Telemedicine: evolving technology in an e-health care world.

This article provides an overview of telemedicine and its expanding capabilities to deliver health care services. Clinical applications, including home care, continue to evolve and expand as the technology improves and the experience of telemedicine service providers grows. As an emerging technology in a changing health care environment, implementation of telemedicine is not without its challenges. The future of telemedicine will be impacted by the emerging emphasis on e-health care.

The preparation of patients for cardiac surgery.

This study examines the impact of a preadmission telephone intervention on anxiety, knowledge, and readiness for discharge for patients attending a preadmission teaching program prior to cardiac surgery. The primary goal of the telephone intervention was to provide support by giving additional information about individual concerns. The telephone intervention did not have an effect on anxiety and knowledge. A significantly higher level of anxiety was found in the experimental group on admission, but this difference became nonsignificant when baseline level and length of waiting time were entered as covariates. The more anxious group rated their perceived knowledge level lower, despite the fact that both groups had similar scores in actual knowledge. Given the potential barrier that anxiety can pose for patient learning, nurses need to adapt their interventions to deal with the patients' feelings of anxiety that accompany cardiac surgery to make the learning process effective.

Detection of group B Streptococcus by immunoassay following enrichment in LIM-selective broth medium.

Rapid immunoassays have been developed to decrease the time to detection of Group B Streptococcus (GBS) carriage in pregnant women. In this study, a total of 162 pregnant women, considered to be high-risk obstetric patients, were seen in the Family Care Center at Memorial Hospital of Rhode Island, a 300-bed teaching hospital associated with Brown University Medical School. Vaginal and rectal specimens were taken and tested for GBS by using two rapid enzyme immunoassays (EIAs) that were compared with culture. Quidel and Hybritech ICON Group B strep tests were run following 4 h incubation in the selective enrichment LIM Group B strep broth; cultures were done both directly and after enrichment. Results with both EIAs were identical, with overall sensitivity, specificity, and positive and negative predictive values of 38%, 98%, 88%, and 84% respectively. However, when women having positive cultures were separated into moderately to heavily colonized (> or = 3 +) and lightly colonized (< or = 2 +) populations, the sensitivities were 82% and 19%, respectively. Although GBS assays are useful in the rapid diagnosis of heavily colonized women, culture following enrichment remains the most sensitive method for a lightly colonized population.

[Preoperative structured patient education]. / Enseignement préopératoire structuré.

This article describes the factors that motivated the nursing staff of the cardiac surgery unit at the Royal Victoria Hospital in Montreal, to revise their preoperative teaching program. The motivating factors described are the length of the preoperative waiting period; the level of preoperative anxiety; the decreased length of hospital stay; the dissatisfaction of the nursing staff with current patient teaching practices; and the lack of available resources. The reorganization of the teaching program was based upon the previously described factors combined with a review of the literature that demonstrated the impact of preoperative anxiety, emotional support and psycho-educational interventions upon the client's recovery. The goals of the new teaching program are to provide the client and the family with cognitive and sensory information about the client's impending hospitalization, chronic illness and necessary lifestyle modifications. The program consists of a system of telephone calls during the preoperative waiting period; a videotape viewing; a tour of the cardiac surgery unit; informal discussion groups; and the availability of nursing consultation to decrease preoperative anxiety. The end result of these interventions is more time for client support and integration of necessary information by the client and family. This kind of program has the potential to provide satisfaction at many levels by identifying client's at risk; increasing client knowledge; increasing support; decreasing anxiety during the preoperative waiting period; and decreasing the length of hospital stay. The nursing staff gained a heightened sense of accomplishment because the program was developed according to the nursing department's philosophy, which includes primary nursing.(ABSTRACT TRUNCATED AT 250 WORDS)