Typology of high users of health services among a rural medicaid population.

Objectives: To identify a typology for high system users among a rural Medicaid population that could assist policy makers and providers in better and more efficiently serving this population.

Design And Sample: Exploratory secondary data analysis of a large integrated Medicaid database in a western state. Five hundred and thirty-nine Medicaid recipients receiving 2 or more state services and receiving 10 or more unique medications.

How well are nurse practitioners prepared for practice: Results of a 2004 questionnaire study.

Purpose: The purpose of this study was to evaluate the perceived preparedness of nurse practitioners (NPs) for practice after completing their basic NP educational programs and to evaluate NPs' perceived preparedness in and their perceived importance of select clinical content areas basic to NP education.

Data Sources: This cross-sectional descriptive study used a written questionnaire consisting of 32 items, two of which contained 25 subitems. Subjects were asked to rate their overall level of preparedness when they completed their NP program and both their level of preparation in and the importance of 25 clinical content areas.

Evaluation of NOC standardized outcome of "health seeking behavior" in nurse-managed clinics.

This study evaluated the accomplishment of the Nursing Outcomes Classification (NOC) outcome "Health Seeking Behavior" in 5 nurse-managed clinics. Nurse practitioners and registered nurses rated patients on 11 indicators of health seeking behaviors, and recorded their level of knowledge of the patient. A total of 556 evaluations were collected.

Evaluation of outcomes: the effects of continuous lateral rotational therapy.

Research on continuous lateral rotational therapy (CLRT) has demonstrated mixed results, but there have been definite benefits described in its use for the prevention and treatment of nosocomial and ventilator-acquired pneumonia. Several studies have shown decreased hospital and intensive care unit costs and lengths of stay, and ventilator days when used appropriately. The intent of this study was to develop a protocol for initiating and discontinuing CLRT and to determine if the protocol would result in more effective and efficient use of this therapy.

Satisfaction with care among homeless patients: development and testing of a measure.

The purpose of this study was to establish the reliability and validity of the Homeless Satisfaction With Care Scale, a measure of satisfaction with care among homeless clients; and to examine selected predictors of satisfaction with care. A descriptive cross-sectional study was conducted comparing an inductively developed measure of satisfaction with 2 established satisfaction measures in a sample of 168 homeless clients who used a rural or an urban clinic. The inductively developed satisfaction scale had good internal consistency reliability and was significantly related to the established measures of satisfaction, supporting its construct validity.

The transtheoretical model of behavior change and smokers in southern Appalachia.

Background: The southern Appalachian states show a high prevalence of smoking, with associated high rates of both heart disease and cancer, yet cultural differences raise questions concerning the applicability of the most frequently used model for smoking cessation, the transtheoretical model, for smokers from this region of the country.

Objective: To identify, by examining the applicability of the transtheoretical model for southern Appalachian smokers, the percentage of individuals in each of the five stages of change, the use of the processes of change from the trans-theoretical model, and the scores on recognized predictors of smoking cessation including the temptation to smoke, the perceived barriers to cessation, the pros and cons of smoking, and nicotine dependence.

Methods: This population-based, descriptive, cross-sectional study used a random sample of 3,800 telephone numbers, which were called up to eight times.

Weaving a new safety net of mental health care in rural America: a model of integrated practice.

Life in rural America is often idealized, yet rural Americans suffer from mental illness in rates comparable to urban America and require similar types of support and services. However, millions of individuals living in rural areas go without needed mental health services. The dominant care model allows the treatment of mental illness to be delivered by non-mental health professionals with little or no education or training in psychiatric care and who have little desire to provide this type of care, resulting most often in ineffective or inappropriate treatment.

Homeless patients' experience of satisfaction with care.

This article explores homeless individuals' experiences of satisfaction with health care, and explores the interrelationship among experiences of being homeless, health perceptions of participants, and experiences of satisfaction with health care. It presents the findings of a phenomenological study that was conducted using participants selected from five sites in one southeastern state. Participant interviews were conducted at a nurse-managed primary health care clinic for homeless, at a night time soup-kitchen, and at three private, not-for-profit, homeless shelters in two different towns.

Integrating teaching, research, and practice in a nurse-managed clinic. A nonrecursive model.

An integrated model for teaching, research, and practice within a nurse-managed clinic is presented to guide faculty and administration in implementing these three roles. The concepts and relationships in the model are described theoretically, and a real clinical setting is used to illustrate the practical application of the model.

Health promotion lifestyles of women experiencing crises.

Women who are experiencing crisis situations, including homelessness, are often perceived as passive victims of their social, economic, and personal circumstances. A few studies have challenged the stereotype of homeless women as passive victims and demonstrated that they are active in seeking solutions to their problems (Hodnicki, Horner, & Boyle, 1992; Montgomery, 1994; Thrasher & Mowbray, 1995). This study surveyed women receiving assistance at a nurse-managed clinic that serves a homeless population to determine their health promotion strategies.

Factors associated with return visits to a homeless clinic.

Associations between characteristics of homeless clients and their return visits to a nurse-managed primary health care clinic were examined using a retrospective chart review of 1,467 records from clients seen between 1991 and 1994. Client characteristics examined included age, education, race, gender, sheltered status, report of chronic disease, and report of family living in the area. Only 47 percent of clients made return visits to the clinic.

Screening clinics for the homeless: evaluating outcomes.

The study evaluated the outcomes of a series of health-screening clinics specifically developed to target the homeless population. Problems screened during this study were selected because of the high prevalence of each among the homeless and included hypertension, diabetes, anemia, tuberculosis, and foot problems. Screening clinics were developed and implemented by faculty and senior baccalaureate nursing students.

From research to practice: the effects of the jointly sponsored dissemination of an arthritis self-care nursing intervention.

Various educational programs have been developed and found to be effective in the self-management of arthritis. This study reexamined the effectiveness of one such program, "Bone Up On Arthritis" (BUOA), when the program was delivered by a community-based service organization to a sample of persons (N = 154) who differed widely in disease type and demographic characteristics. Arthritis Foundation staff implemented BUOA at four national sites; data were collected and analyzed by University of Michigan nurse researchers.

Predictors of progress in smoking cessation.

This study examined the ability of two specific measures of stressors associated with smoking cessation to act as predictors of progress through the stages of smoking cessation as described by Prochaska and DiClemente (1983). Specifically, a 19-item scale measuring barriers to smoking cessation and a 14-item scale measuring smoking cessation self-efficacy were completed by 127 smokers and self-quitters at three time points over a six-month period. Subjects who made progress through the stages of smoking cessation had lower barriers scores initially and had significant changes in their self-efficacy and barriers scores over the six-month period.

Development and testing of the barriers to cessation scale.

The purpose of this research was to develop and test a measure of barriers to smoking cessation. Barriers, reconceptualized within the Transactional Model of Stress (Lazarus, 1966), reflect specific stressors associated with smoking cessation. The measure consists of a 19-item scale, which has been tested in three studies.

Initiation of medical malpractice suits: a conceptualization and test.

Despite the concern with medical malpractice suits and research about them, little is known about why some perceived injuries lead to claims of malpractice while other similar injuries do not. This paper presents a conceptualization and hypotheses regarding the determinants of an injury or perceived injury leading to suit. The conceptualization and hypotheses are tested using information collected from 113 medical malpractice plaintiffs' attorneys in three states.

Targeting ambulatory care cases for risk management and quality management.

Means are needed to identify "highly productive" areas for quality review and risk management in ambulatory care; untargeted medical record reviews have too low a yield and too high a cost to be useful. Highly productive areas are those with important medical and economic consequences, large numbers of cases, and a reasonable potential that problems exist. This paper describes untoward event screens to identify highly productive areas for review based on hospital discharge diagnosis, procedure codes, and parameters such as length of stay and cancer staging.

Ensuring excellence: reconceptualizing quality assurance, risk management, and utilization review.

A new conceptualization of the related activities QA, RM, and UR may allow an organization to ensure appropriate, proficient, and satisfactory care and to ameliorate the consequences of bad outcomes. Three processes incorporated into the conceptualization are essential to ensuring excellence, as are specific attributes of the care process. The difference in initiation of activities (reactive versus proactive) is part of the model; relationships among the essential activities and processes and between reactive and proactive activities are suggested; and viewing data sources or collection as separate from the processes and activities is suggested.

The Albrecht Nursing Model for Home Healthcare. Predictors of satisfaction with a self-care intervention program.

Satisfaction with a self-care intervention program was evaluated through this quantitative study of arthritis clients at home. The results indicate that the clients were highly satisfied with the intervention. In this era of consumer satisfaction with their care, nurse administrator's knowledge of which interventions are satisfying is important for staff development and case management in the community.

Perceived well-being of persons quitting smoking.

The purpose of this study was to examine the perceived well-being of persons who are smokers, nonsmokers, or are quitting smoking. The sample included 74 nonsmokers, 74 smokers, and 92 self-defined quitters. Subjects' well-being was examined controlling for the effects of daily hassles and selected demographic differences.

The relationship between weight gain and nutrition in pregnancy.

Balanced nutrition and weight gain during pregnancy, and the relationship between these variables and pregnancy outcomes were examined. Data were collected from 510 pregnant women and from their prenatal, hospital, and infants' health records. Despite a common assumption in the prenatal literature that weight gain during pregnancy reflects nutritional adequacy, nutrition and weight gain were only weakly related in this sample.

Tobacco, alcohol, and caffeine use during pregnancy.

Research on the effects of smoking, alcohol, and caffeine on the outcomes of pregnancy is reviewed. The strength of the evidence on the effects of these substances is varied, ranging from some clear and consistent findings for smoking to inconsistent findings for caffeine. Evidence regarding alcohol is strong in some areas and less consistent in others.

An investigation of the effects of phenobarbitone on the pharmacokinetics of norethindrone in the rat using liver perfusion and everted gut sacs.

Previous in vivo studies have suggested that phenobarbitone increases the first pass clearance of norethindrone in the rat by induction of enzymes both in the gut wall and liver. In the present study phenobarbitone caused an increase in both the production of highly polar ether-extractable metabolites and the conjugation of the steroid as it crossed the wall of the everted gut sac preparation. In addition, there was a marked increase in the uptake of norethindrone into the liver followed by increased phase I metabolism in the isolated perfused liver.

Rate of onset of hypotensive effect of oral labetalol.

1 Labetalol caused a fall in blood pressure within 2 h or oral doses of 100, 200 and 400 mg in six hypertensive patients. 2 This fall which was dose-related was maximal by 3 h and was sustained when the drug was given in doses of 100 mg 8 hourly, 200 mg 8 hourly and 400 mg 8 hourly. 3 This rapid fall in pressure when labetalol is given by mouth which contrasts to that seen on administration of pure beta-adrenoceptor blocking agents is a valuable therapeutic property.