Appreciating life: being the father of a child with severe cerebral palsy.

This phenomenological study examined the experience of being the father of a child with severe cerebral palsy (CP). Participants were selected using purposive sampling. Two interviews were conducted with 6 English-speaking, biological fathers whose children with CP (ages 5-27 years) were enrolled in a residential and day school in northeastern United States. Audiotaped interviews were transcribed, and thematic analysis was conducted using van Manen's methodology. Themes identified were as follows: Lost in birth; My beautiful unique child; Illness as a way of life…you can't get used to it and after a while it feels like no one cares; Partners-loyalty and commitment; How the world receives my child; Healthcare providers-I'm here; Torn…when your child can't live at home…finding a place to live and grow; and Faith. Clinicians should encourage, value, and include fathers' input during discussions of medical and social problems and when developing long-term care plans. Further research exploring the experiences of fathers of children with CP should be conducted.

Diagnostic utility of an epilepsy monitoring unit.

Guidelines recommend that patients with persist- ent seizures not responsive to standard antiepileptic drugs after 1 year be referred to specialized epilepsy centers for evaluation, which may include inpatient video-electroencephalographic monitoring. This 1-year retrospective, limited-focus review of 213 admissions and 3-year postdischarge review of epilepsy surgery referrals sought to determine if admission to an inpatient adult epilepsy monitoring unit resulted in a definitive diagnosis, a change in diagnosis or treatment, and whether referral patterns were consistent with guidelines. The median duration of time since symptom onset prior to admission was 15 years. At discharge, 87.8% of admissions received a definitive diagnosis. Epilepsy was diagnosed in 73.3% and excluded in 21.6%. Admissions without epilepsy had been treated with antiepileptic drugs for a median of 9 years. Admission resulted in change in treatment in 79%. This review documents the diagnostic utility of an epilepsy monitoring unit while highlighting that time since symptom onset to admission exceeded established guidelines.

Diabetes care processes and outcomes in patients treated by nurse practitioners or physicians.

PURPOSE: The purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners (NPs) and physicians (MDs) in the primary care of adults with type 2 diabetes. METHODS: Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and randomized to an NP or MD practice. Chart reviews were conducted to assess processes of care; patient interviews and hemoglobin A1C (A1C) testing were performed to measure patient outcomes. RESULTS: NPs were more likely than MDs to document provision of general diabetes education and education about nutrition, weight, exercise, and medications. They were more likely to document patient height, urinalyses results, and A1C values. No differences were found in documenting current medications; alcohol, illicit drug, or tobacco use; depression; weight and blood pressure; foot and cardiovascular exams; blood glucose and creatinine testing; or referral to ophthalmologists. No differences were found in patient outcomes. CONCLUSIONS: This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes. NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs; however, these differences were not reflected in 6-month patient outcomes.