[Rupture of the female urethra in pelvic fractures: report of 2 cases]. / Rupture de l'urèthre féminin au cours des fractures du bassin: à propos de deux observations.

Urethral trauma after fracture of the pelvis is rare in women due to the mobility and short length of the urethra, which is consequently better protected in the case of trauma than the male urethra. Vaginal trauma is sometimes associated due to the intimate contact between the urethra and vagina. A pelvic and perineal examination must be systematically performed in all women presenting with pelvic trauma to avoid the morbidity resulting from late diagnosis of urethral trauma. Early surgical operation allows precise repair of the lesions, ensuring a good functional result.

Emotionally intelligent case managers make a difference.

Emotional intelligence is a skill necessary for case managers because of the diversity of their work, the multiple stakeholders they have to deal with on daily basis, and the increased potential for conflict. Managers and administrators need to be cognizant of the role emotional intelligence plays in employee performance and the importance of developing training programs to assist case managers in learning to deal with change and conflict. Case managers must assume responsibility for their actions and work to develop and improve their emotional intelligence skills set. Ultimately, patients and work associates will appreciate the case manager's efforts. Finally, case managers will find work an enjoyable experience and look forward to new opportunities the future holds.

[Treatment of complete rupture of the posterior urethra by endoscopic realignment]. / Traitement des ruptures complètes de l'urèthre postérieur par réalignement endoscopique.

OBJECTIVE: To assess the efficacy and benefit of treatment of complete rupture of the posterior urethra by endoscopic realignment. MATERIAL AND METHODS: Between 1991 and June 1998, 14 men were hospitalised for complete traumatic rupture of the posterior urethra: 13 of them were treated by endoscopic realignment. RESULTS: With a mean follow-up of 29 months, all patients are continent and urinate with a satisfactory urinary stream. Two patients developed an urethral stricture and three others developed two urethral strictures treated by internal urethrotomy (38.4%). Three patients are impotent, one following embolization of both hypogastric arteries (23%). CONCLUSION: Endoscopic realignment of complete rupture of the posterior urethra is a simple, minimally invasive technique, allowing optimal preservation of continence and erection in these young patients. It may induce urethral strictires which can be effectively treated endoscopically and which can be prevented by systematic use of self-calibration of the urethra.

Home healthcare under fire: fraud and abuse.

Fraudulent and abusive practices in home healthcare are costly. They damage the integrity of the home health agency, the home care industry, and home care providers. Federal and state enforcement activities have increased exponentially over the past few years to fight fraud and abuse, resulting in the collection of nearly $1.1 billion in fines, settlements, and administrative impositions in 1997. This article discusses the issues of fraud and abuse and the responsibilities of home healthcare providers toward prevention and control of such practices.

Clarifying case management: what is in a label?

This article critically examines the definitions and component activities of case management in an effort to clarify and provide a better understanding of this phenomenon and to identify the areas that require further development for improving the knowledge base of this field. The approach is not meant to be exhaustive, but rather to offer a detailed analysis of the definitions of case management and delineate important issues relevant to case management practice.

Case management: a heritage more than a century old.

The roots of case management are more than a century deep. This innovative approach to managing, coordinating, expediting, and facilitating patient care is neither new nor exclusively limited to nursing practice. A review of the historic literature reveals that the evolution of case management is a byproduct of creative healthcare efforts associated with different disciplines, including nursing, medicine, mental health, public health, and social work. This article presents a historical review of significant milestones in the evolution of the field of case management and its related tools (i.e., clinical pathways).

Care management: outcomes-based practice for the primary nurse.

Managed care penetration is increasingly dramatically in most health care markets across the country. The impact is the radical redesign of health care systems and the reshaping of the approach to health care from an illness model to a wellness, health promotion model. Integrated delivery systems will facilitate the patient's journey through the continuum of care. The article describes how one institution is streamlining that journey through the integration of care management into the role of the primary nurse who provides direct care.

Hiring case managers: the role of the candidate and the interviewer.

Interviewing for a job and conducting an interview are two challenging tasks nurse case managers experience at some point in their nursing career. One way to overcome such challenges is through learning more about the interview process. For the nurse case manager, the reward of interviewing well is getting hired for the job; for the interviewer, it is selecting the best candidate for the job. In this article, the author discusses the roles of the candidate and the interviewer in the interview process. It provides those interested in becoming nurse case managers with tips, skills, and strategies for assuring a successful interview. It also presents administrators of case management programs with beneficial recommendations for improving their interviewing skills. In addition, it discusses the interview process for potential candidates for nursing case management roles from the time of preparing the resume and cover letter until after the interview is completed.

A ten-step process to develop case management plans.

The use of case management plans has contained cost and improved quality of care successfully. However, the process of developing these plans remains a great challenge for healthcare executives. In this article, the author presents the answer to this challenge by discussing a 10-step format process that administrators of patient care services and case managers can adapt to their institutions. It also can be used by interdisciplinary team members as a practical guide to develop a specific case management plan. This process is applicable to any care setting (acute, ambulatory, long term, and home care), diagnosis, or procedure. It is particularly important for those organizations that currently do not have a deliberate and systematic process to develop case management plans and are struggling with how to improve the efficiency and productivity of interdisciplinary teams charged with developing case management plans.

Evaluating the effectiveness of case management plans.

Case management plans have been used as a strategy for quality improvement and cost containment of healthcare. The authors discuss the methods used for evaluating the effectiveness of these plans. Variance analysis and measuring expected outcomes of care are the main themes. The authors also present one hospital approach to outcomes management that can be used by healthcare administrators to evaluate patient-care outcomes.

[Intestinal infarctions. A re-evaluation of prognostic factors of postoperative mortality]. / Les infarctus intestinaux. Une ré-évaluation des facteurs pronostiques de mortalité post-opératoire.

The aim of this study, based on a series of 67 patients, was to assess the prognostic factors of postoperative mortality of intestinal infarctions (small and large bowel). Known risk factors were studied (age, sex, shock, Concomitant disease, use of arteriography and vasodilators), together with less studied factors, such as recent vascular or cardiac surgery less than 4 months before the infarction and length of bowel infarction. Postoperative mortality was defined as any death occurring within 45 days after surgery. The risk factors were assessed by univariate and multivariate analysis with logistic regression. The postoperative mortality was 63%. Age, shock, other medical diseases, recent cardiovascular surgery, and length of bowel infarction were significant predictive factors of postoperative mortality on univariate analysis. Shock, age greater than 70 years and recent cardiovascular surgery were three independent risk factors selected on multivariate analysis with equivalent weights.

Developing case management plans using a quality improvement model.

Case management plans are viable tools currently used to control healthcare cost and improve quality. The authors present a quality improvement-case management framework to guide nursing and hospital administrators in the development of these plans and to answer any questions they might raise while struggling through the process.