Publications

Abstract

Type II non-insulin-dependent diabetes mellitus (NIDDM) occurs predominantly in adults, especially in those individuals over age 30. This disease was formerly called maturity-onset or adult-onset diabetes. A subclass of NIDDM was devised, however, for those families in which children, adolescents, or young adults develop what is referred to as maturity-onset diabetes of the young. This article reviews issues related to treatment modalities for those with type II NIDDM, including dietary management, physical activity, and pharmacologic therapy.

Abstract

Demonstration sessions of cognitive therapy (Beck), cognitive behavior modification (Meichenbaum), and short-term psychodynamic therapy (Strupp) with the same patient, Richard, were compared. These therapies were analyzed using the Coding System of Therapeutic Focus, a recently developed system to analyze therapist statements in a language that is neutral with respect to psychotherapy orientation. In comparison to the other therapists, Beck focused more on the cognitive triad of Richard's thoughts about self, world, and future. Although all three therapists placed a comparable emphasis on the impact that other people had on the patient, both Meichenbaum and Strupp focused more than Beck on the impact Richard may have had on others.

Abstract

This paper examines the effectiveness of a nursing intervention for elderly hospitalized patients (N=235) as measured by functional outcomes. A nursing intervention targeted at factors which influence acute confusion or delirium employed strategies to educate nursing staff, mobilize patients, monitor medication and make environmental and sensory modifications. Subjects who received the intervention were more likely to improve in functional status from admission to discharge than subjects who did not receive the intervention.

Abstract

Because he’s immunocompromised, your HIV-positive patient is susceptible to a number of skin disorders. Review the following photographs to familiarize yourself with some of them.

Abstract

Using a coding system designed to assess therapists’ in-session focus, we conducted a preliminary investigation of the differential emphasis placed on client’s intrapersonal and interpersonal functioning with interim data collected from an outcome study of a cognitive—behavioral (prescrip-tive) therapy and psychodynamic—interpersonal (exploratory) therapy. Consistent with theory, exploratory therapists made more interpersonal links relative to intrapersonal links. Contrary to theoretical expectation, there was a tendency for prescriptive therapists to place more of a focus on interpersonal, rather than intrapersonal, links. A between-group com-parison revealed that there was no difference between the therapies in their emphasis on intrapersonal or interpersonal links. However, only in exploratory therapy were there positive correlations approaching statis-tical signilicance between the focus on interpersonal links and clienfs improvement in self-esteem and social adjustment. There was also a marginally significant positive correlation between prescriptive therapists’ focus on intrapersonal links and symptom improvement. Although the findings suggest differential mechanisms of change across these two therapeutic orientations, the results should be interpreted cautiously until they can be replicated with a larger sample.

Abstract

OBJECTIVE - To evaluate the impact of a model program of diabetes education and weight reduction on diabetes control and weight loss in obese individuals with non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS - Eighty-two obese diabetic subjects were randomized to three levels of educational intensity: 1) a single individual session, 2) a 12-wk behavior-oriented diabetes education and weight control group intervention, or 3) group intervention plus six individual follow-up sessions. Repeated measures of weight, fasting blood glucose, and HbA1c were collected. Measures of diabetes knowledge, skills, and attitudes were also obtained. RESULTS - By 6 mo, all three intervention groups had a significant weight loss (P < 0.01). The mean weight loss of ∼ 10 lb was independent of treatment group and was maintained over the duration of the study. However, significant improvement in metabolic control was associated with participation in the diabetes education-weight reduction intervention. CONCLUSIONS - The findings of this study indicate that a cognitive behavioral group intervention of diabetes knowledge and weight reduction training can produce weight loss and improvements in diabetes control. The addition of individual counseling as a follow-up maintenance strategy does not appear to have any advantage.

Abstract

Nursing's Agenda for Health Care Reform (1991) embraces primary health care as the focus of a restructured health care system. As part of this reformed system, consumers would access the most cost-effective providers in community-based settings. Removal of financial and regulatory barriers that limit consumer access to providers, such as lack of direct reimbursement by Medicare for nurse practitioners, should be eliminated according to this plan. Senate bills S2103 and S2104 have been recently introduced to the U.S. Senate mandating reimbursement for services provided by nurse practitioners, clinical nurse specialists, nurse midwives, and physician assistants at 97% of physician payment. The aim of this global legislation is to eliminate the current piecemeal mechanisms for nurse practitioner reimbursement and remove financial disincentives. Case examples presented in this article illustrate how obstacles to reimbursement limit access to care for consumers. Quality of care, opportunities for autonomous practice, and control of nursing practice issues have been highlighted as well by the case format. It is intended that these cases would be useful to support changes in patterns of nurse practitioner reimbursement.

Abstract

To determine if DSM‐III criteria or clinical or discharge diagnoses, reviewed retrospectively, are as accurate an indicator of the presence of delirium as prospective evaluation by a psychiatrist. Selection of delirious patients prospectively by a psychiatrist, followed by retrospective record review of the same patients. A referral‐basesd university hospital. From a sample of 235 consecutive medical patients over age 70, 47 delirious patients were identified prospectively by a research psychiatrist using DSM‐III criteria. The medical record of these delirious patients was reviewed after discharge for evidence of delirium. Four patients were assigned ICD‐9 codes suggestive of delirium (sensitivity 0.09). Review of physicians' diagnoses correctly identified 8 of 47 (sensitivity 0.17) patients as being delirious or acutely confused. The specific diagnostic criteria necessary to meet a DSM‐III diagnosis of delirium could be ascertained from 10 of 47 records (sensitivity 0.21). The retrospective medical record review is very imprecise in establishing the diagnosis of delirium. As research in this field moves from descriptive epidemiology to studies of pathogenesis and treatment, prospective designs will be needed.