Resource use and cost of care for patients hospitalised with community acquired pneumonia: impact of adherence to infectious diseases society of america guidelines.

Objective: The objective of this study was to compare the inpatient resource use and cost of care for patients hospitalised with community-acquired pneumonia (CAP) who were treated with preferred antibacterial therapy according to the 1998 Infectious Diseases Society of America (IDSA) guidelines with those who were not treated with preferred therapy.

Methods: A multicentre, observational study was conducted in Florida between 1999 and 2000. Hospitalised adult patients (aged > or = 18 years) started on antibacterial therapy for suspected or confirmed CAP were enrolled in the study.

RN education: a matter of degrees.

Until recently, no research had been done to explore the effect of nurse education on patient care. In a study published in JAMA in September 2003, nursing researcher Linda H. Aiken, RN, PhD, led a study to determine the association between the educational levels of hospital RNs and the mortality of surgical patients.

Preparing nurses for the 21st century: reenvisioning nursing education and practice.

Significant advances in biomedical science and in the complexity of health care, coupled with a worsening nursing shortage and numerous reports of unsafe and inadequate patient care, have prompted concerns about both nursing education and nursing practice. Beginning in 2000, the American Association of Colleges of Nursing (AACN) made a thorough study of nursing education, regulation, and practice issues. Input and consultation were sought from AACN members, nursing practice leaders, regulators, and other health professionals.

Renal regulation of acid-base balance.

Because maintaining a normal body pH is essential to the efficient functioning of many physiologic processes, the body has a number of mechanisms that prevent pH fluctuations. Some of these prevent minute-to-minute pH fluctuations over the course of the day, whereas others maintain pH balance from day to day. The kidney plays a key role in both processes.

Pediatric health care providers' knowledge of pulse oximetry.

Pulse oximetry monitors have become so commonplace in acute health care settings over the last decade that blood oxygen is now considered a "fifth" vital sign. This study assessed the knowledge base related to pulse oximetry technology and clinical interpretation of the data given. A total of 68 participants--nurses, respiratory therapists, and resident physicians at a large general pediatric unit of a children's hospital--completed a survey of open-ended questions.

Renal handling of phosphorus and magnesium.

The kidney is a major regulator of phosphate and magnesium levels. Phosphate reabsorption occurs primarily in the proximal tubule, driven by sodium reabsorption. Phosphate excretion is regulated by dietary adaptation and is stimulated by parathyroid hormone (PTH).

Promoting adherence: effects of theory-based asthma education.

This study compared the effects of a theoretically focused audiotape and a standard educational booklet on asthma preventive medication adherence and other asthma outcomes. Forty-six adult asthmatics were randomly assigned to receive either an experimental audiotape incorporating components of protection motivation theory, a standard asthma management booklet, both, or no educational materials. Outcomes were assessed at baseline, 3 months, and 6 months.

Arginine immunonutrition in critically ill patients: a clinical dilemma.

Commercial enteral nutritional formulas for enhancement of the immune system are widely used in critical care. Immunonutrition with arginine can enhance inflammatory and immunologic responses in animal models and in humans. Although clinical improvements in surgical patients have been reported, benefits in critically ill patients with systemic inflammatory response syndrome, sepsis, or organ failure are less clear.

Renal homeostasis of calcium.

Calcium is critical for many metabolic functions. While 99% of body calcium is found as part of the structure of bone and teeth, 1% found in plasma and body cells is crucial for such functions as blood clotting, nerve impulse conduction, and muscle contraction. The homeostasis of calcium is complex because the gastrointestinal tract, the bones, and the kidneys all affect calcium balance.

Informal caregiving burden: an overlooked aspect of the lives and health of women transitioning from welfare to employment?

Informal caregiving occurs among communities in all socioeconomic strata and is largely provided by women. Although an extensive amount of research focusing on caregiver burden has been conducted within nursing, little is known about informal caregiving among low-income women, particularly within the context of welfare reform. This study examined the extent of informal caregiver burden in low-income women transitioning off welfare and the relationship between informal caregiving and maintaining employment.

Family dynamics and child abuse and neglect in three Finnish communities.

The purpose of this study was to describe family dynamics of Finnish families in which there is abuse or neglect of a child in that family. One adult from 41 families with recognized child abuse/neglect completed the Family Dynamics Measure II (FDM II) consisting of six dimensions of family life, and answered questions about problems, changes and illnesses. Nurses and social workers in community health care and social agencies identified potential subjects in their agencies and collected data.

Diversity in graduate nursing education: an experience in collaboration.

The recent shift in public policy away from the use of affirmative action programs in the admissions process of institutes of higher learning has motivated colleges and universities to explore alternative means for achieving their goal to increase the diversity of their student bodies. The imperative to promote diversity is particularly relevant in nursing education because there is an emphasis on preparing students to enter a profession that is committed to providing health care to all regardless of gender, race, ethnicity, or socioeconomic background. In 1997, the nursing programs at 2 Florida schools-Bethune-Cookman College (B-CC), a historic African-American college, and the University of Florida (UF), a land-grant university-initiated a collaborative relationship with the goals of improving access to graduate education for B-CC graduates and increasing the diversity of the graduate student body at UF.

White coat hypertension: understanding the concept and examining the significance.

Because the concept of white coat hypertension is evolving, a variety of definitions appear in the literature. There has also been continuing debate as to whether white coat hypertension is a benign clinical condition or is associated with increased hypertensive complications. This paper summarizes and evaluates the literature on white coat effect/hypertension, with a focus on the following aspects of the concepts: (1) alternative definitions, (2) prevalence and predictors, (3) prognostic significance, and (4) implications for clinical practice.

Role of nitric oxide in wound healing.

Chronic wounds mainly affect elderly individuals and persons with comorbid diseases due to a compromised immune status. An age-related decline in immune function deters proper healing of wounds in an orderly and timely manner. Thus, older adults with 1 or more concomitant illnesses are more likely to experience and sufferfrom a nonhealing wound, which may drastically decrease their quality of life and financial resources.

Practical aspects of performance improvement in pediatric trauma.

Pediatric trauma performance improvement programs may share some of the criteria tracked by their counterparts in the adult trauma world. However, some of the criteria must be specific to the unique diagnostic and therapeutic needs of children. Nine criteria are defined in terms of the critical issues, what information is required to evaluate the appropriateness of the care provided in regards to those issues, and acceptable thresholds for review.

Sexuality in early childhood: pediatric nurses' attitudes, knowledge, and clinical practice.

This exploratory study assessed pediatric nurses' attitudes, knowledge, and patient care practices related to the sexuality of hospitalized preschool and early school-age children. Sexuality was defined as the sum of the physical, emotional, and psychologic attributes that are expressed in gender identity and behavior. For this study, a questionnaire containing 24 attitude, 20 knowledge, and 29 nursing practice Likert-scale items was used to survey 45 pediatric nurses in a southeastern tertiary care teaching hospital.

Problems inherent in assessing biofeedback efficacy studies.

This paper discusses some of the problems involved in drawing conclusions across studies about the efficacy of biofeedback. It focuses on biofeedback for the treatment of hypertension, but the same difficulties arise when considering the effect of biofeedback in other disorders. Large multicenter studies using the same inclusion and exclusion criteria, biofeedback protocol, and methodology are badly needed if biofeedback practitioners are ever going to demonstrate the real effectiveness of biofeedback.

Performance management data systems for nursing service organizations.

Increasing demands are being placed on nursing administrators to manage the cost-efficiency and quality-effectiveness of the nursing service organization. One effective administrative tool that can be used for both internal management and external reporting of a nursing service organization performance is the performance management data system described in this article. While efforts are underway to build essential elements of a performance management data system, including the structure and content of nursing-sensitive databases and data management methods, no consensus has been reached.

Research support by doctoral-granting colleges/schools of nursing.

Colleges and schools of nursing with doctoral programs focus on developing quality research programs. One effective way of managing and nurturing a research program is through the implementation of a nursing research office or center. The purpose of this study is to describe the resources provided by the colleges/schools of nursing with doctoral programs for research development.

Evidence-based methods to enhance medication adherence.

Medication adherence problems prevent 50% of patients with chronic disorders from receiving the full benefit of prescribed regimens. These problems are consistent regardless of disease, symptom, regimen, or age-group. This article discusses evidence-based recommendations for assessing and improving adherence.

Antecedents, descriptions and consequences of wandering in cognitively-impaired adults and the Safe Return (SR) program.

Unattended wandering is a major problem in cognitively impaired (CI) individuals and can result in those individuals becoming lost in the community. The purpose of this study was to identify important characteristics of unattended wandering and important prevention strategies. Data were compiledfrom registration files and missing and discovery reports collected through the Safe Return (SR) program.

Handling missing data in nursing research with multiple imputation.

Background: In the data analysis phase of research, missing values present a challenge to nurse investigators. Common approaches for addressing missing data generally include complete-case analysis, available-case analysis, and single-value imputation methods. These methods have been the subject of increasing criticism with respect to their tendency to underestimate standard errors, overstate statistical significance, and introduce bias.

Noninvasive measurements of central arterial pressure and distensibility by arterial applanation tonometry with a generalized transfer function: implications for nursing.

Decreased distensibility of large arteries is a strong indicator of cardiovascular risk. Measurements of arterial distensibility can be made noninvasively with the use of an arterial applanation pressure tonometer with a generalized transfer function. This article reviews (1) the concept of arterial distensibility and its relation to pulse wave amplitude, velocity, and reflection; (2) epidemiologic evidence that large-artery stiffness increases cardiovascular risks; and (3) the estimation of arterial distensibility with the use of noninvasive techniques, with an emphasis on measuring pulse wave velocity and calculating the aortic augmentation index.