ABSTRACT
This article describes the evolution, implementation, and outcomes of a collaborative interdisciplinary inpatient program designed to improve the quality of healthcare provided to adult patients with sickle cell disease. Efforts by the clinical nurse specialist were directly responsible for improved patient education, more efficacious treatment of painful crises, and increased specialty consultation. Staff and patient satisfaction with the program have been very encouraging, and a city-wide initiative that embraces a comprehensive approach to the global care of this special needs population has been designed and is currently being implemented.
Subject(s)
Anemia, Sickle Cell/nursing , Health Promotion/standards , Nurse Clinicians/organization & administration , Nursing Care/standards , Nursing, Team/organization & administration , Adult , Anemia, Sickle Cell/diagnosis , Cooperative Behavior , Female , Humans , Interprofessional Relations , Male , Outcome Assessment, Health Care , Professional Role , Program Development , Program Evaluation , United StatesABSTRACT
A nurse-driven clinic that uses a client-centered approach evolved from an independent ambulatory care program. The clinic operates 4 to 5 hours per day and provides patient counseling, health care maintenance, primary care, patient education, and therapeutic care.
Subject(s)
Ambulatory Care Facilities/organization & administration , Nursing Care/organization & administration , Outcome and Process Assessment, Health Care/organization & administration , Primary Health Care/organization & administration , HumansABSTRACT
Rapid exposure of unacclimatized persons to high altitude causes the syndrome acute mountain sickness (AMS). Prophylactic treatment with frequent high doses of dexamethasone has been shown to prevent AMS. To determine whether lower, less frequent doses were effective in preventing AMS, 28 men between the ages of 18 and 32 were exposed to a simulated altitude of 4,570 m for 45 h in a hypobaric chamber on two occasions while taking one of three doses of dexamethasone (4 mg, 1 mg, or .25 mg every 12 h) or a placebo in a double-blind, crossover design. The 4-mg dose of dexamethasone reduced the incidence of AMS symptoms compared with placebo and the other dose levels. Dexamethasone did not alter fluid balance or plasma volume changes, but treatment with 1 mg and 4 mg suppressed cortisol secretion. There was no evidence of adrenal cortical suppression after treatment with dexamethasone or placebo 48 h after discontinuing altitude exposure and drug treatment. The results indicate that 4 mg of dexamethasone twice daily is an effective prophylactic treatment for AMS, while lower doses are relatively ineffective.
Subject(s)
Altitude Sickness/prevention & control , Dexamethasone/therapeutic use , Hypoxia/prevention & control , Adolescent , Adult , Dexamethasone/administration & dosage , Dose-Response Relationship, Drug , Double-Blind Method , Drug Evaluation , Humans , Hydrocortisone/blood , MaleABSTRACT
This study examined the effectiveness of spironolactone as a prophylactic agent for the prevention of acute mountain sickness (AMS). Spironolactone, 25 mg PO QID, or placebo was administered to nine subjects in a double-blind, placebo-controlled, crossover design. Medication was given for 48 h prior to and during a 46-h exposure to 427 mm Hg (4570 m) in a hypobaric chamber. Six subjects demonstrated prevention of either the cerebral or respiratory symptoms of AMS during at least one segment of the altitude sojourn.
Subject(s)
Hypoxia/prevention & control , Spironolactone/therapeutic use , Acute Disease , Adult , Double-Blind Method , Humans , Male , Placebos , Random Allocation , Time FactorsSubject(s)
Bronchi/surgery , Bronchoscopy , Foreign Bodies/surgery , Bronchoscopy/methods , Humans , Male , Middle AgedABSTRACT
Ten patients with Raynaud's disease treated themselves at home using induced vasodilation 3 times/day, every other day, for 18 treatment days. The patients, dressed in indoor clothing, immersed both hands in warm tap water (43-45 degrees C) for 8-10 min while exposed to naturally occurring ambient cold. Results of pre- and posttreatment cold exposures showed a significant mean increase in digital temperature of 3.4 degrees C (p less than .001). Conditioning therapy appears to be an effective, feasible alternative to drug or surgical therapy.
