Survey of finance companies, 2000

Against a backdrop of robust economic activity, the finance company sector expanded briskly over the second half of the 1990s. The value of receivables held by finance companies in the United States rose nearly 50 percent, or about 11 percent a year, between 1996 and 2000. Business lending remained finance companies' major line of activity; the importance to the sector of consumer lending and leasing declined slightly, and the importance of real estate lending rose a bit. These and other findings from the Federal Reserve's mid-2000 benchmark survey of finance companies, as well as developments in the sector since that time, are discussed in this article.Finance companies

Discharge Teaching, Readiness for Discharge, and Post-discharge Outcomes in Parents of Hospitalized Children

Purpose This study explored the sequential relationships of parent perceptions of the quality of their discharge teaching and nurse and parent perceptions of discharge readiness to post-discharge outcomes (parental post-discharge coping difficulty, readmission and emergency department visits). Design/methods In this secondary analysis of data from a longitudinal pilot study of family self-management discharge preparation, the correlational design used regression modeling with data from a convenience sample of 194 parents from two clinical units at a Midwest pediatric hospital. Data were collected on the day of discharge (Quality of Discharge Teaching Scale; Readiness for Hospital Discharge Scale), at 3 weeks post-discharge (Post-Discharge Coping Difficulty Scale), and from electronic records (readmission, ED visits). Results Parent-reported quality of discharge teaching delivery (the way nurses teach), but not the amount of content, was positively associated with parent perception (B = 0.54) and nurse assessment (B = 0.16) of discharge readiness. Parent-reported discharge readiness was negatively associated with post-discharge coping difficulty (B = − 0.52). Nurse assessment of discharge readiness was negatively associated with readmission; a one point increase in readiness (on a 10 point scale) decreased the likelihood of readmission by 52%. Conclusion There is a sequential effect of quality of discharge teaching delivery on parent discharge readiness, which is associated with parent coping difficulty and child readmission. Practice Implications Efforts to improve discharge outcomes should include strategies to build nurse teaching skills for high-quality delivery of discharge teaching. In addition, routine nurse assessment of discharge readiness can be used to identify children at risk for readmission and trigger anticipatory interventions

Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure

INTRODUCTION: There is a 70% higher age-adjusted incidence of heart failure (HF) among Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths as among non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community health care to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing.  METHODS: This study was conducted in two phases and utilised a mixed-methods approach (qualitative and quantitative). Phase 1 used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. An HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources, and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made.  RESULTS: Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this, and members of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. Phase 2: Five Aboriginal participants, mean age 61.6±10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0±6.7% to 58.0±9.7%, a 20.8% increase, and results of the self-care index indicated that the biggest change was in patient confidence for self-care, with a 95% increase in confidence score (46.7±16.0 to 91.1±11.5). Changes in management and maintenance scores varied between patients.  CONCLUSIONS: By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence

Parental mastery of continuous subcutaneous insulin infusion skills and glycemic control in youth with type 1 diabetes

OBJECTIVE: The purpose of this study is to determine whether parental knowledge of the continuous subcutaneous insulin infusion (CSII) device affects glycemic control as measured by hemoglobin A1c (A1C) level. SUBJECTS AND METHODS: Parents of children with type 1 diabetes mellitus (T1DM) using CSII completed a 14-item questionnaire. Questions 1-10 were knowledge-based questions that required the parent to extract specific information from their child\u27s CSII device. Questions 11-14 asked parents to provide a self-assessment of their CSII knowledge. RESULTS: Twenty-two parents of youth with T1DM participated in the study. Ten of the youth were in the Low-A1C group (A1C/=8%). Parents of youth in the Low-A1C group scored statistically better on the 10-item performance survey than parents of youth in the High-A1C group. Most of the parents of children in the Low-A1C group responded that they knew their child\u27s insulin pump very well and that their pump knowledge had increased since their child started on the insulin pump. CONCLUSIONS: Our findings reveal that youth with T1DM whose parents are more knowledgeable about pump functions have optimal glycemic control as evidenced by A1C. These findings underscore the importance of ongoing pump training for both pediatric patients and their parents

Development of a Self‐Management Theory‐Guided Discharge Intervention for Parents of Hospitalized Children

Background Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self‐management of their child\u27s care at home after discharge. Problem No theory‐based discharge intervention exists to guide pediatric nurses\u27 preparation of parents for discharge. Purpose To develop a theory‐based conversation guide to optimize nurses\u27 preparation of parents for discharge and self‐management of their child at home following hospitalization. Methods Two frameworks and one method influenced the development of the intervention: the Individual and Family Self‐Management Theory, Tanner\u27s Model of Clinical Judgment, and the Teach‐Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine‐domain conversation guide for use in acute care pediatric hospitals. Conclusions The theory‐based intervention operationalized self‐management concepts, added components of nursing clinical judgment, and integrated the Teach‐Back method. Clinical Relevance Development of a theory‐based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention

The Importance of Social Cues for Discretionary Health Services Utilization: The Case of Infertility

Infertility is a discretionary health condition; although it carries with it important life course implications, treatment is rarely necessary for health reasons. Sociological theories of medical help-seeking emphasize demographic factors, perceived need, and enabling conditions in health services utilization, but we find that social cues are also strongly associated with health services utilization for infertility. Adjusted for conventional predictors of medical help-seeking, several social cue indicators have significant associations with utilization, including having friends and family with children, perceiving infertility stigma, and having a partner and/or family member who encourages treatment. Perceived need accounts for the largest portion of the variation in utilization. Enabling conditions explain less of the variance than social cues. Social cues should be especially important for discretionary health services utilization. Studies of service utilization for discretionary health conditions should explicitly incorporate a range of measures of social cues into their models

Collection Development Policy, Digital Commons Institutional Repository, University of Nebraska–Lincoln Libraries

Purpose of the University of Nebraska-Lincoln Digital Commons Institutional Repository Collection Development Policy This collection development policy is intended to provide guidance for content selection that anticipates and meets the needs of the communities of the University of Nebraska–Lincoln (UNL). It directly relates to the library\u27s vision statement and defines the scope and standards that guide the services that generate the collection. Purpose of the UNL Digital Commons Institutional Repository The UNL institutional repository (IR) comprises services that result in the stewardship and global online dissemination of content created and selected by UNL authors and affiliates. With the aim of contributing to the broader world of scholarship and facilitating discovery, the repository reflects the intellectual life of the institution. The IR drives a significant level of Web traffic to UNL. As such, the IR may serve as a promotional and marketing tool for authors, programs, and the university as a whole

Seven Years of ACTS Technology Verification Experiments Reviewed

The Advanced Communications Technology Satellite (ACTS) was designed to achieve a 99.5-percent system availability rate and signals with less than one error in 10(exp 7) bits throughout the continental United States. To accomplish such a high rate of system availability, ACTS uses multiple narrow hopping beams and very small aperture terminal (VSAT) technology. In addition, ACTS uses an adaptive rain fade compensation protocol to reduce the negative effects of propagation on the system. To enhance knowledge on how propagation and system variances affect system availability, researchers at the NASA Glenn Research Center at Lewis Field performed technology verification experiments over a 7-yr period (from September 1993 to the present). These experiments include T1VSAT System Availability, Statistical Rain Fade Compensation Characterization, Statistical Characterization of Ka-Band Propagation Effects on Communication Link Performance, and Multibeam Antenna Performance