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1.
Aust J Prim Health ; 2020 Dec 03.
Article in English | MEDLINE | ID: mdl-33264584

ABSTRACT

There has been a growth in Australian school-based nurses to address the inequities confronted by vulnerable students and school populations. Failure to address inequities can be evidenced in intergenerational poverty, poorer health and educational attainment and diminished life opportunities. School-based nurses are ideally located to advocate for public health policies and programs that address social determinants that detrimentally affect the health of school populations. However, school-based nurses can confront professional and speciality challenges in extending their efforts beyond individual student advocacy to effect change at the school population level. Guidance is required to redress this situation. This paper describes public health advocacy, the professional and speciality advocacy roles of school-based nurses and the barriers they confront in advocating for the health of school populations and strategies that can be used by key stakeholders to enhance school-based nursing public health advocacy efforts. School-based nurses who are competent, enabled and supported public health advocates are required if we are to achieve substantial and sustained health equity and social justice outcomes for vulnerable school populations.

2.
Am J Med ; 131(2): e77, 2018 02.
Article in English | MEDLINE | ID: mdl-29362112
3.
Am J Med ; 130(9): 1107-1111.e1, 2017 09.
Article in English | MEDLINE | ID: mdl-28545885

ABSTRACT

BACKGROUND: The Yale New Haven Readmission Risk Score (YNHRRS) for pneumonia is a clinical prediction tool developed to assess risk for 30-day readmission. This tool was validated in a cohort of Medicare patients; generalizability to a broader patient population has not been evaluated. In addition, it lacks indicators of functional status or social support, which have been shown in other studies to be predictors of readmission. The objective of this study was to evaluate the generalizability of the YNHRRS for pneumonia in a general population of hospitalized patients, and assess the impact of incorporating measures of functional status and social support on its predictive value. METHODS: This retrospective chart review comprised all patients admitted to a 563-bed academic medical center with a primary diagnosis of pneumonia between March 2014 and March 2015. Abstraction of clinical variables allowed calculation of the YNHRRS and additional indicators of functional status and social support. The primary outcome was 30-day readmission rate. We created a logistic regression model to predict readmission using the YNHRRS, functional status, and social support as covariates. RESULTS: Among 270 discharges with pneumonia, the observed readmission rate was 23%. The YNHRRS was a significant predictor of readmission in our multivariate model, with an odds ratio of 2.20 (95% confidence interval, 1.29-3.73) for each 10% increase in calculated risk. Indicators of functional status and social support were not significant predictors of readmission. CONCLUSIONS: The YNHRRS can be applied to an unselected population as a tool to predict patients with pneumonia at risk for readmission.


Subject(s)
Activities of Daily Living , Patient Readmission/statistics & numerical data , Pneumonia/epidemiology , Skilled Nursing Facilities/standards , Social Support , Academic Medical Centers/statistics & numerical data , Age Distribution , Aged , Aged, 80 and over , Comorbidity , Female , Hospitalization/statistics & numerical data , Humans , Logistic Models , Male , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Sex Distribution , Skilled Nursing Facilities/statistics & numerical data , United States
4.
Emerg Infect Dis ; 22(9): 1621-3, 2016 09.
Article in English | MEDLINE | ID: mdl-27533890

ABSTRACT

Bacillus cereus is typically considered a blood culture contaminant; however, its presence in blood cultures can indicate true bacteremia. We report 4 episodes of B. cereus bacteremia in 3 persons who inject drugs. Multilocus sequence typing showed that the temporally associated infections were caused by unrelated clones.


Subject(s)
Bacillus cereus/genetics , Bacteremia , Drug Users , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/transmission , Adult , Alleles , Bacillus cereus/classification , Bacillus cereus/isolation & purification , California , Female , Genes, Bacterial , Gram-Positive Bacterial Infections/diagnosis , Humans , Male , Middle Aged , Multilocus Sequence Typing , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/diagnosis , Young Adult
5.
J Gen Intern Med ; 27(7): 825-30, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22331399

ABSTRACT

BACKGROUND: Physicians may counsel patients who leave against medical advice (AMA) that insurance will not pay for their care. However, it is unclear whether insurers deny payment for hospitalization in these cases. OBJECTIVE: To review whether insurers denied payment for patients discharged AMA and assess physician beliefs and counseling practices when patients leave AMA. DESIGN: Retrospective cohort of medical inpatients from 2001 to 2010; cross-sectional survey of physician beliefs and counseling practices for AMA patients in 2010. PARTICIPANTS: Patients who left AMA from 2001 to 2010, internal medicine residents and attendings at a single academic institution, and a convenience sample of residents from 13 Illinois hospitals in June 2010. MAIN MEASURES: Percent of AMA patients for which insurance denied payment, percent of physicians who agreed insurance denies payment for patients who leave AMA and who counsel patients leaving AMA they are financially responsible. KEY RESULTS: Of 46,319 patients admitted from 2001 to 2010, 526 (1.1%) patients left AMA. Among insured patients, payment was refused in 4.1% of cases. Reasons for refusal were largely administrative (wrong name, etc.). No cases of payment refusal were because patient left AMA. Nevertheless, most residents (68.6%) and nearly half of attendings (43.9%) believed insurance denies payment when a patient leaves AMA. Attendings who believed that insurance denied payment were more likely to report informing AMA patients they may be held financially responsible (mean 4.2 vs. 1.7 on a Likert 1-5 scale, in which 5 is "always" inform, p < 0.001). This relationship was not observed among residents. The most common reason for counseling patients was "so they will reconsider staying in the hospital" (84.8% residents, 66.7% attendings, p = 0.008) CONCLUSIONS: Contrary to popular belief, we found no evidence that insurance denied payment for patients leaving AMA. Residency programs and hospitals should ensure that patients are not misinformed.


Subject(s)
Insurance, Health, Reimbursement/statistics & numerical data , Patient Discharge/economics , Treatment Refusal/statistics & numerical data , Adult , Attitude of Health Personnel , Directive Counseling , Female , Hospital Charges/statistics & numerical data , Hospitalization , Humans , Illinois , Insurance, Health/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Medical Staff, Hospital/psychology , Middle Aged , Patient Credit and Collection/statistics & numerical data , Patient Discharge/statistics & numerical data , Retrospective Studies
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