Home health care

Home health care is the fastest-growing expense in the Medicare program because of the aging population, the increasing prevalence of chronic disease and increasing hospital costs. Patients and families are choosing the option of home care more frequently. Medicare's regulations are often considered the standard of care for all home health agency interactions, even when a patient does not have Medicare insurance. These regulations require patients who receive home health care services to be under the care of a physician and to be homebound. The patient must have a documented need for skilled nursing care or physical, occupational or speech therapy. The care must be part time (28 hours or less per week, eight hours or less per day) and occur at least every 60 days except in special cases. A detailed referral and specific care plan maximize the care to the patient and the reimbursement received by the physician.     

Conflict across organizational boundaries: Managed care organizations versus health care providers.

This research examined conflicts that occur across organizational boundaries, specifically between managed care organizations and health care providers. Using boundary spanning theory as a framework, the authors identified 3 factors in the 1st study (30 interviews) that influence this conflict: (a) organizational power, (b) personal status differences of the individuals handling the conflict, and (c) their previous interactions. These factors affected the individuals' behavioral responses or emotions, specifically anger. After developing hypotheses, the authors tested them in a 2nd study using 109 conflict incidents drawn from 9 different managed care organizations. The results revealed that organizational power affects behavioral responses, whereas status differences and previous negative interactions affect emotions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcomes measurement in today''s health care environment

The effects of smoking habits on thyroid function, echo-texture (nodules and/or cysts) and thyroid gland volume were determined by using ultrasound and measuring serum Thyroxin (T4), Triiodothyronine (T3), Thyrotropin (TSH) and TPO antibodies (ab-TPO) in 189 healthy smokers and non-smokers, randomly selected (111 females and 78 males) among the employees of our hospital and their relatives. When the entire group of subjects was considered the mean ratio of thyroid gland volume/body weight was found to be significantly higher in male (P < 0.05) and female (P < 0.05) smokers compared with non-smokers. In female smokers, mean serum thyroid-stimulating hormone (TSH) was lower (P < 0.05) and the degree of smoking was positively correlated with the ratio of thyroid gland volume/body weight (P < 0.05). However, when the subjects with a family history of goitre in first degree relatives were excluded from our study (14 females and 9 males), no significant differences in mean ratio of thyroid volume/weight or TSH between the remaining smokers and non-smokers were detected. In both sexes, the correlation between the degree of smoking and thyroid volume, although positive, did not reach statistical significance. No difference in prevalence of abnormal echogenicity and echo-texture (nodules and cysts) between smokers and non-smokers was detected. It is concluded that smoking habits present a goitrogenic effect only in subjects with a family history of goitre but have no influence on thyroid gland texture.     

Home birth and short-stay delivery. Lessons in health care financing for providers of health care for women

The current restructuring of the U.S. health care delivery system is driven primarily by economic forces. Although primary care providers may understand the roles of technology and advocacy in fostering fundamental change, they may not be familiar with the issues related to financing of health care and, thus, may not fully appreciate the extent to which economic factors influence the character of their professional lives and the services they provide. Analysis of the loss of the home birth option in the 1950s provides a method for understanding and influencing the factors driving health care restructuring today. In examining short-stay delivery in the 1990s, this article also addresses ways in which managed health care systems may improve or restrict women's access to a variety of primary care services.     

Home health care nursing: past and present--Part 1

Carcinoma of the urinary bladder presenting during pregnancy is rare. We report two such cases presenting with gross hematuria, both of which were managed by transurethral electroresection of the tumor; there was no adverse effect on the pregnancies. Transurethral resection thus appears to be the procedure of choice in the management of this condition, and carries minimal morbidity even when performed during pregnancy.     

Rated helpfulness and partner-reported smoking cessation support across the pregnancy-postpartum continuum.

Support interventions have not changed smoking cessation rates significantly. The pregnancy-postpartum continuum presents a unique opportunity to examine patterns of support. Expectant couples (N = 477) were surveyed twice during pregnancy and 3 times postpartum. Partners reported positive and negative smoking-specific support; women reported the helpfulness of partner support. Linear trends suggest that women viewed support as more helpful during pregnancy than during postpartum. Partners' provision of positive support across the continuum depended on their smoking; provision of negative support depended on women's smoking. Partners who smoked provided lower levels of both positive and negative support, especially postpartum. Women who smoked throughout the pregnancy perceived their partner's negative support as helpful. Implications are that partners who smoke may need help staying engaged in the support process. Partners may provide negative support in response to women's smoking cues. Women who are struggling with cessation may not view negative support as negative. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The end of the continuum. Bereavement care for the adult

A method has been developed for the simultaneous analysis of the isomeric N-acetyl-S-(dichlorophenyl)cysteines (also known as dichlorophenylmercapturic acids, DCPMAs) in urine. This procedure allows the determination of 2,3- and 3,4-DCPMAs at the concentrations expected in the urine samples of employees occupationally exposed to 1,2-dichlorobenzene (1,2-DCB). The results of a 1,2-DCB exposure study under standardized conditions show a first-order kinetic for the excretion of DCPMAs, as well as acceptable linear correlations between the urinary concentrations of DCPMAs and the amount of inhaled 1,2-DCB. It therefore seems it would be possible to derive a biological tolerance value for 1,2-DCB based on isomeric DCPMAs as analytical parameters.     

Home care of the elderly. Oral cancer patient

Elderly patients with oral cancer present many challenges in the home healthcare setting. Timely detection of disease, appropriate and timely referrals, and the adverse effects of therapies, nutrition, and depression are discussed in this article. Using a case study, the author offers suggestions on the coordination of services of dental, medical, and nursing professionals and management of adverse dental effects.     

Home care. Doing right for the wrong reason

Abomasal fistulae resulting from right paramedian abomasopexy in eight adult dairy cattle were treated by primary closure of the abdominal wall after surgical resection of the fistulae. The median elapsed time from the abomasopexy to recognition of fistula formation was 16 days (range, 10 to 90 days). All cows had normal electrolyte values, and five cows had mildly increased base excess values (range = 4.0 to 7.8 mEq/L). Surgery was performed with the cows in dorsal recumbency using general anesthesia. The fistulated tissue was resected and the abomasum and body wall were closed primarily. One or two layers of appositional sutures using #2 or #3 polyglactin 910 were used to close the body wall. Mean surgical time was 2.2 hours (range, 1.8 to 2.9 hours). Two cows were lost to follow-up. Five of the remaining six cows returned to production (range, 5 to 30 months). Primary closure of the abdominal wall should be considered in the surgical repair of abomasal fistulae in cows that do not have diffuse peritonitis.     

The Fort Bragg continuum of care for children and adolescents: Mental health outcomes over 5 years.

Controversial early results of the Fort Bragg mental-health-effectiveness study indicated that the continuum of care did not produce better outcomes (i.e., children's rate of improvement was the same in both the demonstration and comparison sites). The present study considered outcomes at 5-year follow-up to examine long-term effects from the continuum of care. A random regression longitudinal model analyzed 10 key outcome variables measured 7 times. Long-term outcomes in continuum-treated children were no better than those of comparison children; results are consistent with those of earlier studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Getting the message across: Age differences in the positive and negative framing of health care messages.

Although valenced health care messages influence impressions, memory, and behavior (Levin, Schneider, & Gaeth, 1998) and the processing of valenced information changes with age (Carstensen & Mikels, 2005), these 2 lines of research have thus far been disconnected. This study examined impressions of, and memory for, positively and negatively framed health care messages that were presented in pamphlets to 25 older adults and 24 younger adults. Older adults relative to younger adults rated positive pamphlets more informative than negative pamphlets and remembered a higher proportion of positive to negative messages. However, older adults misremembered negative messages to be positive. These findings demonstrate the age-related positivity effect in health care messages with promise as to the persuasive nature and lingering effects of positive messages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mutual achievement strivings: A continuum for mental health.

Mental health is defined in transactional terms, i.e., in terms of the intent of an individual towards equality or mutuality of achievement in relating to others. 4 levels of mutual achievement striving are described and a continuum composed of 8 varieties of intention-transactions is offered. Case histories of 64 patients admitted to a psychiatric hospital were examined to isolate events which could be evaluated in terms of the intention-transaction dimension. Each S was assigned a score on this continuum which reflected his degree of "mental health," and these scores were then compared to a measure of severity of mental illness (see 35: 6569), psychiatric diagnosis, type of treatment recommended, and outcome of treatment. Intention-transaction scores correlated positively with the variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A continuum of care: More is not always better.

This article describes an $80-million project designed to test whether a continuum of mental health and substance abuse services for children and adolescents is more cost-effective than services delivered in the more typical fragmented system. The study showed that an integrated continuum was successfully implemented that had better access, greater continuity of care, more client satisfaction, and treated children in less restrictive environments. However, the cost was higher, and clinical outcomes were no better than those at the comparison site. The article concludes that reform of mental health systems alone is unlikely to affect clinical outcomes. Cooperation is needed between mental health providers and researchers to better understand how to improve services delivered in the community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health care in the USSR.

The author received a scientist exchange grant from the National Institutes of Health and visited the USSR as a health-science representative in 1976. He reports that mental health services in the USSR are provided primarily by the medical profession through state mental hospitals and psychiatric sections in general hospitals and clinics. Drug therapy is the main treatment method, but psychotherapy is beginning to make some inroads. Family therapy settings are the newest additions to preventive mental health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)