Crossing 138: two approaches to churn under the Affordable Care Act.

A predicted side effect of the Medicaid expansion and state-based Exchanges under the Affordable Care Act is churn. Churn is the shifting into and out of eligibility for insurance affordability programs due to income changes. Because the line between Medicaid and Exchange eligibility is fine -138% of the federal poverty level -millions of Americans are expected to gain and lose eligibility. Frequently, this churning undermines continuity of care, raises costs, and frustrates those affected. This article explores two proposed programs to mitigate the effects of churn: the Basic Health Program and the Bridge Program. This article evaluates both programs' ability to mitigate the effects of churn, the likely side effects to states' implementing them, and legal and practical obstacles to their implementation. It concludes that the Bridge Program is the better approach.

Forensic psychiatric nursing. Discursive practices and the emergence of a specialty.

1. While some authors argue that specialization is a threat to holistic nursing practice, others suggest that specialization is not only desirable and inevitable but should follow a rigorous process, including specific educational curriculum and examination procedures. 2. Two opposing views regarding forensic nursing are found in contemporary nursing literature. Some authors resist the discourse of specialization in nursing, while the discursive practices of others (e.g., leaders in forensic psychiatric nursing) could reflect a desire for power. 3. Using a poststructuralist approach, the controversy that has accompanied the development of forensic nursing through discursive practices is analyzed.

Marijuana use among adults. A longitudinal study of current and former users.

This study examines the pattern of marijuana use among respondents who have passed the age of risk of onset, as well as some of the correlates related to the initiation and current use of marijuana. The data for this study included 8885 respondents drawn from the National Longitudinal Survey of Labor Market Experience of Youth (NLSY). Based on cross-tabulations of lifetime marijuana use in 1984 and 1994, the following outcomes were examined: incidence of lifetime marijuana use, inconsistent reports of lifetime marijuana use, and current compared with former use. Controlling for the effects of all variables studied, significant and independent effects were noted for sociodemographic factors, former patterns of use, and the use of other substances.

Geropsychiatric restraint use.

OBJECTIVES: To investigate predictors and reasons for restraint use with geropsychiatric patients. DESIGN: A prospective, correlational study. SETTING: The geriatric unit of an acute-care psychiatric hospital. PARTICIPANTS: Twenty-one staff nurses and 131 patients admitted consecutively over a period of 6 months. MEASUREMENTS: Disruptive behaviors were measured with the Nursing Home Behavior Problem Scale (NHBPS), cognitive function was measured with the Mini-Mental State Examination (MMSE), mobility was measured with a Functional Mobility Screen (FMS), and reasons for restraint use were obtained with a questionnaire completed by nurses. RESULTS: Patients with a diagnosis of dementia, impaired mobility, or behavioral problems were more likely to be restrained. The most frequent reasons given by staff for restraint use were an unsteady gait and a risk of falling. The incidence of restraint use was 27.1%. CONCLUSIONS: The use of restraint with geropsychiatric patients may be more common than previously reported and requires further investigation.

Four common mandibular nerve anomalies that lead to local anesthesia failures.

Local anesthesia is essential in treating many dental and oral disorders. However, many types of anatomical anomalies are seen in the nervous system of the mandible that interfere with achieving local anesthesia. The authors describe four such anomalies and offer ways to overcome them when trying to properly anesthetize affected patients.

Scurvy and psychiatric symptoms.

Scurvy is not just a disease of the past, but of the present as well. Yet, the possibility of scurvy is often overlooked in assessing a client's mental health status. Prompt recognition and treatment of scurvy can prevent unnecessary diagnostic testing, as well as a delay in treatment. The author presents a case history of a 55-year-old man with scurvy, delusions, and depression. The client's history, course of illness, treatment, and plan of care are discussed.

Impact of a trauma service on trauma care in a university hospital.

This study describes the experience in a major university hospital for a year before and a year after the institution of a trauma service. Demographic data and severity of injury were similar before and after the trauma service was instituted. Nonetheless, mortality for all trauma patients admitted to an intensive care unit decreased somewhat (from 16.1 to 11.8 percent) in the second period of study. When outcome for trauma patients admitted to the surgical intensive care unit was examined, the differences was more impressive, with a reduction in mortality from 27 percent to 6.1 percent. This reduction seemed to be due largely to a decrease in the number of patients who died from sepsis, multiple organ failure, or both. We suggest that trauma care can be significantly improved by an organized approach to the care of the multiply injured patient. A powerful argument can be made for organizing care of injured patients in major hospitals along the lines of a dedicated trauma service.

Platelet storage pool disease in hybrid rats. F1 fawn-hooded rats derived from crosses with their putative ancestors (Rattus norvegicus).

Fawn-hooded rats have a hemorrhagic disorder known as platelet storage pool deficiency. Parent stocks of Fawn-hooded, Long-Evans, and Wistar (DAB) rats and the progeny of their reciprocal crosses were studied for coat color and percentage 14C-serotonin uptake and secretion by blood platelets. Progeny of Fawn-hooded and Wistar reciprocal crosses were dark- or light-hooded, whereas all reciprocal crosses with the Long-Evans stock were dark-hooded. The light or fawn hood was significantly associated with the reduced serotonin uptake and secretion characteristic of storage pool efficiency.