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Appropriate Care (appropriate + care)
Selected AbstractsTeaching Culturally Appropriate Care: A Review of Educational Models and MethodsACADEMIC EMERGENCY MEDICINE, Issue 12 2006Cherri Hobgood MD Abstract The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient. [source] A national survey of the current state of screening services for diabetic retinopathy: ABCD,Diabetes UK survey of specialist diabetes services 2006DIABETIC MEDICINE, Issue 12 2009D. K. Nagi Abstract The main aims were to ascertain the progress made in the implementation of retinal screening services and to explore any barriers or difficulties faced by the programmes. The survey focused on all the essential elements for retinal screening, including assessment and treatment of screen-positive cases. Eighty-five per cent of screening programmes have a coordinated screening service and 73% of these felt that they have made significant progress. Eighty-five per cent of screening units use ,call and recall' for appointments and 73.5% of programmes follow the National Screening Committee (NSC) guidance. Although many units worked closely with ophthalmology, further assessment and management of screen-positive patients was a cause for concern. The fast-track referral system, to ensure timely and appropriate care, has been difficult to engineer by several programmes. This is demonstrated by 48% of programmes having waiting lists for patients identified as needing further assessment and treatment for retinopathy. Ophthalmology service for people with diabetic retinopathy was provided by a dedicated ophthalmologist in 89.4% of the programmes. Sixty-six per cent of the programmes reported inadequate resources to sustain a high-quality service, while 26% highlighted the lack of infrastructure and 49% lacked information technology (IT) support. In conclusion, progress has been made towards establishing a national screening programme for diabetic retinopathy by individual screening units, with a number of programmes providing a structured retinal screening service. However, programmes face difficulties with resource allocation and compliance with Quality Assurance (QA) standards, especially those which apply to ophthalmology and IT support. Screening programmes need to be resourced adequately to ensure comprehensive coverage and compliance with QA. [source] Turcot syndrome confirmed with molecular analysisEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2007C. Lebrun Turcot syndrome is clinically characterized by the occurrence of primary brain tumor and colorectal tumor and has, in previous reports, been shown associated with germline mutations in the genes APC, MLH1, MHS6, and PMS2. To date, only few families have been documented by molecular analysis. We report two new families with Turcot syndrome to illustrate and review its characteristics and facilitate diagnosis. Molecular analysis revealed two germline mutations, one in the MLH1 gene and one in MSH2. The latter has never been describe in the literature. Personal and familial relevant anamnestic data from patients with glioma might aid in the diagnosis of genetic disorders. The subsequent molecular characterization may contribute to the appropriate care of affected patients and asymptomatic gene carriers. [source] Agonists of proteinase-activated receptor-2 affect transendothelial migration and apoptosis of human neutrophilsEXPERIMENTAL DERMATOLOGY, Issue 10 2007Victoria M. Shpacovitch Abstract:, Skin is the first barrier preventing microorganism invasion in host. Wounds destroy this defense barrier and, without an appropriate care, may lead to sepsis. Neutrophil activation and immigration plays an important role at the inflammatory stage of wound healing. Neutrophils are known to express proteinase-activated receptors (PARs), which can be activated by serine proteases, also by enzymes involved in wound healing. We previously reported that PAR2 agonists up-regulate cell adhesion molecule expression and cytokine production by human neutrophils. Here, we demonstrate that PAR2 agonists (serine proteases as well as synthetic peptides) reduce transendothelial migration of neutrophils and prolong their life in vitro. Synthetic PAR2 agonist also enhanced protective interferon (IFN),-induced Fc,RI expression at neutrophil cell surface. Of note, IFN, is a cytokine, which was used in clinical trials to reactivate human neutrophil functions during sepsis. Moreover, we observed a significant increase of PAR2 expression on cell surface of neutrophils from septic patients as compared with healthy volunteers. Together, our results indicate that PAR2 may be involved in the pathophysiology of neutrophil-endothelial interactions during wound healing or later during sepsis in humans, potentially by affecting neutrophil apoptosis, transendothelial migration and Fc, receptor-mediated phagocytosis. [source] A re-examination of distance as a proxy for severity of illness and the implications for differences in utilization by race/ethnicity ,,HEALTH ECONOMICS, Issue 7 2007Jayasree Basu Abstract The study analyzes the hospitalization patterns of elderly residents to examine whether the relation between distant travel and severity of illness is uniform across racial/ethnic subgroups. A hypothesis is made that severity thresholds could be higher for minorities than whites. Hospital discharge data from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Health Care Research and Quality for New York residents is used, with a link to the Area Resource File and American Hospital Association's survey files. Logistic models compare the association of distant admission with severity corresponding to each local threshold level, race, and type of hospital admission. The study uses four discrete distance thresholds in contrast to recent work. Also, an examination of severity thresholds for distant travel for different types of admission may clarify different sources of disparities in health care utilization. The findings indicate that minorities are likely to have higher severity thresholds than whites in seeking distant hospital care, although these conclusions depend on the type of condition. The study results imply that if costly elective services were regionalized to get the advantages of high volume for both cost and quality of care, some extra effort at outreach may be desirable to reduce disparities in appropriate care. Published in 2006 by John Wiley & Sons, Ltd. [source] Improving Care for Minorities: Can Quality Improvement Interventions Improve Care and Outcomes For Depressed Minorities?HEALTH SERVICES RESEARCH, Issue 2 2003Controlled Trial, Results of a Randomized Objective. Ethnic minority patients often receive poorer quality care and have worse outcomes than white patients, yet practice-based approaches to reduce such disparities have not been identified. We determined whether practice-initiated quality improvement (QI) interventions for depressed primary care patients improve care across ethnic groups and reduce outcome disparities. Study Setting. The sample consists of 46 primary care practices in 6 U.S. managed care organizations; 181 clinicians; 398 Latinos, 93 African Americans, and 778 white patients with probable depressive disorder. Study Design. Matched practices were randomized to usual care or one of two QI programs that trained local experts to educate clinicians; nurses to educate, assess, and follow-up with patients; and psychotherapists to conduct Cognitive Behavioral Therapy. Patients and physicians selected treatments. Interventions featured modest accommodations for minority patients (e.g., translations, cultural training for clinicians). Data Extraction Methods. Multilevel logistic regression analyses assessed intervention effects within and among ethnic groups. Principal Findings. At baseline, all ethnic groups (Latino, African American, white) had low to moderate rates of appropriate care and the interventions significantly improved appropriate care at six months (by 8,20 percentage points) within each ethnic group, with no significant difference in response by ethnic group. The interventions significantly decreased the likelihood that Latinos and African Americans would report probable depression at months 6 and 12; the white intervention sample did not differ from controls in reported probable depression at either follow-up. While the intervention significantly improved the rate of employment for whites and not for minorities, precision was low for comparing intervention response on this outcome. It is important to note that minorities remained less likely to have appropriate care and more likely to be depressed than white patients. Conclusions. Implementation of quality improvement interventions that have modest accommodations for minority patients can improve quality of care for whites and underserved minorities alike, while minorities may be especially likely to benefit clinically. Further research needs to clarify whether employment benefits are limited to whites and if so, whether this represents a difference in opportunities. Quality improvement programs appear to improve quality of care without increasing disparities, and may offer an approach to reduce health disparities. [source] Severe cutaneous reactions caused by barbiturates in seven Iranian childrenINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2009Setareh Mamishi MD Background, The severe adverse cutaneous reactions of erythema multiforme (EM), Stevens,Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare mucocutaneous diseases associated with significant morbidity and mortality. The most common cause is antiepileptic drugs, particularly carbamazepine and lamotrigine, as well as the barbiturates group (phenobarbital and phenytoin). In this article, we present seven children with severe adverse cutaneous reactions caused by barbiturates. Case Reports, The age of the affected children was between 2 and 11 years and they all had a history of taking barbiturates. Their symptoms started 1,3 weeks after the initiation of barbiturates, including a prodrome characterized by 2,3 days of malaise, fever, cough and anorexia, after which the skin and mucosal lesions appeared and worsened. The skin lesions varied from rash to large bullae, plus different forms of mucous membrane involvement. The offending drugs (barbiturates) were stopped immediately and care was largely supportive. Conclusion, As a result of the morbidity and/or mortality associated with EM, SJS and TEN, physicians should keep in mind their differential diagnosis when cutaneous reactions are observed in patients undergoing barbiturate therapy. Furthermore, although TEN and SJS are life-threatening diseases, early detection and appropriate care can lead to a decrease in the incidence of death. The strategies described here seem to be successful and safe because, despite the serious conditions, our patients responded well. All survived. [source] Evaluation of the nano-oligosaccharide factor lipido-colloid matrix in the local management of venous leg ulcers: results of a randomised, controlled trialINTERNATIONAL WOUND JOURNAL, Issue 2 2008Jean-Luc Schmutz Abstract The nano-oligosaccharide factor (NOSF) is a new compound aiming to promote wound closure mainly through inhibition of matrix metalloproteinase (MMP) activity. This factor is incorporated within a lipido-colloid matrix (Techonology Lipido-Colloid-NOSF matrix) and locally released in the wound. The objective of this study was to document the performance (non inferiority or superiority) of the NOSF relative to the Promogran® matrix (oxidised regenerated cellulose, ORC) effect in the local management of venous leg ulcers (VLUs). This was a 12-week, open, two-arm, multicentre, randomised study. Patients were selected if the area of their VLU [ankle brachial pressure index ,0·80] ranged from 5 to 25 cm2 with a duration ,3 months. Ulcers had to be free from necrotic tissue. In addition to receiving compression bandage therapy, patients were randomly allocated to either NOSF matrix or ORC treatment for 12 weeks. The VLUs were assessed on a weekly basis and wound tracings were recorded. Percentage wound relative reduction (%RR) was the primary efficacy criterion. Secondary objectives were wound absolute reduction (AR), healing rate (HR) and % of wounds with ,40% reduction compared with baseline. A total of 117 patients were included (57 NOSF matrix and 60 ORC). Mean population age was 71·3 ± 13·5 years, body mass index was ,30 kg/m2 in 39·3% and 15·4% were diabetics. Fifty-six per cent of the VLUs were present for >6 months, 61% were recurrent and 68% were stagnating despite appropriate care. Mean wound area at baseline was 11·2 ± 7·4 cm2. At the last evaluation, mean difference between the groups for %RR was 33·6 ± 15·0% in favour of NOSF matrix with a unilateral 95% confidence interval (CI) lower limit of 8·6% not including the null value. Therefore, a superiority of NOSF matrix effect compared with ORC was concluded (P = 0·0059 for superiority test). The median of the wound area reduction was 61·1% and 7·7% in the NOSF matrix and control groups, respectively (per-protocol analysis), or 54·4% versus 12·9% in intent-to-treat analysis (p = 0·0286). Median AR was 4·2 cm2 in the NOSF group and 1·0 cm2 with ORC (P = 0·01). Median HR was ,0·056 and ,0·015 cm2/day in NOSF and ORC groups, respectively (P = 0·029). By logistic regression, the NOSF versus control odds ratio to reach 40% area reduction was 2·4 (95% CI: 1·1,5·3; P = 0·026). In the oldest and largest VLUs, a strong promotion of healing effect was particularly observed in the NOSF matrix group compared with the control group. NOSF matrix is a very promising option for the local management of chronic wounds, especially for VLUs with poor healing prognosis. [source] Prognosis of stage I pressure ulcers and related factorsINTERNATIONAL WOUND JOURNAL, Issue 4 2006Miwa Sato Abstract The prognosis of stage I pressure ulcers cannot be predicted; therefore, nursing interventions for preventing their deterioration have not been clearly established. This study describes the clinical course of stage I pressure ulcers and prospectively investigates the factors related to their deterioration. Thirty-one stage I pressure ulcers in 30 patients in a long-term care facility were studied, and morphological changes were assessed every day until the ulcers healed or deteriorated. The physiological changes were assessed by ultrasonography and thermography. Twenty ulcers healed, and 11 deteriorated. The characteristics of deterioration were as follows: (1) double erythema; (2) non blanchable erythema across the whole area determined by glass plate compression; (3) erythema away from the tip of the bony prominence; and (4) expanding erythema on the following day. We analysed the sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio for the diagnostic utility of the indicators of deterioration double erythema and distance from the tip of bony prominence, which can be instantly assessed without the use of any special device. The values were 36·4%, 95·0%, 80·0%, 73·1% and 7·28, respectively. These results suggest that clinicians can predict the prognosis of stage I pressure ulcers by initial assessment and provide appropriate care based on the assessment. [source] Stroke patients in nursing homes: eating, feeding, nutrition and related careJOURNAL OF CLINICAL NURSING, Issue 4 2002SUZANNE KUMLIEN LMSc ,,The purpose of this study was to explore eating, feeding and nutrition among stroke patients in nursing homes as described by their nurses and by assessments. ,,Registered Nurses were interviewed about an individual stroke patient's state of health, care needs and nursing care received and nursing records were reviewed. Information on eating, feeding and nutrition was extracted from the interviews and nursing records. A comprehensive instrument, the Resident Assessment Instrument, was also used to assess these patients' state of health. The domains of eating, feeding and nutrition were focused on in this study. Manifest content analysis was used. ,,The results showed that more than 80% of the stroke patients in nursing homes were assessed as having some sort of dependence in eating. According to the Registered Nurses, 22 out of 40 patients demonstrated different eating disabilities. The number of eating disabilities in individual patients ranged from 1 to 7, which emphasized the complexity of eating disabilities in stroke patients. Dysphagia was reported in almost one-fourth of the patients and 30% were described and/or assessed as having a poor food intake or poor appetite. The Registered Nurses' descriptions of the eating disabilities, nutritional problems and their care were often vague and unspecific. Only six weights were documented in the nursing records and there were no nutritional records. ,,The findings highlight the importance of making careful observations and assessments, and of maintaining documentation about eating and nutrition early after a patient's arrival in the nursing home to enable appropriate care and promotion of health. [source] Caring for clients with dual diagnosis in rural communities in Australia: the experience of mental health professionalsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2005C. DEANS rmn, hv cert This paper identifies and describes the experiences of 13 rural mental health professionals who care for clients diagnosed with a mental illness and a coexisting alcohol and other drug disorder (dual diagnosis). Dual diagnosis is a common problem which is often poorly understood and managed by mental health professionals. The effect of excessive substance use on a person's mental well-being can present as a diagnostic challenge as each condition may mask symptoms of the other. The authors utilized a phenomenological approach to discover the experiences of a group of mental health professionals working in rural communities in Victoria, Australia. Caring for clients diagnosed with dual diagnosis was found to be a complex and stressful role that involved high levels of skill and knowledge. Despite the fact that health professionals in rural areas are expected to deliver the most appropriate care to individuals with a dual diagnosis, a number of these rural health professionals have limited preparation and experience in dealing with arising clinical diagnosis issues. Clinicians experience frustration, resentment and powerlessness in their attempt to understand their clients' drug misuse whilst simultaneously endeavouring to provide a quality mental health service. [source] Considering the care of the suicidal client and the case for ,engagement and inspiring hope' or ,observations'JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2002J. R. Cutcliffe rmn rgn bsc (hons) phd Psychiatric/mental health (P/MH) nursing has rightly been described as a ,broad church', and one that contains many contested matters and areas of differing opinion. One such contested matter is that of the appropriate care for the person who is at risk of suicide. Recent, albeit limited, debate of this issue has taken place, and the literature, such as it is, indicates two principal (though linked) positions. These can be summarized as the ,engagement and hope inspiration' position and the ,observations' position. Given the P/MH nurse's unique position in providing 24-hour, day-to-day care to suicidal clients and the growing problem of suicide within people who suffer from mental health problems, it is both necessary and perhaps timely to consider this debate in more detail. Accordingly, this paper considers the debate regarding care for suicidal mental health care clients. First, the paper briefly describes the historical policy context of care for the suicidal client. Next, it focuses on ,observations' and concludes that there is a range of well-established, empirically based problems or drawbacks to this approach. Following this, it focuses on ,engagement, inspiring hope' and points out the key processes of engagement: forming a relationship, a human,human connection, conveying acceptance and tolerance, and hearing and understanding. The value and importance of these most fundamental of interpersonal processes is described and alluded to throughout the limited research into care of the suicidal client. The paper then describes the range of criticisms that have been levelled at the engagement,inspiring hope approach and considers these criticisms in more detail. As a result of this detailed examination, the paper then reiterates the need to replace ,observations' with ,engagement,hope inspiration' as the principal approach to caring for suicidal mental health clients. [source] Fibromyalgia,Management of a misunderstood disorderJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 7 2007Education & Training Flight Commander), Erin L. Peterson RN, FNP (Major; Family Nurse Practitioner Abstract Purpose: The purpose of this article is to review (a) what is currently known about the pathophysiology of fibromyalgia (FM), (b) how to identify patients who are susceptible to this disorder, and (c) the recommended pharmacological and nonpharmacological treatment options. Data sources: Data sources include reviews and original research from scholarly journals and Internet sites. Conclusions: There are approximately 6 million individuals in the United States diagnosed with FM, making it the third most prevalent rheumatologic disorder in this country. Failure to identify a specific causal mechanism for FM has resulted in a shift in the focus of research from etiology to treatment (Baumstark & Buckelew, 2002). Based on the literature, the most successful interventions for reduction of chronic symptoms in the FM patient is a combination of education, psychological assistance, and exercise, along with medications. It is essential that nurse practitioners (NPs) understand the issues and concerns of patients afflicted with this complex disorder. Although the organic etiology of FM syndrome remains unclear, the goals of treatment are to control pain and improve adjustment, well-being, and daily functioning of these patients to the maximum extent possible. Implications for practice: NPs are in a unique position to help identify patients who may be suffering from FM or those diagnosed with FM reporting inadequate relief of symptoms. The incomplete understanding of the biological underpinnings, as well as the multiple symptoms that characterize FM syndrome, make it a challenging disorder to diagnose and treat. It takes time and patience to care for FM patients, and there are no "quick fixes." Diagnosis is made by a combination of patient history, physical examination, laboratory evaluations, and exclusion of other causes of symptoms confused with FM. Understanding the symptomology and recommended treatments will allow NPs to give appropriate care that may include making referrals for multidisciplinary treatment of these complex patients. [source] Ivermectin Toxicity in 17 ColliesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2002Kate Hopper Ivermectin is widely used in veterinary medicine as an anthelminthic and generally has a wide margin of safety, but Collies are prone to ivermectin toxicity. Two groups of Collies were presented to the University of California Veterinary Medical Teaching Hospital (VMTH) with ivermectin toxicity. The medical records of the 2 groups of Collies were reviewed retrospectively. Group I comprised 5 adult Collies that received at least 400 ,g/kg ivermectin PO and were presented to the VMTH 3 hours after intoxication. These Collies showed marked clinical signs on presentation. Three of these dogs required mechanical ventilation and were euthanized for financial reasons; the remaining 2 dogs were comatose but recovered in 5,7 days. Group II was comprised of 12 adult Collies presented to the VMTH 2 days (n = 10) and 5 days (n = 2) after subcutaneous injection of 200,250 ,g/kg ivermectin. These animals showed greater variation in severity of illness among individuals; 5 animals progressed to stupor or coma, whereas 4 animals remained ambulatory. Most of these dogs' clinical signs deteriorated from the day of intoxication until approximately day 6, from which time they showed gradual but steady improvement. All of the Collies in this group survived, but it took 3 weeks for most of them to recover. Collies suffering from ivermectin toxicity can have a severe and prolonged clinical course requiring intensive nursing care. Respiratory, cardiovascular, and nutritional support may all be required. With appropriate care, however, the prognosis for complete recovery is good. [source] Constructing a ,plausible narrative of progress' for nursing: a neopragmatist suggestionNURSING PHILOSOPHY, Issue 1 2009Walter H. Mason MSN RN PMHCNS-BC CNL Abstract Identity, difference, and the associated subject of cultural diversity pose challenges for nursing. As the demographics of the world change, demands are rising for nurses to provide sensitive, individualized care to people living in our ever-changing global community. Issues concerning gender, sexuality, disability, age, language, economic and occupational status, multiculturalism, and ethnicity are made more complex because many of these topics strike a personal chord for individual nurses. In order for nursing to provide appropriate care to the world's people and to meet future challenges, nursing must define itself in new ways. Kikuchi and Simmons have stated that the best way for nursing to approach this task is through the development of a ,sound' philosophy of nursing that will ,accommodate diversity in nursing thought'. They contend that before we can establish a philosophy of nursing, nurses will have to agree upon the nature of reality, human beings, truth, and knowledge. This paper will suggest that neopragmatism, as described by Richard Rorty, is a way to assure diversity of thought in nursing. However, I will argue against the requirement for this philosophy to be ,sound' in the sense that Kikuchi and Simmons use this term. In place of their call for ,truth and unity in nursing thought'. I will attempt to demonstrate how neopragmatic ideas relate to the construction of what Rorty called a unifying ,plausible narrative of progress'. This change will allow nursing to abandon the dead end debate over epistemologies and instead focus on more important issues related to improving nursing practice. [source] An anonymous survey of registrar training in the use of Kjelland's forceps in AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Marian CHINNOCK Large series suggest that, when used with appropriate care and skill, rotational deliveries with Kjelland's forceps are a safe and useful procedure. We surveyed obstetric trainees in Australia to assess their experience with, and intentions to use, Kjelland's forceps. The response rate was 65%, and it was uncommon for even senior trainees to have performed more than ten Kjelland's forceps rotations during their training. Ninety-four per cent of final-year trainees stated they did not intend to use Kjelland's forceps in their consultant practice. [source] Co-morbid drug and alcohol and mental health issues in a rural New South Wales Area Health ServiceAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2006Bryan Hoolahan Abstract Objective:,In 2003 the New South Wales (NSW) Centre for Rural and Remote Mental Health (CRRMH) conducted an analysis of co-morbid drug and alcohol (D&A) and mental health issues for service providers and consumers in a rural NSW Area Health Service. This paper will discuss concerns raised by rural service providers and consumers regarding the care of people with co-morbid D&A and mental health disorders. Design:,Current literature on co-morbidity was reviewed, and local area clinical data were examined to estimate the prevalence of D&A disorders within the mental health service. Focus groups were held with service providers and consumer support groups regarding strengths and gaps in service provision. Setting:,A rural Area Health Service in NSW. Participants:,Rural health and welfare service providers, consumers with co-morbid D&A and mental health disorders. Results:,Data for the rural area showed that 43% of inpatient and 20% of ambulatory mental health admissions had problem drinking or drug-taking. Information gathered from the focus groups indicated a reasonable level of awareness of co-morbidity, and change underway to better meet client needs; however, the results indicated a lack of formalised care coordination, unclear treatment pathways, and a lack of specialist care and resources. Discussion:,Significant gaps in the provision of appropriate care for people with co-morbid D&A and mental health disorders were identified. Allocation of service responsibly for these clients was unclear. It is recommended that D&A, mental health and primary care services collaborate to address the needs of clients so that a coordinated and systematic approach to co-morbid care can be provided. [source] Health-Care Reform and ESI: Reconsidering the Relationship Between Employment and Health InsuranceBUSINESS AND SOCIETY REVIEW, Issue 3 2010PATRICIA C. FLYNN ABSTRACT The health-care reform promised by the Patient Protection and Affordable Care Act of March 2010 continues our dependence on a central feature of the American health-care system: employer-sponsored insurance (ESI). In this article I will criticize the assumptions regarding market and welfare concerns on which this dependence is based and argue that efforts to mandate ESI ignore both the dynamics of the employment relation and the nature of health-care needs. A comparison between investing in employee education and investing in employee health will reveal the pragmatic challenges to ESI and the covert appeal to employer beneficence on which ESI rests. This paper argues that relying on ESI to guarantee appropriate care for a significant segment of the population is undesirable and unsustainable from both market and moral perspectives. [source] Acute anterior uveitis in primary careCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 2 2007Ian F Gutteridge MScOptom FAAO Acute anterior uveitis is an important ocular disease of considerable interest to therapeutically and non-therapeutically qualified optometrists. This review examines the role of optometrists in the primary care setting and gives guidelines for appropriate care of patients with anterior uveitis. Diagnosis and differentiation from other forms of anterior segment inflammation are the initial requirement. In parallel, possible medical conditions associated with acute anterior uveitis must be considered, with appropriate referral to medical practitioners. In uncomplicated cases of recurrent acute anterior uveitis, optometrists can initiate topical treatment and monitor resolution of inflammation, while being aware of possible complications of both the disease and its treatment. It is especially important in new attacks of anterior uveitis to liaise with the patient's general practitioner about medical investigation for underlying disease. Atypical, complicated or severe anterior uveitis should be promptly referred for specialist care. [source] | ||||||||||||||||||||||