The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses最新文献

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"title":"Insight and imagination.","authors":"V. Carroll","doi":"10.1097/jnn.0b013e3181da4131","DOIUrl":"https://doi.org/10.1097/jnn.0b013e3181da4131","url":null,"abstract":"How are humans different from other animals? What unique characteristics set us apart from other mammals? Language? Many other mammalsV dolphins, chimps, dogsVcommunicate in meaningful ways with each other. Tools? Again, many other mammals use tools in their every day lives. Emotions? We observe behaviors in other mammals that appear similar to human emotion. The Public Broadcasting System recently aired a seriesVBThe Human Spark[Vthat examines these questions. In the three-part series, host Alan Alda joins neuroscientists, archeologists, and primatologists as they try to explain the nature of Bhuman uniqueness.[Using state-of-the-art, high-tech imaging techniques as well as low-tech but scientifically sound laboratory studies of primates, dogs, and human children, scientists examine the ways in which we are similar and those in which we differ. Some of the early evidence of human uniqueness exists in the cave paintings found in southern France. Thirty thousand years ago, our Neanderthal predecessors created extraordinary art that demonstrates imagination, representational thinking, and perhaps a sense of spirituality that we share. Archeological evidence indicates that the Neanderthals lived cooperatively within some sort of social network. However, the Neanderthal line did not survive, leading scientists to ask what really makes us different. Brain size alone? Spoken language or other means of social communication? Better cognitive sequencing? Alda observed the chimps and participated in experiments with them; he and the researchers studying these primates observed the continuity and discontinuity between their skills and ours. Chimps Bmake[ tools and use them efficiently, but they do not save the tools for future, repeated use as we do. Chimps live in social networks that include empathy and cooperation, but these traits are limitedVfor example, sharing food rewards occurs rarely despite nonverbal cues from others in the network. They do not seem to attend to the concerns of others in the group; social understanding is limited. The story of the FOXP2 gene may explain how we made the neurological Bjump[ that explains our uniqueness. Human cognition and abstract thought rely on language. In 1995, Vargha-Khadem et al. published an article that investigated a familial language disorder, a verbal apraxia, linked to a bilateral reduction in the size of affected individuals’ caudate nucleus. Six years later, other researchers announced that they had linked a mutation in a single gene to this language disorder. Named FOXP2, this gene contains a forkhead domain that facilitates transcription fromDNA to RNA. Human FOXP2 differs from chimp FOXP2 in two amino acids; these mutations occurred between 10,000 and 100,000 years ago and have been critical for the development of human speech and the evolution of languageVcritical components of human uniqueness. Language and speech provide us with representational thinking and the ability to conceptualize what ot","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73825072","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}

{"title":"\"Once upon a time...\"--narrative in nursing.","authors":"V. Carroll","doi":"10.1097/jnn.0b013e3181ee513e","DOIUrl":"https://doi.org/10.1097/jnn.0b013e3181ee513e","url":null,"abstract":"","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90175092","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}

{"title":"Leading by example...and with evidence.","authors":"V. Carroll","doi":"10.1097/jnn.0b013e3181f961b6","DOIUrl":"https://doi.org/10.1097/jnn.0b013e3181f961b6","url":null,"abstract":"","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83978576","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}

{"title":"Research and quality improvement activities: when is institutional review board review needed?","authors":"M. McNett, K. Lawry","doi":"10.1097/JNN.0B013E3181B7052E","DOIUrl":"https://doi.org/10.1097/JNN.0B013E3181B7052E","url":null,"abstract":"","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88782088","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}

{"title":"Oh, nurse, where art thou?","authors":"V. Carroll","doi":"10.1097/jnn.0b013e3181a41eeb","DOIUrl":"https://doi.org/10.1097/jnn.0b013e3181a41eeb","url":null,"abstract":"","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88539406","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}

{"title":"Healthcare reform--the time is now.","authors":"V. Carroll","doi":"10.1097/jnn.0b013e31819c48fd","DOIUrl":"https://doi.org/10.1097/jnn.0b013e31819c48fd","url":null,"abstract":"","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80984591","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}

{"title":"DBS: uncharted territory--a nurse's perspective.","authors":"Beka Serdans","doi":"10.1097/JNN.0B013E318193457C","DOIUrl":"https://doi.org/10.1097/JNN.0B013E318193457C","url":null,"abstract":"","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76021895","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}

{"title":"Neuroscience nursing: where do we go from here?","authors":"J. Woods","doi":"10.1097/01376517-200812000-00002","DOIUrl":"https://doi.org/10.1097/01376517-200812000-00002","url":null,"abstract":"","PeriodicalId":94240,"journal":{"name":"The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77504308","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}