Actions taken by nursing education programs in the United States to prevent tuberculosis transmission in nursing students.

Measures to prevent tuberculosis include education and skin testing of at-risk groups, including health care workers. This study focused on policies and practices related to tuberculosis in nursing education programs, especially skin testing and instruction. Data were collected from a stratified random sample of nursing administrators in associate and baccalaureate degree programs in the United States using an instrument adapted from a medical school study. Several factors may have contributed to fewer skin test conversions in nursing programs than in medical schools. Although most nursing education programs considered skin testing a priority, there were inconsistencies related to skin testing type and process when compared with recent Centers for Disease Control and Prevention guidelines. Major content gaps related to multidrug-resistant tuberculosis and the differences between pulmonary and extrapulmonary symptomatology were found.

Complications of peripheral arteriography: a new system to identify patients at increased risk.

PURPOSE: The most quoted literature on arteriographic complications is based on self-reports collected during the mid 1970s. We sought to determine whether those results remain valid despite changes in arteriographic practice and whether patient subgroups at increased risk could be identified. METHODS: Five hundred forty-nine consecutive patients were examined after arteriography and twice over 72 hours. Patients were telephoned at least 2 weeks later to identify delayed complications. The sample was divided into two groups to allow independent validation of suspected prognostic factors. RESULTS: The rate of major complications was 2.9% (16/549), but varied from 0.7% to 9.1% among three strata of relative risk. Rates were highest in patients studied for suspected aortic dissection, mesenteric ischemia, gastrointestinal bleeding, or symptomatic carotid artery stenosis and lowest in patients with trauma or aneurysmal disease. Patients studied for claudication or limb-threatening ischemia had intermediate risk (2.0%). Within these strata, congestive heart failure and furosemide use were the only variables independently associated with a significantly increased complication rate. CONCLUSIONS: Previous reports have overestimated the risk of arteriography for trauma or aneurysm but substantially underestimate the risk for patients with other common conditions. Such stratified complication rates are essential to understand relative costs and benefits of arteriography and other vascular imaging modalities in specific clinical situations.

Planning a continuing education program: the model for health education planning.

1. Development of CE programs for occupational health nurses is integral to professional development. Occupational health nurses are constantly being required to increase and upgrade skills. 2. Evolving issues in health care reform reflect an emphasis on the cost effective, quality care provided by well prepared occupational health nurses. Thus, the need for providing high quality programs and resources for occupational health nurses becomes a challenge for CE providers. 3. The Model for Health Education Planning (MHEP) is used to describe the development of a program. The MHEP includes six phases: initiation, needs assessment, goal setting, planning/programming, implementation, and evaluation. 4. Use of the MHEP ensures that the program planning process is achieved in an appropriate manner. The focus is on meeting the needs of the learner.

Preaortic iliac venous confluence ("marsupial cava"): a rare anomaly of the inferior vena cava.

A patient was shown by computed tomography (CT) to have a rare developmental anomaly of the inferior vena cava (IVC), in which the iliac venous confluence is located anterior (rather than posterior) to the right common iliac artery. Recognition of the anomaly is important prior to surgical intervention in that area, as well as to prevent misinterpretation of the anomaly as representing adenopathy.

The aging work force. Challenges for the occupational health nurse.

1. By the year 2000, 49% of the work force will be between the ages of 35 and 54, and 8 million persons will be older than age 80. 2. Older workers are highly valued because they have a lower rate of absenteeism, are generally popular with the public, and adjust easily to job retraining and the acquisition of new job skills. 3. The emphasis of care will be "protective prevention" and health maintenance with a focus on reducing the decline in workers' health status. 4. A vital role of occupational health nurses is to assist aging employees in accomplishing work goals and successfully planning for the future.

Creative policy-making. Strategies for working with the healthy chronically diseased employee.

As society ages and employees remain in the workplace longer, business managers must develop policies for maintaining the healthy chronically diseased employee in the workplace. With continuing increases in health care insurance costs, business should begin to look at chronic conditions which require repeat visits as well as "big ticket items." Based on an employee perspective approach, a model which presents three categories of healthy chronically diseased employees is utilized in teaching self care activities to insure a productive outcome for the employee. Self-care activities are a key component of the health promotion model, of which four aspects are included: information giving and seeking, encouraging self-responsibility, decision-making, and continued support and follow up.

Sonographic guidance in diagnostic and therapeutic interventions in the pleural space.

One hundred eighty-seven diagnostic and therapeutic interventional procedures in the pleural space were performed by using sonographic guidance. These consisted of diagnostic aspiration (118), drainage of malignant and nonmalignant effusions (41), empyema drainage (17), pleural sclerotherapy with tetracycline or bleomycin (7), and pleural biopsy (4). Diagnostic aspiration was performed with 20-gauge needles, and therapeutic and empyema drainages were performed by trocar technique with either a 7-French Sacks catheter or a specially designed empyema drainage catheter. Pneumothoraces were seen in 3% of the patients, and most of these were treated by the radiologist with placement of a Heimlich valve. We conclude that the use of sonography allows rapid localization of pleural fluid collections and instant monitoring of drainage of noninfected fluid collections and empyemas.

Health promotion. Evolution of a concept.

An examination of the concept of health promotion provides insight into the origins and developmental milestones that have brought us to our current level of application in health care. It is our view that health promotion can occur at any point on the continuum of health and illness. Perhaps it is a semantic struggle that keeps us from movement toward providing the highest quality of health care of which we are capable. The previous examination leads us to contend that there is indeed significant overlap in the intent of the concepts of health promotion and prevention. Further examination of the concept is redundant if our goal is to continue to improve the quality of care. After all, as Nightingale pointed out, our purpose is to do all we can to assist the body in taking care of itself.

Users of coin-operated computerized sphygmomanometry and reasons for utilization: a descriptive study.

A sample of 209 users of coin-operated computerized sphygmomanometers were interviewed during randomly selected hours. Follow-up phone contact was made to determine if any health care action was taken as a result of the blood pressure reading. Results suggest that when used in conjunction with the guidance of a physician or nurse, coin-operated computerized blood pressure machines may help individuals be active participants in the control of high blood pressures.