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This paper describes a user-friendly, Excel spreadsheet model and two data collection instruments constructed by the authors to help states and districts perform cost-benefit analyses of school nursing services delivered by full-time school nurses. Prior to applying the model, states or districts need to collect data using two forms: “Daily Nurse Data Collection Form” and the “Teacher Survey.” The former is used to record daily nursing activities, including number of student health encounters, number of medications administered, number of student early dismissals, and number of medical procedures performed. The latter is used to obtain estimates for the time teachers spend addressing student health issues. Once inputs are entered in the model, outputs are automatically calculated, including program costs, total benefits, net benefits, and benefit-cost ratio. The spreadsheet model, data collection tools, and instructions are available at the NASN website ( http://www.nasn.org/The/CostBenefitAnalysis ).

Asthma and diabetes are major chronic conditions in the United States, particularly in the Medicaid population. The majority of care for these diseases occurs at ambulatory practice sites. The New York State Department of Health Office of Health Insurance Programs (OHIP) worked with IPRO, the New York State Medicare quality improvement organization, to develop and implement a quality improvement project (QIP) for these conditions. The approach was based upon the Chronic Care Model and used an iterative academic-detailing methodology. Clinics and community health centers volunteered to participate and used IPRO-collected data with audit and feedback to improve their practices. Several metrics significantly improved for asthma (e.g., use of anti-inflammatory long term controller agents, assessment of asthma severity, use of asthma action plans) and for diabetes (e.g., lipid testing and control, A1c testing). Key organizational elements of success included senior medical leadership commitment and practice site quality improvement team meetings. OHIP has used the QIP experience to begin patient-centered medical home implementation in New York State.

School nurses have demonstrated a keen interest in research and the research process with the purpose of generating evidence that supports their practice and increases the value of school nursing services. This article will help school nurses to formulate research questions and to identify the components of the research question that delineate the next steps in the development of a research study from such questions. School nurses benefit from collaborating with experienced nurse researchers in order to gain competence in defining research questions.

Objectives: It is standard practice to use lignocaine gel during male urethral catheterization. However, it is commonly believed that topical anaesthetic confers no benefit during female catheterization hence lubricating gel alone is more commonly used. The present study aimed to determine whether lignocaine gel decreased pain compared with water-based lubricating gel for female urethral catheterization in the ED. Methods: This randomized double-blinded study was carried out at two Sydney hospitals – an urban district inner western hospital and a south-western major trauma centre. A convenience sample of 62 alert, cooperative adult female ED patients provided written informed consent. The indications for, and technique of catheterization, were at the discretion of the clinical staff. Pre- and immediate post-procedure pain was scored by the patient on a 100 mm Visual Analogue Scale (VAS). The primary outcome was the difference in VAS scores (post- minus pre-procedure) in millimetres. Values for each group were expressed as medians and interquartile ranges, statistical significance determined using the Mann–Whitney U-test. Results: The groups were well matched for age, indication for catheterization, pre-procedural pain score, catheter size and the number of catheterization attempts. Patients receiving lignocaine gel had a significantly lower median procedural pain score than patients receiving lubricating gel (6 mm vs 33 mm, P = 0.007). Conclusions: Lignocaine gel substantially reduces the procedural pain of female urethral catheterization by comparison with use of a water-based lubricating gel.

Objective To describe the quantity and type of school health services provided by nurses in Boston Public Schools. Setting In 2001, the 63 024 students enrolled predominantly belonged to minority groups (48% black, 28% Hispanic, and 9% Asian) and were eligible for a free or reduced-price lunch (71%). Main Outcome Measure Analysis of the 2001-2002 Boston Public Schools Health Services database. Results A total of 63 024 students generated 721 291 individual encounters with 93.5 full-time equivalent school nurses, including episodic care (57.8%), medication administration (31.5%), procedures (6.2%), and screening (5.1%). A total of 2420 students had an individual health care plan for the administration of medications and procedures during the school day. Students with individual health care plans averaged 117.9 encounters per year with school nurses, and students without averaged 7.2 encounters per year. Outcomes of encounters included school dismissal (3.0%); verbal communication with parents (10.6%), school staff (3.9%), and community agencies or health care providers (1.1%); and referral to a primary care provider (4.6%) or emergency services ( Conclusions Some school-age children receive a large amount of health care from school nurses in Boston Public Schools. We estimate that these children are 8 times more likely to see a school nurse than a pediatric health care provider. These school nurses were involved in the care of children with mental health and chronic health care needs. Despite the extensive amount of care, little is known about the efficacy of the care provided or the effect of these services on health care use.

Poor performance and fraudulent tactics in the automobile repair business consistently head the list of consumer complaints in the United States. Numerous studies have attempted to determine the extent of dishonest acts in auto repair work, but they have suffered from methodological difficulties. This paper is based on examination of 313 repair facilities to whom a battery was presented for testing. Characteristics of honest and dishonest facilities are compared; so too are the attitudes expressed by their managers. A weak association was found between honesty and the size of a business and between honesty and the dealer's view of the severity of punishment. The battery test is said to offer a notable opportunity for continuing and comparative studies of the work of auto repair facilities.

Government rosters of physicians suspended from the Medicare and Medicaid programs because of fraud and abuse indicate that psychiatrists form a disproportionately large segment of the total. Of the factors contributing to this situation, the most notable is that because psychiatrists charge for time rather than for services, they are more readily apprehended if they violate the rules. The authors speculate on whether in fact psychiatrists break the law more than physicians in other-specialties or whether the statistics are purely artifactual.

From the Public Policy Research Organization, University of California, Irvine, California. Supported by a grant from the National Institute of Justice, U.S. Department of Justice (82-1J-CX-0035). An earlier version of this paper was presented at the Meetings of the Academy of Criminal Justice Sciences, Chicago, IL, March 28, 1984. Address correspondence to: Henry N. Pontell, PhD, Program in Social Ecology, University of California, Irvine, CA 92717.