Effect of Long-Term Periodontal Care on Hemoglobin A1c in Type 2 Diabetes.

This was a prospective cohort study evaluating 126,805 individuals with diabetes and periodontal disease receiving care at all Veterans Administration medical centers and clinics in the United States from 2005 through 2012. The exposures were periodontal treatment at baseline (PT0) and at follow-up (PT2). The outcomes were change in HbA1c following initial treatment (ΔHbA1c1) and follow-up treatment (ΔHbA1c2), and diabetes control was defined as HbA1c at <7% and <9% following initial and follow-up treatment, respectively. Marginal structural models were used to account for potential confounding and selection bias. The objective was to evaluate the impact of long-term treatment of periodontal disease on glycemic control among individuals with type 2 diabetes. Participants were 64 y old on average, 97% were men, and 71% were white. At baseline, the average diabetes duration was 4 y, 12% of participants were receiving insulin, and 60% had HbA1c <7%. After an average 1.7 y of follow-up, the mean HbA1c increased from 7.03% to 7.21%. About 29.4% of participants attended their periodontal maintenance visit following baseline. Periodontal treatment at baseline and follow-up reduced HbA1c by -0.02% and -0.074%, respectively. Treatment at follow-up increased the likelihood of individuals achieving diabetes control by 5% and 3% at the HbA1c <7% and HbA1c <9% thresholds, respectively, and was observed even among never smokers. HbA1c reduction after periodontal treatment at follow-up was greater (ΔHbA1c2 = -0.25%) among individuals with higher baseline HbA1c. Long-term periodontal care provided in a clinical setting improved long-term glycemic control among individuals with type 2 diabetes and periodontal disease.

Oncology case management linking structure and process with clinical and financial outcomes.

Case management programs have emerged in a variety of models. Current literature about the structure and process of case management programs has not always clearly described linkages with outcomes. Therefore, the purpose of this article is to describe a case management program, apply the model with oncology patients, and then to clarify the structure and process that the authors believe are correlated strongly with both clinical and financial indicators of quality. Planning for the case management program involved interdisciplinary inpatient staff and personnel from the ambulatory oncology clinics. After program implementation, data on patients with a diagnosis of chemotherapy without acute leukemia (DRG 410) were collected throughout 1 year (March 1995-February 1996). Results indicated a reduction in length of stay and side effects of chemotherapy linked to the improvement in process. The primary recommendation to nurse managers who are considering a case management program is to carefully decide on a structure and process that can be formalized before the program is implemented.

Job satisfaction correlates among Palestinian nurses in the West Bank.

The recruitment and retention of highly qualified nurses present ongoing challenges to nursing service administrators throughout the world. Retention of nurses has been closely linked both to job satisfaction and selected demographic factors. Administrators must be aware of these demographic factors due to their importance to employees. The primary purpose of this study was to examine demographic correlates of job satisfiers and dissatisfiers among nurses in the West Bank of Palestine. Both the McCloskey/Mueller Satisfaction Scale (MMSS) and a single overall job satisfaction item were used to survey the entire population (n = 330) of nurses employed in 20 acute care hospitals. Significant relationships were found between job satisfaction and the demographic characteristics of marital status, distance traveled to work, number of years the nurse worked as an RN, and extended family responsibilities. This study of job satisfaction among nurses in a geographic location not previously studied provides nursing leaders in the West Bank with important information as they seek to retain and recruit nurses. The findings support the use of the MMSS in non-US countries and cultures. However, an argument is presented for further refinement of the instrument and the underlying conceptual framework of the instrument.

Toward an international measure of job satisfaction.

The purpose of this study was to assess the validity of the McCloskey/Mueller Satisfaction Scale (MMSS) in the West Bank, a dissimilar society and culture from the United States, where the instrument was developed. A second purpose was to measure the correlation between the MMSS total score and a single-item measure of job satisfaction. In contrast to the 31-item scale with eight factors of Mueller and McCloskey, four factors emerged in the current study: Interaction, Extrinsic Rewards, Control Over Work Environment, and Professional Participation. The resulting model is more similar to the original 1974 McCloskey conceptual framework than the 1990 eight-factor model.

Agitation: measurement, management, and intervention research.

Strategies for controlling and managing agitation of patients in long-term care populations has been identified as a research priority. Unfortunately, there is a paucity of literature on empirically tested therapeutic interventions for agitation. This manuscript summarizes the literature related to the measurement, management, and interventions for agitation and identifies a nursing research agenda for conducting research in this area. Nonpharmacological and nonrestraint interventions are highlighted and categorized by (1) alterations in care given, (2) environmental adaptations, and (3) behavioral approaches. Future research areas identified by the authors focus on additional types of environmental, interpersonal, and behavioral interventions as well as theoretical predictors of agitation; the influence and role of nursing personnel and caregiver; and the legal and ethical issues involved in caring for patients who manifest agitation.

Collaborative discharge planning: nursing and social services.

Discharge planning impacts hospital costs and patient outcomes. The purpose of this study was to determine the effects of a structured discharge planning program using collaboration between the CNS and the social worker. The quasi-experimental study used a sample of 64 elderly patients. The experimental group (n = 29) had discharge planning directed through collaboration by a CNS and a social worker. After discharge, patients were contacted by telephone about satisfaction and services received. Charts were reviewed for information about length of stay, readmission, and documentation. Data analysis revealed that patients involved in collaborative planning were more satisfied, had a shorter length of stay, had fewer readmissions, and received a higher rate of indicated postdischarge services. Documentation was not significantly affected, except in the area of patient teaching, which was lower in the experimental group. Based on these findings, the collaborative model offers nurse administrators a way to improve outcomes for patients and the organization.

A precepted leadership course based on Bandura's social learning theory.

Transition from student to registered nurse (RN) has long been cited as a difficult time for new graduates entering health care. Bandura's (1977) theory of social learning guided a revision of a nursing leadership course required of baccalaureate student nurses (BSNs) in their final semester. The preceptorship allowed students to work closely with and to practice modeled behaviors of RNs and then receive feedback and reinforcement from both the preceptor and the supervising faculty member. Students were thus prepared to function better in the reality of the practice setting. Positive outcomes were experienced by students, BSN preceptors, faculty, and nurse administrators.

Role modeling: an educational strategy to promote effective cancer pain management.

Successful pain management is a crucial element in the nursing care of the patient with cancer. Among the many problems underlying poorly managed pain, one prominent concern is healthcare professionals' lack of current knowledge. Although educational programs are an established method of increasing knowledge, specific programming strategies may have a more significant impact on knowledge retention. This quasiexperimental study used role modeling as an educational method to improve knowledge retention. A purposive sample of 20 RNs participated in an educational program in which a lecture-only format was used for the control group and a lecture format plus a role-modeling component was used for the experimental group. An oncology pain management assessment tool was administered in a pretest/post-test design with repeated measures. A one-tailed t-test for gain scores was used to test the hypothesis. Mean change scores between groups were similar. Future studies are needed to further analyze the impact of role modeling on similarly matched, but larger, groups.

Characteristics of effective discharge planning programs for the frail elderly.

Changes in the health-care system since Prospective Payment began have directly affected the postdischarge needs of the frail elderly. Effective discharge planning programs are critical to meet the posthospital needs of this population. Effective discharge planning is believed to be associated with an increase in patient health status and satisfaction. Both can be met when plans for posthospital services are made in an organized program. Admission assessment and follow-up programs were identified as two characteristics necessary in a formally structured discharge planning program for effective care of frail elders.

Expanding the clinical specialist's role through outreach.

Reimbursement changes within the health care system have continued to challenge nurse administrators to generate innovative strategies for cost-efficient and effective services. This has resulted in restructured delivery systems for patient care and newly developed services in nursing. A consultation/outreach program was developed to support the clinical nurse specialists (CNS) in their delivery of quality care and to provide services to surrounding rural hospitals while producing revenue for the department of nursing. For the hospital described, the institutional visibility has increased, new revenue has been generated, and the referral base for potential clients has been expanded.

Keeping the program in-house.

The Scott and White Medical Institution identified a need to provide management development to its first-line, middle, and upper management personnel. What kind of program would have institution-wide appeal, application, controlled implementation, and maintenance, and at the same time could be delivered for a reasonable cost and enhance communication? Scott and White found the answer through an in-house, multi-level development program that utilizes available managers as speakers. From the beginning, managers throughout the institution became involved in the development of the program. Their early involvement ensured ease of implementation, appropriate program content, and evaluation. This effective management development program is an excellent model for a medical group seeking to further develop its team of managers.