Home cardiac rehabilitation for congestive heart failure: a nursing case management approach.

As the only major cardiovascular disease increasing in incidence and prevalence, congestive heart failure (CHF) is a major health threat. Progression of the disease often leads to severe disability and requires intensive medical and psychological management. Cardiac rehabilitation for CHF can improve a patient's functional ability, alleviate activity-related symptoms, improve quality of life, and restore and maintain physiological, psychological, and social status. The expansion of home care services and advances in technology allow cardiac rehabilitation to take place in the patient's home. Because of their training in health promotion and prevention, assessment, and coordination of services, nurses are the ideal providers of comprehensive home cardiac rehabilitation. Financially, physically, and psychologically beneficial for CHF patients and their families, home cardiac rehabilitation is also cost-effective for society. This article substantiates the benefits of home cardiac rehabilitation for patients with CHF and explains why nurses are the ideal case managers for such programs.

Revised estimates and projections of Down syndrome births in the United States, and the effects of prenatal diagnosis utilization, 1970-2002.

The objectives of this study were to: calculate revised estimates and projections of United States annual Down syndrome (DS) births for 1970-2002, and estimate the effects of amniocentesis on these baseline DS birth projections. Three models of amniocentesis utilization among 30-34 and greater than or equal to 35-year-old women were considered. The recently revised Census Bureau birth projections, and new single year maternal age DS risk rates estimated from a 1970-1983 Ohio data set, were used. Data from all three Census Bureau projection series were analysed; series II was considered in depth since it is consistent with recent fertility levels. Assuming no use of amniocentesis, total estimated DS births dropped from about 4770 in 1970 to 4120 in 1980 (a 14 per cent decline), but are projected to a plateau of about 5100 by the year 1990 (a 24 per cent increase). DS births to women greater than or equal to 35 would increase dramatically from about 1050 in 1980 to 1900 in 2000 (an 81 per cent increase). Assuming 1983 Ohio prenatal diagnosis ratios for women aged 30-34 (1.7 per cent) and greater than or equal to 35 (23.4 per cent) are used nationally, an annual reduction of about 7 per cent of DS births in 1986 and 9 per cent in 2002 would result. Fifty and 70 per cent utilization among women 30-34 and greater than or equal to 35, respectively, would reduce DS births by about 33 per cent in 1986 and 38 per cent in 2002. Therefore, if the projected increase in DS births is to be averted, utilization of prenatal diagnosis by greater than or equal to 30-year-old women must increase substantially.

Temporal changes in Ohio amniocentesis utilization during the first twelve years (1972-1983), and frequency of chromosome abnormalities observed.

The history of amniocentesis utilization in the seventh largest state of the United States is documented from its inception in 1972 through the first half of 1984. Amniocentesis utilization ratios for Ohio residents aged greater than or equal to 35 have increased from 0.21 per cent (19/9091) in 1972 to 23.4 per cent (1655/7531) in 1983, representing an average annual growth rate of 43.1 per cent. Of the amniocenteses performed from January 1, 1978-July 1, 1984, 71 per cent were referred for advanced maternal age (greater than or equal to 35), 15 per cent for maternal anxiety (30-34), 10 per cent for family history or previous child with a genetic defect, and 4 per cent for other reasons. Between 1978-1983 utilization by women 45 years of age was only 20 per cent higher than women 35 even though their risk of giving birth to a Down syndrome child was bout one order of magnitude higher. In addition, various factors were tested as to whether they affected utilization of amniocentesis by women greater than or equal to 35 during 1978-1983. A strong correlation of +0.89 existed between county population size and utilization ratios. No difference in utilization was found between whites and nonwhites, regardless of county population size. When utilization ratios were compared separately between Protestants, Catholics and other religions in Ohio's most populated county, no statistical differences were found. From 1978-July 1, 1984, the frequency of all cytogenetically abnormal chromosome results observed in Ohio amniocenteses to women greater than or equal to 35 was 2.48 per cent (187/7536). Of these, 2.15 per cent (162/7536) had unbalanced karyotypes. Future maximum amniocentesis utilization for women greater than or equal to 35 is estimated at 60-70 per cent.