Client and Caregiver Perceptions of Adult Day Services: A Program Evaluation

The MJCCA Weinstein Center for Adult Days Services provides social activities and medical services to older adults, including individuals with memory loss. Center administrators requested a program evaluation to explore attraction and retention of clients, beneficial effects of Center activities, and the current case management program. Regular members of the Center’s Traditional Group (n=14) and family caregivers of Memory Loss program attendees (n=10) participated in open-ended interviews in focus groups. Content analysis revealed that clients consider Center activities, staff, and social environment superior to the few other day care alternatives. The activities benefit clients primarily physically and emotionally. Potential areas of improvement include enhanced communication with caregivers and more engaging, mentally-stimulating activities personally significant to participants. Findings reveal that person-centered care is appropriate in the adult day service setting and may guide the Center in program modifications. The evaluation partially satisfies new rules in Georgia for licensure and quality assurance

Meeting Patients Where They Are: A Review of Buprenorphine Administration in the Emergency Department

Background Opioid overdose deaths continue to rise, with over 500,000 people dying in the past twenty years. Associated mortality is high following an opioid-related emergency department visit, which has significantly increased over the years. As the opioid epidemic enters its fourth wave, it positions emergency department clinicians to offer treatment and linkage to care at a critical time for the underlying disease, opioid use disorder (OUD). Objective Clinical review of the efficacy of buprenorphine initiation for treating patients with OUD following an opioid overdose in the emergency department. Discussion Current literature supports that emergency department-initiated buprenorphine is safe and effective, with superior adherence to addiction treatment programs following initiation. In a review of randomized controlled trials assessing continued addiction treatment at 30 days post-initiation, one reported that 78% of patients taking buprenorphine continued treatment, compared to 37% of patients who provided treatment referrals only. Compared to clonidine, patients administered buprenorphine also had a higher rate of continued therapy at 30 days. When evaluating patients 60 days post-initiation, one study showed that significantly more patients taking buprenorphine remained in treatment compared to patients that received a treatment referral or brief intervention within the ED (74% vs. 53% vs. 47%, respectively). Conclusions Buprenorphine has been proven safe and effective in treating OUD for decades; recent literature supports treatment initiation within the ED, identifying patients at elevated risk, and involving them in care prior to discharge. In a worsening opioid epidemic, emergency department treatment standards are quickly progressing. Further research is needed to guide protocol design and remaining barriers affecting or obstructing the broad implementation of ED-administered buprenorphine for treating OUD following an opioid overdose or opioid-related ED visit

Sifting through Truth, Lies and Politics: Evaluating Country Conditions in Asylum Claims on the U.S. Courts of Appeals

This presentation was given at the Annual Meeting of the Midwest Political Science Association

Evaluation of Ribavirin-Poloxamer Microparticles for Improved Intranasal Absorption

Ribavirin is a water-soluble antiviral compound which, owing to its inability to cross the blood-brain barrier, has limited effectiveness in treating viruses affecting the central nervous system. Direct nose-to-brain delivery was investigated for ribavirin in combination with poloxamer 188, an excipient known to enhance the absorption of drug compounds administered intranasally. Composite solid microparticles suitable for intranasal insufflation were prepared by suspending fine crystals of ribavirin in a matrix of poloxamer 188, which were cryogenically milled and characterized to ensure that ribavirin remained stable throughout preparation. In vitro diffusion of ribavirin across a semi-permeable regenerated cellulose membrane showed comparable cumulative drug release after 180 min from both fine solid particles (\u3c20 \u3eµm) and 1:1 ribavirin:poloxamer microparticles (d = 20 µm); however, the initial release from polymer microparticles was slower, owing to gel formation on the membrane surface. When solid ribavirin was directly deposited on excised olfactory mucosa, either as fine drug particles or 1:1 ribavirin:poloxamer microparticles, permeation was significantly increased from microparticles containing poloxamer 188, suggesting additional interactions between the polymer and olfactory mucosa. These data indicate that for highly water-soluble drugs such as ribavirin or drugs subject to efflux by the nasal mucosa, a formulation of poloxmer-containing microparticles can enhance permeability across the olfactory epithelium and may improve direct nose-to-brain transport

Comparing contents of outcome measures in cerebral palsy using the International Classification of Functioning (ICF-CY): a systematic review.

The International Classification of Functioning children and youth version (ICF-CY) provides a universal framework for defining and classifying functioning and disability in children worldwide. To facilitate the application of the ICF in practice, ICF based-tools like the ICF Core Sets are being developed. In the context of the development of the ICF-CY Core Sets for children with Cerebral Palsy (CP), the aims of this study were as follows: to identify and compare the content of outcome measures used in studies of children with CP using the ICF-CY coding system; and to describe the most frequently addressed areas of functioning in those studies. We searched multiple databases likely to capture studies involving children with CP from January 1998 to March 2012. We included all English language articles that studied children aged 2-18 years and described an interventional or observational study. Constructs of the outcome measures identified in studies were linked to the ICF-CY by two trained professionals. We found 231 articles that described 238 outcome measures. The outcome measures contained 2193 concepts that were linked to the ICF-CY and covered 161 independent ICF-CY categories. Out of the 161 categories, 53 (33.5%) were related to body functions, 75 (46%) were related to activities/participation, 26 (16.1%) were related to environmental factors, and 7 (4.3%) were related to body structures. This systematic review provides information about content of measures that may guide researchers and clinicians in their selection of an outcome measure for use in a study and/or clinical practice with children with CP