Two Different Primary Care Approaches for Caring for People With Dementia and Their Families

This study explored an established primary careebased dementia pathway in New Zealand (NZ) and nurse practitioner dementia diagnosis and care in 1 small United States state that has adopted a value-based de- livery model. Central to the NZ model was the education of primary care providers, clear delineation of specialists’ support and referral pathways, and routine and predictable family carer respite. The US re- spondents reported that the essential resources necessary to support the diagnosis and management of dementia were lacking. The primary care of older adults may increasingly be provided by nurse practitioners in the US, and the structured NZ pathway offers a promising approach to adopt in the US. Potential strategies for implementation are detailed

A National Dementia Care Pathway Explored

Background: A national, systematic diagnosis and care pathway has the potential to alleviate pressing challenges experienced by individuals with dementia, their carers, and healthcare providers. International exemplars were sought to compare/contrast dementia care with current practice in the United States (US). The 2013 New Zealand (NZ) Framework for Dementia Care was explored. The aim was to understand this systematic, primary care-led, home- and community-focused dementia management approach from the perspective of those delivering care. Providers in one US state were similarly studied. Method: Maximum variation purposive sampling was used in this qualitative descriptive study of 28 participants (18 New Zealand, 10 United States). Semi-structured interviews were used, with recruitment of participants continuing until data saturation was reached. Data were then explored for themes using qualitative content analysis. Results: National standards in NZ provide a progressive pathway grounded in early primary care diagnosis and adaptable teams that foster caregiver support to decrease their burden. The approach also ensures streamlined access to specialists. This is in contrast to the US, where a reactive rather than proactive approach requires providers to navigate unpredictability as they strive to weave together insufficient, inadequate, inconsistent, and inequitable resources to provide families with foundations for an uncertain future. Conclusion: Compared to the US where only 2.12% of the Medicare spend is on primary care, NZ has a strong primary care foundation. Exploring total cost care models, some states have the capacity to redesign primary care for dementia management within practice and community settings and should take action

Pregnancy rhinitis and rhinitis medicamentosa.

PURPOSE: To present guidelines for the recognition, management, and referral of pregnancy rhinitis with a goal of improving the quality of the pregnancy experience for women afflicted with this condition. DATA SOURCES: A case study illustrating the presentation of a severe case of pregnancy rhinitis is followed a literature review of etiology, diagnosis, and management strategies. CONCLUSIONS: Pregnancy rhinitis is a condition of clinical importance that is frequently exacerbated by use of intranasal decongestant sprays. The resulting rhinitis medicamentosa exacerbates the nasal obstruction, with resulting sleep disruptions that negatively impact the experience of pregnancy. IMPLICATIONS FOR PRACTICE: Nurse practitioners may miss opportunities to provide support, anticipatory guidance, and symptom relief. Anticipatory guidance that stresses the critical necessity of avoiding nasal spray decongestants, environmental modification, use of intranasal saline, moderate exercise, and nasal strips for subjective relief may have the potential to markedly decrease escalation of the condition to a serious disorder

Global Partnerships: An Exploration of Inter-Institutional Research Collaboratives

Society?s most pressing challenges are increasingly global in scale, creating the need for partnerships unconstrained by disciplinary, institutional, or national boundaries. Partnerships across countries, in particular, can gather critical intellectual and material resources to fill institutional gaps and offer complementary strengths. In this context, Betty Rambur is exploring research partnerships that cross national boundaries to determine how to most effectively develop, nourish, and sustain them. She will share preliminary findings from her study, which examines collaborations from the perspective of individuals at different ranks, in several nations, and in an array of institutional types. She will illustrate the languages necessary for ongoing collaboration and present an emerging model for participants to review and critique

Ethics, Economics, and the Erosion of Physician Authority: A Leadership Role for Nurses

The emergence of managed care raises new concerns about the ethics of health care financing and its impact on service delivery. The current outcry, however, fails to recognize that American health care financing has presented serious ethical dilemmas for at least 50 years. What follows is a historic overview of American health care financing, contrasted with current challenges. The intersection between ethics, economics, professionalism, and public authority is explicated, with a critical leader/advocate role for nurses presented

Fostering evidence-based practice in nursing education

Accountability for outcomes is a fundamental responsibility of professional nurses. Central to such accountability is the ability to critique existing practice patterns, discriminate between alternative and often conflicting information, and demonstrate sound decision making in a manner that can be empirically supported. Although evidence-based nursing practice offers a framework to support these activities, long-standing patterns impede using a more scientifically based approach to patient care. These barriers are reinforced by the sheer volume of information and conflicting worldviews that characterize the postmodern era. Teaching and learning strategies to address the challenge of evidence-based nursing practice in the information age are offered for review and possible adoption by nurse educators. Copyright © 1999 by W.B. Saunders Company

Understanding the Culture of Research Collaboration: An Exploration of Transnational Partnerships

Global partnerships with multi-national teams are increasingly referenced as a means to approach the world?s most pressing problems. This interactive session details an empirically derived conceptual framework that describes seven distinct types of inter-institutional, multinational research partnerships along a range of increasing faculty risk, decreasing stability, increasing human factors with compounding interaction costs, and increasing time to research outputs. Participants will critique the framework and discuss applications and implications in reference to their fields and institutions. This presentation is part of the Ideas and Universities International Video Seminar Series. The program theme for the spring 2008 semester is "Universities as Organizations: Looking Inwards, Looking Outwards.

Sudden hearing loss

The condition of “sudden hearing loss” is characterized by an abrupt and usually unilateral reduction of hearing. The loss may affect any frequency and may range from mild to profound in degree. This type of hearing loss causes particular difficulty in assessment because several chronic conditions may manifest similar initial symptoms. Sudden hearing loss is an emergency which demands astute recognition and a prompt otolaryngological referral. The key to prompt recognition in the primary care setting includes the maintenance of a high index of suspicion accompanied by a thorough and accurate patient history. © Williams and Wilkins 1989. All Rights Reserved