Innovative approaches within primary care are needed to reduce fragmented care, increase continuity of care, and improve asthma outcomes in children with asthma. Our objective was to assess the impact of coordinated team-based asthma care on unplanned asthma-related health care utilization. A multidisciplinary asthma team was developed to provide coordinated care to high-risk asthma patients. Patients received an in-depth diagnostic and family needs assessment, asthma education, and coordinated referral to social and community services. Over a 2-year period, 141 patients were followed. At both 1 and 2 years postintervention, there was a significant decrease from preintervention rates in urgent care visits (40%, P = .002; 50%, P < .0001), emergency department visits (63%, P < .0001; 70%, P < .0001), and inpatient hospitalization (69%, P = .002; 54%, P = .04). Our coordinated asthma care program was associated with a reduction in urgent care visits, emergency department visits, and inpatient hospitalizations among high-risk children with asthma.

There is growing emphasis on using patient-reported outcome measures to enhance clinical practice. This study was a retrospective review of scores on the Childhood Asthma Control Test (C-ACT) and the Pediatric Symptom Checklist-17 (PSC-17) at a pediatric primary care center in Boston, Massachusetts. A total of 218 patients were selected at random using billing codes for well-child (WC) care and asthma, excluding complex medical conditions. Cutoff scores were used to identify uncontrolled asthma (C-ACT ⩽19) and clinically significant psychosocial symptoms (+PSC-17). Multiple logistic regression was used to measure associations between C-ACT ⩽19 and +PSC-17, adjusting for covariates. In multivariable analysis, C-ACT ⩽19 at WC visits was associated with +PSC-17 at WC visits (adjusted odds ratio = 3.2 [95% confidence interval = 1.3-8.6]). C-ACT ⩽19 at non-WC visits was also associated with +PSC-17 at WC visits (adjusted odds ratio = 3.1 [95% confidence interval = 1.2-8.9]). Patient-reported outcome measures of asthma control and psychosocial symptoms were positively correlated in this sample.

No abstract

Perioperative nurses commonly care for patients with changes in mental status, especially elderly patients. Three common mental status disorders in the elderly are delirium, depression, and dementia. Each of the disorders can have similar clinical presentations. Despite similarities, the appropriate nursing interventions may vary significantly. Interventions discussed in this article focus on the etiology of the presenting problem and the nursing interventions that will promote the most positive outcome for the patient.

Using nontraditional therapies to replace traditional medical treatment is becoming more popular in the United States. Nurses in the twenty‐first century are faced with the challenge of broadening their view of health care and discovering the benefits of nontraditional, often ancient, health care principles and practices. Health care professionals and patients need to understand, however, that although a nontraditional therapy may be natural or noninvasive, it is not necessarily safe and without consequences. This article discusses the increased use of nontraditional therapies among older adults with a focus on the use and perioperative implications of botanical, herbal, and nutritional supplements. AORN J 77 (May 2003) 913–922.