Patient care classification in Canada in the past has been largely dictated by insurance coverage and the fiscal policies of the individual provinces. In recent years, however, the Canadian Department of Health and Welfare has been promoting the development of a standard patient care classification based on assessment of client or patient needs in regard to the category, type, and level of care. Experimentation with the proposed classification system in several provinces confirms the need in long-term care to include assessment of nursing requirements, physical functioning, and psychosocial assets and liabilities, and points to the importance of using such a classification for planning and evaluating patient care as well as for administrative purposes.
The aim of this study was to investigate the anatomical features of edentulous jaw dental segments (eJDS) in order to offer the most reliable clinical and radiological classification of such segments in planning for implant treatment. A total of 374 patients, 156 men and 218 women, participated in the investigation. The mean age of the patients was 46 years (SD 12.7), ranging between 17 and 73 years. The eJDS were estimated by means of orthopantomogram, computerized tomography, and intraorally with special ridge-mapping callipers for measurement of alveolar process width. A total of 792 screw-shaped and 1-stage Osteofix Dental Implant System (Oulu, Finland) implants were inserted. Dental segments were divided according to the results of the commonly accepted eJDS assessments into 3 clinical-anatomical types. Type I indicated insignificant or no atrophy of eJDS (232 patients with 476 implant sites; 60.1% of the total number). Type II indicated mild to moderate vertical or horizontal atrophy of eJDS (100 patients with 222 sites; 28% of the total number). Type III indicated significant vertical or horizontal atrophy of eJDS (42 patients with 94 sites; 11.9% of the total number). The accuracy of the clinical and radiological classification was adjudged to have been 95.8%. By the process of establishing clinical and radiological classification of the jawbone segments, more reliability was anticipated regarding the insertion of implants both in maxillae and mandibles.
This paper aims to present a theoretical account of professional nursing challenges involved in providing care to patients suffering from chronic obstructive pulmonary disease. The study objectives are patients' and nurses' expectations, goals and approaches to assisted personal body care.
The provision of help with body care may have therapeutic qualities but there is only limited knowledge about the particularities and variations in specific groups of patients and the nurse-patient interactions required to facilitate patient functioning and well-being. For patients with severe chronic obstructive pulmonary disease, breathlessness represents a particular challenge in the performance of body care sessions.
We investigated nurse-patient interactions during assisted personal body care, using grounded theory with a symbolic interaction perspective and a constant comparative method.
Twelve cases of nurse-patient interactions were analysed. Data were based on participant observation, individual interviews with patients and nurses and a standardized questionnaire on patients' breathlessness.
Nurses and patients seemed to put effort into the interaction and wanted to find an appropriate way of conducting the body care session according to the patients' specific needs. Achieving therapeutic clarity in nurse-patient interactions appeared to be an important concern, mainly depending on interactions characterized by: (i) reaching a common understanding of the patient's current conditions and stage of illness trajectory, (ii) negotiating a common scope and structuring body care sessions and (iii) clarifying roles.
It cannot be taken for granted that therapeutic qualities are achieved when nurses provide assistance with body care. If body care should have healing strength, the actual body care activities and the achievement of therapeutic clarity in nurses' interaction with patients' appear to be crucial.
The paper proposes that patients' integrity and comfort in the body care session should be given first priority and raises attention to details that nurses should take into account when assisting severely ill patients.
Action plans are recommended for most patients with persistent asthma to reduce the morbidity associated with this chronic disease. Unfortunately, despite these recommendations, this tool remains underused.
The authors conducted a descriptive study at the asthma clinic of a tertiary care centre to determine the number of asthmatic patients presenting to a respiratory physician (new reference or follow-up visit) who possessed an individualized, written action plan, and to evaluate the patients' level of confidence and perceived efficacy toward their plans. In addition, for all patients in the study, the level of confidence in and the perceived efficacy of three different action plans (two traditional tools versus a simplified tool) were compared.
A total of 92 asthmatic patients were included in the study. Overall, 46% of the patients possessed an action plan. The patients' average level of confidence and perceived efficacy toward their action plans were high (4.1 out of five and 3.3 out of four, respectively). When the three different action plans were compared, the level of confidence in and perceived efficacy of the traditional tools were similar, both being superior to the simplified tool.
The number of asthmatic patients who presented to the asthma clinic and who possessed an action plan was higher than the reported Canadian mean of 10%; however, most of the patients were treated by specialized respiratory physicians, which may explain this improvement. Considering that most patients with persistent asthma should have an individualized, written action plan, the present study confirms that this tool is still not used for all asthmatic patients.
Notes
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Cites: CMAJ. 1999 Nov 30;161(11 Suppl):S1-6110906907
Cites: Am J Respir Crit Care Med. 2001 Jan;163(1):12-811208619
Cites: Can Respir J. 2001 Mar-Apr;8 Suppl A:35A-40A11360046
This study assesses the influence of socio-demographic, psychosocial, clinical and radiological variables on the outcome of patients with mild traumatic brain injury (MTBI) in an acute care inpatient setting.
Retrospective cohort study.
A total of 2127 inpatients with MTBI were included. Outcomes measured were Extended Glasgow Outcome Scale (GOS-E), the FIM® instrument, length of stay (LOS) and discharge destination.
Fifty-four per cent of patients with MTBI with a median GOS-E of 2 were discharged home with no need for further follow-up. Age, LOS, lower Glasgow score (GCS) at admission, insurance coverage and positive CT scans were associated with rehabilitation referrals on discharge. Age, LOS, alcohol and drug abuse, motor vehicle collision and lower GCS at admission were associated with greater physical disabilities and functional impairment at discharge. FIM® cognitive functional scores were higher in women, younger patients and patients without psychiatric disorders. Brain lesions were correlated with longer LOS. CT scan findings in patients with MTBI may help clinicians predict the final outcome and resources required for patient care during their hospitalization and on discharge.
This study can help healthcare professionals in treating and planning future care of patients with MTBI.
