showed that pretreatment ABP was only a better predictor of outcome than OBP in placebo-treated participants. The current study in treated elderly hypertensives from the Second Australian National Blood Pressure study (ANBP2) examined whether pretreatment ABP was a better predictor of mortality than OBP over long-term (∼11 years) follow-up...
June 2, 2018: Blood Pressure Monitoring
Keith Kranker, Linda M Barterian, Rumin Sarwar, G Greg Peterson, Boyd Gilman, Laura Blue, Kate Allison Stewart, Sheila D Hoag, Timothy J Day, Lorenzo Moreno
OBJECTIVES: To evaluate impacts of a telephonic transitional care program on service use and spending for Medicare fee-for-service beneficiaries at a rural hospital. STUDY DESIGN: Observational cohort study. METHODS: Patients discharged from Atlantic General Hospital (AGH) with an AGH primary care provider were assigned a nurse care coordinator for 30 days. The nurse reviewed the patient's conditions, assessed needs for transition support, conducted weekly telephone calls (beginning 24-72 hours after discharge) to monitor adherence to treatment plans, and scheduled follow-up appointments...
May 2018: American Journal of Managed Care
Enrico Brocco, Sasa Ninkovic, Mariagrazia Marin, Christine Whisstock, Marino Bruseghin, Giovanni Boschetti, Raffaella Viti, William Forlini, Antonio Volpe
Diabetic foot is a complication of diabetes affecting 15% of diabetics in their lives. It is associated to diabetic neuropathy and peripheral vascular disease and its incidence has increased. The ulceration is the initial cause of a dramatic process leading, if not correctly treated, to amputations. Both neuropathy, neuro-ischemia and infections have a role in determining healing or worsening of the lesions and 85% of all amputations in diabetic patients are preceded by a foot ulceration deteriorating to a severe gangrene or infection...
May 29, 2018: Journal of Cardiovascular Surgery
Sarah D Berry, Randi R Rothbaum, Douglas P Kiel, Yoojin Lee, Susan L Mitchell
Importance: The decision whether to surgically repair a hip fracture in nursing home (NH) residents with advanced dementia can be challenging. Objective: To compare outcomes, including survival, among NH residents with advanced dementia and hip fracture according to whether they underwent surgical hip fracture repair. Design, Setting, and Participants: We conducted a retrospective cohort study of 3083 NH residents with advanced dementia and hip fracture, but not enrolled in hospice care, using nationwide Medicare claims data linked with Minimum Data Set (MDS) assessments from January 1, 2008, through December 31, 2013...
June 1, 2018: JAMA Internal Medicine
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