Pub Date : 2022-06-01DOI: 10.1097/JNN.0000000000000655
{"title":"A Scoping Review of the Incidence, Predictors, and Outcomes of Delirium Among Critically Ill Stroke Patients.","authors":"","doi":"10.1097/JNN.0000000000000655","DOIUrl":"https://doi.org/10.1097/JNN.0000000000000655","url":null,"abstract":"","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":"82 1","pages":"E3"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77072116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1097/JNN.0000000000000644
{"title":"A Person-Centered Approach to Understanding Stroke Survivor and Family Caregiver Emotional Health.","authors":"","doi":"10.1097/JNN.0000000000000644","DOIUrl":"https://doi.org/10.1097/JNN.0000000000000644","url":null,"abstract":"","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":"11 1","pages":"E2"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80633539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-21DOI: 10.1017/9781108900997.013
C. Stewart‐Amidei
Often the people we work among see themselves as poor. We have the privilege of letting them know that they are not poor in God’s eyes but are valued and valuable. This is a transformation that can inspire communities to make positive changes for themselves. Changes that can also mobilise communities for mission, as they recognise the gifts and abilities that God has given them to share his good news with their neighbours.
{"title":"What can I do?","authors":"C. Stewart‐Amidei","doi":"10.1017/9781108900997.013","DOIUrl":"https://doi.org/10.1017/9781108900997.013","url":null,"abstract":"Often the people we work among see themselves as poor. We have the privilege of letting them know that they are not poor in God’s eyes but are valued and valuable. This is a transformation that can inspire communities to make positive changes for themselves. Changes that can also mobilise communities for mission, as they recognise the gifts and abilities that God has given them to share his good news with their neighbours.","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":"42 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2021-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75513527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.1097/JNN.0000000000000279
Alexander, K. Al-Hafian, S. Amato, Kelly Anderson, C. Arbour, K. Austin, T. Bakas, JJ Baumann, Cynthia Bautista, E. Bay, C. Beal, Karen Bergman, Latresa
Lena Aadal Sheila Alexander Kathryn Al-Hafian Shelly Amato Kelly Anderson Caroline Arbour Kimberley Austin Tamilyn Bakas JJ Baumann Cynthia Bautista Esther Bay Claudia Beal Karen Bergman Latresa Billings Sharon Bottomley Marijean Buhse Nicole Burnham Christine Byrd V. Susan Carroll Cathy Cartwright Krystal Chamberlain Lauren Cittadino Amanda Cramer Daniel Crawford Dare Domico Clint Douglas Deborah Downey
{"title":"Thank You to Reviewers 2016.","authors":"Alexander, K. Al-Hafian, S. Amato, Kelly Anderson, C. Arbour, K. Austin, T. Bakas, JJ Baumann, Cynthia Bautista, E. Bay, C. Beal, Karen Bergman, Latresa","doi":"10.1097/JNN.0000000000000279","DOIUrl":"https://doi.org/10.1097/JNN.0000000000000279","url":null,"abstract":"Lena Aadal Sheila Alexander Kathryn Al-Hafian Shelly Amato Kelly Anderson Caroline Arbour Kimberley Austin Tamilyn Bakas JJ Baumann Cynthia Bautista Esther Bay Claudia Beal Karen Bergman Latresa Billings Sharon Bottomley Marijean Buhse Nicole Burnham Christine Byrd V. Susan Carroll Cathy Cartwright Krystal Chamberlain Lauren Cittadino Amanda Cramer Daniel Crawford Dare Domico Clint Douglas Deborah Downey","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":"16 1","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75381504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1097/JNN.0000000000000244
K. W. Austin, S. Ameringer, A. Starkweather, L. Cloud, J. Sturgill, R. Elswick
Parkinson disease (PD) is a debilitating, progressive neurodegenerative disorder characterized by complex motor and nonmotor symptoms that fluctuate in onset, severity, level of disability, and responsiveness to treatment. The unpredictable nature of PD and the inability to halt or slow disease progression may result in uncertainty and psychological stress. Uncertainty and psychological stress have important implications for symptom and health outcomes in PD. Uncertainty and psychological stress have been shown to worsen symptoms, functional capacity, and quality of life in chronic illnesses; however, the causal mechanisms have yet to be elucidated. We propose a biobehavioral framework for examining uncertainty and psychological stress in PD. The framework considers factors that may contribute to uncertainty and neuroendocrine-immune mechanisms of uncertainty and psychological stress that may influence symptom and health outcomes in PD, for the ultimate purpose of improving symptom and disease progression, functional capacity, and quality of life.
{"title":"Biobehavioral Framework of Symptom and Health Outcomes of Uncertainty and Psychological Stress in Parkinson Disease.","authors":"K. W. Austin, S. Ameringer, A. Starkweather, L. Cloud, J. Sturgill, R. Elswick","doi":"10.1097/JNN.0000000000000244","DOIUrl":"https://doi.org/10.1097/JNN.0000000000000244","url":null,"abstract":"Parkinson disease (PD) is a debilitating, progressive neurodegenerative disorder characterized by complex motor and nonmotor symptoms that fluctuate in onset, severity, level of disability, and responsiveness to treatment. The unpredictable nature of PD and the inability to halt or slow disease progression may result in uncertainty and psychological stress. Uncertainty and psychological stress have important implications for symptom and health outcomes in PD. Uncertainty and psychological stress have been shown to worsen symptoms, functional capacity, and quality of life in chronic illnesses; however, the causal mechanisms have yet to be elucidated. We propose a biobehavioral framework for examining uncertainty and psychological stress in PD. The framework considers factors that may contribute to uncertainty and neuroendocrine-immune mechanisms of uncertainty and psychological stress that may influence symptom and health outcomes in PD, for the ultimate purpose of improving symptom and disease progression, functional capacity, and quality of life.","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":"50 1","pages":"E2-E9"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86593568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-04-01DOI: 10.1097/JNN.0000000000000193
Daiwai M. Olson
G raduation season is right around the corner. Are you ready to assume your responsibility? Every spring, thousands of us will take a big step forward.Wemay celebrate our own personal success by earning a BSN or finishing graduate school. We may celebrate our friends and colleagues who walk across the graduation stage after years of spending nights and weekends in class. For some of us, graduation will be bittersweet, marking the day our daughters and sons prepare to set out on their own academic journeys. With graduation comes a new set of responsibilities. This history of the graduation ceremony goes back centuries and has evolved over time. Likely beginning as an Islamic tradition, graduation historically symbolized that the student was ready to become the teacher. Back then, no distinction was made between the type or level of degree. Scholar, bachelor, master, and doctor were essentially interchangeable terms used to describe someone who had earned the right to share what he or she had learned. They had earned the right to teach. The many traditions of graduation are actually reflections of necessity. Those long robes we all wore when we got our diplomas do indeed reflect learning but maybe not the way you think. Ages ago, scholars (teachers) spent their days teaching. Teaching meant being indoors. Being indoors meant being inside the cold damp halls of the academy. Students often arrived poor and unprepared for the learning environment. However, the scholars had learned a thing or two; they had learned how to keep warm and dry by wearing long robes. Anyone could easily distinguish student from teacher by looking to see who was smart enough to wear robes. Hence, robes became a symbol that one had become educated enough to take on the role of teacher. As nurses, we donned our graduation robes and accepted our diplomas. When we did this, we became part of the fabric of history, and thereby, we agreed to become teachers. We willingly accepted the burden of responsibility to teach our craft. Soon, hospitals and clinics will be bustling with newly graduated nurses; are you ready to assume your responsibility and teach them your craft?
{"title":"Let Them Take the Pebble From Your Hand.","authors":"Daiwai M. Olson","doi":"10.1097/JNN.0000000000000193","DOIUrl":"https://doi.org/10.1097/JNN.0000000000000193","url":null,"abstract":"G raduation season is right around the corner. Are you ready to assume your responsibility? Every spring, thousands of us will take a big step forward.Wemay celebrate our own personal success by earning a BSN or finishing graduate school. We may celebrate our friends and colleagues who walk across the graduation stage after years of spending nights and weekends in class. For some of us, graduation will be bittersweet, marking the day our daughters and sons prepare to set out on their own academic journeys. With graduation comes a new set of responsibilities. This history of the graduation ceremony goes back centuries and has evolved over time. Likely beginning as an Islamic tradition, graduation historically symbolized that the student was ready to become the teacher. Back then, no distinction was made between the type or level of degree. Scholar, bachelor, master, and doctor were essentially interchangeable terms used to describe someone who had earned the right to share what he or she had learned. They had earned the right to teach. The many traditions of graduation are actually reflections of necessity. Those long robes we all wore when we got our diplomas do indeed reflect learning but maybe not the way you think. Ages ago, scholars (teachers) spent their days teaching. Teaching meant being indoors. Being indoors meant being inside the cold damp halls of the academy. Students often arrived poor and unprepared for the learning environment. However, the scholars had learned a thing or two; they had learned how to keep warm and dry by wearing long robes. Anyone could easily distinguish student from teacher by looking to see who was smart enough to wear robes. Hence, robes became a symbol that one had become educated enough to take on the role of teacher. As nurses, we donned our graduation robes and accepted our diplomas. When we did this, we became part of the fabric of history, and thereby, we agreed to become teachers. We willingly accepted the burden of responsibility to teach our craft. Soon, hospitals and clinics will be bustling with newly graduated nurses; are you ready to assume your responsibility and teach them your craft?","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":"25 1","pages":"67"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76076053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-04-01DOI: 10.1097/JNN.0000000000000183
Grace Small
N eurological deficits after a stroke are extremely common. Most patents experience dysarthria, aphasia, facial weakness, and weakness of upper and lower limbs after a stroke (Yanagida, Fujimoto, Inoue, & Suzuki, 2015). Facial hemiparesis, motor weakness of arms, and slurred or strange speech are associated as warning signs of stroke and signal the patient that urgent treatment is needed (National Heart, Lung, and Blood Institute, 2014). Fast treatment allows for quicker reperfusion of the brain tissue, limiting the amount of damage to the brain and the severity of the deficits experienced by the patient. The onset of neurological deficits from stroke is often several minutes after blockage or hemorrhage; however, deficits can continue to develop for up to several days after infarct (National Heart, Lung, and Blood Institute, 2014). Delayed motor deficits or progressive motor deficits (PMD) that develop several years after stroke are relatively rare in the literature. One notable case study discusses delayed neurological deterioration including worsening of dysarthria and ataxia several months after pontine hemorrhage (Menezes Cordeiro, Tavares,Reim,o, Geraldes, & Ferro, 2013). This progression was attributed to an increase in the area of hypertrophy in the pontine region, confirmedwithmagnetic resonance imaging (MRI) comparison (Menezes Cordeiro et al., 2013). However, research has shown that it is common for survivors of stroke to experience mental health disorders such as depression and anxiety; in fact, up to a third of survivors are eventually diagnosed with such disorders (Hackett, Yapa, Parag, & Anderson, 2005). Other mental health disorders such as delusions and hallucinations are not well documented in the literature. The purpose of this article is to gain a better understanding of delayed motor and psychological disorders in a stroke survivor.
中风后神经功能缺损极为常见。大多数患者在中风后会出现构音障碍、失语、面部无力和上肢和下肢无力(Yanagida, Fujimoto, Inoue， & Suzuki, 2015)。面部偏瘫、手臂运动无力、口齿不清或说话奇怪都是中风的警告信号，提醒患者需要紧急治疗(National Heart, Lung, and Blood Institute, 2014)。快速治疗允许脑组织更快的再灌注，限制对大脑的损伤量和患者经历的缺陷的严重程度。中风引起的神经功能障碍通常在血管堵塞或出血后几分钟出现;然而，缺血可在梗死后持续发展数天(National Heart, Lung, and Blood Institute, 2014)。迟发性运动缺陷或进行性运动缺陷(PMD)在中风后几年发展相对罕见的文献。一个值得注意的案例研究讨论了延迟的神经系统恶化，包括在脑桥出血几个月后构音障碍和共济失调的恶化(Menezes Cordeiro, Tavares,Reim,o, Geraldes， & Ferro, 2013)。这一进展归因于脑桥区域肥大面积的增加，磁共振成像(MRI)对比证实了这一点(Menezes Cordeiro等人，2013)。然而，研究表明，中风幸存者通常会经历精神健康障碍，如抑郁和焦虑;事实上，多达三分之一的幸存者最终被诊断出患有这种疾病(Hackett, Yapa, Parag， & Anderson, 2005)。其他精神疾病，如妄想和幻觉，在文献中没有很好的记录。本文的目的是为了更好地了解中风幸存者的迟发性运动和心理障碍。
{"title":"Progressive Motor Deficits and Psychosis After Stroke: A Case Presentation.","authors":"Grace Small","doi":"10.1097/JNN.0000000000000183","DOIUrl":"https://doi.org/10.1097/JNN.0000000000000183","url":null,"abstract":"N eurological deficits after a stroke are extremely common. Most patents experience dysarthria, aphasia, facial weakness, and weakness of upper and lower limbs after a stroke (Yanagida, Fujimoto, Inoue, & Suzuki, 2015). Facial hemiparesis, motor weakness of arms, and slurred or strange speech are associated as warning signs of stroke and signal the patient that urgent treatment is needed (National Heart, Lung, and Blood Institute, 2014). Fast treatment allows for quicker reperfusion of the brain tissue, limiting the amount of damage to the brain and the severity of the deficits experienced by the patient. The onset of neurological deficits from stroke is often several minutes after blockage or hemorrhage; however, deficits can continue to develop for up to several days after infarct (National Heart, Lung, and Blood Institute, 2014). Delayed motor deficits or progressive motor deficits (PMD) that develop several years after stroke are relatively rare in the literature. One notable case study discusses delayed neurological deterioration including worsening of dysarthria and ataxia several months after pontine hemorrhage (Menezes Cordeiro, Tavares,Reim,o, Geraldes, & Ferro, 2013). This progression was attributed to an increase in the area of hypertrophy in the pontine region, confirmedwithmagnetic resonance imaging (MRI) comparison (Menezes Cordeiro et al., 2013). However, research has shown that it is common for survivors of stroke to experience mental health disorders such as depression and anxiety; in fact, up to a third of survivors are eventually diagnosed with such disorders (Hackett, Yapa, Parag, & Anderson, 2005). Other mental health disorders such as delusions and hallucinations are not well documented in the literature. The purpose of this article is to gain a better understanding of delayed motor and psychological disorders in a stroke survivor.","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":"13 1","pages":"68-70"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82010767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.1097/JNN.0000000000000162
Apoorva Gopalakrishna, S. Alexander
Parkinson disease is an incredibly complex and multifaceted illness affecting millions of people in the United States. Parkinson disease is characterized by progressive dopaminergic neuronal dysfunction and loss, leading to debilitating motor, cognitive, and behavioral symptoms. Parkinson disease is an enigmatic illness that is still extensively researched today to search for a better understanding of the disease, develop therapeutic interventions to halt or slow progression of the disease, and optimize patient outcomes. This article aims to examine in detail the normal function of the basal ganglia and dopaminergic neurons in the central nervous system, the etiology and pathophysiology of Parkinson disease, related signs and symptoms, current treatment, and finally, the profound impact of understanding the disease on nursing care.
{"title":"Understanding Parkinson Disease: A Complex and Multifaceted Illness.","authors":"Apoorva Gopalakrishna, S. Alexander","doi":"10.1097/JNN.0000000000000162","DOIUrl":"https://doi.org/10.1097/JNN.0000000000000162","url":null,"abstract":"Parkinson disease is an incredibly complex and multifaceted illness affecting millions of people in the United States. Parkinson disease is characterized by progressive dopaminergic neuronal dysfunction and loss, leading to debilitating motor, cognitive, and behavioral symptoms. Parkinson disease is an enigmatic illness that is still extensively researched today to search for a better understanding of the disease, develop therapeutic interventions to halt or slow progression of the disease, and optimize patient outcomes. This article aims to examine in detail the normal function of the basal ganglia and dopaminergic neurons in the central nervous system, the etiology and pathophysiology of Parkinson disease, related signs and symptoms, current treatment, and finally, the profound impact of understanding the disease on nursing care.","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":"30 1","pages":"320-6"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81228798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-01-01DOI: 10.1097/jnn.0b013e318207b65a
V. Carroll
Managed care has been an inescapable part of healthcare for decades. We encounter it collectively as healthcare providers and individually as healthcare consumers. The ways in which managed care plans pay for services, as well as the services for which they pay, underpin the provision of almost all healthcare in the United States. Managed care options and reimbursement are critical points in the discussion of healthcare reform. Tiered copayments for prescription drugs have long been a part of insurers’ cost containment strategies, with patients paying fixed amounts from their own funds when a prescription is filled; the dollar amounts vary depending on the cost of a particular drug and whether a less expensiveVgenericValternative exists. Generic drugs were nearly always less expensive for the individual consumer because competition from generic drugs ‘‘is the most effective way of slowing the spiraling cost of pharmaceuticals’’ (AARP’s Brief Amicus Curiae, 2010). Drug copayments were traditionally divided into three tiers; copayment costs were less for Tier I drugs and more expensive for Tier 3 drugs. The incentive to choose a generic form of a drug, when available, was lower cost. Now, however, the growing number of biologic drugs available to treat cancer, immune disorders, and a variety of chronic illnessesVincluding multiple sclerosis (MS)Vhas caused some insurers to create a fourth copayment tier. This fourth tier has been introduced for drugs that are particularly expensive, and patients are being asked to pay a significantly larger ‘‘share’’ of the cost, often as much as 20%Y30% of the fixed cost of these agents. Included in the Tier 4 group are drugs like the tumor necrosis factor blocker etanercept, trastuzumab (Herceptin), the interferons, and glatiramer acetate (Copaxane). Patients who require Tier 4 drugs are likely to incur ‘‘Iout-of-pocket (OOP) expenses which far exceed what their budgets can bear’’ (Lee & Emmanuel, 2008, p. 333). Newer oral biologic agents will have no generic equivalent, will be patent protected for many years to come, and will certainly be classified as Tier 4 agents in terms of copayments. What does this mean for our patients? The evidence tells us that as OOP costs rise, adherence to therapy falls. A study reported in the Journal of Managed Care Pharmacy (Gleason et al., 2009) indicated that OOP expenses greater than $200 for MS medication were associated with increased prescription abandonment; in other words, patients simply stopped having their prescriptions filled. Their analysis of administrative claims over a 2-year period found that individuals were 8% more likely to stop therapy for every $10 increase in OOP drug costs. More than 400,000 individuals in the United States have been diagnosed with MS, and an additional 10,000+ new cases are identified annually. Adherence to current biologic treatment regimens is complicated by injection anxiety, adverse reactions to the injections, real and/or perceived l
几十年来，管理式医疗一直是医疗保健不可避免的一部分。我们作为医疗保健提供者和个人作为医疗保健消费者共同遇到它。管理式医疗计划支付服务费用的方式，以及他们支付的服务，是美国几乎所有医疗保健服务的基础。管理医疗方案和报销是讨论医疗改革的关键点。长期以来，处方药的分层共付一直是保险公司成本控制策略的一部分，当处方被填满时，患者从自己的资金中支付固定金额;金额取决于特定药物的成本以及是否存在更便宜的非专利替代品。对于个人消费者来说，仿制药几乎总是更便宜，因为来自仿制药的竞争“是减缓药品成本螺旋式上升的最有效方式”(AARP的法庭之友简报，2010)。药品共同支付传统上分为三个层次;一级药物的共付费用较低，三级药物的共付费用较高。当有仿制药时，选择仿制药的动机是更低的成本。然而现在，用于治疗癌症、免疫系统疾病和多种慢性疾病(包括多发性硬化症(MS))的生物药物越来越多，这促使一些保险公司创建了第四个共同支付级别。第四层是针对那些特别昂贵的药物，病人被要求支付更大的费用“份额”，通常高达这些药物固定成本的20%至30%。第4级包括肿瘤坏死因子阻滞剂依那西普、曲妥珠单抗(赫赛汀)、干扰素和醋酸格拉替默(Copaxane)等药物。需要第4级药物的患者可能会产生“自费(OOP)费用，远远超过他们的预算可以承受”(Lee & Emmanuel, 2008, p. 333)。较新的口服生物制剂将没有仿制药，将在未来许多年受到专利保护，并且在共同支付方面肯定会被归类为第4级制剂。这对我们的病人意味着什么?证据告诉我们，随着OOP成本的上升，对治疗的依从性下降。《管理护理药学杂志》(Journal of Managed Care Pharmacy, Gleason et al.， 2009)报道的一项研究表明，MS药物的OOP费用超过200美元与处方放弃增加有关;换句话说，病人只是停止了他们的处方。他们对两年时间内行政索赔的分析发现，面向对象的药物费用每增加10美元，个体停止治疗的可能性就增加8%。在美国，有超过40万人被诊断患有多发性硬化症，每年还有1万多例新病例被确诊。注射焦虑、注射不良反应、实际和/或感知的疗效不足以及成本，使当前生物治疗方案的依从性变得复杂。在治疗的前6个月，停药或放弃率在9%至20%之间(Lipsy, 2010)。随着较新的口服生物制剂进入治疗领域和市场，患者将能够选择一种不需要注射的药物，这对维持治疗的依从性具有巨大的积极作用。不利的一面是，这些药物将在许多年内没有通用(更便宜)的形式，并将以第4级共同支付进入市场。作为神经科学的护士，我们如何在这一正在展开的经济场景中发挥作用?我们可以倡导更好、更具成本效益的治疗。我们可以争取改变食品和药物管理局批准仿制药配方的程序。我们可以游说修改分层共付结构。我们可以教病人和家属以促进最佳结果的方式照顾自己。作为医疗保健提供者和个人消费者，我们可以积极参与更广泛的讨论，讨论我们将如何应对总体上不断上涨的医疗保健成本。套用黄金法则，我们应该“以我们希望被管理的方式来管理他人”。
{"title":"How will we manage?","authors":"V. Carroll","doi":"10.1097/jnn.0b013e318207b65a","DOIUrl":"https://doi.org/10.1097/jnn.0b013e318207b65a","url":null,"abstract":"Managed care has been an inescapable part of healthcare for decades. We encounter it collectively as healthcare providers and individually as healthcare consumers. The ways in which managed care plans pay for services, as well as the services for which they pay, underpin the provision of almost all healthcare in the United States. Managed care options and reimbursement are critical points in the discussion of healthcare reform. Tiered copayments for prescription drugs have long been a part of insurers’ cost containment strategies, with patients paying fixed amounts from their own funds when a prescription is filled; the dollar amounts vary depending on the cost of a particular drug and whether a less expensiveVgenericValternative exists. Generic drugs were nearly always less expensive for the individual consumer because competition from generic drugs ‘‘is the most effective way of slowing the spiraling cost of pharmaceuticals’’ (AARP’s Brief Amicus Curiae, 2010). Drug copayments were traditionally divided into three tiers; copayment costs were less for Tier I drugs and more expensive for Tier 3 drugs. The incentive to choose a generic form of a drug, when available, was lower cost. Now, however, the growing number of biologic drugs available to treat cancer, immune disorders, and a variety of chronic illnessesVincluding multiple sclerosis (MS)Vhas caused some insurers to create a fourth copayment tier. This fourth tier has been introduced for drugs that are particularly expensive, and patients are being asked to pay a significantly larger ‘‘share’’ of the cost, often as much as 20%Y30% of the fixed cost of these agents. Included in the Tier 4 group are drugs like the tumor necrosis factor blocker etanercept, trastuzumab (Herceptin), the interferons, and glatiramer acetate (Copaxane). Patients who require Tier 4 drugs are likely to incur ‘‘Iout-of-pocket (OOP) expenses which far exceed what their budgets can bear’’ (Lee & Emmanuel, 2008, p. 333). Newer oral biologic agents will have no generic equivalent, will be patent protected for many years to come, and will certainly be classified as Tier 4 agents in terms of copayments. What does this mean for our patients? The evidence tells us that as OOP costs rise, adherence to therapy falls. A study reported in the Journal of Managed Care Pharmacy (Gleason et al., 2009) indicated that OOP expenses greater than $200 for MS medication were associated with increased prescription abandonment; in other words, patients simply stopped having their prescriptions filled. Their analysis of administrative claims over a 2-year period found that individuals were 8% more likely to stop therapy for every $10 increase in OOP drug costs. More than 400,000 individuals in the United States have been diagnosed with MS, and an additional 10,000+ new cases are identified annually. Adherence to current biologic treatment regimens is complicated by injection anxiety, adverse reactions to the injections, real and/or perceived l","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":"94 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83267364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.1097/JNN.0B013E3181D4A37F
R. Schwartz
Huntington's disease (HD) is a progressive neurogenetic disorder that has a 50% inheritance rate. The ability to have 100% confirmation of the illness became a reality with the discovery of the gene in 1993. The effect of confirmatory testing and the issues faced by the individual and the family facing diagnosis have not been addressed. The purpose of this research study was to explore the meaning of being diagnosed with HD using narrative inquiry. Ten participants, during the first year of diagnosis, were asked to tell their story of what it meant to be diagnosed with HD. A holistic-content approach was used for data analysis. An integrated narrative, "The Story of HD: Ripples From a Stone Skipping Across the Lake," was created from the stories. The stories were analyzed for plot, predicaments, protagonist, and antagonist. The predicaments of "discovering the existence of HD," "confirming the diagnosis of HD," "revealing the diagnosis to others," and "experiencing the reverberations of HD" served as the main chapters that formed the structure of the stories. Each predicament contains a set of themes that function as subheadings for the chapters. In the final chapter or epilogue, participants were asked to reflect on the meaning of being diagnosed with HD. The psychological impact of receiving a positive genetic diagnosis has implications for patients and their extended families. Nurses should develop their understanding of the role of genetics in healthcare today. Clinical evaluations of the effectiveness of treatments and assessment for changes in mood, behavior, and motor function are an essential part of nursing care. Advocacy and supportive roles must be incorporated into the patient visit. Patient education material on home safety, nutrition, medication management, and general health practices should be provided during the outpatient visits. Through the development of a more comprehensive role, the nurse can assist patients and families in finding the personal meaning of being diagnosed.
{"title":"Ripples from a stone skipping across the lake: a narrative approach to the meaning of Huntington's disease.","authors":"R. Schwartz","doi":"10.1097/JNN.0B013E3181D4A37F","DOIUrl":"https://doi.org/10.1097/JNN.0B013E3181D4A37F","url":null,"abstract":"Huntington's disease (HD) is a progressive neurogenetic disorder that has a 50% inheritance rate. The ability to have 100% confirmation of the illness became a reality with the discovery of the gene in 1993. The effect of confirmatory testing and the issues faced by the individual and the family facing diagnosis have not been addressed. The purpose of this research study was to explore the meaning of being diagnosed with HD using narrative inquiry. Ten participants, during the first year of diagnosis, were asked to tell their story of what it meant to be diagnosed with HD. A holistic-content approach was used for data analysis. An integrated narrative, \"The Story of HD: Ripples From a Stone Skipping Across the Lake,\" was created from the stories. The stories were analyzed for plot, predicaments, protagonist, and antagonist. The predicaments of \"discovering the existence of HD,\" \"confirming the diagnosis of HD,\" \"revealing the diagnosis to others,\" and \"experiencing the reverberations of HD\" served as the main chapters that formed the structure of the stories. Each predicament contains a set of themes that function as subheadings for the chapters. In the final chapter or epilogue, participants were asked to reflect on the meaning of being diagnosed with HD. The psychological impact of receiving a positive genetic diagnosis has implications for patients and their extended families. Nurses should develop their understanding of the role of genetics in healthcare today. Clinical evaluations of the effectiveness of treatments and assessment for changes in mood, behavior, and motor function are an essential part of nursing care. Advocacy and supportive roles must be incorporated into the patient visit. Patient education material on home safety, nutrition, medication management, and general health practices should be provided during the outpatient visits. Through the development of a more comprehensive role, the nurse can assist patients and families in finding the personal meaning of being diagnosed.","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":"49 1","pages":"157-68"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85103709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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