Psycho-social factors affecting elders' maltreatment in long-term care facilities.

AIM: To examine and analyse major variables affecting maltreatment of elderly nursing home residents. The study was based on two theoretical paradigms: the theoretical model for predicting causes of maltreatment of elderly residents developed by Pillemer, and the Theory of Reasoned Action developed by Ajzen & Fishbein. METHODS: The study employed a correlational quantitative method. The research population consisted of the staff of 22 nursing homes in Israel. Six hundred questionnaires were distributed in these facilities and 510 were completed and returned (85%). In addition, 24 questionnaires were distributed among directors of the facilities and 22 were returned (91.6%). FINDINGS: Slightly more than half of the staff sampled reported abuse of elderly residents over the past year, as manifested in one or more of types of maltreatment. The total number of various types of maltreatment reported was 513. About two-thirds of the cases were incidents of neglect. Seventy per cent of respondents reported that they had been present at incidents in which another staff member abused an elderly resident in one or more types of maltreatment, and in such situations mental abuse and mental neglect were the most prevalent forms of maltreatment. CONCLUSION AND RECOMMENDATIONS: This is the first study to examine elder maltreatment in the long-term care population of Israel. The research findings produce an expanded and improved research model investigating elder maltreatment in long-term nursing homes.

Decreased prevalence of asymptomatic choroidal metastasis in disseminated breast and lung cancer: argument against screening.

AIM: To determine the frequency of visually asymptomatic choroidal metastases in patients with disseminated breast and lung carcinomas in order to establish optimal patient management policies. METHODS: All patients with confirmed metastatic disease treated in our institution between January 2002 and December 2003 were invited to undergo a funduscopic examination and a B-scan ultrasound evaluation. RESULTS: Of the 169 study participants, 77 had breast cancer (64 with metastases in one organ and 13 with multiple-organ involvement) and 92 had lung cancer (85 with metastases in one organ and 7 with multiple-organ involvement). No patient with metastatic breast cancer and two patients with metastatic lung disease (each with multiple-organ involvement) were found to have choroidal metastases. The choroidal metastases were detected by both the funduscopic and ultrasound examinations. CONCLUSIONS: The 2.17% incidence of choroidal metastasis in disseminated lung cancer and the 0% incidence in disseminated breast cancer speaks against the practicality of screening for early detection of choroidal metastasis among these patients, even though it would lead to early implementation of appropriate, often vision saving, therapeutic management. Its low incidence probably testifies to progress achieved by enhanced systemic oncological treatment policies that have been introduced into routine patient management over the past few years.

The consequences of a major bile duct injury during laparoscopic cholecystectomy.

Bile duct injury is perhaps the most feared complication of laparoscopic cholecystectomy. The focus of this study was on the immediate and short-term outcome of patients who have undergone repair of major bile duct injuries with respect to hospital stay, perioperative interventions, and reoperations. The records of patients who underwent surgery at three academic hospitals in Philadelphia (Hospital of the University of Pennsylvania, Thomas Jefferson University Hospital, and Graduate Hospital) from 1990 to 1995 for repair of a major biliary injury following laparoscopic cholecystectomy were reviewed. A major biliary injury was defined as any disruption (including ligation, avulsion, or resection) of the extrahepatic biliary system. Small biliary leaks not requiring surgery were excluded. Thirty-two patients sustained major bile duct injuries. The injury was recognized immediately in 10 patients. The remaining 22 patients had pain (59%), jaundice (50%), and/or fever (32%) as the symptom heralding the injury. Bismuth classification was as follows: 13% of patients were class I, 63% were class II, 7% were class III, 7% were class IV, and 10% were class V. Biliary reconstruction included a Roux-en-Y hepaticojejunostomy in 30 patients and two were primary repairs. There was one postoperative death from multiorgan system failure. The mean length of hospital stay after repair was 17 +/- 8 days. Over a mean follow-up period of 11.5 +/- 10.5 months, 11 patients (38%) required 19 emergency readmissions, most commonly for cholangitis. Five patients (17%) required postoperative balloon dilatation for biliary stricture. At follow-up 18 patients (62.0%) remain asymptomatic with normal liver function, eight (28%) are experiencing episodic cholangitis, and three (10%) are asymptomatic with persistently elevated liver function values. The consequences of a major biliary tract injury following laparoscopic cholecystectomy include a complex operative repair resulting in a lengthy postoperative stay with an increased risk of death, an excessive number of perioperative diagnostic and therapeutic studies, frequent readmissions (often as emergencies), and a lifelong risk of restricture. The "cost" to these patients remains enormous.

The relation of widows' needs and resources to perceived health and depression.

The study investigated the relationship of widowhood-related needs and resources to physical health and to depressed affect. Participants were 246 widowed women of all ages, who were widowed from 1 to 7 years, and who were drawn by stratified-random sampling from widows living in urban areas in Israel, and receiving social insurance payments. The findings show that although there was a significant added contribution by resources, the unique contribution of needs to the health and depression variance was generally maintained. Length of widowhood was not related either to health or depression, while widows' age was significantly related to both. The findings suggest that needs, as well as resources are necessary concepts for a fuller understanding of the coping process of widows.

Impact of case management on hospital charges of PWAs in Georgia.

To determine the effects of case management in controlling hospital based costs for persons with AIDS (PWAs), a retrospective review of records of deceased PWAs was performed. The study compared diagnosis-to-death hospital charges for PWAs who received care under a care management model (n = 60) with PWAs receiving care within a non-case managed approach (n = 60). Hospital charges were adjusted for inflation. PWAs receiving care within the case managed model had significantly lower hospital-based changes than the non-case managed group. Additionally, PWAs in the case managed group lived significantly longer between HIV diagnosis and death, and lived longer between their first AIDS-related hospital admission and death.

The role of fine needle aspiration biopsy cytology in the evaluation of the clinically solitary thyroid nodule.

The imputation that a clinically solitary nodule is a suspicious sign of carcinoma has been the cause of too many surgical procedures as well as the subject of much controversy. This study evaluated the effectiveness of fine needle aspiration (FNA) biopsy cytology in diagnosing the uninodular goiters in 286 patients who presented with clinically solitary nodules. The final diagnoses in these cases included carcinoma (4.7%), adenoma (6.3%), autonomous nodule (11.0%), colloid goiter (45.8%), colloid cyst (17.4%) and chronic thyroiditis (13.4%). The proportion of patients with cancer in this group was the same as in patients with multinodular and diffuse goiters. These findings call attention to (1) the fact that any thyroid disease may appear as a uninodular goiter and (2) the frequency with which lymphocytic thyroiditis was cytologically diagnosed, even in cases with negative antibody titers. The cytologic diagnosis of benign disease has contributed to a reduction in the number of unnecessary surgical procedures; only 24.1% of our patients with uninodular goiters underwent surgery.

Professional support: an essential component in a cardiovascular risk reduction program.

1. A comprehensive cardiovascular risk reduction program includes cardiovascular risk reduction factors combined with professional support and the importance of health as an attainment of life goals. 2. This study revealed significant reduction in weight, serum glucose, and diastolic blood pressure levels following participation in the program. 3. Professional support, or continuing interaction with health professionals, assisted consumers to continue motivation and reinforce health promoting activities.

Seminar methods for RN to BSN students.

Registered Nurse (RN) students entering a bachelor of science in nursing program (BSN) often view themselves as competent nurses who practice in a professional manner. It is not always clear to these students why the baccalaureate degree is considered the foundation for professional nursing. This creates a challenge for faculty to develop teaching strategies that increase understanding of professional roles and responsibilities, foster appreciation for the different levels of nursing practice, and promote incorporation of theory and research into all aspects of nursing. The authors present three strategies that were used successfully in a seminar series for RNs enrolled in a BSN completion program.

Perspectives on academic dishonesty.

Academic dishonest behaviors, such as lying, cheating, and plagiarism, are destructive and must be recognized and addressed early in the development of professional nurses. Faculty must be concerned with the relationship between student integrity in the classroom and clinical or professional behaviors. The authors discuss student motivation and attitudes toward unethical practices, faculty responses, and responsibilities when these incidents arise, and strategies for preventing academic dishonesty.

Clinical case studies: a strategy for teaching leadership and management.

In the realities of clinical practice, BSN students are expected to demonstrate both clinical and managerial skills. Presenting leadership and management content through the use of complex patient situations in a clinical case study approach can assist in preparing them. This approach demonstrates to students that leadership and management is an integral part of professional practice.

Cultural diversity and conflict in the health care workplace.

Cultural diversity issues affect the health care workplace and nursing practice. The Lowenstein-Glanville conflict model can be used for assessing and intervening in racial and status conflict in hospital settings. Implications for nursing practice include recognizing that cultural diversity will continue to grow in the health care workplace. Nurses must increase sensitivity, become aware of cultural nuances and issues, and make cultural assessment a routine part of their assessment and planning, not only for patient care, but also with their co-workers and subordinates.

A case management demonstration project for the frail elderly in Israel.

This article presents an evaluation of an innovative community-based case management demonstration project for the frail elderly in Israel. The evaluation study was part of a nine-countries European project within the framework of the 1999 International Year of the Older People. The Department for the Aged of the Israeli Ministry of Labor and Social Affairs and the author initiated the project. The basis for the project development is described, including institutional structure, workers' qualifications, technical resources, and clients assessment criteria. The findings showed increased quality of life for the elders and their caregivers, more coordination and cooperation between various social and health services, activation of a variety of services, and client satisfaction. Recommendations are made to continue and expand this type of project to a larger segment of the elderly population.

A legislative infrastructure that fosters case management. The Israeli Long-Term Care Insurance Law.

This article presents a legislative infrastructure that fosters the development of case management model and demonstration projects within the framework of the Israeli Long-Term Care Insurance Law of 1988. A brief demographic description of the aged population of Israel is presented along with an outline of the basic policy and service structures. The basic principles of the Long-Term Care Insurance law are presented, discussed and analyzed, outlining the pathways that the law guarantees that foster case management interventions and projects.

Acromegalia y cáncer de tiroides

RESUMEN: Introducción La acromegalia se asocia con un mayor riesgo de morbilidad y mortalidad por cáncer. Sin embargo, los datos respecto de la incidencia de cáncer en acromegalia son controvertidos. Objetivos Describir las características clínicas, bioquímicas e imagenológicas de un grupo de pacientes acromegálicos con carcinoma diferenciado de tiroides (CDT). Analizar las características de riesgo de recurrencia (RR) y respuesta en el seguimiento (RtaSg) y comparar la evolución con la de pacientes con CDT no acromegálicos. Materiales y métodos Se realizó un análisis retrospectivo multicéntrico de pacientes con diagnóstico de acromegalia y CDT. Se realizó un análisis comparativo entre los pacientes de bajo RR inicial acromegálicos con una muestra aleatoria de pacientes no acromegálicos con CDT de bajo RR inicial (1:4). Resultados Se analizaron 16 pacientes con diagnóstico de CDT y acromegalia. En 93,8% se hizo el diagnóstico por ecografía, sólo el 50% tenían un nódulo tiroideo palpable. En el momento del diagnóstico del CDT, los valores de IGF-1 fueron 1,8 ± 1,3 LSN, con 62,5% con acromegalia activa. La histología fue papilar en todos los casos, el 56,3% variedad clásica y el resto papilar variedad folicular. El 75% de los pacientes presentó un Estadio I (12/16), sólo 3 pacientes Estadio II y 1 Estadio IVb. El RR inicial fue bajo en el 87,6% (14/16), intermedio en 1 paciente y alto en 1 paciente. Las respuestas al final del seguimiento fueron: 86,7% (13/15) sin evidencia de enfermedad, 1 paciente bioquímica incompleta y 1 estructural incompleta. La RtaSg no tuvo diferencias con los no acromegálicos. Conclusiones Los pacientes acromegálicos con CDT presentaron predominantemente un bajo RR inicial. Al realizar la comparación con el grupo control, se puede concluir que el CDT en pacientes acromegálicos no presentó una evolución más agresiva.